Clinical Endocrinology (Clin Endocrinol )

Publisher: Blackwell Publishing

Description

Clinical Endocrinology publishes papers and reviews which focus on the practical aspects of clinical endocrinology, such as protocols for investigation of endocrine disorders, imaging in endocrinology and the clinical application of molecular endocrinology. It also features reviews, current therapy papers and cases of the month. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.

Impact factor 3.35

  • Hide impact factor history
     
    Impact factor
  • 5-year impact
    3.26
  • Cited half-life
    7.40
  • Immediacy index
    0.87
  • Eigenfactor
    0.02
  • Article influence
    0.99
  • Website
    Clinical Endocrinology website
  • Other titles
    Clinical endocrinology (Oxford, England: Online)
  • ISSN
    1365-2265
  • OCLC
    46569692
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Blackwell Publishing

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • Some journals impose embargoes typically of 6 or 12 months, occasionally of 24 months
    • no listing of affected journals available as yet
  • Conditions
    • See Wiley-Blackwell entry for articles after February 2007
    • Publisher's version/PDF cannot be used
    • On author's server, institutional server or subject-based server
    • Server must be non-commercial
    • Publisher copyright and source must be acknowledged with set statement ("The definitive version is available at www.blackwell-synergy.com")
    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Blackwell Publishing' is an imprint of 'Wiley'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to evaluate an association between testosterone, sex hormone binding globulin, and body composition as well as the influence of genetic and environmental factors on the association. A cross-sectional study. community-based study. 1,083 Korean men including 144 pairs of monozygotic twins. Levels of serum total testosterone (TT) and sex hormone binding globulin (SHBG) were measured by chemiluminescence immunoassay, and free testosterone (cFT) was calculated using Vermeulen's method. Detailed body composition was measured using dual-energy X-ray absorptiometry. We performed linear mixed regression analysis with consideration of familial correlations and covariates. Each 1-SD increase in age-adjusted levels of TT, cFT, and SHBG were associated with lower levels of adiposity measures and absolute measures of lean body mass. On the other hand, percentage total lean mass increased with increasing levels of TT, cFT, and SHBG (P <0.05). Bivariate variance-component analyses revealed that most body composition measures had a significant inverse unique environmental correlation with both TT and SHBG, and a significant genetic correlation with TT. A co-twin control study in monozygotic twins showed that within-pair differences in adiposity measures were inversely associated with within-pair differences in the levels of TT and SHBG, while within-pair differences in lean mass were inversely associated with within-pair differences in the levels of TT. The significant associations of body composition with testosterone and SHBG were influenced by both genetic and environmental factors. Further efforts to elucidate related genes and modifiable environmental factors are needed. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background It is unclear whether the rate of Vitamin D deficiency in paediatric cancer survivors is higher than in the background population, and whether this is of pathological significancePatients and Methods25OHD was measured in a previously studied group of 208 survivors (n=108 paediatric 5-17 years, n=99 adults 18-39 years) and compared with paediatric (5-17 years; n=132) and adult controls (25-35 years; n=1393 from the AusDiab cohort) adjusted for age and gender. Relationships with treatment factors (irradiation, bone marrow transplantation and intensity of treatment) along with overweight/obesity (defined by BMI), abdominal adiposity (waist:height ratio >0.5) and hyperinsulinism or abnormal glucose tolerance (HI/aGT) were sought.Results25OHD concentrations were similar in paediatric survivors compared with controls (64.3 ±21.6nmol/L vs. 66.3 ±22.8nmol/L), with no effect of age or gender. Adjusted for gender, rates of 25OHD deficiency (< 50nmol/L) were higher in adult survivors compared with Ausdiab controls (42.4% vs. 20.8%; p<0.001). Apart from time since diagnosis (p=0.03), no relationship with treatment factors was detected. In multivariate regression analysis, abdominal adiposity (p=0.001) but not overweight/obesity by BMI status nor HI/aGT, was associated with significantly lower 25OHD concentrations.Conclusions Adult survivors are at increased risk of abnormalities in vitamin D compared to the background population, probably reflecting longer time since diagnosis. Like others, we have not identified any contributory treatment related factors. Vitamin D deficiency does not appear to be associated with the development of abnormal glucose tolerance in this population.