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PubMed2006

[High doses of inhaled budesonide and adrenal function in children with severe asthma].

BACKGROUND: The use of inhaled steroids is common in the treatment of bronchial asthma in children. AIM: To assess adrenocortical function in children with severe asthma receiving inhaled budesonide for six or more months. MATERIAL AND METHODS: Children with severe asthma that required 800 microg/day or more of inhaled budesonide and that did not required systemic steroids for more than six days in the last four months to control their disease, were studied. Serum cortisol was measured one hour after administration of 0.25 mg of ACTH (Cosyntropin) intravenously. The test was considered normal if post stimulation serum cortisol was over 18 microg/ml. RESULTS: Twenty children (aged 5 to 14 years, 15 males), were studied. The stimulation test was normal in 17 children. CONCLUSIONS: Alterations in adrenal function are present in a small proportion of asthmatic children who require 800 microg/day of inhaled budesonide.

Administration, Inhalation↗
PubMedDate not supplied

Lymphoma as a model for chronic illness: effects on adrenocortical function testing.

Many dogs with chronic illness have serum biochemical abnormalities consistent with hyperadrenocorticism (HAC). Lymphoma (LSA) is a chronic disease of dogs. The purpose of this study was to evaluate adrenocortical screening test results in dogs with LSA to evaluate their specificity. Criteria for inclusion in the study included a diagnosis of LSA, an expected survival time of 16-56 weeks, no glucocorticoid treatment beyond 4 weeks after the initiation of chemotherapy, no evidence of HAC, and owner consent. Post-ACTH stimulation plasma cortisol concentrations (PACs), urine cortisol : creatinine (UC : Cr) ratios, and maximal left adrenal width measurements were performed at the time of LSA diagnosis before the initiation of chemotherapy and at 16, 24, 32, 40, and 52 weeks or until the loss of remission or the development of another disease. Ten dogs met the criteria for inclusion. Forty-two PACs were performed; 1 abnormal, 2 borderline, and 39 normal values were detected. Thirty-five maximal left adrenal width measurements were obtained; 0 abnormal, 5 borderline, and 30 normal measurements were detected. Thirty-six UC : Cr ratios were obtained, with 26 abnormal, 4 borderline, and 6 normal values detected and 9 of 10 dogs having at least 1 abnormal value. These data suggest that in dogs with LSA, the UC : Cr ratio frequently is abnormal and may not be a specific test for HAC, or it may be the most sensitive test for increases in cortisol secretion due to chronic illness. Maximal left adrenal width measurements and PACs were almost always normal and may be more specific for HAC or less sensitive for demonstrating chronic increases in cortisol secretion.

Adrenal Cortex↗
PubMed1991

Adrenocortical function testing in dairy cows and its effect on milk yield.

Administration of 6IU synthetic ACTH1-24 intravenously to six Holstein-Friesian cows resulted in a cortisol peak concentration after 1 hour of 148 +/- 34.2 ng/ml. Basal plasma cortisol concentration (4.84 +/- 0.83 ng/ml) was reached 5 hours after ACTH injection. Until 7 days after ACTH administration no effect on milk yield was recorded. So it is concluded that a dose of 6 IU ACTH1-24 is sufficient for a conspicuous release of cortisol without any alteration in milk production. This dose can be used as a standard test for the evaluation of adrenocortical function in lactating cows when administered intravenously at 9 a.m. and when plasma samples for cortisol assay are collected just prior to administration and at 10 a.m.

Adrenal Cortex↗
PubMed1992

Value of serum dehydroepiandrosterone sulfate assay in the evaluation of pituitary-adrenal insufficiency after pituitary adenomectomy.

