Endocrine Abstracts

The prevalence of diabetes and glucose intolerance is close to 50% in people older than 65. At the same time, near 50% of people with type 2 diabetes are ≥ 65 years old. But being these figures relevant enough to raise a special consideration about how to manage diabetes in this population, there are other reasons supporting the need of that a special consideration. These other needs are not quantitative but qualitative ones, making older people with diabetes a particula...

Pituitary dwarfism has been known for many decades, originally as a component of organic panhypopituitarism. GH for clinical use was purified by Maurice Raben from human cadaveric pituitaries and tested for the first time and with success in 1957 in a patient with childhood onset disease. Moreover, pivotal short term studies on the metabolic effects were performed in both healthy and hypopituitary adults. The concomitant introduction of imunnoassays for GH led to the introduct...

Hormone-secreting adrenal tumours are rare occurrences in women or reproductive age. The commonest is phaeochromocytoma, followed by primary aldosteronism and Cushing’s syndrome. The shared maternal phenotypic feature of these tumours in marked hypertension. They may be difficult to diagnose as many of the clinical features are mimicked by pregnancy, e.g. flushing, weight gain, palpitations. Furthermore hypertensive disease occurs in approximately 5% of pregnant women. Ho...

Treatment for congenital hypothyroidism (CH), based on thyroid extracts, was introduced more than 100 years ago and resulted in a compelling improvement of impaired growth, obesity, depression and severe delay of motor development. However, severe mental retardation remained despite treatment. It was only after the implementation of neonatal screening for CH in 1970s that intellectual outcomes improved to an average normal IQ. However, whether complete normalization of cogniti...

Bone turnover markers reflect the work of the osteoblast and the osteoclast. They can be measured in blood or urine and allow for an inexpensive and non-invasive way to study bone metabolism. They have been evaluated for their use in predicting risk of fracture, accelerated bone loss or the presence of secondary osteoporosis, but for all these uses they are not yet established. They are useful in monitoring the response to treatment of osteoporosis, especially with drugs such ...

More and more devices are becoming available for people with diabetes. Should you advise your patients to use a pedometer? How can insulin pumps be of help? An insulin pump is the best way to accommodate the changing insulin needs over the 24 hours of the day and gives one the opportunity to temporarily stop insulin administration in case of unanticipated exercise, which is impossible when using injection therapy. Trials have mainly been done in Type 1 diabetes, but a recent t...

Graves’ disease (GD) is a heterogeneous autoimmune disorder affecting, with varying degrees of severity, the thyroid, eyes and skin. GD is the most common cause of hyperthyroidism. The incidence peaks between 30 and 50 years of age, but people may be affected at any age. Hyperthyroidism is caused by autoantibodies stimulating the TSH receptor on thyroid cells. The severity of thyrotoxicosis in GD is variable and the response to anti-thyroid drugs is difficult to predict. ...

During the last couple of years an essential increase of newly diagnosed NENs has been observed, however it should be underlined that many cases represent new challenges for the medical staff. Development of personalized approach to NEN patients on the basis of knowledge rapidly coming from genetic/molecular research, improvement of biochemical/imaging diagnostic methods and availability of more efficient therapeutic options, means that existing guidelines are still being chan...

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The major abnormality in type 1 diabetes is insulin deficiency. Type 2 diabetes is also characterized by an insulin secretory defect so that many patients are on insulin therapy. Methods of replacing insulin have improved throughout the decades, but there are still limiting factors that prevent the achievement of a better HbA1c levels such as hypoglycaemic events and glycaemic variability, weight gain and fatty liver. Additionally, most patients wish to do less insulin injecti...

Thyroid neoplasias show a wide range of biological behaviours from indolent to highly aggressive, invasive and metastatic cancers. The great majority of thyroid carcinomas are successfully treated with surgery, radioactive iodine and TSH suppressive therapy. However, a subset of tumors can behave aggressively, with distant metastasis and/or local invasion. These patients have a poor prognosis and a shorter survival, remaining a challenging task in treatment options. Cytotoxic ...

Gaucher disease (GD) is a rare, genetic, autosomal recessive lysosomal storage disease with multi-system manifestations caused by a deficiency of the lysosomal enzyme glucocerebrosidase, which leads to an accumulation of its substrate glucosylceramide (glucocerebroside) in macrophages of various tissues with an inflammatory response and a release of cytokines. In general population its incidence is approximately 1/40 000 to 1/60 000, rising to 1/800 in Ashkenazi Jews. Clinical...

The introduction of PCSK9 inhibitors has changed the paradigm of dyslipidemia treatment. These monoclonal antibodies produce an incremental LDL reduction of about 60% add-on current therapy. Achieving LDL concentrations below 40 mg/dl is usual. The recent publication on the effect of very low LDL concentrations on atherosclerotic plaque burden (Glagov study) and on cardiovascular outcomes (Fourier and Spire) show the impact of this therapy in cardiovascular prevention. In the ...

Dramatic improvements in cancer survival over the past four decades means that greater than 80% of children diagnosed with cancer can expect to survive for more than five years. For some cancers, such as acute lymphoblastic leukaemia and Hodgkin’s disease, cure rates exceed 90%. Currently, there are over 26000 young adults living in the UK, 600 000 across France, Italy, Switzerland, Netherlands and the Nordic countries and 363 000 in the US, who are survivors of childhood...

Survival rates of childhood cancer have improved markedly and today more than 80% of those diagnosed with a pediatric malignancy will become 5-year survivors. Nevertheless, survivors exposed to cranial radiotherapy (CRT) are at particularly high risk for long-term morbidity, such as endocrine insufficiencies, metabolic complications and cardiovascular morbidity. Deficiencies of one or more anterior pituitary hormones have been described following therapeutic CRT for primary br...

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The modulation of appetite, satiation and food intake stems from the interplay of central mechanisms of homeostasis, hedonism and cognitive control, receiving and integrating information on energy balance and feeding status of the body from peripheral organs, including dietary and gut-related signals. Obesity is a phenotype, likely resulting from the dysregulation of one or more of the above mechanisms. Different mechanisms may prevail in different people, though leading to a ...

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