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Further to the paper by Chng et al, entitled "Value of sonographic features in predicting malignancy in thyroid nodules diagnosed as follicular neoplasm on cytology", published in the 2014 December issue of Clinical Endocrinology, we wish to make the following comments: (a) We agree that a high TIRADS score such as TIRADS 4C and TIRADS 5 are considered as high risk of thyroid malignancy. Indeed, depiction of a strongly hypoechoic focal area within the follicular thyroid nodule can be a strong argument for malignancy, namely in cases of oncocytomas, anaplastic transformation or presence of double tumor components (poorly differentiated cells). However, a few number of nodules classified as such are benign thus leading to excessive surgery (1). (b) We would emphasise that these thyroid nodules should undergo a full ultrasonography (US) examination, with colour flow / Doppler examination searching for features suggestive of malignancy in addition to TIRADS criteria. The Doppler US features include central anarchic tangled vascularization, penetrating vessels (the so called sword sign), and high resistivity index on Doppler waveform analysis (2, 3). Conversely, the spoke's wheel vessel pattern is suggestive of nodule benignity (4). (c) Benign collapsed thyroid cystic nodules typically show malignant US criteria according to TIRADS classification. In our experience, such nodules are almost avascular. This may be spontaneous or secondary to thyroid nodule fine needle aspiration (FNA) or percutaneous alcoholization / radiofrequency ablation (5, 6). Comparison to the previous US imaging examination is essential confirm the diagnosis. Retrospective review of the previous imaging using picture archiving and communication system (PACS) can show a characteristic significant shrinking of previously large benign (TIRAD2 or 3) thyroid nodule without malignant ipsilateral nodes (Figure 1). In conclusion, we recommend that Doppler US and review of any previous US findings is essential before of TIRADS 4C and 5 thyroid nodules are referred for surgery. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • N Pandeya, Ds McLeod, K Balasubramaniam, Pd Baade, Ph Youl, Cj Bain, R Allison, Sj Jordan
    [Show abstract] [Hide abstract]
    ABSTRACT: Thyroid cancer incidence has been increasing worldwide. Some suggest greater ascertainment of indolent tumours is the only driver, but others suggest there has been a true increase. Increases in Australia appear to have been among the largest in the world so we investigated incidence trends in the Australian state of Queensland to help understand reasons for the rise. Thyroid cancers diagnoses in Queensland 1982-2008 were ascertained from the Queensland Cancer Registry. We calculated age-standardized incidence rates (ASR) and used Poisson regression to estimate annual percentage change (APC) in thyroid cancer incidence by socio-demographic and tumour-related factors. Thyroid cancer ASR in Queensland increased from 2.2 to 10.6/100,000 between 1982-2008 equating to an APC of 5.5% (95% Confidence Interval (CI) 4.7-6.4) in men and 6.1% (95%CI 5.5-6.6) in women. The rise was evident, and did not significantly differ, across socio-economic and remoteness-of-residence categories. The largest increase seen was in the papillary subtype in women (APC 7.9 %, 95%CI 7.3-8.5). Incidence of localized and more advanced-stage cancers rose over time although the increase was greater for early stage cancers. There has been a marked increase in thyroid cancer incidence in Queensland. The increase is evident in men and women across all adult age groups, socioeconomic strata and remoteness-of-residence categories as well as in localized and more advanced-stage cancers. Our results suggest 'over-diagnosis' may not entirely explain rising incidence. Contemporary etiological data and individual-level information about diagnostic circumstances are required to further understand reasons for rising thyroid cancer incidence. