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PubMed1984

Short-term effects of desogestrel and ethinyloestradiol on serum proteins in women.

The effects of the new progestagen desogestrel on the changes induced by ethinyloestradiol (EE) on the serum levels of sex hormone binding globulin (SHBG), transcortin, ceruloplasmin and haptoglobin were studied in healthy female volunteers. Desogestrel (0.125 mg or 0.250 mg) administered in combination with 0.050 mg EE was compared with 0.050 mg EE alone. After 7 and 14 days the three regimens induced similar changes in the serum levels of transcortin, ceruloplasmin and haptoglobin. Desogestrel at a dose level used in oral contraceptives did not inhibit the EE-induced increase in SHBG capacity while its influence on this parameter at twice the clinical dosage (0.250 mg) used was still minor. It can be concluded that with respect to the parameters studied desogestrel in the clinical dosage used has no detectable oestrogenic or androgenic effect.

Adult↗
PubMedDate not supplied

Circadian and circaseptan rhythmicities in corticosteroid-binding globulin (CBG) binding activity of human milk.

It has been demonstrated that human milk contains a corticosteroid-binding globulin (CBG, transcortin) which is very similar to that isolated from plasma. It is agreed, moreover, that the cortisol environment of the breast is important for the synthesis of major milk proteins. It was of interest, therefore, to investigate whether milk transcortin exhibits circadian variations in the binding activity as does the plasma counterpart. Twelve lactating women, aged 23-35 years, collected specimens of milk just before feeding at different times of the 24-h cycle for 3 consecutive days in the first week of lactation. Six women extended milk collection for at least a 28-days span in the first 2 months of lactation. To obtain whey, milk was centrifuged in cellulose nitrate tubes at 105,000 g for 30 min at 4 degrees C. Specific cortisol binding activity of CBG was measured by an adsorption technique and data were expressed as a function of protein content. Cortisol levels in milk were measured by radioimmunoassay. Rhythmometric analyses (single- and mean-cosinor procedures) yielded detection of a significant circadian rhythm in 'apparent specific binding activity' for cortisol (ASBA-F) whereas no significant oscillation was found as far as milk cortisol concentrations were concerned. Mean acrophase of the CBG-binding activity in milk was located in the evening, lagging behind the corresponding activity in serum by approximately 8 h. A circaseptan rhythmicity in milk binding activity was also present in our longitudinal series at a high level of significance. These results provide evidence that CBG binding activity in human milk has a clear circadian rhythm in the face of ecchronic milk cortisol concentrations. Phase-shift with regard to the rhythm of the plasma counterpart may be accounted for by processes of milk accumulation before nursing The significance of circadian and circaseptan variations in specific cortisol (and other steroids) binding in milk awaits further investigation.

Circadian Rhythm↗
PubMed1980

[Change in adrenal glucocorticoid function in myocardial infarct complicated by cardiogenic shock].

The article deals with the results of study of bound and free 11-oxycorticosteroids and the reserve binding capacity of transcortin in 65 patients with myocardial infarction complicated by various types of cardiogenic shock. The most significant increase in the level of 11-oxycorticosteroids and decrease in transcortin reserve binding capacity were found in patients with true cardiogenic shock.

11-Hydroxycorticosteroids↗
PubMed1977

Macromolecular binding of glucocorticoids in human mammary carcinoma.

The presence of glucocorticoid receptors was examined in 100 primary and 22 metastatic human breast cancer lesions. Aliquots of cytosol were incubated in vitro with tritiated cortisol and dexamethasone with and without competing steroids. Two different types of glucocorticoid receptors were detected. One is similar to transcortin; it sediments at 4 S in the ultracentrifuge, has a dissociation constant in the same range (10(-8) M), and does not bind fluorinated corticosteroids. While every tumor showed cortisol binding, very high activity (greater than 1000 fmoles/g tissue) was detected in 38% of primaries and in 59% of metastases. Plasma transcortin could be excluded as the source of binding activity. The other receptor binds both natural and fluorinated corticosteroids, has a higher affinity (Kd 10(-9) M), and sediments at 8 S. It was present in 23% of tumors and its quantity (26 to 995 fmoles/g) was much less than that of cortisol binder (50 to 6000 fmoles/g). While there was no correlation between the two glucocorticoid receptors, 80% of dexamethasone receptor-positive cases also had estrogen receptor. The results indicate that a significant proportion of these tumors could be subject to glucocorticoid influence.

Adrenal Cortex Hormones↗
PubMed1980

Serum protein binding of prednisolone in four species.

