Simon J B Aylwin

Simon J B Aylwin
King's College Hospital NHS Foundation Trust · Department of Endocrinology

MA MB BChir PhD FRCP

About

188
Publications
24,408
Reads
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5,362
Citations
Citations since 2017
60 Research Items
2114 Citations
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Introduction
Simon Aylwin is the Lead Clinician for endocrinology at King’s College Hospital with special interests in pituitary tumours, thyroid disorders, adrenal tumours and cancer, neuroendocrine tumours, inherited endocrine tumour syndromes, bariatric medicine and hyponatraemia. He leads the pituitary and adrenal multidisciplinary teams at King’s for patients with pituitary and other endocrine-related tumours and cancers. He has a private practice at the London Bridge Hospital and at The London Clinic.
Additional affiliations
January 2011 - present
King’s Health Partners
Position
  • Professor (Associate)
July 2001 - present
King's College Hospital NHS Foundation Trust
Position
  • Consultant Endocrinologist and Lead Clinician

Publications

Publications (188)
Article
Full-text available
Background The thyroid hormone receptor α gene (THRA) transcript is alternatively spliced to generate either thyroid hormone receptor (TR)α1 or a non-hormone-binding variant protein, TRα2, the function of which is unknown. Here, we describe the first patients identified with a mutation in THRA that affects both TRα1 and TRα2, and compare them with...
Article
Pheochromocytoma crisis is an endocrine emergency associated with significant mortality. There is little published guidance on the management of pheochromocytoma crisis. This clinical practice update summarises the relevant published literature, including a detailed review of cases published in the past five years, and a proposed classification sys...
Article
Full-text available
Context: Glucagon-like peptide-1 (GLP-1) is a gut peptide that promotes insulin release from pancreatic β-cells and stimulates β-cell hyperplasia. GLP-1 secretion causing hypoglycemia has been described once from an ovarian neuroendocrine tumor (NET) but has not been reported from a pancreatic NET (pNET). Objective: A 56-yr-old male with a previ...
Article
The majority of prolactinomas respond to dopamine agonist therapy, but a proportion are resistant, requiring other treatments including surgery and/or radiotherapy. Temozolomide is an oral chemotherapy agent, which has been used as a salvage therapy to treat aggressive pituitary adenomas and carcinomas, including prolactinomas, unresponsive to all...
Article
Bariatric surgery is the most effective treatment for achieving long-term weight loss in morbidly obese patients. This study investigated prospective changes in gut hormones and metabolic indices after Roux-en-Y gastric bypass (RYGB). Six patients were seen before, and at 1, 3 and 6 months after operation. Blood was collected after a 12-h fast and...
Article
Parathyroid carcinoma is one of the least common endocrine malignancies, and accounts for approximately 1% of all patients with primary hyperparathyroidism. A systematic review of peer-reviewed literature published between January 2000 and March 2022 via Medline, Embase, Cochrane Central Register of Controlled Trials, EudraCT, ClinicalTrials.gov, C...
Article
Full-text available
Postprandial hyperinsulinaemic hypoglycaemia with neuroglycopenia is an increasingly recognised complication of Roux-en-Y gastric bypass (RYGB) and gastric sleeve surgery and may detrimentally affect patient quality of life. One likely causal factor is Glucagon Like Peptide-1 (GLP-1), which has an exaggerated rise following ingestion of carbohydrat...
Conference Paper
In December 2020 NICE issued guidance, recommending the use of 3mg Liraglutide for the management of patients with BMI ≥35kg/m2, prediabetes and increased CVD risk seen in a Tier 3 service. This highlighted the need for the development of a national registry to capture real life outcomes of this treatment. OMDT is a bespoke implementation of Dendr...
Article
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Introduction: Paediatric cohorts of central diabetes insipidus (CDI) have shown varying prevalence for different causes of CDI. The objective of this study was to determine the causes of CDI and long-term outcome in children and adolescents from a Tertiary Paediatric Endocrinology unit. Methods: The clinic database was searched to identify patie...
Article
Full-text available
Objective: The insulin tolerance test (ITT) is the gold standard endocrine test used to assess the integrity of the growth hormone (GH) and cortisol axes. The ITT has potential risks, and severe hypoglycaemia may necessitate intravenous glucose rescue. There is no clear consensus as to the optimal insulin dose for the ITT. Therefore, we sought to...
