Inhibins and activins are dimeric proteins of the transforming growth factor-superfamily which have been shown to be expressed in the adrenal cortex. Recent studies have suggested a role for these peptides in the pathogenesis and/or function of adrenal tumours. To investigate further their physiological and pathological roles, we have documented immunoreactivity for inhibin , A and B subunits in normal adult and fetal human adrenals, in hyperplastic adrenals and in adrenal tumours.In the normal and hyperplastic adult gland, diffuse immunopositivity was demonstrated for subunits, suggesting that activins ( dimers) can be expressed in all zones. Inhibin was limited to the zona reticularis and the innermost zona fasciculata in the normal gland, extending centripetally into the zona fasciculata in hyperplasia, supporting a role for ACTH in the regulation of expression, and suggesting that expression of inhibins ( dimers) is restricted.Immunopositivity for all three subunits was seen in both fetal and definitive zones of the fetal cortex, indicating that both inhibins and activins could be expressed in both.Immunopositivity for all three subunits was seen in most adrenocortical tumours. Loss of immunopositivity for inhibin in a subgroup of carcinomas might indicate a role in tumour progression. The greater intensity of staining for inhibin in tumours associated with Cushing's syndrome again suggests a link with cortisol production.

Uncertainty exists about risk:benefit of proximal intestinal exclusion with Endobarrier (EB), a novel endoscopic duodenal jejunal liner device for obesity, both with and without diabetes. In view of this, during 2017, an independent, secure, on-line registry was established under the auspices of the Association of British Clinical Diabetologists, for the collection of safety and efficacy data worldwide. As of December 2017, data had been entered on 403 patients {age 51.3 ± 11.8 year, 62% male, 89% europid, 74% diabetes, BMI 42.6 ± 10.2 kg/m2} from 13 centres in 4 countries: Australia, Austria, Czech Republic and United Kingdom. EB led to many benefits, including: in those with both baseline and explant data, mean ± SD weight fell by 14.5 ± 10.3 kg from 125.3 ± 26.7 to 110.8 ± 26.4 kg (n = 265 p<0.001), HbA1c by 1.4 ± 1.6%, from 8.7 ± 1.8 to 7.2 ± 1.2% (n = 195, p<0.001) and systolic BP fell from 138.5 ± 18.1 to 130.0 ± 17.2 mmHg (n = 149, <0.001). There were 23 (5.7%) serious adverse events (SAE) and 37 (9.2%) less serious AEs (Table). All SAE patients made a full recovery. The median (range) weight loss in those with early removal for GI bleed was 6.5 (0-29) and with early removal for liver abscess was 17.2 (7-21) kg. Some SAEs could have been avoided if patients had adhered to guidelines. The benefits of EB therapy are likely to reduce the complications of diabetes. This 1st international data from the EB registry suggests that the likely benefits of EB, far outweigh the risks. Disclosure R.E.J. Ryder: Other Relationship; Self; AstraZeneca. Speaker's Bureau; Self; Bioquest, Janssen Pharmaceuticals, Inc.. Other Relationship; Self; Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Novo Nordisk A/S. L. Munro: None. J.J. McMaster: None. J. Bessell: None. J.M. Bascomb: None. J.E. Collins: None. L. Kow: None. J. Chisholm: None. H. Sourij: Speaker's Bureau; Self; Boehringer Ingelheim GmbH, Novo Nordisk A/S, Amgen Inc., Sanofi, MSD K.K.. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH, MSD K.K., GI Dynamics Inc.. P.N. Pferschy: None. J.P. Teare: Research Support; Self; GI Dynamics Inc.. J.C. Mason: None. J.P. Byrne: None. M.C. Wyres: None. M.L. Cull: None. W. Burbridge: Other Relationship; Self; Menarini Group. S.P. Irwin: None. M. Yadagiri: None. E. Fogden: None. M. Anderson: None. P. Sen Gupta: None. M. Benes: None.