Osteopenia in patients with androgen insensitivity may relate to defective androgen action, oestrogen deficiency or a combination of the two. These observations have implications for the management of patients with androgen insensitivity and may provide insight into the effects of androgens on the female as well as the male skeleton.

Cranial diabetes insipidus (CDI) is a treatable chronic condition that can potentially develop into a life-threatening medical emergency. CDI is due to the relative or absolute lack of the posterior pituitary hormone vasopressin (AVP), also known as anti-diuretic hormone. AVP deficiency results in uncontrolled diuresis. Complete deficiency can lead to polyuria exceeding 10 L/24 h. Given a functioning thirst mechanism and free access to water, patients with CDI can normally maintain adequate fluid balance through increased drinking. Desmopressin (DDAVP, a synthetic AVP analogue) reduces uncontrolled water excretion in CDI and is commonly used in treatment. Critically, loss of thirst perception (through primary pathology or reduced consciousness) or limited access to water (through non-availability, disability or inter-current illness) in a patient with CDI can lead to life-threatening dehydration. This position can be further exacerbated through the omission of DDAVP. Recent data have highlighted serious adverse events (including deaths) in patients with CDI. These adverse outcomes and deaths have occurred through a combination of lack of knowledge and treatment failures by health professionals. Here, with our guideline, we recommend treatment pathways for patients with known CDI admitted to hospital. Following these guidelines is essential for the safe management of patients with CDI.

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The pilot study was undertaken to evaluate the role of FNA cytology in the clinical management of patients with thyroid swelling, in a District General Hospital (DGH) setting. One hundred and eleven patients were investigated over a period of 3 years, with a total of 142 fine needle aspirations. Statistical analysis showed a sensitivity of 71%, a specificity of 91% and a false negative rate of 2.7%. These results compare very favourably with other institutions. This study therefore shows that thyroid nodule FNA cytology can be performed in a DGH with a high standard of diagnostic accuracy, the results of which play a key role in patient management.

Diabetes Insipidus (DI) is a name given historically to two conditions, which result in "diabetes," which is Greek for "syphon" or polyuria.The "Insipidus" refers to urine being insipid. "Cranial DI" is so called because it relates to a cause within the head characterized by deficiency of vasopressin [antidiuretic hormone (ADH)] secretion from the posterior pituitary. Treatment is with desmopressin, a synthetic long-acting analogue of vasopressin. In contrast, "Nephrogenic DI" is due to resistance of the renal tubules to vasopressin action.The term "DI" distinguishes it from diabetes mellitus (DM), which describes polyuria with sweet urine. Over several decades, the word "diabetes" has become synonymous with "Diabetes Mellitus" in most lay and nonendocrine medical arenas.The problem of "DI" terminology is painfully illustrated by a tragic and avoidable death. In 2009, a 22-year-old man was admitted to a London teaching hospital for an elective hip replacement. He was fit and well but was pan anterior and posterior hypopituitary requiring full replacement therapy, including desmopressin, after successful treatment for a suprasellar germinoma the previous year.Treatment for the germinoma with high-dose glucocorticoid therapy had caused avascular necrosis of his hip. A pre-admission assessment had recommended that the endocrine team in the hospital be informed on his admission. On admission to the orthopaedic ward, his drug card was completed with the appropriate pituitary hormone replacement therapy including desmopressin, but the endocrine team was not informed.Although the hip operation the next day was without incident, back on the ward, he became confused. His mother told the ward staff that "he gets like this when he doesn't take his medication."The following day, he was even more confused and the ward staff found his condition challenging. A psychiatric opinion was sought as he had a history of previous marijuana use. Various options to sedate him were suggested. He was put in a sideward. At this stage, the patient himself called the police by phone and pleaded for help as "I am so thirsty and they are not giving me anything to drink." The police came to the ward, but were reassured by the ward staff and left. His blood sugar and electrolytes were taken, and although the glucose was normal, the serum sodium was 149 mmol/L. A medical review was requested but did not happen. At just after 09:00 hours, the next morning, the patient had a fatal cardiac arrest with a serum One means to avoid this catastrophe is an educational programme in all hospitals, and, where electronic prescribing systems are in place, a mandatory flag is placed for desmopressin with warnings that this is a life-sustaining therapy and must never be omitted, and supplies must be obtained immediately, or a doctor called.(We have also flagged all steroid and insulin prescriptions.)Another way to reduce the chance of failure of recognition of DI by staff and distinguish it from DM would be if the name was changed to avoid the word "diabetes." S...