Endocrine Abstracts

Background: Adrenal insufficiency (AI) is a life-threatening condition if left unmanaged. Despite treatment patients can expect a life expectancy that is shortened by 12 years secondary to probable inherent over-replacement associated with oral glucocorticoid regimens. Thrice-daily hydrocortisone is the most common regimen used. Very low-dose prednisolone (2-4 mg) is an alternative with lower uptake due to the absence of evidence for its use. This study fills this literature g...

Introduction: Thyrotroph pituitary hyperplasia in context of severe primary hypothyroidism is rare and usually occurs due to loss of thyroxine feedback inhibition and overproduction of thyrotropin-releasing hormone, leading to pituitary gland enlargement. Pituitary hyperplasia caused by primary hypothyroidism responds well to thyroid hormone replacement therapy and rarely requires surgical intervention. Case presentation: A 42-year-old female with backgr...

Background: Studies suggest that glucocorticoid hypersecretion alongside primary hyperaldosteronism (PA) is common and may contribute to the adverse metabolic phenotype. Adrenal crisis post-surgery for PA is rare.Aim: To determine the prevalence of cortisol co-secretion in PA in patients at Imperial College London NHS Trust, Hammersmith Hospital (a tertiary referral centre for adrenal tumours).Methods: Am...

Introduction: We offer patients needing glucocorticoid replacement in primary and secondary adrenal insufficiency the choice of either once daily prednisolone or thrice daily hydrocortisone. A recent European study found no difference between prednisolone and hydrocortisone users in several markers, including glucose, weight, body mass index (BMI), systolic and diastolic blood pressure and waist circumference, although they did suggest an increase in cholesterol and low densit...

Background: Studies suggest that glucocorticoid hypersecretion alongside primary hyperaldosteronism (PA) is common and may contribute to the adverse metabolic phenotype. Adrenal crisis post-surgery for PA is rare.Aim: To determine the prevalence of cortisol co-secretion in PA in patients at Imperial College London NHS Trust, Hammersmith Hospital (a tertiary referral centre for adrenal tumours).Methods: Am...

Introduction: We offer patients needing glucocorticoid replacement in primary and secondary adrenal insufficiency the choice of either once daily prednisolone or thrice daily hydrocortisone. A recent European study found no difference between prednisolone and hydrocortisone users in several markers, including glucose, weight, body mass index (BMI), systolic and diastolic blood pressure and waist circumference, although they did suggest an increase in cholesterol and low densit...

Introduction: Glucocorticoid replacement in adrenal insufficiency may be achieved by administering thrice- daily hydrocortisone or once-daily very low dose (2-4 mg) prednisolone. Prednisolone’s longer half-life enables once-daily dosing, improving patient satisfaction and compliance. At very low doses, it has shown no difference in most markers of metabolic risk when compared with hydrocortisone. At Imperial College Healthcare NHS Trust (ICHNT), use of an eight-hour troug...

Introduction: Liberal glucocorticoid replacement therapy prevents Addisonian crises in individuals with adrenal insufficiency (AI). Prednisolone is six to eight times more potent than hydrocortisone. There is inter-individual variation in glucocorticoid metabolism wherein 5 mg prednisolone once-daily may result in over-replacement in most individuals, with subsequent long-term morbidity and mortality.Methods: Data from individuals on established predniso...

A 53 year old female weighing 117 kg was thought to be slightly cushingoid by her GP who checked a morning cortisol. This was surprisingly undetectable (<28nM) on 13th June 2022. The patient was urgently referred for a medical opinion. A repeat cortisol in A&E was 29nM with an undetectable ACTH. Given the lack of clinical features of adrenal failure, further history was obtained. The patient appeared well on examination, and denied any inhaled, oral/ topical steroid us...

Background: Adrenal insufficiency (AI) is a life-threatening condition which requires long term glucocorticoid (GC) replacement. Patient misdiagnosis results in inappropriate GC use, which has significant adverse effects and is associated with an increased mortality risk. The insulin tolerance test (ITT) is the gold standard test for diagnosis, but the widely accepted cut-off value of ≤550 nmol/l used to diagnose AI is founded on outdated immunoassays. Use of this cut-of...