Publications
240 results found
Vimalesvaran S, Narayanaswamy S, Yang L, et al., 2017, Using kisspeptin to assess GnRH function in an unusual case of primary amenorrhoea, Endocrinology, Diabetes & Metabolism, Vol: 16, ISSN: 2052-0573
SUMMARY: Primary amenorrhoea is defined as the failure to commence menstruation by the age of 15 years, in the presence of normal secondary sexual development. The potential causes of primary amenorrhoea extend from structural to chromosomal abnormalities. Polycystic ovarian syndrome (PCOS) is a common cause of secondary amenorrhoea but an uncommon cause of primary amenorrhoea. An early and prompt diagnosis of PCOS is important, as up to 30% of these women are predisposed to glucose intolerance and obesity, with the subgroup of women presenting with primary amenorrhoea and PCOS displaying a higher incidence of metabolic dysfunction. We describe a case of an 18-year-old female presenting with primary amenorrhoea of unknown aetiology. Although initial investigations did not demonstrate clinical or biochemical hyperandrogenism or any radiological evidence of polycystic ovaries, a raised luteinising hormone (LH) suggested a diagnosis of PCOS. If PCOS was the correct diagnosis, then one would expect intact hypothalamic GnRH and pituitary gonadotropin release. We used the novel hormone kisspeptin to confirm intact hypothalamic GnRH release and a GnRH stimulation test to confirm intact pituitary gonadotroph function. This case highlights that kisspeptin is a potential unique tool to test GnRH function in patients presenting with reproductive disorders. LEARNING POINTS: Polycystic ovarian syndrome (PCOS) can present with primary amenorrhoea, and therefore, should be considered in the differential diagnosis.PCOS is a heterogeneous condition that may present in lean women with few or absent signs of hyperandrogenism.GnRH stimulation tests are useful in evaluating pituitary function; however, to date, we do not have a viable test of GnRH function. Kisspeptin has the potential to form a novel diagnostic tool for assessing hypothalamic GnRH function by monitoring gonadotropin response as a surrogate marker of GnRH release.Confirmation of intact GnRH function helps consolidate a
Meeran K, Choudhury SM, Wass J, 2017, The scandal of generic drug pricing: drug regulation policies need review., BMJ, Vol: 356, Pages: j947-j947, ISSN: 1756-1833
Sam AH, Hameed S, Harris J, et al., 2016, Validity of very short answer versus single best answer questions for undergraduate assessment, BMC Medical Education, Vol: 16, ISSN: 1472-6920
BackgroundSingle Best Answer (SBA) questions are widely used in undergraduate and postgraduate medical examinations. Selection of the correct answer in SBA questions may be subject to cueing and therefore might not test the student’s knowledge. In contrast to this artificial construct, doctors are ultimately required to perform in a real-life setting that does not offer a list of choices. This professional competence can be tested using Short Answer Questions (SAQs), where the student writes the correct answer without prompting from the question. However, SAQs cannot easily be machine marked and are therefore not feasible as an instrument for testing a representative sample of the curriculum for a large number of candidates. We hypothesised that a novel assessment instrument consisting of very short answer (VSA) questions is a superior test of knowledge than assessment by SBA.MethodsWe conducted a prospective pilot study on one cohort of 266 medical students sitting a formative examination. All students were assessed by both a novel assessment instrument consisting of VSAs and by SBA questions. Both instruments tested the same knowledge base. Using the filter function of Microsoft Excel, the range of answers provided for each VSA question was reviewed and correct answers accepted in less than two minutes. Examination results were compared between the two methods of assessment.ResultsStudents scored more highly in all fifteen SBA questions than in the VSA question format, despite both examinations requiring the same knowledge base.ConclusionsValid assessment of undergraduate and postgraduate knowledge can be improved by the use of VSA questions. Such an approach will test nascent physician ability rather than ability to pass exams.
Williams EL, Choudhury S, Tan T, et al., 2016, Prednisolone replacement therapy mimics the circadian rhythm more closely than other glucocorticoids, The Journal of Applied Laboratory Medicine, Vol: 1, Pages: 152-161, ISSN: 2576-9456
BackgroundThis study examined the pharmacokinetic profile of prednisolone.MethodsUsing a newly developed ultra-performance liquid chromatography MS/MS method, prednisolone profiles in healthy volunteers and patients with adrenal insufficiency already treated with prednisolone were prospectively analyzed in a tertiary center.ResultsTwelve prednisolone day curves were analyzed. Six patients with secondary adrenal insufficiency provided 7 curves and 3 healthy volunteers provided 5 curves, 1 of which was with the prednisolone administered in divided doses. The mean prednisolone dose required for adequate replacement in hypoadrenal patients was 3.86 mg. The overall mean maximal serum concentration (Cmax) was 114.0 μg/L and was achieved at an average time to maximal concentration (Tmax) of 1.43 h. Total glucocorticoid exposure was represented by the mean area under the curve to 24 h (AUC0–24h), which was 518.2 μg|·|h/L. Splitting the dose substantially increased the total glucocorticoid exposure.ConclusionsThe pharmacokinetic profile of prednisolone is similar to the published profile of dual-release hydrocortisone. Once-daily prednisolone can thus be used as a replacement for hydrocortisone. Further studies need to be carried out to accurately calculate an equivalent replacement dose. Prednisolone levels are a useful adjunct to dose adjustment when low doses are being used for replacement.