The value of dehydroepiandrosterone sulfate (DHEA-S), a specific marker of adrenal androgen production, in the assessment of clinical states of hypercortisolism and hypocortisolism has been suggested. Since the way to simply test for ACTH reserve in patients (pts) with pituitary tumors after adenomectomy is not standardized, in this study serum DHEA-S concentration was measured in order to establish whether its determination might be a sensitive index of ACTH deficiency. Serum DHEA-S concentration was evaluated in 29 pts with hypothalamic-pituitary tumors (16 females, 13 males, aged 20-70 yr), 14 of whom had GH-secreting adenomas, 13 nonfunctioning adenomas, 1 prolactinoma and 1 craniopharyngioma. Serum DHEA-S and cortisol (F) levels were determined both before and every day for 8 days after pituitary adenomectomy. Before surgery in all pts mean DHEA-S and F basal values were 3.57 +/- 0.42 mumol/L and 391.8 +/- 29.0 nmol/L, respectively. Eight out of 29 pts showed reduced DHEA-S levels (0.85 +/- 0.19 mumol/L), which remained lower than normal in the postsurgical period; on the contrary, F levels were reduced in only 2 and 3 cases before and after surgery, respectively. In 3 other pts DHEA-S levels were normal before surgery and then were low in the postoperative period, while serum cortisol remained normal in all cases. In most of these patients, the finding of impaired responses to hypothalamic-pituitary-adrenal tests, together with a reduced corticosteroid urinary excretion, confirmed the existence of a secondary hypoadrenalism and the necessity for an adequate replacement therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed2000

Low dose (1 microg) ACTH test in the evaluation of adrenal dysfunction in pre-clinical Addison's disease.

OBJECTIVE: The presence of 21-hydroxylase autoantibodies (21OHAb) is a marker of adrenal autoimmunity and can be used to identify subjects with pre-clinical Addison's disease. The low-dose (1 microg) ACTH test (LDT) is more sensitive than the high-dose (250 microg) test (HDT) for the diagnosis of pituitary adrenal insufficiency, but no information is available on the use of a LDT in subjects with autoimmune adrenalitis and primary adrenal insufficiency. The aim of our study was to evaluate the clinical use of the LDT in the diagnosis of early adrenocortical dysfunction in patients with adrenal autoantibodies. DESIGN AND METHODS: Firstly, we evaluated the cortisol responses to both a LDT and a HDT in a group of 12 healthy volunteers. We then performed a LDT in 11 subjects positive for 21OHAb, but without clinical signs of Addison's disease identified by screening 920 patients with one or more organ-specific autoimmune diseases. In all cases, the LDT was followed by a sequential HDT which was used as a control test of the sensitivity and specificity of the LDT. RESULTS: In healthy subjects, the peak cortisol levels after the LDT were similar to those after the classical HDT. In 21OHAb-positive subjects, the LDT showed a pathological response in five out of 11 (45%) cases and the diagnostic concordance between the results of the LDT and those of the HDT was 100%. All the five cases with pathological LDT were also positive for adrenal cortex autoantibodies (ACA) and 4/5 had high levels of basal ACTH. One subject with pathological LDT developed clinical Addison's disease 4 months after the test had been performed. CONCLUSIONS: Our study demonstrates that the low dose ACTH test has a high diagnostic sensitivity and specificity for primary adrenal insufficiency and suggests that it can accurately identify subjects with pre-clinical adrenal dysfunction.

Addison Disease↗
PubMed2000

Adrenocortical insufficiency in infants with congenital diaphragmatic hernia: a pilot study.

BACKGROUND/PURPOSE: Prior reports have documented that premature infants do not have normal serum levels of cortisol. In contrast, full-term infants usually have adequate cortisol levels. The stress response in critically ill infants may be vital to their recovery. The purpose of this pilot study was to determine whether critically ill full-term infants with congenital diaphragmatic hernia (CDH) show a subnormal adrenal stress response. METHODS: Random serum cortisol levels in infants with CDH (n = 10) were measured using fluorescent polarization immunoassay. In addition, serum cortisol levels were measured after exogenous adrenocorticotropic hormone stimulation (Cosyntropin stimulation test). RESULTS: Six of the 10 infants studied died. Most (79%) of the cortisol levels were subnormal (<7 microgm/dL). Although no significant differences in mean cortisol levels from terminally ill infants compared with surviving infants were detected, survivors tended to have higher cortisol levels. Cosyntropin stimulation resulted in inappropriately low cortisol levels in 2 of the 4 fatally ill patients tested (<30 microgm/dL) and normal responses in the 2 survivors tested. CONCLUSIONS: Infants born with CDH may have an inadequate adrenal stress response despite a life-threatening anomaly. A large-scale prospective study may be warranted to confirm this apparent association. Corticosteroid therapy may be beneficial in this population of patients.

