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Objective: Isolated biochemical central hypothyroidism is a presentation we are experiencing more frequently as endocrinologists, with variation in levels of investigation between physicians. We therefore conducted research to investigate the final diagnosis and clinical outcome of patients across multiple hospitals in South Wales with biochemical isolated central hypothyroidism; namely to establish whether this isolated biochemical picture was clinically significant. We also analysed whether there is an association between this biochemical picture and treatment with antidepressant and antipsychotic medications, and how common this is. Design: We performed a retrospective observational study of patients across nine different hospitals in South Wales. We analysed patients referred to endocrinology at each site over a 6‐year period with unexplained isolated biochemical central hypothyroidism. Materials and Methodology: 1022 individual patients' thyroid function test results were identified from our biochemical database using our inclusion criteria. After exclusion criteria were applied, 71 patients' results were analysed as to the final pathophysiology of their central hypothyroidism. Result: Of the 71 patients included in the study, none were found to have any clinically significant pathology on pituitary imaging. On reviewing their medications, 46/71 (65%) were found to be taking psychotropic medications. Conclusions: Our study strongly suggests isolated central hypothyroidism, in the absence of other pituitary hormone dysfunction or visual field defect, does not require further investigation, saving resources as well as sparing patients unnecessary anxiety. It also strongly supports a relationship between patients taking psychotropic medications and biochemical isolated central hypothyroidism, an association only described in a very limited amount of literature before this, and further supporting our previous single‐centre study findings. The mechanism behind this is likely to be the suppression of thyrotropin secretion via antagonism of the dopamine‐serotoninergic pathway. In our opinion, patients found to have isolated biochemical central hypothyroidism who are taking psychotropic medications can therefore be regarded to have a recognised cause for this biochemical finding and do not require further radiological investigation. [ABSTRACT FROM AUTHOR]

A man in his 60s with a history of multiple myeloma diagnosed 6 months previously was referred with a diagnosis of a sellar mass. He reported a 3-month history of headaches associated with double vision which appeared to improve with corticosteroid treatment. An MRI scan revealed a 3.7 cm x 3 cm x 2.6 cm sellar mass with erosion into the sphenoid sinus and extending to the right cavernous sinus. Pituitary function tests were normal apart from hypogonadotrophic hypogonadism. A diagnosis of plasmacytoma was considered and so transphenoidal biopsy of the sellar lesion was organised, which revealed sheets of mature appearing plasma cells, staining exclusively for κ-light chain immunoglobulins. He was to be started on chemotherapy for the myeloma and radiotherapy for the plasmacytoma. The patient's clinical course was complicated by community-acquired pneumonia and renal failure resulting in his death a month after the diagnosis of plasmacytoma. [ABSTRACT FROM AUTHOR]

Abstract: Type 2 diabetes is a progressive disease characterized by decline in β-cell function and insulin resistance. The development of liraglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist, has been shown in clinical trials to be an effective drug with beneficial effects on β-cell function and improved glycemic control, without the side effects of weight gain and hypoglycemia that frequently limit the use of oral anti-diabetic drugs. Furthermore, its prolonged half-life makes it suitable for once daily administration. Liraglutide is demonstrated to be an effective agent in combination with commonly used oral antidiabetic drugs such as metformin and sulphonylureas, with a significant number of patients achieving their glycemic targets without hypoglycemia. In this review, the results from clinical trials utilizing liraglutide in combination with metformin or sulphonylurea are summarized with regards to efficacy and safety. [ABSTRACT FROM AUTHOR]

Background Hospital-acquired diabetic ketoacidosis (HADKA) can complicate hospital admission in people with type 1 diabetes (T1D) and type 2 diabetes (T2D). We aimed to determine the characteristics of such patients and the reasons for HADKA. Methods A retrospective analysis of patients referred to diabetes services with HADKA at Morriston Hospital between January 2016 and January 2022 was undertaken. Patients that were included were admitted without diabetic ketoacidosis (DKA), were aged 18 years and over, and who subsequently developed DKA in hospital. Results Twenty-five patients were included with a mean age of 65.2 years; nine (32.0%) were men, 13 (52.0%) had T1D and 12 (48.0%) had T2D. Patients had a mean pre-admission glycated haemoglobin of 84.7 mmol/mol, and 17 (68.0%) were insulin-treated. Most were admitted under medicine (n=14; 56.0%) and the remainder under surgery (n=11; 44.0%). More common reasons for HADKA were erroneous insulin administration (n=9; 36.0%), infection (n=7; 28.0%) and surgery (n=5; 20.0%). Five (20.0%) patients required intensive care admission, and the mean length of hospital stay was 42.6 days (range 2--173). Three (12.0%) patients died during the hospital admission. Conclusion HADKA was identified in a significant number of patients at our hospital and was associated with significant mortality. Earlier recognition of ketonaemia and associated medication use may prevent HADKA and improve outcomes. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 5–10% of premenopausal women. In addition to its well-established reproductive effects, PCOS is a metabolic disorder characterised by insulin resistance, hyperandrogenism and dyslipidaemia but the effects of these disturbances on oxidative stress and nitric oxide metabolism are not known. We thus sought to compare measures of oxidative stress and nitric oxide metabolites in patients with PCOS and healthy volunteers (HV). Preliminary data from banked frozen plasma samples obtained from a phenotypically detailed cohort of PCOS patients (age 29.4±6.6 years, BMI 33.2±7.4kg/m2) and age/BMI-matched HV showed similar nitrite (PCOS [n =25] 153±16.57nmol/l, HV [n =17] 187.8±26.59nmol/l, p =NS) but lower nitrate levels in subjects with PCOS (PCOS [n =33] 7.3±1.92μmol/l, HV [n =27] 24.54±2.59μmol/l, p <0.001). The PCOS and control group displayed similar lipid profiles (TC: 4.79±0.1 and 4.5±0.06, HDL: 1.35±0.1 and 1.38±0.05 and LDL: 2.93±0.15 and 2.76±0.15, respectively). Plasma nitrite correlated inversely with LDL concentrations in subjects with PCOS (r =−0.531, p <0.05) but not in HVs. There were no significant relationships between plasma nitrate and lipid levels. Inspired by these results, data will be presented at this meeting from a fresh group of subjects in which these parameters are compared in the context of an increased free radical formation (detected as direct spin-trapping of lipid-derived radicals in patient blood) and ORAC status that result from dysfunctional lipid metabolism within PCOS. Abbreviatons: PCOS, polycystic ovary syndrome; HV, healthy volunteers; NS, non-significant; TC, total cholesterol; HDL, high-density lipoprotein; LDL, low-density lipoprotein; ORAC, oxygen radical absorbance capacity. [Copyright &y& Elsevier]