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To evaluate the association between subclinical thyroid dysfunction and psychiatric disorders using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).DesignCross-sectional study.PatientsThe study included 12,437 participants from the ELSA-Brasil with normal thyroid function (92.8%), 193 (1.4%) with subclinical hyperthyroidism and 784 (5.8%) with subclinical hypothyroidism, totaling 13,414 participants (50.6% of women)MeasurementsThe mental health diagnoses of participants were assessed by trained raters using the Clinical Interview Schedule – Revised (CIS-R) and grouped according to the International Classification of Diseases 10 (ICD-10). Thyroid dysfunction was assessed using TSH and FT4 as well as routine use of thyroid hormones or anti-thyroid medications. Logistic models were presented using psychiatric disorders as the dependent variable and subclinical thyroid disorders as the independent variable. All logistic models were corrected for multiple comparisons using Bonferroni correction.ResultsAfter multivariate adjustment for possible confounders, we found a direct association between subclinical hyperthyroidism and panic disorder Odds ratio [OR], 2.55; 95% Confidence Interval (95% CI), 1.09-5.94; and an inverse association between subclinical hypothyroidism and generalized anxiety disorder (OR, 0.75; 95% CI, 0.59-0.96). However, both lost significance after correction for multiple comparisons.Conclusion Subclinical hyperthyroidism was positively associated to panic disorder and negatively associated with anxiety disorder, although not significantly after adjustment for multiple comparisons.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective This study aimed to assess insulin resistance according to maternal age at childbirth.Patients and methodsThe data used in this study were obtained from the 2010 Korean National Health and Nutrition Examination Survey. The present study included a total of 2,233 non-diabetic female subjects ≥ 30 years of age that were subdivided into groups according to their obesity and abdominal obesity (AOB) statuses. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to quantify the insulin resistance according to age at first childbirth and last childbirth.ResultsAge at first childbirth showed a negative relationship with HOMA-IR in both the non-obese and non-AOB groups, while age at last childbirth showed a positive relationship with HOMA-IR in both the non-obese and non-AOB groups. A multivariate logistic regression analysis revealed that age at first and last childbirth were significantly associated with the highest HOMA-IR quartile. The odds ratio was 0.9 [95% confidence interval: 0.82–0.98] for age at first childbirth, and 1.07 [95% confidence interval: 1.01–1.14] for age at last childbirth in the non-obese and non-AOB groups.Conclusion In conclusion, the present study suggests that insulin resistance is increased in females who experienced their first childbirth at a younger age or their last childbirth at a later age, particularly in non-obese individuals. Because these data suggest that childbearing age could be an independent risk factor for diabetes, a high-quality prospective study assessing the relationship between childbearing age and insulin resistance should be performed.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Total urinary cortisol and metabolites represents cortisol production and metabolism. We hypothesised that to assay metabolites could add some information to the one provided by a sole cortisol assay.Design and patientsWe set up an inexpensive multiplex mass spectrometry assay to quantify cortisol metabolites. We investigated 43 patients with benign secreting (AT+) or silent (AT-) adrenal tumours compared to 48 lean (Nl) or 143 obese (Ob) subjects, and to 26 patients with a Cushing's disease (CD). The initial investigation included immunoreactive quantification of urinary free cortisol (UFC).ResultsCortisol and metabolites were over-excreted in CD but not in Ob subjects. Nl and Ob were thus pooled in a control population (Ctl).Cortisol, tetrahydrocortisol (THF) and tetrahydrocortisone (THE) excretions were significantly increased in AT compared to Ctl subjects whereas immunoreactive UFC was similar. A logistic regression retaining cortisol, THF, and α- and β-cortolone as significant analytes allowed the construction of a receiver-operating characteristics (ROC) curve significantly better than the curve generated by cortisol alone (area under the curve (AUC) 0.927 vs 0.729, respectively p<0.0001).More importantly, although there was no significant difference between Ctl vs AT- subjects for cortisol or metabolites a logistic regression retaining cortisol, alloTHF, and α- and β-cortolone as significant analytes generated a ROC curve performing significantly better than cortisol alone (AUC 0.910 vs 0.635, respectively p<0.0001).Conclusion Cortisol and metabolites excretion is modified in AT, including AT-, patients even without modification of UFC. Clinical usefulness of these biomarkers has to be investigated in prospective studies following-up patients with AT.