Adrenal Cortex Function Tests↗
PubMed2006

Triple-A syndrome--the first Chinese patient with novel mutations in the AAAS gene.

We report on the first Chinese patient with triple-A syndrome, who presented at 22 months with status epilepticus secondary to hyponatraemia and hypoglycaemia. Subsequent endocrine investigations confirmed primary adrenal insufficiency and aldosterone deficiency. In the presence of achalasia and alacrima, this patient satisfies the diagnostic criteria of triple-A syndrome. Further molecular testing detected compound heterozygous mutations in the AAAS gene: a c.580C --> T transition in exon 7 and a c.771delG single nucleotide deletion in exon 8. Testing of parents and brother confirmed their heterozygous carrier status.

Adrenal Cortex Diseases↗
PubMed1999

Plasma cortisol concentrations following cortisone infusion in dogs before and after treatment with cortisone acetate.

OBJECTIVE: To evaluate effects of iatrogenic hyperadrenocorticism on plasma cortisol concentrations produced by an infusion of hydrocortisone in dogs. PROCEDURE: Plasma cortisol concentrations were measured regularly during a 6 h infusion of hydrocortisone sodium succinate at two dose rates. The infusions were performed before and after treatment for 30 d with oral cortisone acetate at 10 mg/kg/24 h, divided thrice daily. Adrenal activity during the experimental period was assessed by weekly ACTH stimulation tests. RESULTS: Both infusion rates produced lower plasma cortisol concentrations after treatment for 30 d with cortisone. CONCLUSION: Prior exposure to high concentrations of glucocorticoids may result in accelerated metabolism of glucocorticoids administered subsequently. This may necessitate increased dosages when using glucocorticoids to support inadequate adrenal function.

Administration, Oral↗
PubMed1995

Effect of exogenous adrenocorticotropic hormone administration on plasma corticosterone concentrations in American black ducks (Anas rubripes).

A protocol for the adrenocorticotropic (ACTH) stimulation test in American black ducks (Anas rubripes) was established with synthetic ACTH, cosyntropin (Cortrosyn); ACTH stimulation testing was conducted on 31 adult ducks (14 males, 17 females) in September 1993. Plasma corticosterone concentrations were measured on heparinized blood samples collected 30 min, and 1, 2, and 4 hr post-injection. In comparison with saline controls, cosyntropin (0.25 mg/duck) produced a two- to three-fold increase in corticosterone 30 min after administration. Maximal concentrations ranged from 132 to 312 ng/ml and occurred between 1 and 2 hr post-injection. Corticosterone concentrations declined to basal, pre-injection values after 4 hr. Endogenous ACTH release in response to handling stress was evident in control ducks after saline injection but did not interfere with interpretation of the stimulation test. Recommendations for the ACTH stimulation test in black ducks include a 30 min acclimatization period for recently captured or relocated ducks and determination of plasma corticosterone concentration 1 to 2 hr following intramuscular injection with 0.25 mg cosyntropin.

Adrenal Cortex Function Tests↗
PubMed1977

An evaluation of laboratory tests for the detection and differential diagnosis of Cushing's syndrome.

