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Lewis A.S.,Regional Center for Endocrinology and Diabetes | Mccourt H.J.,Queens University of Belfast | Ennis C.N.,Regional Endocrine Laboratory | Bell P.M.,Regional Center for Endocrinology and Diabetes | And 4 more authors.
Metabolism: Clinical and Experimental | Year: 2013

Aims The effect of dietary sucrose on insulin resistance and the pathogenesis of diabetes and vascular disease is unclear. We assessed the effect of 5% versus 15% sucrose intakes as part of a weight maintaining, eucaloric diet in overweight/obese subjects. Methods Thirteen subjects took part in a randomised controlled crossover study (M:F 9:4, median age 46 years, range 37-56 years, BMI 31.7 ± 0.9 kg/m2). Subjects completed two 6 week dietary periods separated by 4 week washout. Diets were designed to have identical macronutrient profile. Insulin action was assessed using a two-step hyperinsulinaemic euglycaemic clamp; glucose tolerance, vascular compliance, body composition and lipid profiles were also assessed. Results There was no change in weight or body composition between diets. There was no difference in peripheral glucose utilization or suppression of endogenous glucose production. Fasting glucose was significantly lower after the 5% diet. There was no demonstrated effect on lipid profiles, blood pressure or vascular compliance. Conclusion A low-sucrose diet had no beneficial effect on insulin resistance as measured by the euglycaemic glucose clamp. However, reductions in fasting glucose, one hour insulin and insulin area under the curve with the low sucrose diet on glucose tolerance testing may indicate a beneficial effect and further work is required to determine if this is the case. Clinical Trial Registration number ISRCTN50808730. © 2013 Elsevier Inc. Source


Graham U.M.,Regional Center for Endocrinology and Diabetes | Hunter S.J.,Regional Center for Endocrinology and Diabetes | McDonnell M.,Regional Endocrine Laboratory | Mullan K.R.,Regional Center for Endocrinology and Diabetes | Atkinson A.B.,Regional Center for Endocrinology and Diabetes
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Context: Cyclical Cushing's syndrome is detected in our center by collecting sequential early morning urine (EMU) samples for cortisol to creatinine ratio over 28 d. The Endocrine Society suggests that nocturnal salivary cortisol (NSC) may be used to assess patients for cyclical Cushing's. However, there is only very limited evidence that it correlates with EMU testing or that it demonstrates cycling over 28 d. Objective: We sought to correlate NSC with EMU results collected the following morning and to determine whether NSC could be used to detect cyclical Cushing's. Design and Setting: An observation study of 28-d collections for NSC and EMU was performed in a tertiary referral center over 1 yr. Patients: A 28-d collection of NSC and EMU was performed in 10 patients with confirmed or suspected Cushing's syndrome. Main Outcome Measure: The main outcome of the study was the correlation of salivary and urinary cortisol with graphical assessment of results for cycling. Results: Eleven collections were performed. One patient with cyclical Cushing's completed the collection before and after cabergoline therapy. Two hundred seventy matched salivary and urinary results were correlated (r = 0.79; P < 0.001). In two patients with cyclical Cushing's, EMU and NSC followed a similar cyclical pattern. In one patient with recurrent cyclical Cushing's, cortisol was elevated in both saliva and urine but with more prominent cycles in saliva. Conclusion: NSC correlated well with EMU. NSC detected all cases of cyclical Cushing's. Therefore, NSC may prove to be an additional option or replacement for EMU in detecting cyclical Cushing's syndrome. Copyright © 2013 by The Endocrine Society. Source


McHenry C.M.,Regional Center for Endocrinology and Diabetes | Bell P.M.,Regional Center for Endocrinology and Diabetes | Hunter S.J.,Regional Center for Endocrinology and Diabetes | Thompson C.J.,Beaumont Hospital | And 6 more authors.
Clinical Endocrinology | Year: 2012

