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Clinical practice

Share your audits, surveys and research projects

The Society is committed to advancing research for patient benefit and has created this area to enable members to engage in each other’s research surveys, audits and projects, and promote collaboration. 

If you would like to advertise your work here and receive valuable input from other members, please complete the application form and email it to research@endocrinology.org. 

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In order to evaluate your application, the data that you submit via this form will be shared with the relevant Endocrine Network Convenors, staff working for the Society for Endocrinology and its Clinical Committee. We will store your data securely and only authorised personnel will be able to access it.

Share your views

Take part in the surveys below and help your colleagues gather important feedback from the endocrine community to improve patient care.

Live surveys, audits and projects

Carbimazole Titration App

Lead authors: Tristan Richardson
Lead Institution: Royal Bournemouth Hospital/ University Hospitals Dorset
Deadline: 20 November 2021
Queries to:
derek.kelly1@nhs.net

This survey is to understand current management of patients on carbimazole and seek views on an app being developed to automatically calculate carbimazole dose adjustment based on thyroid assessment test results, which aims to replace some of the time intensive dose-adjustment of carbimazole for patients and HCPs.

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The biochemical investigation of PCOS

Lead authors: James Hawley and Wiebke Arlt
Lead Institution: Manchester University NHS Foundation Trust / Birmingham NHS Foundation Trust
Deadline: November 2021
Queries to:
James.hawley@mft.nhs.uk

Biochemical investigation is frequently undertaken to aid the diagnosis of PCOS. However, there remains no consensus on which tests are included, what cut-offs should be applied and what other conditions should be excluded before confirming a diagnosis.

This survey has been designed to gather information on current reporting practices.

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Survey of diagnostic and management approach to incidentally found non-functioning pituitary microadenomas

Lead authors: Niki Karavitaki, Ross Hamblin and Athanasios Fountas
Lead Institution: Birmingham
Deadline: ongoing
Responses to: 
Clinical@endocrinology.org

The advances and expansion in the availability of radiological investigations have led to an increase in the detection of incidental pituitary lesions. The majority are non-functioning pituitary microadenomas and referrals for their assessment are becoming more frequent in endocrine clinical practice. Evidence-based data on the most optimal initial assessment, as well as on the safe and cost-effective follow-up are scarce and, therefore, extent of investigation, frequency and length of monitoring remain unclear. This survey will help identify whether management strategies differ significantly amongst clinicians.

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Archive

Anticoagulation practice in patient with Cushing’s syndrome (CS)

Lead authors: Kristina Island, Aparna Pal, John Newell-Price and John Wass
Lead Institution: Oxford
Deadline: 31 August 2021
Responses to: Clinical@endocrinology.org

Background:
The increased risk of thromboembolic disease in patients with Cushing’s syndrome (CS) is well recognized with the association first reported 50 years ago(1-3). Since then, several studies have confirmed the higher risk of DVT and PE in patients with CS, the majority published in case series of patients with Cushing’s disease (CD), and most often noted in the peri-operative period (4-9).

Risk of VTE in CS is thought to be in the order of a 10-fold increased risk and most notable in the first year following diagnosis (4,10). VTE accounts for 3.6-11% of all deaths in CS patients (17).

The highest risk seems to be in association with surgery and has been most studied in the context of CD post pituitary surgery (4, 10, 11). However, elevated VTE risk is also recognised post adrenalectomy for CS (12-13). Of note, VTEs have also occurred whilst on anticoagulation: in their retrospective, single centre study, Suarez et al note that 12.8% of the VTE in CS occurred in patients who were anticoagulated with prophylactic enoxaparin at the time of the event, emphasising the high risk (13). There are limited data examining the actual impact of thromboprophylaxis on VTE incidence in CS. A couple of studies have done this retrospectively and note fewer events in anticoagulated groups or after thromboprophylaxis became routine practice in their centres (7,14).

Although a previous survey by members of the Pituitary Society showed routine perioperative VTE prophylaxis had increased (15), this practice is not routine, nor is there a consensus around when, and for how long treatment should be given, nor is it clear if similar regimes should be instituted post adrenalectomy. The 2015 Endocrine Society guidelines do suggest thromboprophylaxis but no specific recommendations are made (16). They advise:

1) Evaluating CS patients for risk factors of venous thrombosis
2) In patients with CS undergoing surgery, we suggest perioperative prophylaxis for venous thromboembolism.

Aim
To establish what is the current thromboprophylaxis practice in patients with adrenal and pituitary source CS across Endocrinology centres in the UK

Method
All UK endocrinology centres will be contacted with details of the project and a request to complete a survey of their current practice of anticoagulation in CS patients which will be collated and analysed at the SFE and Oxford.