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Follistatin (FST) is a regulator of the biological activity of activin A (Act A), binding and blocking it, which could contribute to the modulation of its pro-inflammatory activity during pregnancy. We sought to investigate, in this nested case-control study, FST serum levels during normal pregnancy and correlate it with the FST profile in preeclamptic pregnant women, normal pregnant women followed three months postpartum, and eumenorrheic non-pregnant women throughout the menstrual cycle.Subjects and MethodsFST serum levels determined by ELISA, biochemical, and anthropometric variables were measured in normal pregnant (n=28) and preeclamptic (n=20) women during three periods of gestation. In addition, FST serum levels were measured in a subset of normal pregnant women (n=13) followed three months postpartum and in eumenorrheic non-pregnant women (n=20) during the follicular and luteal phases of the menstrual cycle.ResultsFollistatin serum levels in the eumenorrheic non-pregnant and postpartum group were significantly lower when compared to levels throughout gestation (p<0.01). Serum FST levels increased in each period of pregnancy analyzed, being significantly higher towards the end of gestation (p<0.01). FST levels were lower in late pregnancy in preeclamptic women compared to normal pregnant women (p<0.05). Finally, FST levels were higher in the luteal phase when compared with the follicular phase of the menstrual cycle (p<0.05).Conclusions These analyses would permit the consideration that changes in FST levels during pregnancy contribute to the control of the Act A system.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Brown adipose tissue (BAT) in the supraclavicular and perirenal regions plays a key role in mammalian energy balance and has been proposed as a promising candidate to reduce the spread of the obesity epidemic (1, 2). Urged by the connection between brown adipocytes and muscle cells (3, 4) as well as the results of animal research demonstrating a beneficial impact of regular exercise on BAT mass and activity (3, 5), we recently conducted the first human study investigating whether habitual (i.e., usual weekly participation) physical activity is linked with BAT activity and/or mass in humans (6).This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015; in press.
  • [Show abstract] [Hide abstract]
    ABSTRACT: ObjectiveA possible association between serum 25-hydroxyvitamin D and testosterone levels has been reported, however, contradictory results have emerged.DesignTo investigate a causal link between vitamin D and testosterone status, we studied the effect of vitamin D supplementation on serum testosterone concentrations in three independent intervention studies including male patients with heart failure (study 1), male nursing home residents (study 2) and male non-western immigrants in the Netherlands (study 3).Methods In study 1, 92 subjects were randomized to either vitamin D (2000 IU cholecalciferol daily) or control. Blood was drawn at baseline, after 3 and 6 weeks. In study 2, 49 vitamin D deficient subjects received either vitamin D (600IU daily) or placebo. Blood was drawn at baseline and after 8 and 16 weeks. In study 3, 43 vitamin D deficient subjects received either vitamin D (1200IU daily) or placebo. Blood was drawn at baseline and after 8 and 16 weeks.Serum 25-hydroxyvitamin D levels were measured using LC-MS/MS or radioimmunoassay. Testosterone levels were measured using a 2nd generation immunoassay.ResultsSerum 25-hydroxyvitamin D levels significantly increased in all treatment groups (median increase of 27, 30, and 36 nmol/L in study 1, 2, 3, respectively) but not in the control groups. The documented increase in 25-hydroxyvitamin D levels, however, did not affect mean testosterone concentrations at the end of the study (median increase of 0, 0.5, and 0 nmol/L in study 1, 2, and 3, respectively) .Conclusions In this post-hoc analysis of 3 small clinical trials of limited duration in men with normal baseline testosterone concentrations, vitamin D supplementation was not associated with an increase in circulating testosterone concentrations.