Basil George Issa

• MB BCh, MD, FRCP, MRCPI
• Consultant Physician and Endocrinologist at Manchester University NHS Foundation Trust

Background The prevalence of adrenal incidentaloma (AI) is increasing, with pressure on healthcare systems. While earlier guidelines recommended repeat endocrine testing to ensure stability, the recent European guidelines suggest that is not necessary if initial tests were reassuring. Aim To explore the utility of this guidance on repeat endocrine...

Case 1 A 19 year old primigravida, 35 weeks gestation, presented with acute severe right flank pain and vomiting. She underwent a MR cholangiopancreatography following advice from the gastroenterologists. This revealed a right adrenal gland haemorrhage 46×24×40 mm. CRP was raised at 151mg/l. Random cortisol, potassium and plasma metanephrines (pMET...

Background Adrenal incidentaloma (AI) is an increasingly recognised finding, with pressure on healthcare systems. Earlier guidelines recommended interval scanning and testing to ensure stability. However, the recent European guidelines do not recommend the need for repeat scanning if initial assessment is reassuring. Aim To explore the utility of...

Correlation between midnight and post dexamethasone salivary cortisone and cortisol and post dexamethasone serum cortisol concentrations in patients with unilateral and bilateral adrenal incidentalomas Background: The commonest functional abnormality in adrenal incidentalomas (AI) is autonomous cortisol secretion. Most guidelines recommend a 1 mg o...

Background: Adrenal incidentalomas (AI) are incidentally identified lesions whilst scanning for other purposes. They are mostly benign and hormonally inactive but about 20% are hormonally-active or malignant, requiring prompt intervention. The overall reported AI prevalence is 3-5% but increases with age (up to 7% of those above 70 years). Guidelin...

Background: Adrenal incidentalomas (AI) are incidentally identified lesions whilst scanning for other purposes. They are mostly benign and hormonally inactive but about 20% are hormonally-active or malignant, requiring prompt intervention. The overall reported AI prevalence is 3-5% but increases with age (up to 7% of those above 70 years). The arra...

Background: The most common functional abnormality in adrenal incidentalomas (AI) is autonomous cortisol secretion. Most guidelines recommend a 1 mg overnight dexamethasone suppression test (ONDST) as a screening test for this abnormality. There is some evidence that simultaneous measurement of post dexamethasone serum dexamethasone (SD) with serum...

A 51-year old woman was admitted with multiple cerebral, pulmonary and intra-abdominal abscesses. The combination of apparent immunosuppression, obesity, diabetes mellitus, hypertension, hypokalaemia, osteoporotic fractures and bilateral shoulder avascular necrosis led to a clinical diagnosis of Cushing’s syndrome (CS). This was biochemically confi...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the impact of hypoglycaemic agents in polycystic ovarian syndrome on: pregnancy outcome (maternal and fetal); glycometabolic parameters as reported by the investigators (e.g. glucose, levels, insulin levels, glycosylated haemoglobin, insulin sensiti...

Background: The aim of this study was to explore the influence of extended-release niacin/laropiprant (ERN/LRP) versus placebo on high-density lipoprotein (HDL) antioxidant function, cholesterol efflux, apolipoprotein B100 (apoB)-containing lipoproteins, and mediators of vascular inflammation associated with 15% increase in high-density lipoprotei...

Type 2 diabetes mellitus is a major cause of morbidity and premature mortality in the Western world. It is responsible for about 10% of the NHS spend (about £286/second in the UK). Of those diagnosed with type 2 diabetes, 25% are thought already to have evidence of complications indicating that the disease has been present for 4–7 years.1 Where peo...

A 51-year-old obese lady was admitted with multiple cerebral, pulmonary and intra-abdominal abscesses. She was referred to the endocrine team because of newly-diagnosed type 2 diabetes mellitus. The combination of apparent immunosuppression, obesity, diabetes mellitus, hypertension, hypokalaemia, osteoporotic fractures and bilateral shoulder avascu...

