Endocrine Abstracts

Background: Glucocorticoid replacement is life saving in adrenal insufficiency. There are established guidelines for management of adrenal insufficiency. This audit was under taken to evaluate whether we are implementing these guidelines in our day to day management of patients with adrenal insufficiency.Method: A retrospective study was performed on 18 patients. Data was collected from clinical records on the proforma and were evaluated against the reco...

Background: Many patients with Addison’s disease experience decreased general wellbeing, mood and physical activity. This decrease in Quality of Life (QoL) is probably related to suboptimal glucocorticoid replacement therapy (GRT). Overreplacement frequently occurs and this can lead to side effects on the long term. The objective of this study was to investigate the effect on QoL of individual adjustment of GRT in order to approach normal cortisol levels as closely as pos...

Objective: The structure of psychological and somatic complaints of aging male patients in relation to sex hormone patterns and metabolism has not been fully elucidated, especially in regard to late-onset hypogonadism.Methods: We investigated the nature of complaints in 434 consecutive patients aged 50–86 years attending our andrology unit and their association with physical characteristics, life style habits and sex hormone levels.<p class="abs...

Objective: A reliable form of androgen substitution therapy in terms of favorable kinetics and tolerance as well as effective restoration of androgenicity is paramount in hypogonadal men. A feasible modality is the intramuscular injection of the long-acting ester testosterone undecanoate (TU).Design: We report data from 22 patients (15 with primary and 7 with secondary hypogonadism) aged 30 to 65 years (mean 43.8±8 years) who received injections of ...

The preparation of Sandostatin LAR® injections using a 2 ml ampoule of vehicle solution may be associated with some technical difficulties of administration, with adverse consequences for patients. The development of a 2.5 ml prefilled syringe may alleviate some of these problems. We have compared these two methods of Sandostatin LAR® administration in 17 patients with acromegaly and 5 patients with neuro-endocrine tumours, (6 drug naïve, 1...

An asymptomatic 66-year-old man was referred for investigation of chronic hypernatraemia. Plasma sodium varied between 146–152 mmol/l and potassium was normal over several years. There was no relevant past, family or drug history. There were no symptoms or signs of hypercotisolism or other endocrinopathy either. Clinical examination was normal.Initial investigations were as follows – sodium 149 mmol/l, potassium 4.3 mmol/l, urea 7.9 mmol/l, cre...

Objective: To investigate the insulin response during a 5 hour Oral Glucose tolerance test (OGTT) in subjects with and without symptoms of reactive hypoglycaemia.Methods: 12 patients with suspected reactive hypoglycaemia were studied. After fasting from midnight, they were given a 75 g glucose drink at 9 am the following morning. Plasma glucose and insulin levels were measured at baseline and at 30 minute intervals for 5 hours. Relative insulin increase,...

A recent study has reported impaired subjective health status (SHS) in 79 patients with primary adrenal insufficiency (AI) despite routine steroid replacement1. Here we have performed a survey in a large cohort of patients with primary and secondary AI. 348 patients (148 outpatients and 200 registered participants of the self-help network for adrenal and pituitary diseases) were contacted by mail. 256 (74%) agreed to participate and received a disease specific and 3...

Introduction: Intramuscular Testosterone Undecanoate (TU, Nebido®) has become available in November 2004 in Europe for the treatment of male hypogonadism. Continuous physiological hormone replacement is necessary for transgender patients, both prior to the gender adjustment operation and for the remainder of the individual’s lifetime. The administration of long-acting TU therefore stood to reason as part of cross-gender testosterone therapy for female-to-m...

Introduction: Over the last five years testosterone therapy in men became more safe, efficient and ‘patient-friendly’ with the introduction of new testosterone preparations. Testosterone gels are in widespread use, but they are associated with the risk of interpersonal transfer and need daily application. Recently, injectable testosterone undecanoate (TU, Nebido®) has become available in Europe.Long term data of aging males with...

Contracts with primary care encourage screening for diabetes and as a result a fasting blood glucose is frequently performed on asymptomatic patients. During the last year three such patients were found to have significant hypoglycaemia with elevated c-peptide levels and were referred for further investigation.The first, a 50 year old woman, developed significant hypoglycaemia 22 hours into a fast with elevated c-peptide and insulin levels. A CT scan of ...

Aim: Sibutramine, orlistat and metformin appear beneficial for the treatment of adult with obesity. Several investigators have suggested that larger weight losses might be achieved by combining weight loss agents. The aim of this study was to compare the effectiveness of sibutramine monotherapy versus sibutramine plus metformin combination therapy in obese women with normal glucose tolerance.Material-method: This is a 6 month, prospective and randomized ...

