Endocrine Abstracts

Pituitary infarctions are not unknown in patients with pituitary tumours. We describe here a 39-year-old lady, who presented with a history of sudden onset severe headache without any restriction of her visual fields. She had features of acromegaly with enlarged hand and feet size, progressive deepening of her voice and coarsening of facial features over the preceding year. She also had a euthyroid multinodular goitre. CT scan and MRI of the pituitary gland suggested cystic de...

Salivary cortisol (SalC) potentially has advantages over serum cortisol (SerC) as it is easier to collect and possibly reflects unbound (free) cortisol. SalC levels are approximately 10 times lower than SerC and require high measurement precision best addressed by liquid chromatography–tandem mass spectrometry (LC-MS/MS), which in contrast to previously used radioimmunoassays eliminates cross-reactivity by other steroids. We describe the use of LC-MS/MS to evaluate the po...

Itraconazole increases glucocorticoid levels through inhibition of CYP3A4 in the liver. Recent case-reports have shown that the co-administration of itraconazole with inhaled glucocorticoids in asthmatics may result in suppression of their HPA axis and a Cushing’s phenotype. We have evaluated the impact of this interaction on the cortisol axis in a double-blind randomised placebo-controlled study.Twenty-seven patients with severe asthma (17 women; m...

The GH receptor antagonist pegvisomant entered clinical trials in 1997 and was (UK) marketed in 2005. There is little long-term experience with this novel drug. We report the experience from two centres that used common protocols to manage 58 patients (36 male, median age 53, range 27 78) since 1997. Before commencing pegvisomant, patients had IGF-I above the upper limit of normal (ULN) of age-related reference ranges (median 1.8 xULN, range 1.2–4.1 xULN) and were uncontr...

In patients with pituitary disease stimulation tests, such as the insulin tolerance test, are performed as tests of the HPA axis and widely used as the basis for commencing hydrocortisone replacement therapy.We conducted a pilot study to investigate the relationship between the peak cortisol response to insulin-induced hypoglycaemia and daily CPR. Isotopic CPRs were studied in 10 patients (5 male, mean age 44±13 years) with pituitary disease and a s...

Patients with acromegaly die prematurely from CVD. Hypertension is more prevalent with increased peripheral vascular resistance thought to be due to structural remodelling of resistance vessels.We investigated structural properties and reactivity of small arteries in 20 healthy controls(55±11 years, 10 m) and 43 patients with acromegaly (55±14 years, 29 m), split into active disease (AD, n=17, 56±15 years, 13 m) or remission (CD, <i...

Without adequate treatment patients with acromegaly die prematurely from cardiovascular disease (CVD); however the contribution of atherosclerosis in this process is controversial. Increased carotid IMT is an early morphological marker of atherosclerosis and predictor of subsequent cardiovascular events. Contradictory data exist regarding IMT in patients with acromegaly.We measured carotid IMT in 79 patients with acromegaly (47 male, mean age 55±14 ...

IGF-I is a marker of activity of the growth axis. It is accepted that the interpretation of IGF-I values requires age- and gender-specific reference ranges (RR).We have studied IGF-I assay performance by circulating 2 blood samples with different clinical scenarios to 23 centers [IDS-OCTEIA (n=2), DPC-Immulite (3), DPC-Immulite 2000 (4), in-house RIA (1), Nichols-Advantage (10) and Nichols-IRMA (3)] participating in the UK-NEQAS IGF-I scheme. Participant...

We have previously reported comparisons of ACROQOL, a disease-specific questionnaire for QOL in patients with acromegaly, with the non-disease-specific generic tools Psychological General Well-Being Schedule (PGWBS) and EUROQOL and disease-specific signs and symptoms score (SSS). ACROQOL comprises 22 questions (subdivided into physical and psychological classes, total score out of 110 quoted as percentage, higher scores = better QOL). SSS rates 5 features of acromegaly each ra...

The risks of over and under-replacement with glucocorticoid replacement therapy are well-known. In an attempt to minimise these risks cortisol day curves (CDC) are performed in many centres, however there is a dearth of data on the reproducibility of this assessment and the relationship between symptoms and serum cortisol levels. To address these issues, we have performed 2 cortisol day curves within 7 days in 20 patients (9 male, mean age 54 years, range 25-79, 6 primary and ...