Background: It is estimated that gestational diabetes (GDM) accounts for 87.5% of all diabetes cases in pregnancy and is associated with worse pregnancy outcomes. Macrosomia is one of the main complications of GDM and antenatal management strategies are directed at ensuring normal foetal growth. Ultrasonography is a useful tool for estimating foeta...

Pica, the deliberate ingestion of non-food substances, has been described in different antenatal populations in some parts of the world. Although the aetiology remains unclear, pica has been associated with complications such as anaemia in pregnancy. Little is known regarding the existence of this phenomenon in a high-risk antenatal population such...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the impact of hypoglycaemic agents in polycystic ovarian syndrome on: • pregnancy outcome (maternal and fetal); • glycometabolic parameters as reported by the investigators (e.g. glucose, levels, insulin levels, glycosylated haemoglobin, insulin se...

Recently, glycosylated haemoglobin (HbA1c) has been recommended by the American Diabetes Association (ADA), the World Health Organisation and subsequently by many other professional bodies as a diagnostic tool for diabetes mellitus. However, the cut-off values suggested vary between these groups and uncertainties remain regarding the limitations of...

Introduction: Niacin is one of the oldest drugs used in the treatment of dyslipidemia. Previously its use has been limited because of excessive flushing. Now an agent laropiprant (LRP) has been developed, which blocks the flushing pathway. Therefore, it is time to collate available information to assess the safety and tolerability of combining nia...

Measurement of the 24-h urinary free cortisol is a valuable screening test of endogenous hypercortisolism and, although false positive results may occur in a few situations, for example endogenous depression, false negative results are unusual. We report a case of a 48-year-old lady with pituitary-dependent Cushing's disease, whose 24-h urinary fre...

We investigated the role of hypothalamic glutamate receptors in mediating the stimulatory effect of low glucose (< 5 mM) on somatostatin release. We also studied whether alteration in glutamate release might contribute to the reduced hypothalamic somatostatin response to low glucose observed in diabetic (Goto-Kakizaki) rat hypothalami. Hypothalamic...

We report the case of a 33-year-old male presenting with bilateral gynaecomastia whose karyotype was mosaic with 60% of the cells showing an isochromosome for the short arm of the Y chromosome and 40% showing 45,X complement. Further investigation revealed evidence of a stage one seminoma of the right testis and complete azoospermia. He was treated...

Editor—A woman known to have a multinodular goitre and primary hyperparathyroidism presented with a two day history of sudden onset of pain and swelling in the left side of the neck, sore throat, and dysphagia. Two days later she developed bruising over the front of the neck and upper chest (fig 1). Ultrasound examination confirmed the presence of...

We have studied the effects of glucose on the release of somatostatin (SS), TRH and GHRH from incubated hypothalami of normal and genetically diabetic, Goto-Kakizaki (GK) rats. The active isomer d -glucose caused a dose-related inhibition of SS, TRH and GHRH from normal rat hypothalami over a 20-min incubation period in vitro . In contrast, in GK r...

Insulin-induced hypoglycaemia is the standard method for assessment of the hypothalamo-pituitary-adrenal (HPA) axis of patients with pituitary or hypothalamic disease. It has been claimed that a normal cortisol response to the 30-minute ACTH stimulation test (AST) obviates the need to perform the insulin stress test (IST) in these patients. The obj...

The regulation of growth hormone (GH) secretion is complex, depending on the interaction of a wide array of central and peripheral feedback signals. In this brief review we will build up a picture of the current understanding of GH control mechanisms, highlighting areas of particular clinical relevance.

Eosinophilic fasciitis is a syndrome usually characterized by limb and joint pain, a raised sedimentation rate, hypergammaglobulinaemia, subcutaneous fasciitis and peripheral as well as tissue eosinophilia. We present a case with a positive tissue diagnosis, but who presented predominantly with marked nocturnal sweating and pyrexia.