Endocrine Abstracts

Some 50 years on from the originally published description of gestational diabetes mellitus, debates continues as to the significance of minor degrees of glucose intolerance for maternal/fetal outcome. Confusion has been compounded by different diagnostic practices and the likelihood that there is a continuum of risk. A fundamental lack of robust evidence is reflected in the lack of consensus among published guidelines. The picture has been further complicated by the current s...

In foetuses at risk of virilising CAH, prenatal treatment can be offered by administration of dexamethasone (DEX) via the mother in order to prevent genital malformations. Accumulating evidence from animal studies and epidemiological data raise concerns regarding the long term consequences of excess glucocorticoids on the developing foetus. The European study PREDEX is organized as an open, controlled, non-randomised, multicentre trial. The impact of DEX on the general well-be...

Thyroid disorders are common among women of childbearing years. However, the diagnosis of thyroid disorders during pregnancy is confounded by the normal alteration in thyroid physiology. Serum TSH levels decrease at the end of the first trimester, mirroring the increase in serum hCG levels; hCG is thyrotropic and causes a slight increase in serum free T4 concentrations. With the drop in serum hCG as pregnancy progresses, serum free T4 levels decline and may decrease below the ...

The main source of vitamin D is by the conversion of 7-dehydrocholesterol in the skin to cholecalceferol upon exposure to sun’s ultraviolet B radiation. Vitamin D in diet may be supplied as cholecalceferol or as ergocalciferol, which is derived from plant sources. Vitamin D is metabolised in the liver to 25-hydroxyvitamin D (25OHD; measure of an individual’s vitamin D status) and by kidneys to 1,25-dihydroxyvitamin D, which is responsible for calcium & phosphorou...

Normal pubertal development is characterised by a decline in insulin sensitivity resulting from the effects of elevated growth hormone levels on peripheral glucose uptake in muscle. The increased glucose availability for other tissues leads to protein sparing, contributing to the anabolism of puberty. Insulin also has an important role in the regulation of the tempo of puberty through its actions on SHBG and IGFBP-1 which, in part, determine the bioavailability of sex steroids...

The association (and similarities) of polycystic ovary syndrome with the metabolic syndrome, in which excessive (visceral) accumulation and insulin resistance are patho-physiologically linked suggests an important role for weight loss and weight loss maintenance both for symptom improvement and improved fertility in the short term, and reduced cardiovascular and metabolic risk over the patient’s lifetime. A number of studies have confirmed that in PCOS, dietary-induced we...

The polycystic ovary syndrome (PCOS) is the commonest hormonal disorder to affect women. The cardinal features are menstrual cycle disturbance, hyperandrogenism and polycystic ovaries. Both slim and overweight women with PCOS tend to be more insulin resistant than weight-matched women with normal ovaries. The degree of menstrual irregularity and anovulatory infertility appears to correlate with the degree of hyperinsulinaemia, which in turn correlates with obesity. Lifestyle i...

Hyperandrogenism in PCOS often manifests itself with the cosmetically disfiguring problems of acne, androgenetic alopecia and hirsutism. These conditions cause considerable psychological morbidity in women with PCOS.Specific treatments for these cosmetic problems should be considered in addition to hormonal or other therapy.Topical retinoids are an appropriate first line therapy for most cases of acne particularly when comedones pr...