Exenatide therapy in insulin-treated type 2 diabetes and obesity was associated with very significant reductions in weight and insulin doses. Exenatide should be considered in people with type 2 diabetes on insulin and have obesity, weight gain and poor glycaemic control.

Background: Vitamin D deficiency is increasingly recognized in patients with primary hyperparathyroidism but some clinicians are reluctant to replace vitamin D due to concerns with aggravating hypercalcaemia. We investigated the impact of vitamin D repletion in asymptomatic patients with normocalcaemic and hypercalcaemic primary hyperparathyroidism. Methods: This is a retrospective analysis of 111 patients with elevated parathyroid hormone concentrations (>6.4 pmol/L) referred to our endocrine clinic between January and December 2012; we identified 39 patients with primary hyperparathyroidism and vitamin D deficiency, i.e. 25 hydroxy vitamin D <20 mg/L. Patients were categorized into normocalcaemic (n ¼ 23) and hypercalcaemic (n ¼ 16) groups and the impact on biochemical parameters was recorded after at least six months treatment with either 1600 or 3200 units daily of cholecalciferol. Results: Both normocalcaemic and hypercalcaemic groups showed a rise in 25 hydroxy vitamin D concentrations after replacement (p <0.0001). Parathyroid hormone concentrations fell in the normocalcaemic group (p ¼ 0.08) but individually, five patients showed a rise (8-38% of baseline). In the hypercalcaemic group, parathyroid hormone remained static but the adjusted calcium concentration fell significantly (p ¼ 0.006) except in two patients who showed mild rises (3 and 6%, respectively). There was no deterioration in renal function or calcium-related adverse events in any of the groups. Conclusions: Our study supports the safety of vitamin D replacement in patients with mild asymptomatic primary hyperparathyroidism and coexistent vitamin D deficiency. Repletion does not aggravate hypercalcaemia and may limit disease progression. Patients with normocalcaemic primary hyperparathyroidism need further characterization from longitudinal studies.

OBJECTIVEWe studied the prevalence of endocrine dysfunction in subjects with idiopathic Parkinson’s disease (IPD) on newer dopaminergic agents (DA). DA are also used in endocrine hypersecretory states in small doses and we hypothesized that endocrine dysfunction was likely in IPD where DA were used in comparatively much higher dosage.PATIENTS AND METHODSTwenty-five subjects with IPD, established on DA, were recruited to this cross-sectional study. We measured insulin-like growth factor-1, prolactin, luteinizing hormone, follicle stimulating hormone, thyroid function, oestradiol or testosterone and cortisol levels following a short synacthen test.RESULTSWe studied 18 males and 7 females, whose median age was 72 years, and whose median time from diagnosis, and duration of treatment was 27 months (interquartile range 17–45 and 13–39 months, respectively). (1) Endocrine tests were normal in 19 of 25 subjects at recruitment. Minor abnormalities reverted to normal on repeat testing in three of six with initial abnormalities; two had persistent abnormalities and the third subject could not be further investigated. Therefore, 22 of 24 (92%) with IPD on DA therapy had normal endocrine profiles. (2) The cortisol response to ACTH was normal in 24 of 25 subjects (96%). (3) Eleven subjects (44%) had isolated PRL suppression. There were no differences between the suppressed PRL and “normal” PRL groups. However, a higher number of them were on non-ergoline-derived DA (83% vs 31%; P < 0.05).CONCLUSIONSWe have demonstrated that newer non-ergoline DA therapy caused only minimal endocrine perturbations in subjects with IPD. Their clinical significance can only be speculative currently. The cortisol response to ACTH was normal in almost all but a significant minority had suppressed prolactin levels.

SummaryBackgroundHyperandrogenic states in pregnancy are rare but arise most commonly due to new-onset ovarian pathology in pregnancy. We describe the case of a young woman who presented in the latter half of her pregnancy with features of hyperandrogenism. We review the biochemical and imaging findings and discuss the differential diagnosis.Case presentationA 26-year-old woman presented in the later part of her pregnancy with widespread hirsutism. Biochemical testing confirmed hyperandrogenism (testosterone, 13.7 nmol/l and second-trimester pregnancy range, 0.9–4.9 nmol/l), although she had no history of menstrual disturbance, hirsutism or acne prior to conception. Radiological evaluation (ultrasound and magnetic resonance imaging) revealed multiple cystic lesions in both ovaries, leading to a presumptive diagnosis of hyperreactio luteinalis (HL). The implications of maternal hyperandrogenism on foetal virilisation were considered and the patient was counselled appropriately. She delivered a healthy baby boy uneventfully. Androgen levels, hirsutism and acne normalised within a few weeks of delivery.ConclusionHL can occur at any stage of pregnancy and is an important differential diagnosis in pregnant patients with features of androgen excess. Most cases regress spontaneously after delivery and major interventions are usually not needed.Learning points Hyperandrogenism in pregnancy is rare.Clinical features are similar to the non-pregnant state in the mother but virilisation in the foetus can have profound consequences.HL and pregnancy luteoma are the most common ovarian pathologies leading to hyperandrogenism in pregnancy.Spontaneous regression occurs in the post-partum period in the vast majority of cases and surgery is only required for local complications.