Endocrine Abstracts

Hypopituitarism has been reported in 28-65% of long-term survivors of traumatic brain injury (TBI). We attempted to define the natural history of post-traumatic hypopituitarism in order to devise guidelines for the optimal timing of patient assessment and hormone replacement.Fifty consecutive patients with severe or moderate TBI were enrolled in a prospective study of pituitary function during the acute phase, at 6 months and, at 12 months following TBI....

The syndrome of inappropriate antidiuretic hormone (SIADH) is characterised by euvolamic hyponatraemia. Patients with SIADH continue to drink normal amounts of fluid, despite plasma osmolalities well below the physiological osmotic threshold for the onset of thirst. The regulation of thirst has not been previously studied in SIADH. We studied the characteristics of osmotically-stimulated thirst and vasopressin (AVP) secretion, and the non-osmotic suppression of thirst and AVP ...

Recent evidence suggests a high prevalence of neuroendocrine dysfunction in patients following traumatic brain injury (TBI), but dynamic anterior pituitary assessment were performed in relatively small number of patients and posterior pituitary function remains poorly investigated.We studied 102 consecutive patients (84 males) who had survived severe or moderate TBI [initial Glasgow Coma Scale (GCS) score 3-13] at a mean (+/- standard deviation) of 19 +/...

Severe hyponatraemia (SHN, <120 mmol/l) is reported to be associated with mortality as high as 50%; although there are several international guidelines for management of SHN, there are few data on the impact of treatment. We have longitudinally audited our treatment outcomes of SHN. We present the results of three audit periods, of six months each, from 2005, 2010 and 2015. The three periods represented; 2005, prior to hospital policy for SHN, 2010, audit of impact of poli...

A 24 year old man presented with gait instability, myalgia, and cognitive decline, after a holiday in Crete; his alcohol intake exceeded 200 units/week. He had marked facial dysmorphism, with frontal bossing, and global muscle weakness. He had hypernatraemic dehydration (plasma sodium 175 mmol/l urea 16.9 mmol/l), but denied thirst. Urine concentration was 894 mOsm/kg, excluding diabetes insipidus. CK was elevated at 15,540 U/l. CT brain shown marked hydrocephalus. Rhabdomyoly...

Background: SIADH is the most frequent underlying cause of hyponatraemia but is frequently ignored and suboptimally treated.Aim: To identify the treatment applied in clinical practice for hyponatraemia due to SIADH and to evaluate the effect of fluid deprivation.Method: A prospective, non-intervention observational study of a sequentially evaluated cohort of hyponatraemic patients during first 48 h after hospitalization from Januar...

Introduction: Excess mortality due to hyponatraemia is well documented but it is not clear whether the mortality associated with SIADH is different to that associated with non-SIADH hyponatraemia (NSH).Methods/design: Prospective evaluation of all patients admitted with or developing hyponatraemia in a tertiary hospital (pNa <130 mmol/l) in January 2015. Diagnosis of SIADH was based on standard clinical and biochemical criteria (pNa, spot urine sodiu...

Recently the American Diabetes Association (ADA) adopted a lower cut off for (IFG) Impaired fasting glucose (greater than or equal to 5.6 millimol per litre). We suggested that performing oral glucose tolerance tests (OGTT), in all subjects with IFG according to the new ADA criteria, would result in very little new diagnosis of Diabetes Mellitus (DM) and to test this hypothesis we reviewed our recent experience with OGTTs.Between August 2001 and June 200...

Studies in the general population have shown a prevalence of the metabolic syndrome of 17-25%. We have studied the prevalence of the metabolic syndrome in patients with diabetes mellitus (DM). A total of 150 consecutive patients with type 1 (21%) or type 2 DM (79%), mean age 59.1y (28-85), attending for annual review were studied to determine if they satisfy (ATP III) diagnostic criteria for the metabolic syndrome. Fasting plasma glucose, triglycerides, HDL cholesterol, blood ...

The insulin tolerance test (ITT) is the gold standard for assessing growth hormone (GH) and cortisol production in pituitary disease, However it is potentially hazardous, requires medical supervision and adequate hypoglycemia may not be achieved. We retrospectively examined the records of 185 consecutive patients aged 14-76 years with pituitary disease who underwent the ITT over 18 months. Testing was performed in the endocrine day ward by an experienced endocrine nurse. Absol...