Endocrine Abstracts

The ACTH receptor (ACTH-R) is the second member of the melanocortin receptor family that includes five seven-transmembrane G protein-coupled receptors, and has been shown to be predominantly expressed in the adrenal cortex. It has been postulated that ACTH may regulate its own secretion through ultra-short loop feedback within the pituitary, and as ACTH-secreting adenomas are characterised by resistance to glucocorticoid feedback, they may also have dysregulated ACTH feedback....

Introduction: Type 1 diabetes (T1D) onset may start years prior to clinical presentation. Screening children and young people (CYP) for T1D using islet autoantibodies (IAb) through research studies is gaining international momentum, since screening reduces diabetic ketoacidosis, hospitalisation and offers access to drug therapies for delaying T1D onset1. Recently, ISPAD provided recommendations on monitoring for pre-clinical T1D in CYP, however no U...

Background: Screening algorithms for the identification of growth-disorders are routinely used in several countries. In the UK, the use of the Coventry consensus for the referral of children with suspected growth-disorders performs poorly compared to more sophisticated screening mechanisms used elsewhere. We aimed to test an algorithm developed to screen for growth-disorders in 2- to 8-year-old UK children.Methods: The a...

Objective: Biochemical assessment of male hypogonadism relies on estimation of freely available testosterone. Gold standard measurement is by equilibrium dialysis but this is not practical in clinical use. We compared two calculation methods; bioavailable (non-SHBG bound) testosterone (Morris et al.), and free (non-SHBG non-albumin bound) testosterone (Vermeulen et al.) for their diagnostic performance.Design: Free testosterone and bioa...

Background: Inappropriately high aldosterone in patients with primary hyperaldosteronism (PHA) is due to increased aldosterone synthase (CYP11B2) activity. Selective in vivo imaging of overexpressed CYP11B2 in adrenals with positron emission tomography (PET) has not yet been achieved due to close homology of enzymes involved in aldosterone and cortisol (CYP11B1) synthesis.Aim: Synthesize a fluorine-18 labelled highly selective CYP11B2 inhibitor,...

Background: Primary aldosteronism (PA) is an important, potentially curable, cause of hypertension. Distinguishing unilateral and bilateral causes is a critical step in determining who should be considered for adrenalectomy. Adrenal vein sampling (AVS) remains the gold standard for lateralisation. However, AVS is technically challenging with limited availability. To address this, we have introduced molecular imaging using PET/CT with the radiotracer [11C]Metomidate ...

Background: Radioactive iodine therapy (RAI) is established as a safe and effective treatment for adults with Grave’s disease. As thyrotoxicosis in children is rare, it is difficult to obtain high quality evidence about the safety and efficacy of RAI. We present data from our centre between 2007 and 2017.Methods: 20 paediatric patients with hyperthyroidism (16F), median age 15.7 years (range 10.8–19.3) had RAI in our centre either one or two do...

Background: Inappropriately high aldosterone in patients with primary hyperaldosteronism (PHA) is due to increased aldosterone synthase (CYP11B2) activity. Selective in vivo imaging of overexpressed CYP11B2 in adrenals with positron emission tomography (PET) has not yet been achieved due to close homology of enzymes involved in aldosterone and cortisol (CYP11B1) synthesis.Aim: Synthesize a fluorine-18 labelled highly selective CYP11B2 inhibitor, [18...

Case history: A previously well 45-year-old lady presented with a 3-year history of hypertension initially diagnosed at a routine health check. Her blood pressure (BP) was 170-180/90-100 mmHg.Investigations: Showed hypokalaemia (K+= 3 mmol/l; NR 3.5-5.3 mmol/l), raised aldosterone (976pmol/l; NR 100-500pmol/l) and supressed renin activity (<0.2nmol/l/h), meeting criteria for diagnosing primary aldosteronism (PA). CT adrenals showed a 2.5 cm left adre...

A 65-year-old Afro-Caribbean gentleman, with a >10-year history of hypertension, frequently recorded blood pressures of >160/80 mmHg. His serum electrolytes showed Na+ 145 mmol/l and K+ 3.2 mmol/l. MRI demonstrated 13 mm left medial-limb adrenal adenoma. His hypertension was uncontrolled on treatment with amlodipine 10 mg OD, spironolactone 50 mg OD, losartan100 mg OD and doxazosin 16 mg OD. Although his quality of life was reduced, and he dislike...