Abbara A, Clarke S, Nesbitt A, et al., 2016, Gonadotrophin secretion is a useful adjunct in the assessment of patients with hyperprolactinaemia, Publisher: OXFORD UNIV PRESS, Pages: 98-98, ISSN: 0268-1161
Sam AH, Shah S, Saleh K, et al., 2015, Clinical outcomes in patients with nonfunctioning pituitary adenomas managed conservatively, CLINICAL ENDOCRINOLOGY, Vol: 83, Pages: 861-865, ISSN: 0300-0664
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- Citations: 23
Daniel E, Aylwin S, Mustafa O, et al., 2015, Effectiveness of Metyrapone in Treating Cushing's Syndrome: A Retrospective Multicenter Study in 195 Patients, JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, Vol: 100, Pages: 4146-4154, ISSN: 0021-972X
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- Citations: 132
Ramachandran R, Bech P, Murphy KG, et al., 2015, Comparison of the Utility of Cocaine- and Amphetamine-Regulated Transcript (CART), Chromogranin A, and Chromogranin B in Neuroendocrine Tumor Diagnosis and Assessment of Disease Progression, Journal of Clinical Endocrinology & Metabolism, Vol: 100, Pages: 1520-1528, ISSN: 1945-7197
Jayasena CN, Izzi-Engbeaya C, Narayanaswamy S, et al., 2015, Associations of coefficient of variation of serum GH with previous radiotherapy, hypopituitarism and cardiac disease in patients with treated acromegaly, Clinical Endocrinology, Vol: 82, Pages: 870-875, ISSN: 0300-0664
Stevens JL, Constantinides V, Todd J, et al., 2014, Do flow volume loops alter surgical management in patients with a goitre?, CLINICAL ENDOCRINOLOGY, Vol: 81, Pages: 916-920, ISSN: 0300-0664
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- Citations: 1
Cegla J, Troke RC, Jones B, et al., 2014, Coinfusion of low-dose GLP-1 and glucagon in man results in a reduction in food intake, Diabetes, Vol: 63, Pages: 3711-3720, ISSN: 0012-1797
Obesity is a growing epidemic, and current medical therapies have proven inadequate. Endogenous satiety hormones provide an attractive target for the development of drugs that aim to cause effective weight loss with minimal side effects. Both glucagon and GLP-1 reduce appetite and cause weight loss. Additionally, glucagon increases energy expenditure. We hypothesized that the combination of both peptides, administered at doses that are individually subanorectic, would reduce appetite, while GLP-1 would protect against the hyperglycemic effect of glucagon. In this double-blind crossover study, subanorectic doses of each peptide alone, both peptides in combination, or placebo was infused into 13 human volunteers for 120 min. An ad libitum meal was provided after 90 min, and calorie intake determined. Resting energy expenditure was measured by indirect calorimetry at baseline and during infusion. Glucagon or GLP-1, given individually at subanorectic doses, did not significantly reduce food intake. Coinfusion at the same doses led to a significant reduction in food intake of 13%. Furthermore, the addition of GLP-1 protected against glucagon-induced hyperglycemia, and an increase in energy expenditure of 53 kcal/day was seen on coinfusion. These observations support the concept of GLP-1 and glucagon dual agonism as a possible treatment for obesity and diabetes.