The protein binding of prednisolone in serum from humans, rabbits, dogs, and rats was determined by equilibrium dialysis. Two nonlinear least-squares regression programs were used to characterize transcortin and albumin binding of the steroid. The animal species differed markedly in their ability to bind prednisolone, but the rabbit was most similar to humans in transcortin concentration and affinity constant.

Animals↗
PubMed1981

Dose dependent pharmacokinetics of prednisone and prednisolone in man.

Six healthy male volunteers were given 5, 20, and 50 mg of oral prednisone and 5, 20, and 400 mg doses of intravenous prednisolone. Plasma and urine concentrations of prednisone and prednisolone were determined by HPLC, and the binding of prednisolone to plasma proteins was measured by radioisotopic and equilibrium dialysis techniques. The pharmacokinetics of both oral prednisone and intravenous prednisolone were dose-dependent. The mean oral dose plasma clearances of prednisone ranged from 572 ml/min/1.73 m 2 for the 5 mg dose to 2271 ml/min/1.73 m 2 for the 50 mg dose. Changes in prednisone half-life were insignificant, but increases in the half-life of its metabolite were dose-dependent. The systemic plasma clearance of i.v. prednisolone was dose-dependent and increased from 111 to 194 ml/min/1.73 m 2 over the 5 to 40 mg i.v. dosage range. The steady-state volume of distribution also increased, but little change in mean transit time and half-life was found. The binding of prednisolone to plasma proteins was markedly concentration-dependent, and a two compartment, nonlinear equation was used to characterize the effective binding of prednisolone to transcortin and albumin. The apparent pharmacokinetic parameters of protein-free and transcortin-free prednisolone were relatively constant with dose. The interconversion of prednisone and prednisolone varied with time and dose, although prednisolone concentrations dominated by 4- to 10-fold over prednisone. In urine, 2-5% of either administered drug was excreted as prednisone and 11-24% as prednisolone. The apparent renal clearances of both steroids were also nonlinear and unrelated to protein binding. These studies indicate that the pharmacokinetics of prednisone and prednisolone are dose-dependent and that protein binding does not fully explain their apparent nonlinear distribution and disposition.

Adult↗
PubMed1993

Corticosterone is a preferable ligand for measuring rat brain corticosteroid receptors: competition by RU 28362 and RU 26752 for dexamethasone binding in rat hippocampal cytosol.

It is unclear whether in vitro corticosteroid receptor binding assays have used inappropriately high concentrations of synthetic corticosteroid competitors, thereby potentially introducing error into estimates of type I (mineralocorticoid) and type II (glucocorticoid) receptor binding. To determine more accurately the concentration of blockers necessary to discriminate between these two sites, we have derived Ki values for the competition of dexamethasone, RU 28362 and RU 26752 for [3H]corticosterone and [3H]dexamethasone binding in rat hippocampus. Non-specific binding of both radioligands was defined with unlabeled dexamethasone to exclude transcortin. The type II agonist RU 28362 competed for only a portion of [3H]corticosterone binding, exhibiting a Ki of 0.5 nM for this binding. In contrast, RU 28362 fully competed all binding of a saturating concentration of [3H]dexamethasone, even though [3H]dexamethasone also recognized type I receptors, defined as specific [3H]corticosterone binding in the presence of 80 nM RU 28362. RU 28362 competition for [3H]dexamethasone binding exhibited characteristics of a 2-site interaction, with Kis of 0.3 and 194 nM. The type I receptor antagonist RU 26752 competed less effectively for [3H]corticosterone and [3H]dexamethasone binding, but nonetheless competed fully within a 1000-fold concentration range. Even at a level less than 125 x its Ki for type I binding, RU 26752 still inhibited virtually all type II receptor binding by [3H]corticosterone. We conclude that type I and II receptors in rat brain are best distinguished using [3H]corticosterone as the labelling ligand, with cold RU 28362 and dexamethasone to eliminate binding to type II and transcortin sites, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Androstanols↗
PubMed1982

Studies on high affinity binding of mineralo- and glucocorticoids in rabbit aorta cytosol.

