MRCP (Endo) Speciality Certificate Examination Preparation Seminar

The college of physicians ran the first ever endocrinology MRCP in May 2009. A Specialty Certificate Examination is now a compulsory component of assessment for Certificate of Completion of Training (CCT) for all UK trainees whose specialist training began in or after August 2007, and is voluntary for those who started before this date.

All UK and overseas trainees who have obtained MRCP(UK) are eligible to take the SCE (Specialty Certificate Examinations). UK trainees who are in a specialty training post but do not hold MRCP(UK) are also eligible.

The SCEs comprise of two 3 hour papers containing 100 best of five questions and are conducted as computer based tests. Each SCE is held once each year.

Candidates who pass the examination will be awarded a “Certificate” in the specialty concerned. All those with a Specialty Certificate and MRCP(UK) who are recommended to PMETB by the JRCPTB for a CCT will be entitled to apply for the post nominal MRCP(Specialty).

To aid in preparation for this exam a seminar will be held on:

Date – 24th February 2010,

Time –  5.30pm and 7.30pm

At the Clinical Sciences Centre,

School of Clinical Sciences,

University Hospital Aintree,

Longmoor Lane,

Liverpool L9 7AL

Refreshments will be available from 5.00pm

The speakers will be Professor Ian MacFarlane and Dr Christina Daousi of the Endocrinology Research Unit and University Hospital Aintree. Both are members of the RCP Question Writing Board and RCP Exam Board.

Please confirm your attendance by email to Kim Russell on: russell_kim_l@lilly.com

Organised by Eli Lilly

Is Haemoglobin A1c a step forward in the diagnosis of diabetes?

This article discusses the pros and cons of utilizing haemoglobin A1c for the diagnosis of diabetes as recommended by the recent consensus statement from the ADA,EASD and IDF.The authors acknowledge the benifits of the shift to haemoglobin A1c while highlighting the potential pittfalls of this strategy related to haemoglobinpathies, conditions of shortend red cell survival and standardization.http://www.bmj.com/cgi/content/extract/339/nov10_1/b4432

SFE BES 2010 in Manchester, deadline for abstract submission is 16 November,2009.

The Society for Endocrinology BES 2010 meeting will take place at the Manchester Central Convention Complex in Manchester on 15-18 March 2010. The conference promises an exciting scientific programme packed with oral communications, clinical expert sessions, medal lectures and much more.

Dates for your diaries:

Abstract submission deadline: 16 November 2009

 

Earlybird registration deadline: 18 January 2010

Free SfE BES places for trainees: applications open 2 November-4 December 2009

Further information and the preliminary programme are now available at the website below. If you have any queries please contact the conferences department at: conferences@endocrinology.org.

Diabetic retinopathy, but not nephropathy, benefits from angiotensin receptor blocking

A very interesting study which explores the role of angiotensin receptor blocking treatment in preventing diabetic nephropathy in normotensive and normoalbuminuric patients. The benefits of early introduction of ACEI/ARB treatment in slowing progression of nephropathy in albuminuric patients has already been established but the investigators of this study conclude that such treatment has no benefit in preventing biopsy  proven nephropathy in normoalbuminuric patients.

Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes. Michael Mauer, M.D., Bernard Zinman, M.D., Robert Gardiner, M.D., Samy Suissa, Ph.D., Alan Sinaiko, M.D., Trudy Strand, R.N., Keith Drummond, M.D., Sandra Donnelly, M.D., Paul Goodyer, M.D., Marie Claire Gubler, M.D., and Ronald Klein, M.D., M.P.H. N Engl J Med 2009 361: 40-51

Background Nephropathy and retinopathy remain important complications of type 1 diabetes. It is unclear whether their progression is slowed by early administration of drugs that block the renin–angiotensin system.
Methods We conducted a multicenter, controlled trial involving 285 normotensive patients with type 1 diabetes and normoalbuminuria and who were randomly assigned to receive losartan (100 mg daily), enalapril (20 mg daily), or placebo and followed for 5 years. The primary end point was a change in the fraction of glomerular volume occupied by mesangium in kidney-biopsy specimens. The retinopathy end point was a progression on a retinopathy severity scale of two steps or more. Intention-to-treat analysis was performed with the use of linear regression and logistic-regression models.
Results A total of 90% and 82% of patients had complete renal-biopsy and retinopathy data, respectively. Change in mesangial fractional volume per glomerulus over the 5-year period did not differ significantly between the placebo group (0.016 units) and the enalapril group (0.005, P=0.38) or the losartan group (0.026, P=0.26), nor were there significant treatment benefits for other biopsy-assessed renal structural variables. The 5-year cumulative incidence of microalbuminuria was 6% in the placebo group; the incidence was higher with losartan (17%, P=0.01 by the log-rank test) but not with enalapril (4%, P=0.96 by the log-rank test). As compared with placebo, the odds of retinopathy progression by two steps or more was reduced by 65% with enalapril (odds ratio, 0.35; 95% confidence interval [CI], 0.14 to 0.85) and by 70% with losartan (odds ratio, 0.30; 95% CI, 0.12 to 0.73), independently of changes in blood pressure. There were three biopsy-related serious adverse events that completely resolved. Chronic cough occurred in 12 patients receiving enalapril, 6 receiving losartan, and 4 receiving placebo.
Conclusions Early blockade of the renin–angiotensin system in patients with type 1 diabetes did not slow nephropathy progression but slowed the progression of retinopathy.