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Non-invasive stress tests for the diagnosis of significant coronary arterial stenosis requiring intervention are not perfect. We investigated whether plasma metabolome during the oral glucose tolerance test (OGTT) can improve the diagnosis.MethodsA total of 117 subjects with positive stress test results who received coronary angiography were recruited. After excluding subjects with a history of myocardial infarction and subjects who did not receive OGTT, the 18 subjects without significant stenosis were selected as controls. Another 18 age- and sex-matched subjects with significant stenosis were selected as cases. Plasma metabolome from samples obtained in fasting, 30-minutes, and 120-minutes after OGTT were measured using liquid chromatography combined with time-of-flight mass spectrometry.ResultsWe found 5 metabolites which can identify patients with significant stenosis independent to clinical risk factors, including diabetes, hypertension, hypercholesterolemia, smoking, and history of percutaneous coronary intervention (all p<0.05). The area under the receiver operating characteristic curve (AUROC) of these metabolites was 0.799-0.818 at fasting and 30-minutes after OGTT. The addition of metabolites to clinical factors increases the AUROC (0.616, 95% CI 0.429-0.803 for model with clinical factors only; 0.824, 95% CI 0.689-0.959 for model with 4 metabolites and clinical factors). The changes of plasma metabolite levels during OGTT did not significantly improve the diagnostic performance.Conclusions Fasting plasma metabolome, but not change of plasma metabolome during OGTT, can improve the diagnosis of significant stenosis in patients with positive non-invasive stress tests results.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: A 23-year-old woman with metastatic phaeochromocytoma was found to have a previously unclassified variant in the von Hippel Lindau disease gene (c.361G>C). We use this case to highlight the issue of unclassified single nucleotide variants and the approaches to help predict whether they are disease causing or neutral. With increasing use of genetic testing, and widespread clinical use of next-generation sequencing around the corner, this issue is likely to become more prominent.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • Christian Trolle, Britta Hjerrild, Kristian Havmand Mortensen, Sine Knorr, Hanne Maare Søndergaard, Jens Sandahl Christiansen, Claus Højbjerg Gravholt
    [Show abstract] [Hide abstract]
    ABSTRACT: Background An unfavorable cardiovascular and metabolic phenotype causes 3-fold excess mortality in Turner syndrome (TS), and perturbed cardiac substrate metabolism is increasingly recognized as a common component of cardiovascular and metabolic diseases. We therefore hypothesized that myocardial glucose uptake (MGU) is reduced in TS and that growth hormone (GH) treatment improves MGU. To this end, this controlled trial elucidates MGU in TS and the impact of 6 months of growth hormone treatment on MGU.Methods and ResultsWomen with TS (n=9) were examined at baseline, sequentially treated with either Norditropin® SimpleXx or placebo and re-examined after 6 months. MGU and myocardial blood flow (MBF) were measured using 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) during a hyperinsulinemic euglycemic clamp (at baseline and 6 months). Blood pressure measurement, blood sampling, echocardiography, and dual energy X-ray absorptiometry scan were also performed. Age-matched female controls (n=9) were examined once. Baseline MGU was reduced in TS (0.24±0.08 vs. 0.36±0.13 μmol/g/min in controls; p=0.036) despite similar insulin sensitivity (whole body glucose uptake (M-value): 9.69±1.86 vs. 9.86±2.58 mg/(min*kg) in controls; p=0.9). Six months of GH carried no impact on MGU (0.25±0.08 vs. 0.26±0.12 μmol/g/min in the placebo group; p=0.8). Plasma glucose, low-density cholesterol, and triglycerides increased, while M-value and exercise capacity decreased during 6 months of GH treatment.ConclusionMGU is reduced in TS despite normal insulin sensitivity. GH treatment does not alter MGU despite decreased whole body insulin sensitivity. A perturbed cardiac glucose uptake appears to be a feature of TS.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • Smita Baid Abraham, Brent S. Abel, Ninet Sinaii, Elizabeth Saverino, Matthew Wade, Lynnette K. Nieman
