Endocrine Abstracts

Adrenocortical carcinoma (ACC) is a rare malignant tumour arising from the adrenal cortex, with an estimated annual incidence of one to two patients per million. Ectopic ACCs are extremely rare. They are believed to arise from cortical fragments arrested during embryologic migration and have been found close to the adrenal gland or along the path of gonadal descent. The majority of ACCs are sporadic, however, ACC has been linked with genetic disease processes, including multip...

A 34 year old male diagnosed with congenital adrenal hyperplasia (21 hydroxylase deficiency, salt wasting variety) shortly after birth. Initial presentation was poor feeding with hypoglycemia, pigmented scrotum with elevated 17-OH progesterone. He had a right orchidopexy at age 9 for undescended testis. He was admitted multiple times with adrenal crises during his childhood. He went through puberty and achieved height of 177 cm which is 75th centile. His sister also has CAH. H...

A 56-year-old male presented in 2017 with acute symptomatic hyponatraemia. He was admitted with a seizure and a plasma sodium of 112 mmol/l. His past medical history was notable for alcohol excess and smoking. The acute presentation was managed with 3% hypertonic saline infusion in ITU. Plasma osmolality was 240 mOsm/Kg, urine osmolality 327 mOsm/kg and sport urine sodium 28 mmol/l. CT TAP showed some oesophageal thickening only; endoscopy was normal. He made a good recovery f...

Introduction: Some patients complain of excessive daytime somnolence following pituitary surgery.Aim: To investigate the presence of obstructive sleep apnoea (OSA) following surgery for non functioning pituitary adenomas (NFPA).Design and methods: We assessed the prevalence of OSA in 16 routinely selected patients following surgery for NFPA and 13 obese controls attending a tertiary referral centre, by means of the Epworth Sleepine...

GnRH is released from the hypothalamus in a pulsatile manner and binds to specific receptors (GnRHR) in the anterior pituitary gland to stimulate follicle-stimulating hormone (FSH) and luteinizing hormone (LH) subunit gene expression and subsequent FSHβ and LHsecretion. The FSH and LH subunits are preferentially stimulated by pulsatile GnRH at low and high pulse frequencies, respectively. The transcription factors, cAMP response element binding protein (CREB) and inducibl...

The incidence of type 1 diabetes in children under 5 years is increasing. The insulin requirements, eating regimens and reaction to invasive procedures make this group a challenging cohort to manage on multiple daily injections. NICE Guidance was amended in 2008 to include the option of using CSII at diagnosis in the under 5’s.Seven CSII starts at diagnosis have been done (from 2009 to current). CSII is initiated within 72 h from initial diagnosis, ...

Clinical trials of multiple dose insulin (MDI) or pump therapy (CSII) suggest a short term effect with a waning of effect over time – the ‘Hawthorn Effect’. This may relate to interest in the patient during the trial or to lack of reinforcement of the education and training programme. We reviewed our experience in this area where we have used a structured education programme for CSII and MDI over the last 6–8 years and used Quality Control Theory to explore...

Objective: Factitious hypoglycaemia presents diagnostic difficulties. We report a case presenting with hypoglycaemia, due to use of herbal remedies for enhancement of sexual performance.Case: A 73-year-old male known to have peptic ulcer admitted with feeling dizzy and unwell, with blood glucose of 1.6 needed 10% dextrose infusion in the first 48 h of admission. Medications folic acid, adcal d3, omeprazole 20 mg, herbal medicine for improving sexual func...

Background: Obesity is the excessive accumulation of adipose tissue to the extent that health may be impaired. Determination of the mechanisms governing adipose deposition and body weight regulation are now a scientific priority. High dietary fat intake is generally considered to be a factor in obesity’s multi-factorial aetiology and the metabolic syndrome. Yet not all dietary fats appear to be obese genic to the same degree.Objective: To study the ...

Several recent studies have identified Npr2 gene mutations (encoding the guanylyl cyclase B (GC-B) receptor) as causing dwarfism and achondroplasia. Npr2 null mice have a similar bone phenotype, pituitary growth hormone deficiency and female infertility. As the endogenous ligand for GC-B, C-type natriuretic peptide (CNP) is expressed at high levels in the anterior pituitary of rats and mice, we examined whether components of the natriuretic peptide system were al...