High affinity, specific binding-sites to mineralocorticoids and glucocorticoids, with characteristics of steroid receptors, have been found in rabbit aorta cytosol. Binding parameters (dissociation constants and number of binding sites per mg of cytosol protein) were determined from Scatchard plots, after statistical treatment of the data with the aid of a computer program, for the following tritiated steroids: 11-desoxycorticosterone (DOC), aldosterone (Aldo), progesterone (Prog), corticosterone (BK), cortisol (FK) and dexamethasone (Dex). The specificity of binding was then examined by means of steroid competition studies. The results of these experiments indicate that three different types of high-affinity binding sites to adrenal steroids are present in aorta cytosol: Type A, with the highest affinity for DOC; Type B, with the highest affinity for FK; Type C, with the highest affinity for Dex. In accordance with the relative competitive potencies of various steroids for these binding sites, Type A is designated as the "arterial mineralocorticoid binder", clearly differing in its binding characteristics from the cytoplasmic mineralocorticoid binders in known target tissues to these steroids (e.g. the renal receptor), while Type C is designated as the "arterial glucocorticoid binder", closely resembling the classical glucocorticoid receptor in known target tissues to glucocorticoids. Type B exhibited some of the binding characteristics of transcortin and may represent a modified, intracellular transcortin. While Types B and C are present also in the cytosol of inferior vena cava. Type A was only in the aorta. The role of these binders is not known at present. Arguments are presented in favor of a hypothesis that the Type A (mineralocorticoid) binder represents an arterial wall; and that, under certain conditions, this action leads to an increased contractility of arterial and arteriolar smooth muscles, increased peripheral resistance and hypertension.

Animals↗
PubMed1984

Plasma protein binding interaction of prednisone and prednisolone.

The plasma protein binding interaction of prednisone and prednisolone were characterized by equilibrium dialysis. Prednisone and prednisolone are bound equally but weakly to human albumin (affinity constant, K approximately equal to 1 X 10(3) M-1). Transcortin affinity for prednisolone is 10-fold greater (51.3 X 10(6) M-1) than that for prednisone (4.3 X 10(6) M-1). In competition under pharmacologic conditions, prednisolone inhibits prednisone binding to transcortin producing linear binding averaging 55%. Prednisone does not affect prednisolone binding and does not complicate pharmacokinetic studies of the latter.

Binding, Competitive↗
PubMed1988

Investigation of the corticosteroid receptor system in rat hippocampus by ion exchange fast protein liquid chromatography.

In order to study the receptor system for adrenocortical steroids, hippocampal cytosolic preparations--containing both type I and type II receptors--were subjected to anion exchange fast protein liquid chromatography (FPLC). With running buffer containing Tris, EDTA, and glycerol three peaks (1-3) were eluted from the column at 220, 400 and 560 mM NaCl respectively regardless of whether [3H]corticosterone or [3H]RU 28362 had been used as radiotracer. None of the peaks was caused by serum transcortin as revealed by control studies. However, the sequestering influence of transcortin on receptor binding of corticosterone could be demonstrated by the FPLC technique with mixtures containing serum and hippocampus cytosol. Competition experiments with cytosolic samples revealed that type I receptor was present only in peaks 2 and 3 while type II was found in all three peaks in variable amounts, depending on the presence of molybdate. When molybdate was added to the running buffer only two peaks (2 and 3) were eluted, both containing type I and type II receptors. Peak 1 was attributed to the activated type II receptor while peak 2 represented nonactivated receptors. The origin of peak 3 remains uncertain. The data indicate that molybdate must be present in the cytosolic preparation and in the running buffer to keep type II receptor in its nonactivated form. Type I receptor was probably not transformed into the activated form in the absence of molybdate but lost binding capacity and/or affinity for corticosterone.

Androstanols↗
PubMed1988

Altered metabolism and decreased efficacy of prednisolone and prednisone in patients with hyperthyroidism.

To evaluate the effect of hyperthyroidism on the protein binding and metabolism of prednisolone, eight subjects with hyperthyroidism were investigated before and after thyroid status returned to normal. Hyperthyroidism was associated with a reduced volume of distribution of prednisolone, a decreased systemic availability of prednisolone after oral prednisone, a displacement of the prednisolone in equilibrium with prednisone equilibrium toward prednisone, and an increased nonrenal clearance of unbound prednisolone in the presence of an impaired 6 beta-hydroxyprednisolone formation. After oral prednisone or intravenous prednisolone, patients with hyperthyroidism had lower albumin-bound, transcortin-bound, and unbound concentrations of prednisolone but normal affinities of albumin and transcortin for prednisolone binding. These differences in prednisolone plasma concentrations were biologically relevant, because the capacity of these plasma samples to inhibit allogeneically stimulated lymphocytes was lower by 70% in the hyperthyroid than in the euthyroid state. Thus hyperthyroidism reduces the biologic effect of prednisolone and exhibits a differential effect on various enzymes involved in the catabolism of prednisolone.

