Endocrine Abstracts

Background: The blood supply of the pituitary gland comes via a portal circulation from the hypothalamus. During pregnancy, the anterior pituitary gland enlarges but the blood supply cannot increase, as it is derived from a capillary plexus. The pituitary is thus vulnerable to arterial pressure changes and infarction secondary to hypotension. We describe a case of a male patient with large pituitary adenoma who developed Sheehan’s like syndrome due to adenoma infarction s...

Overt primary adrenocortical failure is preceded by several stages of subclinical hypoadrenocorticolism. Individuals with type 1 diabetes (T1D) or who have other autoimmune conditions are at risk for the development of Autoimmune Addison's disease (AAD). These at risk individuals can be identified by the detection of adrenal autoantibodies (AAb).The aim of this study was two fold: firstly, to evaluate the sensitivity of early morning cortisol: ACTH ratio...

A 25 year old female presented with a two year history of secondary amenorrhoea and expressible galactorrhoea. There was no history of headache or visual disturbance, and the patient took no regular medication. Examination, including formal perimetry, was normal. Investigations revealed a moderately elevated prolactin 1,029 (NR 59-619 mU/ml), 9am cortisol 366 nmol/L, remainder of pituitary profile normal. An MRI pituitary revealed a macroadenoma with stalk deviation and bowing...

Background: Hypoglycaemia unawareness is thought to be due to very tight control of diabetes but may also be due to very longstanding slowly progressive hypoglycaemia. We describe a patient who had no warning of very severe hypoinsulinaemic hypoglycaemia.Case Presentation: A 65-year-old gentleman presented with recurrent hypoglycemia that responded to IV glucose. A chest X-ray revealed a space occupying lesion and furthe...

Graves’ disease typically follows a relapsing and remitting course. Most patients with recurrent hyperthyroidism after withdrawal of antithyroid drugs (ATDs) are offered definitive treatment with radioactive iodine. This retrospective study aimed to identify clinical and biochemical indices that predict relapse following ATD withdrawal, which could allow earlier definitive treatment to be initiated.We studied 70 patients with Graves’ disease wh...

We assessed whether the hypothalamic-pituitary-adrenal (HPA) axis is affected after withdrawal of oral steroids in patients who have been on steroids for at least ten years. Recent advances in treatment of patients with severe asthma with inhaled fluticasone propionate, and the use of steroid sparing drugs such as methotrexate has allowed the withdrawal of long term oral steroids in patients who otherwise had steroid dependant disease.We performed a 250 ...

Once daily oral prednisolone has been shown to mimic the normal circadian rhythm better than other glucocorticoids. Our advice is to take prednisolone first thing on waking and before breakfast to try to mimic the normal circadian rhythm as closely as possible. The leaflet that comes with prednisolone suggests that it should be taken with food. Enteric-coated prednisolone (EC) is believed to be kinder on the stomach, but there is no evidence for its use. We compared EC with st...

Replacing glucocorticoids in patients with adrenal insufficiency is challenging, as endogenous cortisol levels rise before waking. Currently we use steroid replacement first thing in the morning. Administration of a delayed release preparation last thing at night, if reliable, could mimic the rise in cortisol that occurs before waking. Lodotra is a modified release prednisone that has a delay in the onset of action, and when given last thing at night, might cause a rise in lev...

A 41 year old Emirati man was reviewed in January 2016 for hypercholesterolaemia managed on diet alone, but direct questioning revealed gradual onset erectile dysfunction over 2 years, treated by a urologist elsewhere. Initial response to Cialis had waned over 18 months. Testosterone replacement (Nebido) had been initiated in June 2015 on the basis of one low morning total testosterone of 3.89 nmol/L (normal range 8.64 – 29). SHBG and prolactin...

Once daily oral prednisolone has been shown to mimic the normal circadian rhythm better than other glucocorticoids. Our advice is to take prednisolone first thing on waking and before breakfast to try to mimic the normal circadian rhythm as closely as possible. The leaflet that comes with prednisolone suggests that it should be taken with food. Enteric-coated prednisolone (EC) is believed to be kinder on the stomach, but there is no evidence for its use. We compared EC with st...