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[Addison's disease: principal clinical associations and description of natural history of the disease].

From 1967 to 1988 we studied 75 cases of Addison's disease (AD). An autoimmune etiology was found in 68%, while previous tubercular infection was demonstrated in 21% of the cases; minor causes were involved in 3%, and in 8% of the cases the disease remained of unknown origin. Autoimmune adrenalitis has become the most frequent cause of AD as a consequence of decreased tubercular infection. Autoimmune AD prevailed in children or in young people, and tubercular AD in adults. The finding of calcifications in adrenals and/or other organs was the specific diagnostic sign for the identification of tubercular forms. On the other hand, the finding of circulating adrenal autoantibodies (AA) and/or other organ specific autoantibodies was the fundamental diagnostic marker of autoimmune forms. In 72% of the cases autoimmune AD is associated with other organ-specific autoimmune diseases. Subjects with AA but without clinical signs of hypoadrenalism were considered to have "potential AD", because they showed a high risk of developing clinical hypoadrenalism. This condition develops over a long period characterized by different stages of subclinical adrenal hypofunction. Steroid cell autoantibodies (StCA) are frequently detectable in patients with autoimmune AD, in whom they are markers of autoimmune premature ovarian failure. The study of StCA-positive cases without hypogonadism will be important to clarify whether or not these autoantibodies could be markers of potential autoimmune hypogonadism.

Addison Disease↗
PubMed1987

[Adrenal function in patients with chronic obstructive lung diseases].

The hydrocortisone and ACTH blood levels, 17-hydroxycorticosteroids urine excretion and suprarenal function stimulation with Synacthen were studied in 22 patients with chronic obstructive pulmonary disease and 12 healthy persons as controls. The results show the presence of reliably higher hydrocortisone and 17-hydroxycorticosteroids levels in patients with low partial oxygen pressure as well as a higher ACTH plasma level and a strong Synacthen stimulation. After a comprehensive treatment including oxygen therapy the blood concentrations of hydrocortisone, ACTH, 17-hydroxycorticosteroids fell to levels found in healthy persons. The study shows that hypoxemia stimulates the suprarenal-cortex secretion.

17-Hydroxycorticosteroids↗
PubMed1986

Urinary excretion rates of 15 free steroids: potential utility in differential diagnosis of Cushing's syndrome.

To evaluate their potential usefulness in the differential diagnosis of Cushing's syndrome, we estimated the urinary excretion rates of the following non-metabolized, unbound steroid hormones: pregnenolone, progesterone, 17-OH-pregnenolone, 17-OH-progesterone, dehydroepiandrosterone (DHEA), androstenedione, testosterone, dihydrotestosterone, 11-deoxycorticosterone, 11-deoxycortisol, corticosterone, cortisol, 18-OH-11-deoxycorticosterone, 18-OH-corticosterone, and aldosterone. These were measured in normal subjects and in patients with Cushing's disease, adrenal adenoma, or ectopic corticotropin syndrome. We used "high-performance" liquid chromatography and subsequent radioimmunoassay. Our results indicate that simultaneous estimation of urinary free cortisol and DHEA may be useful in differential diagnosis of hypercorticoid states due to adrenal adenoma and Cushing's disease.

ACTH Syndrome, Ectopic↗
PubMed1975

Inhaled corticosteroids compared with oral prednisone in patients starting long-term corticosteroid therapy for asthma. A controlled trial by the British Thoracic and Tuberculosis Association.

Inhaled beclomethasone dipropionate and inhaled betamethasone valerate have been compared with oral prednisone in the treatment of 75 patients with asthma who were starting long-term corticosteroids for the first time. Both of the inhaled corticosteroids controlled asthma as well as did oral prednisone in those who had responded to therapy in the initial period of the trial. A daily dose of 400 mug of inhaled drug was approximately equivalent to 7-5 mg daily of prednisone. Prednisone suppressed the adrenal response to tetracosactrin, whereas the mean responses in the groups receiving inhaled corticosteroids did not change significantly from pre-trial values. The 30% incidence of other systemic unwanted effects of prednisone contrasted sharply with the low incidence (5%) of symptomatic oropharyngeal candidiasis in the patients receiving inhaled corticosteroids. In a sample of 19 patients no change in exfoliative cytology was detected over the period of the trial nor was there any evidence of fungal colonisation of the bronchial tree. There was no difference between the three treatment groups in the number of antibiotic courses prescribed. The persistent production of sputum made no difference to the response to inhaled corticosteroids. Patients not on sodium cromoglycate did as well in the trial as those receiving sodium cromoglycate. Both inhaled beclomethasone dipropionate and inhaled betamethasone valerate have advantages over oral prednisone in the maintenance treatment of patients with asthma, but in the management of exacerbations systemic corticosteroids will usually be needed as a supplement to inhaled therapy.

Administration, Intranasal↗
PubMed1977

[Glucocorticoid function of the adrenals and the state of the sympathetic-adrenal system in newborn infants with an hypoxic lesion of the central nervous system].

The convened studies demonstrated an activation of the hypothalamo-hypophysis-adrenal and sympathico-adrenal system in the newborn with slight and moderately expressed forms of CNS lesions. At the same time there was a relative insufficiency of such functions in children with severe forms of CNS lesions. The achieved data permit to substantiate the pathogenetical therapy.

11-Hydroxycorticosteroids↗