Endocrine Abstracts

Background: 11β-hydroxysteroid dehydrogenases (11β-HSD1&2) interconvert cortisol (F) and cortisone (E). Although 11β-HSD1 reductase activity has been measured in vivo, E production (dehydrogenase activity) has not been quantified using a Gold Standard technique, steady state tracer infusion.Aim: To develop a method to measure E production in vivo using the stable isotope tracer d2-cortisone (d2E).Me...

Topical glucocorticoid therapy causes adverse effects in human skin including a reduction in dermal fibroblast proliferation and extracellular matrix protein secretion (e.g. collagen 1) and epidermal thinning – effects paralleled in photoexposed and elderly skin. These cause reduced wound healing rates and a loss of elasticity with increased fragility and transepidermal water loss – signs also typical of Cushing’s syndrome characterised by raised circulating cor...

Cortisol is regenerated from cortisone by 11βHSD1 reductase in cells from VAT. Mice overexpressing 11βHSD1 in adipocytes have more glucocorticoids in the portal vein (PV) and hepatic insulin resistance. In humans, hepatic vein (HV) sampling during D4-cortisol tracer infusion confirmed substantial splanchnic cortisol generation, and indirect modelling suggested major contributions from both liver and VAT. PV sampling in dogs, however, did not reveal cortisol release f...

Since July 2005 our centre has offered an e-mail enquiry service to General Practitioners. This service was established for two reasons, firstly to create a more efficient way of dealing with clinical enquiries from primary care and secondly with a long term objective to reduce GP referral rates. The service is manned by Endocrine/Diabetes Specialist Registrars and is part of their training commitment. Compared to telephone calls it gives the registrar more chance to think thr...

A 62-year-old lady was referred to our Department with a nine-month history of facial swelling, easy bruising, and centripetal weight gain. She had a longstanding history of depression, hypertension, and osteoarthritis. She was taking citalopram, buspirone, atenolol and bendrofluazide. A few months earlier she had received bilateral intra-articular knee injections at her local hospital for arthritic pain. On examination she had thin skin with multiple bruises, facial puffiness...

Type 2 diabetes manifests when pancreatic β-cells secrete inadequate insulin in response to elevated glucose. A known culprit in metabolic diseases is excessive exposure to glucocorticoids (GCs). GCs increase hepatic gluconeogenesis, decrease insulin sensitivity in skeletal muscle and adipose tissue and suppress the development of β-cells. In rodents, inactive GC 11-dehydrocorticosterone (A) is converted to active corticosterone (B) by the enzyme 11β-hydroxyster...

Research in farm animals has long been a cornerstone of our understanding of reproduction and holds similar opportunities for understanding mechanisms by which stress affects fertility. Sheep and cow experimental models are appropriate to humans, especially as detailed longitudinal studies are possible because of size and access to ovaries.Failure to realise genetic potential is a better definition of stress than ‘an increase in corticoids’; ma...

ACRD presents with clinical features of hyperandrogenism in females similar to those of PCOS (acne, hirsutism, oligomenorrhea, infertility), and precocious puberty in males. Obesity also occurs in some cases. Increased cortisol clearance leads to an increased hypothalamic-pituitary-adrenal axis drive resulting in elevated serum androgen levels and a decreased urinary cortisol metabolite: cortisone metabolite ratio below 0.5 (normal adult range 0.7–1.3). These observations...

Introduction: In our centre prior to 2003, testosterone implantation was undertaken by rotational junior medical staff. A specialist nurse role in testosterone implantation was developed within the Oxford Department of Endocrinology over a nine month period.Aim: To assess the adverse effects and the complications from testosterone implants offered by a specialist nurse committed to this task.Method: Since 2003, 200 implants have be...

Ectopic ACTH syndrome (EAS) is characteristically associated with neuroendocrine tumours and small cell carcinomas (SCC) typically of the bronchus. We report a rare case of EAS secondary to gastric adenocarcinoma.A 52-year old man presented to our department with a few week history of proximal myopathy, easy bruising, anxiety and weight loss. He was tanned and hypertensive. Laboratory investigations revealed hypokalaemia (2.3 mmol/l), hyperglycaemia and ...