Rahman A, Meeran K, 2014, The link between type 2 diabetes and pancreatic adenocarcinoma is yet to be established, ANNALS OF ONCOLOGY, Vol: 25, Pages: 2290-2290, ISSN: 0923-7534
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- Citations: 1
Daniel E, Aylwin SJB, Ball SG, et al., 2014, Clinical Effectiveness of Metyrapone Monotherapy in 195 Patients with Cushing's Syndrome, ENDOCRINE REVIEWS, Vol: 35, ISSN: 0163-769X
Fikri R, Todd J, Palazzo F, et al., 2014, The Lost Subtype of Conn's Syndrome. Case Series of Aldosterone & Cortisol Co-Secreting Adenomas Complicated By Post Retroperitoneal Adrenalectomy Hypoadrenalism Requiring Glucocorticoid Replacement, ENDOCRINE REVIEWS, Vol: 35, ISSN: 0163-769X
Allum M, Barnes S, Jackson J, et al., 2014, Repeat Adrenal Vein Sampling Demonstrating Bilateral Aldosterone Secretion after Initial Discordant Results in the Investigation of Conn's Syndrome, a Case Report, ENDOCRINE REVIEWS, Vol: 35, ISSN: 0163-769X
Hill N, Meeran K, 2014, The dark truth about vitamin D licensing: food or drug?, BMJ, Vol: 348
Hill N, Meeran K, 2014, VITAMIN D MINEFIELD The dark truth about vitamin D licensing: food or drug?, BMJ-BRITISH MEDICAL JOURNAL, Vol: 348, ISSN: 1756-1833
Dubb SS, Tafader A, Meeran K, et al., 2014, Hypertension in a teenager: a family affair., BMJ Case Rep, Vol: 2014
We present a young, lean, female patient following surveillance by the general practitioner for abnormally high blood pressure readings. Her grandmother died at a young age because of hypertension which shows her family has significant history for hypertension. Her symptoms and signs included feeling hot and nauseous following exercise, sweating and palpitations. Her young age and significant family history immediately prioritises secondary causes including phaeochromocytoma and familial syndromes causing hypertension. Urinary results showed significantly elevated norepinephrine, MRI scanning revealed a mass not within but adjacent to the right adrenal gland while CT-based scanning showed no other ectopics. The patient subsequently underwent surgical intervention at Great Ormond Street Hosptial and following a difficult procedure, that initially started laparoscopically and was converted to open, the tumour was excised. Histopathology and genetic analysis ultimately revealed the patient to have suffered from a paraganglioma type 4 syndrome with a missense mutation of the SDHB gene.
Amin A, Sam AH, Meeran K, 2014, Glucocorticoid replacement., BMJ, Vol: 349
Izzi-Engbeaya C, Meeran K, Dhillo WS, 2013, Kisspeptin is providing new insights into the control of reproduction, CLINICAL MEDICINE, Vol: 13, Pages: 547-548, ISSN: 1470-2118
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- Citations: 1
Pinato DJ, Tan TM, Toloue S, et al., 2013, An expression signature of the angiogenic response in gastrointestinal neuroendocrine tumours: correlation with tumour phenotype and survival outcomes., British Journal of Cancer, Vol: 110, ISSN: 1532-1827
Constantinides VA, Christakis I, Touska P, et al., 2013, Retroperitoneoscopic or laparoscopic adrenalectomy? A single-centre UK experience, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 27, Pages: 4147-4152, ISSN: 0930-2794
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- Citations: 27
Izzi-Engbeaya C, Zac-Varghese S, Palazzo F, et al., 2013, A young fit man presenting to the emergency department with a painful neck due to a thyroid abscess, QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, Vol: 106, Pages: 1041-1042, ISSN: 1460-2725
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- Citations: 2
Pinato DJ, Tan TM, Toloue-Kalami-Toussi S, et al., 2013, AN EXPRESSION SIGNATURE OF THE ANGIOGENIC RESPONSE IN GASTROINTESTINAL NEUROENDOCRINE TUMOURS: CORRELATION WITH TUMOUR PHENOTYPE AND SURVIVAL OUTCOMES, Annual General Meeting of the British-Society-of-Gastroenterology, Publisher: BMJ PUBLISHING GROUP, Pages: A29-A29, ISSN: 0017-5749
Jayasena CN, Modi M, Palazzo F, et al., 2013, Associations of serum 25-hydroxyvitamin D with circulating PTH, phosphate and calcium in patients with primary hyperparathyroidism, CLINICAL ENDOCRINOLOGY, Vol: 78, Pages: 838-843, ISSN: 0300-0664
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- Citations: 8
Cegla J, Jones B, Seyani L, et al., 2013, Comparison of the overnight metyrapone and glucagon stimulation tests in the assessment of secondary hypoadrenalism, CLINICAL ENDOCRINOLOGY, Vol: 78, Pages: 738-742, ISSN: 0300-0664
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- Citations: 14
Sam AH, Meeran K, 2013, Recent advancements in the drug treatment of endocrine diseases, CLINICAL MEDICINE, Vol: 13, Pages: 170-175, ISSN: 1470-2118
Pinato DJ, Ramachandran R, Toussi STK, et al., 2013, Immunohistochemical markers of the hypoxic response can identify malignancy in phaeochromocytomas and paragangliomas and optimize the detection of tumours with VHL germline mutations, BRITISH JOURNAL OF CANCER, Vol: 108, Pages: 429-437, ISSN: 0007-0920
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- Citations: 34
Martin NM, Patel M, Nijher GMK, et al., 2012, Adjuvant lithium improves the efficacy of radioactive iodine treatment in Graves' and toxic nodular disease, CLINICAL ENDOCRINOLOGY, Vol: 77, Pages: 621-627, ISSN: 0300-0664
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- Citations: 17
Maurice JB, Troke R, Win Z, et al., 2012, A comparison of the performance of <SUP>68</SUP>Ga-DOTATATE PET/CT and <SUP>123</SUP>I-MIBG SPECT in the diagnosis and follow-up of phaeochromocytoma and paraganglioma, EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, Vol: 39, Pages: 1266-1270, ISSN: 1619-7070
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- Citations: 78
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