Endocrine Abstracts

Background: Mitotane is a strong inducer of hepatic CYP3A4 activity (cortisol metabolism) and increases cortisol-binding globulin (CBG). High hydrocortisone dosages are necessary in patients with adrenocortical cancer (ACC) on mitotane treatment. The newly modified release hydrocortisone has not been used in mitotane-treated ACC patients yet.Aim: To compare cortisol (serum and saliva), calculated free serum cortisol and ACTH levels in ACC patients on mit...

ACC is a rare, heterogeneous malignancy with poor prognosis. Data from the German ACC Registry (n=478) indicate a 5-year survival rate of 47%. In addition to mitotane, cytotoxic drugs are standard of care in advanced ACC. The best results have been reported by Berruti et al. for the combination of mitotane with etoposide, doxorubicin and cisplatin with an objective tumor response rate of 49% in 72 patients. A response rate of 36% was published for the combination...

Background: Neither dosage nor duration of systemic glucocorticoid therapy are reliable indicators of subsequent adrenal insufficiency. The dexamethasone suppression test is a measure of feedback sensitivity of the hypothalamic–pituitary–adrenal axis to cortisol. We hypothesized that this test predicts the later development of an adrenal insufficiency after a 14 days’ course of oral prednisone in healthy volunteers.Methods: We analyzed dat...

Available glucocorticoid (GC) replacement regimens in adrenal insufficiency (AI) only roughly correspond to physiological steroid profiles. Control of substitution quality is therefore difficult but significant, as even mild chronic over- or under-replacement may be clinically relevant. FKBP5 regulates GC receptor sensitivity by reducing its affinity to cortisol when bound to the receptor complex. FKBP5 methylation has been inversely correlated with cortisol levels both in hea...

Background: Potentially fatal adrenal crises (AC) still occur in educated patients with adrenal insufficiency (AI). Identifying predisposing factors is necessary for prevention in this patient population.Objectives: Investigating clinical and biochemical fingerprints of increased susceptibility to AC.Material and methods: Our study population included 260 patients with chronic AI, classified as high and low risk according to the fr...

Introduction: Patients with mutations in the Succinate Dehydrogenase Complex Subunit B (SDHB) gene are predisposed to neuroendocrine tumours such as parangangliomas, phaeochromocytomas and gastrointestinal stromal tumours. Individuals who are carriers but have no manifestation of disease require regular surveillance. Our tertiary endocrine service provides follow up/surveillance for these patients and we cover a wide geographical area throughout the West of Scotland.<p cla...

Background: The chemokine receptor CXCR4 and its associate receptor CXCR7, that modulates CXCR4 function, have been associated with tumor progression and metastasis in human cancers. In ACC, Ki67 index and ENSAT stage are the most important prognostic parameters.Objective: To assess expression of CXCR4 and CXCR7 in adrenal cancer and correlate results with clinical outcome.Methods: CR expression was assessed by immunohistochemistry...

Introduction: Although long-term complications such as nephrocalcinosis and renal insufficiency are well-known in chronic hypoparathyroidism (HPT), standardized investigations of their prevalence and causes are still lacking.Objective: To systematically investigate the prevalence of renal calcifications and dysfunction and their predictors in a well-characterized cohort of patients with HPT.Methods: Cross-sectional assessment of co...

Introduction: Reduction of quality of life in patients with chronic hypoparathyroidism (HPT) has been reported by several studies. Additionally, self-report data point to a higher prevalence of anxiety disorders in HPT compared to patients after thyroidectomy.Objectives: To characterize psychiatric diseases in a systematically reviewed cohort of patients with chronic HPT.Methods: We systematically assessed psychiatric comorbidities...

Adrenal crisis (AC) is a life threatening condition in chronic adrenal insufficiency (AI). Furthermore, recent data demonstrate increased mortality in this patient group.Incidence and causes of adrenal crisis as well as general morbidity and hospitalization was assessed in 472 patients in a prospective trial. Patients were contacted via mail every 6 months and in case of AC additionally by phone to evaluate the exact circumstances of AC. Criteria for AC ...