References
1. Pezzulich RA, Mannix JrH. Immediate complications of adrenal surgery. Ann Surg. 1970; 172:125-130.
2. Sjoberg HE, Blomback M, Granberg PO. Thromboembolic Complications, Heparin Treatment and Increase in Coagulation Factors in Cushing’s Syndrome. Acta Med. Scand. 1976; 199:95.
3. Conn W. Epidemiology of Venous Thromboembolism. Ann Surg. 1977; 186:149-164.
4. Stuijver DJ, van Zaane B, Feelders RA, Debeij J, Cannegieter SC, Hermus AR, van den Berg G, Pereira AM, de Herder WW, Wagenmakers MAEM, Kerstens MN, Zelissen PMJ, Fliers E, Schaper N, Drent ML, Dekkers OM, Gerdes VEA. Incidence of venous thromboembolism in patients with Cushing’s syndrome:a multicenter cohort study. J Clin Endocrinol Metab. 2011;96(11):3525-3532.
5. Small M, Lowe GDO, Forbes CD, Thomson JA.Thromboembolic complications in Cushing’s syndrome. Clinical endocrinology. 1983; 19(4):503-511.
6. Manetti L, Bogazzi F, Giovannetti C, Raffaelli V, Genovesi M, Pellegrini G, Ruocco L, Iannelli A, Martino E. Changes in
coagulation indexes and occurrence of venous thromboembolism in patients with Cushing’s syndrome: results from a prospective study before and after surgery. Euro J Endocrinol. 2010; 163(5):783-791.
7. Boscaro M, Sonino N, Scarda A, Barzon L, Fallo F, Sartori MT, Patrassi GM, Girolami A. Anticoagulant prophylaxis markedly reduces thromboembolic complications in Cushing’s syndrome. J Clin Endocrinol Metab. 2002; 87(8):3662-3666.
8. La Brocca A, Terzolo M, Pia A, Paccotti P, De Giuli P, Angeli A.
Recurrent thromboembolism as a hallmark of Cushing’s syndrome. J Endocrinol Invest. 1997; 20(4):211-214.
9. Wagner J, Langlois F, Lim DST, McCartney S, Fleseriu M. Hypercoagulability and Risk of Venous Thromboembolic Events in Endogenous Cushing’s Syndrome: A Systematic Meta-Analysis. Front Endocrinol (Lausanne). 2019; 9:805.
10. Van Zaane B, Nur E, Squizzato A, et al. Hypercoagulable state in Cushing’s syndrome: a systematic review. J Clin Endocrinol Metab. 2009;94(8):2743–2750.
11. Rees DA, Hanna FW, Davies JS, Mills RG, Vafidis J, Scanlon MF. Long-term follow-up results of transsphenoidal surgery for Cushing’s disease in a single centre using strict criteria for remission. Clin Endocrinol (Oxf). 2002;56(4):541–551.
12. Babic B, De Roulet A, Volpe A, Nilubol N. Is VTE prophylaxis necessary on discharge for patients undergoing adrenalectomy for Cushing syndrome? J Endocr Soc. 2019;3(2):304–313.
13. Suarez M, Stack M, Hinojosa-Amaya J, Mitchell M, Varlamov E, Yedinak C, Cetas J, Sheppard B, Fleseriu M. Hypercoagulability in Cushing Syndrome, Prevalence of Thrombotic Events: A Large, Single-Center, Retrospective Study. J Endocr Soc. 2020;4(2):1-11.
14. Barbot M, Daidone V, Zilio M, Albiger N, Mazzai L, Sartori MT, et al. Perioperative thromboprophylaxis in Cushing’s disease: what we did and what we are doing? Pituitary (2015) 18:487–93.
15. Fleseriu MBB, Swearingen AGB, Melmed S. Hypercoagulability in Cushing’s disease: a risk awareness and prophylaxis survey on behalf of the Pituitary Society. The Pituitary Society website. 2017. https://www.pituitarysociety.org/sites/all/pdfs/15_Pituitary_Congress_program.pdf
16. Lynnette K. Nieman, Beverly M. K. Biller, James W. Findling, M. Hassan Murad, John Newell-Price, Martin O. Savage, Antoine Tabarin, Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 8, 1 August 2015, Pages 2807–2831
17. Varlamov EV, Langlois F, Vila G, Fleseriu M. MANAGEMENT OF ENDOCRINE DISEASE: Cardiovascular risk assessment, thromboembolism, and infection prevention in Cushing's syndrome: a practical approach. Eur J Endocrinol. 2021 Apr 22;184(5):R207-R224. doi: 10.1530/EJE-20-1309. PMID: 33539319.


Subacute Thyroiditis after COVID-19 Vaccination

Lead author: William Bennet
Lead Institution: Sheffield
Deadline: 25 June 2021
Responses to: 
Clinical@endocrinology.org

The Society's Clinical Committee request your help to gather data on the occurrence of subacute thyroiditis after COVID-19 vaccination.

Dr William Bennet and colleagues in Sheffield have had a case of subacute thyroiditis develop shortly after viral vector DNA COVID-19 vaccination (Oxford-AZ), and there is a literature report of it occurring following mRNA COVID-19 vaccination. They want to find out your experience of this, to determine if this is a relatively common occurrence that endocrinologists must remain vigilant for.