Article
Full-text available
A 49-year-old teacher presented to his GP with lethargy and lower limb weakness. He had noticed polydipsia, polyuria and had experienced weight loss, albeit with an increase in central adiposity. He had no concomitant illnesses and took no regular medications. He had hypercalcaemia (adjusted calcium: 3.34mmol/L) with hyperparathyroidism (PTH: 356...
Article
Full-text available
Approximately 20% of patients diagnosed with a phaeochromocytoma or paraganglioma carry a germline mutation in one of the succinate dehydrogenase (SDHx) genes (SDHA, SDHB, SDHC and SDHD), which encode the four subunits of the SDH enzyme. When a pathogenic SDHx mutation is identified in an affected patient, genetic counselling is proposed for first-...
Conference Paper
Background: Liraglutide 3mg daily is an approved, prescription injectable GLP-1 receptor agonist, which can reduce weight in patients with obesity, with or without obesity complications. Methods: We conducted a 24-week, open-label real-world study involving 62 participants with a BMI >30kg/m2 or >27kg/m2 if they had co-existing dyslipidaemia or h...
Article
Full-text available
Prolactinomas represent the most common type of secretory pituitary neoplasms, with a therapeutic management that varies considerably based on tumour size and degree of hyperprolactinemia. The aim of the current study was to evaluate the relationship between serum prolactin (PRL) concentrations and prolactinoma size, and to determine a cutoff PRL v...
Conference Paper
Case History A 49-year-old teacher presented to his GP with lethargy and lower limb weakness. He had noticed polydipsia and polyuria, and had experienced weight loss albeit with an increase in central abdominal fat mass. He had previously undergone cholecystectomy and colonic polypectomy. He took no regular medications. Investigations He had hyper...
Article
Full-text available
Calcitonin-secreting neuroendocrine neoplasms of the lung are rare, with few cases reported in the literature. Differentiating between medullary thyroid carcinoma and an ectopic source of calcitonin secretion can represent a complex diagnostic conundrum for managing physicians, with cases of unnecessary thyroidectomy reported in the literature. Thi...
Article
Full-text available
Women with obesity are at risk of pelvic floor dysfunction with a three-fold increased incidence of urgency urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index 30kg/m2 s...
Preprint
Abstract Calcitonin-secreting neuroendocrine neoplasms of the lung are rare, with few cases reported in the literature. Differentiating between medullary thyroid carcinoma and an ectopic source of calcitonin secretion can represent a complex diagnostic conundrum for managing physicians, with cases of unnecessary thyroidectomy reported in the litera...
Article
Background : The COVID-19 pandemic has created unprecedented pressures on healthcare systems worldwide, necessitating a reorganisation of elective services. Within all specialties, including bariatric surgery, this required a re-evaluation of patient prioritisation to limit harm due to delays in treatment while ensuring those who will benefit most...
Article
Objective: To report the clinical presentation, management and outcomes of young patients with prolactinomas (<20 years) and conduct a systematic review and meta-analysis. Patients and design: Clinical, biochemical and radiological data (1996-2018) were collected from our centre. A systematic review and meta-analysis of published literature (199...
Article
Objectives IgG4-related hypophysitis is a novel clinical disease entity, which is typically seen in the sixth decade of life and is typically complicated by hypopituitarism. We describe an adolescent female with IgG4-related hypophysitis with normal pituitary function and summarize the relevant literature. Case presentation A 11.8-year-old girl pr...
Article
Full-text available
Purpose Moderate hyperprolactinaemia (2-5 times upper limit of normal) occurring in a patient with a normal pituitary MRI is generally considered to be due to a lesion below the level of detection of the MRI scanner assuming macroprolactin and stress have been excluded. Most patients with mild-to-moderate hyperprolactinaemia and a normal MRI respon...
Preprint
SUMMARY Women with obesity are at risk of pelvic floor dysfunction with a three-fold increased incidence of urgency urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index 3...
Preprint
Prolactinomas represent the most common type of secretory pituitary neoplasms, with a therapeutic management that varies considerably based on tumour size and degree of hyperprolactinemia. The aim of the current study was to evaluate the relationship between serum prolactin (PRL) concentrations and prolactinoma size, and to determine a cutoff PRL v...