Administration, Oral↗
PubMed1976

Identification and properties of renal mineralocorticoid receptors in relation to glucocorticoid binders in rat liver and kidney.

The binding of the natural mineralocorticoid aldosterone and the glucocorticoid corticosterone to macromolecules in rat liver and kidney cytoplasmic fractions was compared by various chromatographic procedures. Equilibration of kidney cytosol with 10nM-aldosterone, either alone or in the presence of a competing steroid, was ideal for ionexchange chromatography of DEAE-cellulose DE-52, and revealed the presence of four sorts of binding components. One of these, eluted in the 0.001M-phosphate pre-wash, and another, less abundant, forming a peak at 0.006M-phosphate, did not bind corticosterone at equimolar concentrations, and appear to constitute the mineralocorticoid-specific 'MR' receptor in rat kidney. They could not be detected in the liver. Radioactivity eluted in the 0.02 and 0.06M-phosphate regions on DEAE-cellulose DE-52 appears to be due to [3H]aldosterone binding to glucocorticoid-specific 'GR' receptors and to transcortin respectively, since labelling was greater with corticosterone even at 10 nM than with the mineralocorticoid at 100nM and since [14C]corticosterone bound to blood serum transcortin was always co-chromatographed in the 0.06M-phosphate region. These two components appear to be identical with those in the liver and could be labelled maximally only by 100nM-corticosterone. The separation between specific mineralo- and glucocorticoid-binding species was less clear when chromatography was attempted on DEAE-Sephadex A-50 columns, possibly because of disaggregation into subunits in the presence of the high KC1 concentrations required for elution. Competitive binding followed by filtration through Sephadex G-200 gel indicated that cellular MR binders, unlike GR receptors, exist mostly as high-molecular-weight aggregates, although both appear to exhibit a comparable monomeric molecular weight of approx. 67000.

Aldosterone↗
PubMed1983

Renal mineralocorticoid receptors and hippocampal corticosterone-binding species have identical intrinsic steroid specificity.

There is current evidence for two classes of hippocampal glucocorticoid receptors (GR)--one classical, [3H]dexamethasone [( 3H]Dex)-binding sites in glial cells, and the other [3H]corticosterone-preferring sites in neuronal cells. In the presence of 1 microM of the synthetic glucocorticoid RU26988 (11 beta, 17 beta-dihydroxy-17 alpha-propynylandrost-1,4,6,-trien-3-one) to exclude tracer from [3H]Dex sites, hippocampal cytosol from adrenalectomized/ovariectomized Sprague-Dawley rats binds [3H]Dex to sites (Kd at 4 degrees C, 0.77 X 10(-9) M; 65 fmol/mg of protein) with the following order of specificity: aldosterone (Aldo) = 9 alpha-fluorocortisol (9 alpha F-cortisol) = deoxycorticosterone (DOC) = corticosterone greater than cortisol much greater than Dex; [3H]Aldo, [3H]DOC, and [3H]corticosterone binding show identical specificity in the presence of RU26988. Addition of 1% adrenalectomized/ovariectomized rat plasma (but not plasma heated at 56 degrees C for 30 min) alters the specificity to: 9 alpha F-cortisol greater than or equal to Aldo greater than or equal to DOC much greater than Dex greater than or equal to corticosterone greater than or equal to cortisol, consistent with sequestration of DOC, corticosterone, and cortisol by transcortin and similar to classical mineralocorticoid receptor (MR) binding of [3H]Aldo in renal cytosol (9 alpha F-cortisol greater than or equal to Aldo greater than or equal to DOC much greater than corticosterone greater than or equal to cortisol greater than or equal to Dex). Separation of other renal binders from transcortin by hydroxylapatite adsorption established the intrinsic specificity of [3H]Aldo binding to MR as: DOC greater than or equal to Aldo greater than or equal to 9 alpha F-cortisol greater than or equal to corticosterone greater than cortisol much greater than Dex, parallel to that of the [3H]corticosterone-binding sites in hippocampus. These studies suggest (i) that hippocampal [3H]corticosterone-binding sites and renal MR may have identical intrinsic specificity for steroids, with apparent specificity differences the result of tissue-specific sequestration of naturally occurring steroids other than Aldo and (ii) that an identical steroid-binding species may thus be occupied under physiological conditions by a mineralocorticoid in one tissue (kidney) and a glucocorticoid in another (hippocampus).