An audit examining self-management skills and pre hospital management of adrenal crisis. This audit was performed following a clinical incident involving an Addison’s patient who suffered and survived a cardiac arrest as a direct result of an adrenal crisis. The patient involved in the initial incident lived close to a major A&E.The paramedic arm of the audit came about after consideration of the geographical nature of this locality. Even if the...

Autoimmune hypoadrenalism (Addison’s disease) is a relatively rare condition; recent research has found the European prevalence to be up to 140 per million [Lovas & Husebye 2002]. It frequently occurs in association with other organ-specific autoimmune diseases, both endocrine and non-endocrine. Previous studies identified a considerable range in the prevalence of associated conditions and, because of the rarity of the disease, were often drawn from relatively small s...

Previous evidences have suggested that in adults with organic hypopituitarism the condition of GH deficiency (GHD) could mask the presence of other pituitary deficits. In our experience, both central hypothyroidism and hypoadrenalism were unmasked during rhGH therapy in adults with GHD due to central organic lesions. Few and conflicting information are available about the relationship among GHD, rhGH therapy and gonadal function. Aim of the present study was to investigate the...

Research suggests regular assessment of steroid replacement therapy (SRT) is important to avoid over replacement. Also patients need regular educational updates to optimise management of SRT during illness.Over a three-month period (2004) we surveyed SRT and knowledge in patients with primary or secondary hypoadrenalism. Patients were given a questionnaire when attending clinic. We assessed type of SRT, dose and timing; compliance with medication; patien...

Introduction and aims: Following treatment for acromegaly, both growth hormone (GH) and insulin-like growth factor-I (IGF-I) levels are predictive of mortality. These data are derived from studies of either a single GH or the mean circadian GH, with a threshold of 2 mcg/l. However, consensus target criteria (Giustina et al. 2000) require: a nadir GH of <1 mcg/l on OGTT and IGF-I within the age/sex-adjusted normal range. We aimed to determine the degree to which norm...

Women with Turner Syndrome (TS) often feel well but require detailed screening for potential sequelae, which may impact on their quality of life, morbidity and mortality. They may also have psychological issues around living with the condition. It is our opinion that women with TS benefit from attending a specialised clinic and consequently an Adult TS Clinic (ATSC) was set up, however the opinion of the women attending such a service is not known. A survey was therefore condu...

We previously demonstrated that acromegalic patients with normal IGF-I levels after surgery also met the current criteria for cure (i.e. postglucose GH nadir <1 μg/l) after long term monitoring. Since some Authors recently proposed to even lower the present GH nadir cut off value, the aim of this study was to confirm its adequacy to define long lasting disease remission. A group of 24 acromegalic patients (9 M&15 F, age 54.2±9.6 yrs) normal IGF-I levels and p...

Introduction: Large prolactinomas are uncommon and there is limited information on their presentation and progression. In this study we reviewed the presenting features, associated endocrinopathy and the response to treatment.Methods: 16 patients (aged 20–80 years, 75% male) were identified from our endocrine database as presenting with prolactin >20,000 mU/l between 1985 and 2005.Results: 75% of patients presented with ma...

Introduction: It is accepted that hyperprolactinaemia associated with microprolactinoma may prove self-limiting in 25–30% women, and there is some suggestion from series of mixed gender that the same may be true in men.Methods: We have therefore reviewed the outcome in all men with microprolactinomas managed at the Department of Diabetes and Endocrinology, City Hospital, Nottingham, between 1994 and 2002. All had sustained and previously untreated h...

Turner syndrome (TS) is associated with more frequent ophthalmic morbidity.The goal: To investigate the prevalence and severity of ophthalmic problems in patients with TS diagnosis established on a detailed karyotype analysis.Patients and method: 73 girls with TS aged 2–30 (mean 14.34±6.39) were involved in the study. 45,X monosomy was found in 57.8% of them, different mosaic pattern in 33.8% and structural aberration in ...

Introduction: Diabetic patients are at high risk of developing diabetic autonomic neuropathy (DAN). The aim of this study was to compare autonomic scoring and measurements from a new device the ANSiscope™ (Dyansys, Inc) of diabetic patients who do not suffer from DAN complications. Method: After approval of the Ethics committee, 18 diabetic patients (mean age 48±7.5) without any complication due to DAN were included in the study. They all underwent 3 standard autono...

Guidelines for the use of Growth Hormone (GH) replacement in adults with GH deficiency (GHD) were published by the National Institute for Clinical Excellence (NICE) in 2003. We undertook an audit to ensure that patients attending our adult endocrinology clinic were being prescribed GH in accordance with NICE guidelines.Patients commenced on GH replacement between June 2004 and June 2005 were included in the audit. Data was collected from medical notes, a...