Article
Full-text available
Purpose: Obesity is a chronic relapsing-remitting disease and a global pandemic, being associated with multiple comorbidities. Laparoscopic adjustable gastric banding (LAGB) is one of the safest surgical procedures used for the treatment of obesity, and even though its popularity has been decreasing over time, it still remains an option for a certa...
Article
Full-text available
Context Germline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are responsible for a subset of familial isolated pituitary adenoma (FIPA) cases and sporadic pituitary neuroendocrine tumors (PitNETs). Objective To compare prospectively diagnosed AIP mutation-positive (AIPmut) PitNET patients with clinically presenting pat...
Article
Full-text available
Obesity is an ever growing pandemic and a prevalent problem among men of reproductive age that can both cause and exacerbate male-factor infertility by means of endocrine abnormalities, associated comorbidities, and direct effects on the precision and throughput of spermatogenesis. Robust epidemiologic, clinical, genetic, epigenetic, and preclinica...
Article
Craniopharyngiomas are surgically challenging brain tumors. Postoperatively, quality of life is often significantly impaired due to neurological and endocrinological complications. Currently, FDA approved systemic treatments are not available for patients in whom craniopharyngiomas recur after surgery and radiation. Papillary craniopharyngiomas are...
Article
Full-text available
Papillary craniopharyngiomas (PCPs) are characterized by the presence of BRAF V600E mutations, which are emerging as a useful guide for diagnosis and treatment decision making. The ongoing multicenter phase 2 Alliance A071601 trial is evaluating the efficacy of BRAF and mitogen‐activated protein kinase kinase (MEK) inhibitors for patients with PCPs...
Conference Paper
Full-text available
Objective Water-clear cell parathyroid adenoma (WCCA) is an extremely rare cause of primary hyperparathyroidism (PHPT). Our objective was to report a patient with a WCCA that was managed by our Department and to review the relevant literature in order to further our understanding of this rare entity. Methods We retrospectively reviewed the case not...
Article
Full-text available
Tumours of the anterior pituitary can manifest from all endocrine cell types but the mechanisms for determining their specification are not known. The Hippo kinase cascade is a crucial signalling pathway regulating growth and cell fate in numerous organs. There is mounting evidence implicating this in tumour formation, where it is emerging as an an...
Article
Full-text available
Objective: ATL1103 is a second-generation antisense oligomer targeting the human GH receptor. This phase 2 randomised, open-label, parallel-group study assessed the potential of ATL1103 as a treatment for acromegaly. Design: 26 patients with active acromegaly (IGF-I >130% upper limit of normal) were randomised to subcutaneous ATL1103 200 mg eith...
Article
Full-text available
Background: Adrenal venous sampling (AVS) is considered the gold standard for lateralisation of aldosterone production in patients with primary aldosteronism (PA). However, in some patients AVS is not technically successful and management may depend on radiological findings. Aim: To determine 1) the success rate of AVS and 2) the outcomes after su...
Article
Full-text available
Introduction: Multi-modal therapy for adrenocortical carcinoma (ACC) includes surgery, therapy with the adrenolytic agent mitotane and systemic chemotherapy. Achievement of therapeutic mitotane concentrations (≥14 mg/l) has been related to improved outcomes. Aim: To evaluate the effectiveness of a defined* high dose protocol mitotane therapy in pa...
Article
Full-text available
Introduction: Moderate hyperprolactinaemia occurring in a patient with a normal pituitary MRI, assuming macroprolactin and stress are excluded, is generally considered to be due to a lesion below the level of detection of the MRI scanner. Most patients with mild-moderate hyperprolactinaemia and a normal MRI respond to dopamine agonist therapy. We d...
Article
Full-text available
Background Germline pathogenic variants in SDHB/SDHC/SDHD are the most frequent causes of inherited phaeochromocytomas/paragangliomas. Insufficient information regarding penetrance and phenotypic variability hinders optimum management of mutation carriers. We estimate penetrance for symptomatic tumours and elucidate genotype–phenotype correlations...
Article
Background:Germline pathogenic variants in SDHB/SDHC/SDHD are the most frequent causes of inherited phaeochromocytomas/paragangliomas. Insufficient information regarding penetrance and phenotypic variability hinders optimum management of mutation carriers. We estimate penetrance for symptomatic tumours and elucidate genotype-phenotype correlations...