Aldosterone↗
PubMed1982

The binding of prednisolone in human serum and to recrystallized human albumin in vitro.

1 Prednisolone binding in human serum and to recrystallized human serum albumin was measured by continuous ultrafiltration. 2 At serum concentrations of prednisolone up to 0.6 micron, 95.0% was bound but at higher concentrations the binding became non-linear falling to 80.5% at 1.8 microns. At even higher concentrations binding in serum became linear again and paralleled the binding to albumin which was linear throughout the entire range of prednisolone concentrations. 3 A binding model was proposed which included a saturable component attributable to binding to transcortin and a non-saturable binding to albumin. 4 Computer simulations using the experimentally determined binding parameters of the model indicated that binding in serum was critically dependent on transcortin concentration and almost independent of albumin concentration.

Adult↗
PubMed1987

Characterization of corticosterone feedback regulation of ACTH secretion.

Adrenalectomy-induced increases in ACTH secretion in rats are returned to normal by an action of corticosterone on the brain, not on the pituitary. Five days after adrenalectomy with constant steroid replacement, the concentration of free corticosterone in plasma which reduces plasma ACTH by 50% is approximately 0.8 nM. By contrast, the concentration of free plasma corticosterone required for 50% reduction of thymus wet weight or plasma transcortin concentration (both targets for glucocorticoid action) is about 4.5 nM. These results suggested that the inhibition of ACTH by corticosterone might be mediated by association of the steroid with high affinity, type I corticosteroid receptors, whereas the inhibition of thymus weight and transcortin might be mediated by association of the steroid with lower affinity, type II receptors. The results of studies comparing the ability of corticosterone, dexamethasone and aldosterone to inhibit adrenalectomy-induced ACTH secretion support the hypothesis that basal ACTH secretion in rats is mediated by association of corticosterone with type I receptors.

Adrenalectomy↗
PubMed1982

Endogenous and exogenous glucocorticoids in cushingoid patients.

The pharmacokinetics of prednisone/prednisolone and the time-course of endogenous hydrocortisone were investigated in 15 stable renal transplant patients and 12 patients with oral mucocutaneous vesiculoerosive diseases. All 27 patients were given their usual prednisone dose orally on one occasion, and 24 were given an equivalent amount of prednisolone intravenously on another occasion. After dosing, 8-14 plasma samples were obtained for the determination of total prednisolone, prednisone, and hydrocortisone concentrations by high performance liquid chromatography and unbound prednisolone concentrations by equilibrium dialysis. The bioavailability of prednisone, the interconversion of prednisone into prednisolone, the total and unbound prednisolone clearances, the prednisolone binding capacity of albumin and transcortin, and the affinity of albumin for prednisolone were not different when the 14 patients without cushingoid side effects were compared with the 13 cushingoid patients. Patients with cushingoid side effects had a higher affinity constant for prednisolone binding to transcortin, more frequently exhibited peak hydrocortisone levels within the normal range, and more often had measurable (greater than 10 ng/ml) hydrocortisone in the plasma samples collected during the kinetic studies, as compared with those not showing side effects. The data suggest that endogenous hydrocortisone production is not as suppressed in patients with visible cushingoid signs as in noncushingoid patients and that no significant difference in the pharmacokinetics of exogenous glucocorticoids exists between patients with and without cushingoid side effects.

Blood Proteins↗
PubMed1992

Feedback sensitivity of the rat hypothalamo-pituitary-adrenal axis and its capacity to adjust to exogenous corticosterone.

