Endocrine Abstracts

Polycystic ovary syndrome (PCOS) affects 10% of women and is associated with an increased risk of type 2 diabetes and fatty liver disease. Androgen excess is an important driver of metabolic risk in PCOS. In adipose tissue from women with PCOS, increased activation of androstenedione (A4) to testosterone (T) by the enzyme AKR1C3 results in systemic lipotoxicity. Recent in-vitro studies also demonstrated that T and 11-ketotestosterone (11KT) activate the androgen recep...

Introduction: The effects of maternal suboptimal gestational thyroid function (SGTF) on age 3 offspring’s cognitive function were investigated in the Controlled Antenatal Thyroid Screening (CATS) randomised trial, comparing SGTF mothers who received (SGTF-T), or didn’t (SGTF-U), levothyroxine during pregnancy. The analysis was repeated at age 9 in the CATS-II follow-up study, also including children of mothers with normal gestational thyroid function (NGTF). Here we ...

Context: Suboptimal thyroid function in pregnancy is associated with adverse obstetric outcomes but it is unclear whether levothyroxine treatment, initiated during pregnancy is beneficial.Design & Participants: Retrospective analysis of the Controlled Antenatal Thyroid Screening (CATS) study with obstetric outcomes obtained through data-linkage in the Secure Anonymised Information Linkage (SAIL) databank. We studied 13,224 pregnant women; 12,608 had ...

Objectives: The Controlled Antenatal Thyroid Screening (CATS) study I was a randomised trial investigating the effects of levothyroxine treatment for suboptimal gestational thyroid function (SGTF), evaluating mothers with normal gestational thyroid function (NGTF), SGTF who received (SGTF-T), or didn’t (SGTF-U), levothyroxine during pregnancy. The present follow-up study (CATS II) reports the long-term effects of SGTF and levothyroxine treatment on anthropometric and card...

Background and aims: 5α reductase 1 and 2 (SRD5A1 (expressed in liver and adipose), SRD5A2 (expressed in liver) inactivate cortisol to 5α-dihydrocortisol in addition to their role in the generation of dihydrotestosterone and therefore regulate the tissue availability of cortisol. Dutasteride (dual SRD5A1 and SRD5A2 inhibitor) and Finasteride (selective SRD5A2 inhibitor) are commonly prescribed, but their potential metabolic effects have only recently been identified....

Introduction: Adrenocortical carcinoma (ACC) is an aggressive malignancy with a high rate of recurrence. Regular post-operative follow-up imaging is necessary, but associated with high radiation exposure and frequent diagnostic ambiguity. Urine steroid metabolomics has recently been introduced as a novel diagnostic tool for the detection of adrenocortical malignancy in patients with adrenal incidentalomas. Here we present the first clinical study assessing the performance of t...

Bariatric surgery for obesity remains the most effective method to achieve weight loss and improvements in mortality. However, as the number of procedures increases to match the rising burden of obesity, unusual metabolic complications are now coming to the fore. One example of this is postprandial hypoglycaemia (PPH). The incidence of PPH has been reported as <1% although this problem is underreported. A correct diagnosis is essential as the condition can be extremely dis...

Steroid sulfatase (STS) cleaves the sulfate moiety off steroid sulfates, including DHEAS, the inactive sulfate ester of the adrenal androgen precursor DHEA. Deficient DHEA sulfation, the opposite enzymatic reaction to that catalysed by STS, results in androgen excess by increased conversion of DHEA to active androgens. STS deficiency (STSD) due to deletions or inactivating mutations in the X-linked STS gene manifests with ichthyosis, but androgen homeostasis in STSD h...

Cushing’s disease (CD) and Ectopic ACTH syndrome (EAS) stem from excess circulating adrenocorticotropic hormone (ACTH) and resulting hypercortisolemia. In CD, excess ACTH is secreted from pituitary tumors, whereas excess ACTH in EAS arises from nonpituitary tumors. ACTH acts on the adrenal melanocortin type 2 (MC2) receptor to control the synthesis and secretion of adrenal hormones, including the stress hormone cortisol (corticosterone in rats) which accounts for the com...

Background: Adrenocortical tumours (adenoma or carcinoma) present in well-recognised ways: hormones excess (Cushing’s, Conn’s, virilisation) or hormonally silent with symptoms of mass effect, or found incidentally on imaging. We present 3 cases of adrenal tumours, referred to our regional adrenal multidisciplinary meeting with unusual presenting features.Case 1: post-menopausal bleeding: A previously well 57-year-old female presented with vagin...