Objective Addition of dehydroepiandrosterone sulphate (DHEAS) to standard pituitary replacement may improve quality of life and glucose metabolism. Conflicting results from the previous work probably relate to differences in populations studied and assessment techniques used. We examined the effects of DHEAS on insulin action and the quality of life in female patients with hypopituitary hypoadrenalism. Design Randomized, double-blind, placebo-controlled, crossover design was used. Patients received either DHEAS 50 mg daily or placebo for 12 weeks. Patients Fourteen hypopituitary females on stable standard replacement therapy and with low DHEAS were enrolled. Measurements Insulin action by euglycaemic hyperinsulinaemic clamp and extensive quality of life parameters were assessed after each treatment. Results Serum DHEAS (DHEAS 5·4 ± 0·8 vs placebo <0·8 ± 0·0 μm; P < 0·001) and androstenedione (DHEAS 4·1 ± 0·8 vs placebo 1·3 ± 0·2 nm; P < 0·05) rose to within the normal range after DHEAS 50 mg daily. There were no differences between treatments in testosterone, sex hormone-binding globulin (SHBG) or IGF-1. Quality of life measures were unchanged after DHEAS. There were no differences between treatments in fasting glucose, serum insulin, HbA1c or in insulin action (glucose infusion rates required to maintain euglycaemia; DHEAS 21·9 ± 2·5 vs placebo 24·5 ± 2·1 μmol/kg/min; P = 0·4). Triglyceride concentrations were lower following DHEAS (DHEAS 1·24 ± 0·18 vs placebo 1·41 ± 0·19 mm; P < 0·05) but other lipid parameters remained unchanged. Conclusion There were no differences compared with placebo in quality of life or insulin action after DHEAS replacement therapy for 12 weeks. These results do not provide evidence for the addition of DHEAS to standard hypopituitary replacement therapy. © 2012 Blackwell Publishing Ltd. Source


Graham U.M.,Regional Center for Endocrinology and Diabetes | Ellis P.K.,Imaging Center | Hunter S.J.,Regional Center for Endocrinology and Diabetes | Leslie H.,Regional Endocrine Laboratory | And 2 more authors.
Clinical Endocrinology | Year: 2012

Objective Patients with primary aldosteronism (PA) who are suitable for surgery should undergo adrenal computerised tomography (CT) and adrenal venous sampling (AVS). A retrospective study was performed of 100 patients with PA. We determined the optimal AVS lateralisation ratio for unilateral disease and reviewed adrenalectomy outcomes evaluating which characteristics predicted hypertension cure. Methods AVS was performed in 93 patients. Lateralisation criteria were assessed using ROC curve analysis. The outcome of adrenalectomy was reviewed in 39 patients and predictive factors for cure determined using univariate and multivariate analysis. Results Of previously published criteria, ROC curve analysis found a cortisol corrected aldosterone affected to unaffected (Aldo/Cort A:U) cut-off of 2·0 was the best predictor of adenoma identifying 80·4% of patients. A novel ratio calculated by dividing the affected to unaffected ratio by the unaffected to peripheral ratio [(Aldo/Cort A:U)/(Aldo/Cort U:IVC)] was successful in identifying 87·0% of patients. Cure rate for blood pressure after adrenalectomy was 38·5% with improvement in 59·0%. On univariate analysis, predictors of post-operative hypertension were increased weight, raised creatinine, left ventricular hypertrophy (LVH) and male sex. On multivariate analysis, male sex and higher pre-operative systolic blood pressure were predictive. Conclusions Patients with PA should have CT scanning and AVS. Aldo/Cort A:U >2·0 is the most accurate of previously published ratios in predicting unilateral disease. When patients were carefully selected for surgery, 97% had cure or improvement in blood pressure control. Further confirmatory work is required on a novel ratio which was even more predictive in our series. © 2011 Blackwell Publishing Ltd. Source


Wallace I.R.,Regional Center for Endocrinology and Diabetes | Satti N.,Regional Center for Endocrinology and Diabetes | Courtney C.H.,Regional Center for Endocrinology and Diabetes | Leslie H.,Regional Endocrine Laboratory | And 5 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Context: Macroprolactinemia is a common finding in patients with hyperprolactinemia. There are no published long-term follow-up studies. Objective: The aim of this study was to describe findings after prolonged follow-up in a previously published cohort of patients with macroprolactinemia. Study Population: We studied 51 patients identified as having macroprolactinemia after polyethylene glycol precipitation. Design: Clinical assessment and serum prolactin assay were repeated in 51 patients with macroprolactinemia after a median follow-up of 9.9 yr (range, 9-11 yr). Results: Median age at presentation was 41 yr (range, 18-55 yr). Mean serum prolactin concentration at presentation was 1885 mU/liter, and after follow-up 1370 mU/liter. At follow-up, headache had been experienced in 12 patients (24%) and oligomenorrhea in five (10%). Galactorrhea was present in only two patients (4%). No visual deterioration was noted in 50 patients. One had a transient bitemporal hemianopia. No patients developed an autoimmune condition. Microadenoma had been identified in four patients at presentation with no new pituitary imaging abnormalities identified at follow-up. Conclusions: During prolonged follow-up, no symptomatic progression was noted in any of our patients. This study suggests that patients with macroprolactinemia and normal concentrations of monomeric prolactin can be reassured, and extended endocrine review of such patients is not required. Copyright © 2010 by The Endocrine Society. Source

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