Chronic stress causing elevated morning (AM) corticosterone (B) concentrations of 2-8 micrograms B/dl does not appear to inhibit subsequent activity in the hypothalamic-pituitary-adrenal (HPA) axis, a surprising finding in view of the known depression in AM basal ACTH by only 3 micrograms B/dl in adrenalectomized rats. To distinguish between the possibilities that either intact rats are less sensitive to B feedback than adrenalectomized rats, or that chronic stress facilitates responses in the HPA axis, we elevated basal B levels in young male rats with slow-release B pellets in the absence of stress. Between 4-6 days after implantation of B pellets at three doses that elevated basal AM (diurnal trough) plasma B to approximately 1.2, 4, and 10 micrograms/dl, we studied basal ACTH and B at trough (AM) and peak evening (PM) times of the diurnal cycle, as well as the responses to the stress of restraint and blood collection from the tail at each time of day. We also determined mean daily plasma B, insulin, and glucose from samples collected at six intervals during the day. Adrenal, thymus, and body wts were measured as were transcortin (CBG) and adrenal phenylethanolamine-N-methyl transferase activity. Compared to controls implanted with wax pellets, all doses of B inhibited adrenal wt and AM stress responses and tended to inhibit pituitary ACTH content and adrenal phenylethanolamine-N-methyl transferase activity. Inhibition with the middle dose B pellet was close to maximally effective for these endpoints. Plasma glucose and thymus wt were significantly decreased and insulin was significantly increased in the middle and highest B pellet groups, with significantly greater effects at the highest dose. The gain in body wt and transcortin concentrations were significantly decreased only in the highest dose groups, in which mean daily plasma B was approximately 10 micrograms/dl, a level that clearly overwhelmed the capacity of the adrenocortical system to respond to any stimulus tested. By contrast, rats with low and middle dose B pellets appeared to adjust HPA axis function by decreasing the peak diurnal increase in B, so that 24-h mean B levels did not differ from control, and were maintained at approximately 5 micrograms/dl. Both of these groups also had inhibited ACTH responses to stress applied during the diurnal trough (AM). By contrast, neither group had inhibited ACTH responses to stress applied during the diurnal peak (PM). We conclude that: 1) The HPA axis of intact rats is extremely sensitive to exogenous B.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenal Glands↗
PubMed2006

Hypothalamic pituitary adrenal function during critical illness: limitations of current assessment methods.

CONTEXT: Activation of the hypothalamic-pituitary-adrenal (HPA) axis represents one of several important responses to stressful events and critical illnesses. Despite a large volume of published data, several controversies continue to be debated, such as the definition of normal adrenal response, the concept of relative adrenal insufficiency, and the use of glucocorticoids in the setting of critical illness. OBJECTIVES: The primary objective was to review some of the modulating factors and limitations of currently used methods of assessing HPA function during critical illness and provide alternative approaches in that setting. DESIGN: This was a critical review of relevant data from the literature with inclusion of previously published as well as unpublished observations by the author. Data on HPA function during three different forms of critical illnesses were reviewed: experimental endotoxemia in healthy volunteers, the response to major surgical procedures in patients with normal HPA, and the spontaneous acute to subacute critical illnesses observed in patients treated in intensive care units. SETTING: The study was conducted at an academic medical center. PATIENTS/PARTICIPANTS: Participants were critically ill subjects. INTERVENTION: There was no intervention. MAIN OUTCOME MEASURE: The main measure was to provide data on the superiority of measuring serum free cortisol during critical illness as contrasted to those of total cortisol measurements. RESULTS: Serum free cortisol measurement is the most reliable method to assess adrenal function in critically ill, hypoproteinemic patients. A random serum free cortisol is expected to be 1.8 microg/dl or more in most critically ill patients, irrespective of their serum binding proteins. Because the free cortisol assay is not currently available for routine clinical use, alternative approaches to estimate serum free cortisol can be used. These include calculated free cortisol (Coolens' method) and determining the free cortisol index (ratio of serum cortisol to transcortin concentrations). Preliminary data suggest that salivary cortisol measurements might be another alternative approach to estimating the free cortisol in the circulation. When serum binding proteins (albumin, transcortin) are near normal, measurements of total serum cortisol continue to provide reliable assessment of adrenal function in critically ill patients, in whom a random serum total cortisol would be expected to be 15 microg/dl or more in most patients. In hypoproteinemic critically ill subjects, a random serum total cortisol level is expected to be 9.5 microg/dl or more in most patients. Data on Cosyntropin-stimulated serum total and free cortisol levels should be interpreted with the understanding that the responses in critically ill subjects are higher than those of healthy ambulatory volunteers. The Cosyntropin-induced increment in serum total cortisol should not be used as a criterion for defining adrenal function, especially in critically ill patients. CONCLUSIONS: The routine use of glucocorticoids during critical illness is not justified except in patients in whom adrenal insufficiency was properly diagnosed or others who are hypotensive, septic, and unresponsive to standard therapy. When glucocorticoids are used, hydrocortisone should be the drug of choice and should be given at the lowest dose and for the shortest duration possible. The hydrocortisone dose (50 mg every 6 h) that is mistakenly labeled as low-dose hydrocortisone leads to excessive elevation in serum cortisol to values severalfold greater than those achieved in patients with documented normal adrenal function. The latter data should call into question the current practice of using such doses of hydrocortisone even in the adrenally insufficient subjects.

Adrenal Glands↗