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To validate the diagnostic utility of Cortrosyn™ stimulated aldosterone in the differentiation of primary (PAI) and secondary adrenal insufficiency (SAI); and to evaluate the effect of urine sodium levels and posture on test performance.DesignCross-sectional study.Methods Healthy volunteers (HV; n=46), patients with PAI (n=26), SAI (n=29) participated in the study. Testing included cortisol and aldosterone (by liquid-chromatography tandem mass spectrometry) measurements at baseline and 30 and 60 minutes after 250 μg Cortrosyn™. Plasma corticotropin (ACTH), renin activity (PRA) and urine spot sodium as a proxy for 24 h urine sodium excretion were measured at baseline. The effect a sitting or semi-fowlers posture was evaluated in healthy volunteers.ResultsA Cortrosyn™ stimulated aldosterone level of 5 ng/dl (0.14 nmol/L) had 88% sensitivity and positive predictive value and 89.7% specificity and negative predictive value for distinguishing PAI from SAI. Spot urine sodium levels showed a strong correlation with peak aldosterone levels (r = -0.55, P = 0.02, n = 18) in the SAI but not PAI or HV groups. Posture did not have a significant effect on results.Conclusions Once diagnosed with adrenal insufficiency, a stimulated aldosterone value of 5 ng/dl (0.14 nmol/L) works well to differentiate PAI from SAI. However, clinicians should be aware of the possible effect of total body sodium as reflected by spot urine sodium levels on aldosterone results. A 24-hour urine sodium measurement may be helpful in interpretation.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: We strongly disagree with the commentary on our paper set out by Ahmet Ucar that “Age-related serum dehydroepiandrosterone sulphate (DHEA-S) levels per se should not be considered a reliable surrogate parameter for clinical presentation of adrenarche” as it reflects a clear misunderstanding of the aims of our work. Indeed, on no occasion in our paper do we propose or defend that DHEA-S per se should be considered a surrogate parameter of clinical presentation of adrenarche.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 01/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: One of the most common dynamic testing procedures for assessment of adrenocortical function is the standard corticotropin or the cosyntropin test. The aim of this review is to examine the evidence base underlying the corticotropin test in the management of the critically ill patient. The principle behind the corticotropin test is the demonstration of an inappropriately low cortisol production in response to exogenous ACTH, a situation analogous to physiological stress The corticotropin test was originally described in non stressed subjects, and its applicability and interpretation in the setting of critical illness continues to generate controversy. Attempting to determine the prevalence of an abnormal corticotropin test in critical illness is complicated by the use of different end points and different populations. Moreover, the test result is also influenced by the assay used for measurement of plasma cortisol. Trials assessing the relationship between corticotropin response and severity of stress and organ dysfunction have produced divergent results, which may reflect differences in the methodology and the association being measured. Moreover controversy exists with respect to the methodology and the interpretation with respect to the following variables: dose of corticotropin, end points for assessment- total or free cortisol, effect of plasma cortisol variability, adrenal blood flow and its equivalence with other tests of adrenocortical function. The corticotropin test is used widely in the evaluation of adrenocortical function in the endocrine clinics. Its role in the critically ill patient is less well established. Several confounding variables exist and to have a "one size fits all" approach with a single endpoint in the face of several methodological and pathophysiological confounders may be flawed and may result in the institution of inappropriate therapy. The current evidence does not support the use of the corticotrophin test in critical illness to assess adrenocortical function and guiding steroid therapy in critical illness. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Congenital hypogonadotropic hypogonadism (CHH) is a rare genetic disease that results from defective secretion or insensitivity to gonadotropin-releasing hormone (GnRH), or both, and presents with absent or partial puberty due to sex steroid deficiency.