Endocrine Abstracts

Background: The low-dose short synacthen test (LDSST) is the most popular diagnostic test for adrenal insufficiency in UK. Although various dosing strategies exist 1 μg is most commonly employed but not commercially available. A BSPED survey revealed 14 different methods for diluting the 250 μg/ml ampoules. We investigated whether differing dilution strategies, made up using standard ward not laboratory equipment, result in differences in Synacthen dose administered....

Background: X-rays of the left hand and wrist are used to assess skeletal maturity. The Tanner-Whitehouse 3 (TW3) scoring method provides a framework for calculating bone age but specifies exact hand position. We noted a number of poor quality films, caused by difficulty with hand placement, e.g. scrunching of the fingers. This compromises the ability to score accurately and in a proportion necessitates re-X-ray, resulting in additional time, cost and radiation exposure. We in...

Hypoglycaemia is an almost unavoidable consequence of iatrogenic insulin therapy in type 1 diabetes. Recurrent hypoglycaemia (RH) results in suppression of normal counter-regulatory hormonal and physiological responses (CRR) to future episodes increasing the risk of severe hypoglycaemia. The mechanisms responsible for this phenomenon remain unclear but may reflect changes in critical hypothalamic glucose sensing neurons (GSN). We set out to indirectly test the hypothesis that ...

A prevailing concept regarding the mechanism controlling the timing of puberty proposes that GnRH release from the hypothalamus increases at puberty due to a loss of transsynaptic inhibition, accompanied by an increase in neuronal/glial excitatory inputs to GnRH neurons. Without negating the importance of this intercellular communication process, recent evidence suggests that a critical inhibitory/excitatory Yin-Yang mechanism regulating the advent of puberty is epigenetic in ...

Introduction: The short Synacthen test (SST) is a popular diagnostic investigation for adrenal insufficiency (AI). Cannulation and blood sampling are required making it invasive, time-consuming and resource-intensive. Salivary cortisol is a well-established alternative to serum sampling. We have developed a non-invasive alternative to the 1 μg SST, using a novel formulation of Synacthen (with a nasal drug enhancer, chitosan) given nasally and utilising saliva to measure t...

Introduction: Ovotesticular disorders of sexual development (DSD) are a rare form of DSD with co-existence of both ovarian and testicular tissue in one or both gonads.Case report: A term infant (weight+1.38 SDS) presented at birth with severe penoscrotal hypospadias, a small phallus and a right hemiscrotum with descended gonad (external masculinization score 1.5). Pelvic ultrasound revealed no mullerian structures, a small right gonad with probable epidi...

Background: Bone age studies require X-ray of the left hand and wrist to assess skeletal maturity. The Tanner-Whitehouse 3 (TW3) scoring method provides an objective framework for calculating bone age and specifies exact placement of the hand. In our service we have noted a number of poor quality films, caused by difficulty with hand placement, e.g. scrunching of the fingers. This compromises the ability to score accurately and in a proportion necessitates re-X-ray, with time,...

Rationale: Although many adolescents meet the NICE criteria for bariatric surgery there is a reluctance to undertake or commission such irreversible procedures in young people. Balloons are temporary, reversible, safer and more acceptable and in adults have been shown to promote a clinically significant change in BMI of 4.0–9.0 kg/m2 But due to subsequent weight regain, bypass surgery is preferred.This is a feasibility study of endocsopic...

We have previously shown that the current guidelines for monitoring thyroid function post radioiodine (RI), may not detect hypothyroidism until it has become severe, in a significant proportion of cases (J Endocrinol Invest 2012 35 82–86). An alternative more intense follow-up strategy was used whereby patients had TSH and FT4 measured at 4-week intervals post RI for 6 months. Endocrine specialist nurse-led telephone and nurse-led out-...

Background: Children presenting with diabetic keto-acidosis (DKA) as an initial presentation of diabetes mellitus are often unwell, with associated increases in mortality and morbidity. While electrolyte imbalances such as hypokalaemia and hypophosphataemia are well recognised, the incidence of hypercalcaemia is less well documented.Case: A previously healthy 12-year-old boy presented to hospital with a history suggestive of new onset diabetes. Initial b...