Endocrine Abstracts

Adrenal insufficiency is a rare adrenal disorder that can be made more complicated by an adrenal crisis even to a life-threatening situation. An adrenal crisis occurs when the body has a shortage of the hormone cortisol. If the patient does not receive the correct treatment an adrenal crisis can be fatal. This can be avoided by correctly and carefully following the ‘stress instructions’ (also known as ‘sick day rules’). A significant percentage of patients ...

Serum GH and IGF-I levels are closely correlated but discordance between GH and IGF-I levels can occur in patients with acromegaly either as a consequence of biological factors or as an artefact of the means of assessment or definitions of normality.Pegvisomant as a GH receptor antagonist lowers serum IGF-I but, due to negative feedback, increases GH levels. Raloxifene has been shown to lower IGF-I in men and women with acromegaly and oestrogen has been ...

The McCune–Albright syndrome is a rare condition of variable severity that typically presents in childhood and is characterized by the triad of fibrous dysplasia (FDP), endocrinopathy and café-au-lait spots. The syndrome was independently described by Donovan McCune (1902–1976) and Fuller Albright (1900–1969) approximately 70 years ago and is now recognized to be the result of post-zygotic somatic constituently activating mutations of the alpha subunit of t...

Introduction: Prolactinomas account for approximately 40% of all pituitary adenomas, with an estimated prevalence of 100 prolactinomas per million adults. Dopamine agonists currently represent the mainstay of treatment. Nevertheless, increasing dopamine-agonist dosage, surgery, and radiotherapy may be necessary in some cases, such as aggressive, dopamine-agonist resistant or atypical prolactinomas.Case: We report the case of a 55 year old man who was inc...

Up to 90% of patients treated with radioactive iodine treatment for hyperthyroidism develop hypothyroidism, in some cases many years after treatment. The majority of patients receiving RI in our clinic were referred from clinics throughout the northwest of England and attend on one occasion for RI treatment with follow-up by the referring physician. The Royal College of Physicians guidelines recommend centres administering RI have a system for regular patient monitoring to ide...

The prevalence of gallstones (GS) is increased in acromegaly and is further increased by somatostatin analogue (SA) therapy. The incidence has variously been reported to be between 10 and 63%, but they are often asymptomatic and rarely require definitive management. However, there is evidence suggesting that discontinuation of SA therapy may precipitate acute biliary problems.We have analysed our experience of symptomatic gallstones in all 44 patients (2...

In many centres a test dose (TD) of octreotide is administered prior to commencing LAR. The value of the TD as a predictor of subsequent response to therapy remains uncertain. We have studied the relationship of the GH response to a TD to the subsequent response to LAR in 26 patients (median age 59 years, range 20- 84). After baseline GH sampling, 50mcg subcutaneous octreotide was administered and sampling continued for six hours. Results of the TD were compared to the lowest ...

Serum IGF-I is increasingly used, and IGFBP-3 has been proposed, as a marker of treatment efficacy in patients with acromegaly. IGF-I bioactivity and half-life are dependent on the degree of IGF-I incorporation into 150kDa ternary complexes with IGFBP-3 and ALS. When serum GH is lowered in patients with acromegaly all three ternary complex components decline, but effects on ternary complex formation have not been described. We investigated GH action on ternary complex formatio...

Cardiovascular outcomes are better predicted by 24 hour ambulatory BP monitoring than random clinic BP (mmHg). In acromegaly, hypertension is common and cardiovascular disease is the principal cause of death. We investigated prevalence and characteristics of hypertension in 44 patients (26 male, mean age 53.1 ± 14.2), 17 of whom were receiving treatment for hypertension. A random clinic BP (normal <140/90) and IGF-I were measured prior to 24 hr ABPM assessment (Astra...

There is increasing reliance on published consensus criteria for clinical decision-making in states of GH excess and deficiency. NICE eligibility criteria for GH treatment include a peak GH response <9 mU/L during an ITT. To determine the adequacy of GH assay performance for diagnosing GH deficiency (GHD), we have assessed the variability in 101 UKNEQAS reported results from a single sample with a value close to 9.0 mU/L. For all laboratories (n=101) median GH was 11.1 mU/L...