Article
Full-text available
Background: Adrenocortical carcinoma (ACC) is a rare malignancy, with an annual incidence of 1 or 2 cases per million. Biochemical diagnosis is challenging because up to two-thirds of the carcinomas are biochemically silent, resulting from de facto enzyme deficiencies in steroid hormone biosynthesis. Urine steroid profiling by GC-MS is an effectiv...
Article
Full-text available
Introduction Increased visceral adipose tissue (VAT) has been shown to be associated with the development of insulin resistance, type 2 diabetes, stroke, and ischemic heart disease. It remains unknown whether fat distribution impacts on coagulation markers and/or the risk of venous thrombosis. This study evaluates markers of hypercoagulability in c...
Poster
Full-text available
This poster describes an interesting case of pheochromocytoma in which constipation was the presenting symptom.
Article
Full-text available
Purpose: Blockade of the angiotensin-renin system, with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), has been shown to improve cardiac outcomes following myocardial infarction and delay progression of heart failure. Acromegaly is associated with a disease-specific cardiomyopathy, the pathogenesis of whic...
Conference Paper
Introduction: Primary aldosteronism (PA) is the most common endocrine cause of hypertension affecting up-to 10% of hypertensives. Saline suppression, a confirmatory test for PA helps avoiding patients undergoing invasive lateralisation procedures due to a false positive aldosterone-to-renin ratio (ARR). The proposed cut-off to exclude PA is post-sa...
Conference Paper
Background: Phaeochromocytoma and paraganglioma (PPGLs) are rare neuroendocrine tumours arising from the adrenal medulla and paraganglia. Biochemical assessment relies on demonstrating elevated concentrations of catecholamines and their metabolites. Analytical methods for catecholamine and metanephrine measurement vary in sensitivity and specificit...
Conference Paper
Background: Understanding hypoadrenal patients’ perceptions of adrenal crisis is vital in the prevention of this endocrine emergency. This study explored the experiences, knowledge and attitudes of hypoadrenal patients to adrenal crises and their prevention. Method: A cross-sectional qualitative study using structured interviews with patients with...
Conference Paper
Background: Metyrapone inhibits 11-β hydroxylase and causes a subsequent rise in the cortisol precursor, 11-deoxycortisol. Cortisol measurements by immunoassays are susceptible to interference and reagent antibody cross-reactivity with cortisol precursors when used in patients receiving metyrapone treatment. Clinicians rely on clinical and biochemi...
Article
Background: Untreated Cushing’s disease has a high mortality rate. Transsphenoidal surgery is usually first line treatment and in the hands of a skilled experienced surgeon can achieve a cure rate of up to 80%. For those with recurrent or un-resectable disease, a combination of external beam radiotherapy, stereotactic radiotherapy, repeat transsphe...
Conference Paper
Introduction: Pituitary and adrenal Cushing’s may be managed by pharmacological-inhibition of adrenal steroidogenesis, using metyrapone and/or ketoconazole. Assessment of biochemical control is challenging owing to cross-reactivity in immunoassays (e.g. cortisol and 11-deoxycortisol) leading to over/under-treatment. Off-target effects can also resu...
Article
Full-text available
Objective: To determine if functional imaging using (11)C-methionine positron emission tomography co-registered with 3D gradient echo MRI (Met-PET/MRI), can identify sites of residual active tumour in treated acromegaly, and discriminate these from post-treatment change, to allow further targeted treatment. Design/methods: Twenty-six patients wi...
Article
Objective To determine if functional imaging using ¹¹C-methionine positron emission tomography co-registered with 3D gradient echo MRI (Met-PET/MRI), can identify sites of residual active tumour in treated acromegaly, and discriminate these from post-treatment change, to allow further targeted treatment. Design/methods Twenty-six patients with pers...
Conference Paper
Full-text available
Adrenocortical carcinoma (ACC) is a rare malignancy, accounting for up to 11% of adrenal masses investigated in referral centres. Diagnosis remains a challenge. Up to two-thirds are biochemically inactive, resulting from de facto enzyme deficiencies in the steroid hormone biosynthetic pathways, as shown by urine steroid profiling by gas chromatogra...