Endocrine Abstracts

Introduction: Short synacthen test (SST) has become the standard method of assessing the hypothalamic–pituitary–adrenal (HPA) axis. However, there are still variances in practice with regards to performing and interpreting this test in particular the need for measuring cortisol level at both time 30 and 60 min.Methods: A retrospective review of 500 consecutive SST performed at a University teaching Hospital in Dublin between 2005 and 2012. Seru...

Lithium is used in psychiatric practice as maintenance therapy in bipolar disorder. It has a narrow therapeutic index with serious toxic potential. Lithium is associated with multiple endocrine and metabolic disturbances but data regarding the rates of these in individual patients is lacking. In a tertiary referral centre, all patients on lithium therapy from 2000 to 2014 were identified. The aim of this study was to assess the impact of lithium therapy on the development of e...

A 48-year-old man was referred for investigation of uncontrolled hypertension on four agents (olmesartan, felodipine, hydrochlorothiazide and spironolactone) and a 3 cm right-sided adrenal adenoma (pre-contrast Hounsfield units 25). Endocrine investigation for the hypertension and adrenal mass included: androstenedione 19.9 nmol/l 2.8–10.5) (elevated on two occasions on a Siemens Coat-A-Count assay), DHEA 0.7 μmol/l (2.1–15.2), 1 mg overnight dexamethasone suppr...

In the pathogenesis of obesity, dysregulated tissue cortisol metabolism (controlled by 11β-HSD1), is postulated to be involved. Fifteen patients (seven mens, mean BMI 50.8±7 kg/m2) awaiting Roux En Y gastric Bypass (RYGB) surgery underwent assessment of 11β-HSD1 activity using cortisol generation profile. Corticosteroids in serum and subcutaneous adipose tissue microdialysis fluid and urinary corticosteroid metabolites were analysed by liquid and gas ...

Glucocorticoid (GC) excess is characterized by increased adiposity, skeletal myopathy and insulin resistance. Despite increasing use of GCs as therapeutic agents, the precise molecular mechanisms that underpin GC-induced insulin resistance are unknown. Within skeletal muscle, 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) converts cortisone (11-dehydrocorticosterone in rodents) to the active GC, cortisol (corticosterone in rodents) and thus amplifies local GC act...

Acromegaly and hypopituitarism are associated with elevated standardised mortality ratios (SMR) of between 1.3–3 and 1.2–2.17, respectively. There is little data on the role of hypopituitarism and in particular ACTH deficiency on mortality in patients with acromegaly and less still known about the role of hydrocortisone (HC) replacement. There is data to suggest that previous HC regimens may have overestimated normal cortisol production rates and recent data that hig...

The aim of treatment in patients with acromegaly is to achieve serum GH/ IGF-I concentrations associated with cure or normalisation of mortality. Using the West Midlands acromegaly database (n=501) we assessed a number of parameters in the follow up of patients with acromegaly including the reliability of basal fasting GH in predicting nadir or mean GH during oral glucose tolerance test (OGTT) or growth hormone day curve (GHDC) respectively, the degree of discordance be...

Acromegaly is a rare disease characterised by excessive Growth hormone (GH) production from a pituitary adenoma. Subfertility is common in acromegaly and has various aetiologies, therefore pregnancy in acromegaly is rare. We present a case series of 19 pregnancies in 13 women with acromegaly from the newly formed Irish National Pituitary Registry. Twelve women had pituitary macroadenomas, one woman had a microadenoma. The age of the women ranged from 28 to 40 years with a medi...

Idiopathic intracranial hypertension (IIH) is a condition of unknown aetiology characterised by raised intracranial pressure, chronic headaches and blindness. Akin to polycystic ovary syndrome (PCOS), IIH patients are almost exclusively obese females of reproductive age. A distinct androgen excess profile has been noted in PCOS. Here, we aimed to delineate androgen metabolism in IIH compared to PCOS and simple obesity.Women w...

Idiopathic intracranial hypertension (IIH) is a condition of unknown aetiology characterised by raised intracranial pressure, chronic headaches and blindness. Akin to polycystic ovary syndrome (PCOS), IIH patients are almost exclusively obese females of reproductive age. A distinct androgen excess profile has been noted in PCOS. Here, we aimed to delineate androgen metabolism in IIH compared to PCOS and simple obesity.Women w...