Endocrine Abstracts

A 52 year old man presented 5 years ago with a history of persistent rhinorrhea, blocked nose and epistaxis. MR scanning revealed blockage of the ethmoid sinus with polypoidal material extending into the nasopharynx, anterior cranial fossa and right orbit. He had craniofacial resection of the lesion and histology confirmed an olfactory neuroblastoma.He represented in 2005 with a two-week history of generalized weakness, lack of energy, and bilateral ankl...

Cushing’s syndrome is a rare endocrine disorder which the Royal College of Physicians/Society for Endocrinology Guidelines – Pituitary Tumours (1997) suggest should only be differentially diagnosed in centres with appropriate technical and enocrinological expertise. We conducted an audit against these guidelines of the management of Cushing’s syndrome in our unit (population covered 250, 000) over the 3-year period between January 2003 and January 2006. Aetiolog...

In ACTH-dependent Cushing’s syndrome, the high dose dexamethasone suppression test (HDDST) has been traditionally used to identify differentiate between pituitary-dependent Cushing’s disease and ectopic ACTH production. However, more recently, concerns regarding the diagnostic accuracy of the HDDST have led to many centres abandoning this test in preference to bilateral inferior petrosal sinus sampling (IPSS). We aimed to establish current consensus in the UK for the...

Methyl oxime–trimethylsilyl (MO-TMS) derivatisation with gas chromatography–mass spectrometric (GC-MS) analysis has been well established in the analysis of glucocorticoids and is still used in many laboratories for profiling endogenous steroids for clinical purposes. There appears to be a clinical need to extend the analysis to xenobiotic glucocorticoids, primarily to elucidate cases of patients presenting with adverse symptoms associated with glucocorticoid excess,...

Ritonavir is a protease inhibitor used in the treatment of HIV infection. It can potentiate the effect of inhaled corticosteroids, resulting in iatrogenic Cushing’s syndrome.We present a case of a 21-year-old female who had acquired HIV infection at birth, who also had moderately severe asthma since childhood treated with inhaled salbutamol 100 mcg prn and fluticasone 500 mcg bd. She had twice-yearly exacerbations requiring oral steroids. She commen...

Cushing’s syndrome is characterized by a diverse set of clinical manifestations, including hypertension, apparent obesity and metabolic aberrations such as diabetes, dyslipidaemia, ultimately leading to the metabolic syndrome. AMP-activated protein kinase (AMPK) is an intracellular energy sensor. It integrates nutritional and hormonal signals by switching on catabolic pathways, such as fatty acid oxidation and glycolysis and switching off anabolic pathways, such as fatty ...

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