The term Sheehan syndrome refers to the development of pituitary necrosis due to ischemia within a few hours of delivery. Usually, antecedent hypotension and shock are present, resulting most commonly from obstetric hemorrhage. In such instances evidence of adrenal and thyroid insufficiency should be sought. A classical symptom of Sheehan’s syndrome is the absence of lactation after delivery related to prolactin deficiency. We retrospectively analysed 64 patients who were...

Background: Prolactin levels are affected by stress, and in patients with moderate hyperprolactinaemia, a repeat test and/or a resting prolactin has been recommended, but there are very few data addressing the utility of these additional measurements.Aim: To study the value of: A) Repeat measurement and B) Resting measurement of serum prolactin in mild to moderate prolactin excess (510–7500 IU/L).Methods and subjects: Case not...

The purpose of this study was to explore the use of testosterone treatment and patients’ knowledge in male hypogonadism. A questionnaire was sent to all 213 patients on testosterone replacement therapy recorded in our clinic database, with a response rate of 35.7% (n=76). Respondents’ age ranged from 19 to 87 years (mean=44.5; S.D.=16.2). Causes of hypogonadism for this group are presented in Table 1.<table boarder="1" cellpadding="3" cellsp...

We evaluate the short and long-term outcomes following diagnosis and treatment of pituitary dependent Cushing’s disease from a single centre. From 1971, there were 47 patients with proven endogenous cortisol excess, of whom, 43 (92%) had pituitary dependent Cushing’s disease. The median age of this cohort was 38±11years and the majority (77%) were females. 17 patients had primary treatment either with radiotherapy (n=9), bilateral adrenalectomy (n=...

Prolactin (PRL) exists in different forms in human serum. The predominant form is little PRL (23 kDa) with smaller amounts of big PRL (50–60 kDa), that may be also associated with big big PRL (bbPRL) or macroprolactin (150–170 kDa). A lower biological activity in vivo of bbPRL was reported. Aim of the study was to evaluate the clinical impact of macroprolactin and the association between macroprolactinaemia and polycystic ovary syndrome (PCOS). A group of 115 ...

Objective: Evaluate the influence of altered cortisol binding globulin (CBG) concentration on total cortisol and calculated free cortisol (CFC) during the 250 μg ACTH test.Methods: We included 100 unmedicated healthy individuals (HI) (50M:50F), 13 women taking oral contraception (OC), and 5 men with nefrotic syndrome (NS, prior to glucocorticoid treatment; hypoalbuminaemia <9 g/l; proteinuria >1.6 g/24 h). An ACTH-test was performed between ...

Objective: To determine whether transdermal oestrogen (E2) preparations alter total cortisol and cortisol binding globulin (CBG) concentration similarly to oral E2 treatment.Methods: This cross-sectional, observational study compared levels of total serum cortisol, CBG, the free cortisol index (FCI) and salivary cortisol levels (as a measure of free cortisol) in oestrogen naïve women (n=15), women taking oral oestrogen (...

Management of patients with gender dysphoria (transsexualism) is often difficult, and most patients are routinely managed outwith specialist gender identity clinics. We carried out a retrospective case-note survey of 21 patients attending a routine adult endocrine clinic (ages 24–64 y; 13 male-to-female (MF) and 8 female-to-male (FM)).All MF and 6 of 8 FM patients were on hormonal treatment. 6 of 13 MF patients took oestrogen alone, 6 used oestrogen...

Bone loss in treated Addison’s disease (autoimmune hypoadrenalism) is often attributed to supraphysiological doses of glucocorticoid. The largest international survey to date (N=613) suggests that other factors are also likely to be associated with bone loss in these patients and that an intrinsic risk of bone loss in autoimmune hypoadrenalism cannot be ruled out. This survey also found significant rates of osteoarthritis among autoimmune hypoadrenalism patients. 1...

Addison’s disease is notoriously difficult to diagnose and has been labelled ‘the master of unforgiving disguise’. In the largest international survey of autoimmune Addison’s disease to date (N=613), we asked patients to recall their symptoms at diagnosis. The results confirm the challenges of diagnosis, in that no patients recalled all the standard symptoms.Hyperpigmentation with dizziness on standing/blackouts and weight loss...

Hormonal treatment (HT) represents the only complete therapy of the consequences of the postmenopausal estrogenic deficiency. Quality of life in postmenopausal women is often compromised. We evaluated the quality of life (appreciated with IQL questionnaire) in 80 postmenopausal women – 40 with intact uterus, treated with natural estrogens associated with progestin, and 40 non-treated women. Group selection (treated/not treated) was made function of the inform consent of t...

Hyponatraemia is the commonest electrolyte abnormality in hospitalised patients. It is often seen in patients with complex medical problems and in the critically ill. We determined the outcome for patients identified to have hyponatraemia over a one month period.Methods: We reviewed all in-patients with severe hyponatraemia, defined as serum sodium <125 mmol/l (135–146) at Hope Hospital during April 2005. Patients were identified retrospectively...