(1) Little is known about the impact of CHH on perceived general well-being, as evaluated by health-related quality of life (HRQoL). Three previous studies have evaluated HRQoL in males with HH, and all reported decreased scores, whereas only one work has reported on HRQoL specifically in patients with CHH. (2) We analyzed HRQoL in a well-characterized population of CHH males, and paid special attention to the relationship between early clinical signs of profound GnRH deficiency (i.e. history of microphallus and/or cryptorchidism) and HRQoL later in life. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: A physiological increase in androgen levels occurs during adolescence. Measuring androgen concentrations is the best method to distinguish normal evolution processes from hyperandrogenic disorders. The increase in circulating androgens during puberty is inversely associated with insulin sensitivity in normal weight girls. To assess circulating levels of ovarian androgens and anti-Müllerian hormone (AMH) at baseline and after GnRH analogue (GnRH-a) stimulation in normal pubertal girls across different Tanner stages. We also studied the association between this response and insulin sensitivity. Prospective study of healthy girls (6-12 years) from the local community (n=63). Tanner I (n=23) subjects were assessed cross-sectionally, and Tanner II girls (n=40) were evaluated every six months until they reached Tanner V. Early morning dehydroepiandrosterone sulphate (DHEA-S), AMH, sex hormone-binding globulin (SHBG), androstenedione, glucose and insulin levels were measured. A GnRH-a test (500 μg/m(2) ; sc) and oral glucose intolerance test (OGTT) were performed. Differences throughout puberty were evaluated. Basal and stimulated testosterone, DHEA-S, and stimulated 17-hydroxyprogesterone (17OHP) were inversely associated with insulin sensitivity (WIBSI) from the beginning of puberty, whereas androstenedione was directly associated with gonadotrophins. AMH was inversely associated with basal and stimulated gonadotrophins and directly with insulin area under the curve (AUC) only in the early stages of puberty. 17OHP and testosterone-responsiveness increased significantly during puberty in all subjects, whereas testosterone levels changed less consistently. This pattern of ovarian-steroidogenic response was most evident during mid- and late puberty. Moreover, during late puberty only, basal 17OHP, testosterone and DHEA-S were positively associated with gonadotrophins. In normal non-obese girls born appropriate for gestational age, androgen synthesis was associated with insulin sensitivity in early puberty and with LH only in late puberty. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is an autosomal recessive disorder and represents one of the most common inborn disorders of metabolism.1 Based on recent outcome studies,2,3 awareness of long-term health problems in CAH has significantly increased amongst many different medical specialities caring for patients with CAH. One particular issue is the variability of frequency, onset and development of hypertension in patients with CAH.4This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Report the prevalence of parathyroid carcinoma (PC) in patients with multiple endocrine neoplasia type 1 (MEN1) and review of the literature.Background Primary hyperparathyroidism (PHP) is the most common manifestation of MEN1. The occurrence of PC in patients with MEN1 is rare and the literature regarding the clinical manifestations – including the prevalence of the disease – is scarce.ContextSingle tertiary care center experience from 1977 to 2013.DesignElectronic search of the medical records to identify a cohort of patients with MEN1. Literature review based on current case reports.PatientsSingle case of PC in a cohort of 348 patients with MEN1. Ten cases of PC in patients with MEN1 reported in the literature.MeasurementClinical features of PC in patients with MEN1.ResultsThe prevalence of PC in 348 patients with MEN1 was found to be 0.28% (95% CI, 0 - 1.4%). Based on the current published cases of PC in patients with MEN1, 54.5% were women, mean age at diagnosis was 48.3 years, and the serum PTH concentrations at least 4 times the upper limit of the reference range in 73% of the cases.ConclusionPC in patients with MEN 1 is rare with a prevalence of 0.28% and the clinical features are similar to PC in patients without MEN1.This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014;