Do we need to routinely monitor BMD in patients on bisphosphonate therapy?

Is it helpful to routinely monitor bone mineral density in patients who are being activley treated with bisphosphonates? If so, do we need to check both hip and spine BMD or would either of the two be suficient on its own? The National Osteoporosis guideline has no recommendations on this yet but this study provides useful evidence to guide future practice.

http://www.bmj.com/cgi/content/full/338/jun23_2/b2266

Isolated Hypogonadotrophic Hypogonadism (IHH) due to GNRH1 gene mutation

This interesting article discusses a newly described homozygous mutation of GNRH 1 as a cause of non-syndromic normosmic IHH in two members of a family from a non-consanginous marriage. GNRH receptor gene mutations have previously been described as a cause of familial and sporadic IHH, but these two cases are the first GNRH1 gene mutations described in humans. The article also summarizes the genetic defects encountered in anosmic IHH. http://content.nejm.org/cgi/content/full/NEJMoa0900136

NW Diabetes/Endocrinology SpR Teaching Day: 23-Jun-2009

Northwest Diabetes/Endocrinology SpR Teaching Day
Main Auditorium, Education Centre, Christies Hospital
Tuesday 23rd June 2009
PCOS, Endocrine disorders in Pregnancy and Sub-clinical Thyroid Disorders
Morning Session
0900 Registration, Tea and Coffee

0930-1020 An update on the Management of PCOS
Dr Mishra, Consultant Physician and Endocrinologist, Oldham General Hospital
10:20-11:00 A laboratory prospective on the investigations of PCOS and hyperandrogenism
Dr Michael France, Consultant in Chemical Pathology, Central Manchester University Hospitals Foundation Trust

1100-1115 Tea/Coffee

1115-1205 Fertility in patients with PCOS, investigations a treatment
Dr Luciano Nardo, Consultant in Reproductive Medicine & Surgery, Central Manchester University Hospitals Foundation Trust
1205-1235 PCOS and cardiovascular risk
Dr Sofia Salahudeen, SpR Diabetes and Endocrinology, Central Manchester University Hospitals Foundation Trust

1235-1315 Lunch by courtesy of Bristol Myers Squibb

Afternoon session
1315-1405 Management of endocrine disorders in pregnancy
Dr Basil Issa, Consultant Endocrinologist, South Manchester University Hospitals Foundation Trust
1405-1430 Journal Club
Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. Eur J Endocrinol. 2009 Mar 9
Dr Kelly Cheer, ST3 Tameside Hospital
1430-1520 Subclinical Hypo- and Hyperthyroidism; A review of evidence and Management
Prof Georg Brabant, Professor in Endocronology, Christie Hospital.

1520-1540 Tea/Coffee break

1540-1700 Endocrine Case Presentation and discussion
Dr Stephen McGlynn
Dr Sanjaya Dissanayake
1635 Close

Graves’ disease

Graves’ disease. Brent GA. N Engl J Med 2008; 358:2594-2605

Extract: A 23-year-old woman presents with palpitations. Over the past 6 months, she has reported loose stools, a 10-lb (4.5-kg) weight loss despite a good appetite and food intake, and increased irritability. She appears to be anxious and has a pulse of 119 beats per minute and a blood pressure of 137/80 mm Hg. Her thyroid gland is diffusely and symmetrically enlarged to . . .

Intensive versus conventional glucose control in critically ill patients

Intensive versus Conventional Glucose Control in Critically Ill Patients. The NICE-SUGAR Study Investigators. N Engl J Med 2009; 360:1283-1297

ABSTRACT

Background: The optimal target range for blood glucose in critically ill patients remains unclear.

Methods: Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to require treatment in the ICU on 3 or more consecutive days were randomly assigned to undergo either intensive glucose control, with a target blood glucose range of 81 to 108 mg per deciliter (4.5 to 6.0 mmol per liter), or conventional glucose control, with a target of 180 mg or less per deciliter (10.0 mmol or less per liter). We defined the primary end point as death from any cause within 90 days after randomization.

Results: Of the 6104 patients who underwent randomization, 3054 were assigned to undergo intensive control and 3050 to undergo conventional control; data with regard to the primary outcome at day 90 were available for 3010 and 3012 patients, respectively. The two groups had similar characteristics at baseline. A total of 829 patients (27.5%) in the intensive-control group and 751 (24.9%) in the conventional-control group died (odds ratio for intensive control, 1.14; 95% confidence interval, 1.02 to 1.28; P=0.02). The treatment effect did not differ significantly between operative (surgical) patients and nonoperative (medical) patients (odds ratio for death in the intensive-control group, 1.31 and 1.07, respectively; P=0.10). Severe hypoglycemia (blood glucose level <40 mg per deciliter [2.2 mmol per liter]) was reported in 206 of 3016 patients (6.8%) in the intensive-control group and 15 of 3014 (0.5%) in the conventional-control group (P<0.001). There was no significant difference between the two treatment groups in the median number of days in the ICU (P=0.84) or hospital (P=0.86) or the median number of days of mechanical ventilation (P=0.56) or renal-replacement therapy (P=0.39).

Conclusions: In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter.