Endocrine Abstracts

The diagnosis and differential diagnosis of hypercortisolism can be a major clinical challenge and involves several stages. In each stage different approaches are currently followed. There are, however, some general principles. In brief, after critical judgement of clinical features, the first step is to assess whether endogenous hypercortisolism is present. First-line tests to screen for hypercortisolism include measurement of 24 h urinary cortisol excretion, cortisol diurnal...

The diagnosis of Cushing’s syndrome firstly involves making or excluding the diagnosis. If the diagnosis is confirmed then an accurate diagnosis is needed as treatment modalities are in general specific to the aetiology. The diagnosis can be straightforward when symptoms and signs are classical and advanced. In these patients 24 h urinary free cortisol levels are markedly raised, late evening serum and salivary cortisol levels are raised and there is failure to suppress s...

Health care payers (governments or insurance plans) are increasingly challenging new health services, including medicines, to prove their value and several European countries have established agencies to help with this task. The example of NICE in England is one example but the Scottish Medicines Consortium (SMC) offers another.In its first four years the SMC has considered 14 endocrinology products, accepting eleven for use (79%). Manufacturers submit e...

The clinical syndrome associated with profound growth hormone deficiency (GHD) in adults has now been established and recognised for more than ten years. The multiple physiological and metabolic actions of growth hormone (GH) has been shown in a logical way to translate into recognisable symptoms and signs in individuals lacking the hormone. Normalization of abnormal physiological and metabolic parameters secondary to GH-replacement therapy has been demonstrated beyond reasona...

Iodine-131 is increasingly the treatment of choice of the hyperthyroidism of Graves’ disease and nodular goitre and is gaining popularity as a means of achieving significant goitre shrinkage in euthyroid patients. There is, however, anxiety among a significant number of patients about the dangers of radiation in general and it is these same patients who pose the question of whether prolonged treatment with antithyroid drugs is an acceptable alternative. In the past, physi...

Radioiodine (131-I)- in use for more than 50 years for hyperthyroidism, with or without goitre, and also more recently for non-toxic goitre- has proven effective in the treatment of hyperthyroidism as well as in reducing goitre size. In hyperthyroidism, one or two 131-I doses will cure nearly all patients. Factors such as: sex, age, morphological goitre type, size of goitre, presence of thyroid autoantibodies, and pre- and post-radioiodine antithyroid drug (ATD) therapy influe...