1. Results of tests for the diagnosis of Cushings syndrome of varoius aetiologies are discussed for twenty-five patients in whom the pathology was established by operation or autopsy. 2. Control values for the urinary excretion of free cortisol, 17-OHCS, Porter-Silber chromogens (P-SC) and 17-OS and plasma levels of P-SC are compared with those for normal subjects. 3. The results indicated that urinary values are within the normal range for some patients with Cushing's syndrome. 4. Plasma levels of P-SC in the morning were within the normal range for the majority and elevated for the rest. 5. Some patients showed day-night variation of plasma P-SC but evening values were above the normal range. 6. The expected response for low dosage dexamethasone was found in all patients tested but unexpected responses followed high dosage in some. 7. Plasma 11-OHCS in the five patients tested failed to respond to insulin induced hypoglycaemia. 8. Metyrapone administration and corticotrophin infusion tests had limited usefulness in establishing the aetiology of the disease. The 17-OHCS excretion became raised in the response to corticotrophin and the evaluation was prolonged beyond normal responsiveness.

17-Hydroxycorticosteroids↗
PubMed1981

Functional capacity of suprarenal cortex in patients on long-term dialysis.

The authors have repeatedly examined the functional capacity of suprarenal cortex in patients on long-term dialysis by means of ACTH stimulation test. Out of 148 examinations, normal reaction was found in 111 cases, partially insufficient in 16 cases, and fully insufficient in 21 cases. Primary suprarenal insufficiency is considered for the reason of insufficient production of cortisol which develops due to enforced changes of regulatory mechanism in glucocorticoids production as a reaction on repeated long-term losses of cortisol through semipermeable membrane. According to the authors, the mentioned facts are of great significance since they may result in changes which influence the survival of patients on long-term dialysis in a negative way.

11-Hydroxycorticosteroids↗
PubMed1989

Further analysis of the disturbed adrenocortical function in the cerebro-hepato-renal syndrome of Zellweger.

Plasma aldosterone, corticosterone, 11-deoxycorticosterone, progesterone, 17-hydroxyprogesterone, 11-desoxycortisol, cortisol and cortisone were determined simultaneously in small plasma samples obtained during an i.v. ACTH (Synacthen) stimulation test in five patients (age 4-7 years) with Zellweger syndrome. The response of all ACTH-dependent steroids to Synacthen was severely impaired in all patients, despite normal basal levels. It can be concluded that the biochemical defect in adrenal steroidogenesis causing the inadequate response to ACTH injection is located proximal to progesterone. We propose that the lack of responsiveness to ACTH is secondary to an abnormality of ACTH receptors on the adrenocortical cell. The extremely low levels of non-specific lipid transfer protein may be a contributing factor.

Adrenal Cortex↗
PubMed1999

Dysregulation of adrenal 11 beta-hydroxylase activity in hypertensive subjects: usefulness of the ACTH 1-17 stimulation test.

BACKGROUND AND AIM: The aim of this study was to determine the validity of our previous hypothesis of adrenal 11 beta-hydroxylase (11-OH) dysregulation in "essential" low-renin hypertension. METHODS AND RESULTS: A comparison was made between 30 hypertensive patients and 30 age-matched controls (NC) in basal conditions and after ACTH stimulation (ACTH 1-17) test. The 11-deoxycortisol (S) and deoxycorticosterone (DOC) integrated areas under the curve (AUCs) of stimulus were significantly higher in the hypertensives (p < 0.001) and pointed to adrenal 11-OH dysregulation. CONCLUSIONS: The ACTH 1-17 test detects impairment of 11-OH activity of probable genetic origin. The relative mineralocorticoid excess thus provoked could be an additional cause of "essential" low-renin hypertension.

Adrenal Cortex↗
PubMedDate not supplied

Adrenal cortical function and reserve in lepromatous leprosy.

22 chronic Lepromatous Leprosy patients of over 10 years duration, 17 non-reactional and 5 in reactional state who have not taken steroids as part of treatment were selected for the study. Serum cortisol was estimated by Radio-immuno-assay. Samples for basal values were collected at 8.00 A.M. Stimulated values were estimated in samples collected 8 hours after ACTH gel 40 units IM or 2 hours after 0.15 unit/kg BW Plain Insulin I.V. Basal cortisol values are: Normal controls 123.06 +/- 57.33 ng/ml. Non-reactional: 100.47 +/- 30.33 ng/ml; Reactional 141.4 +/- 43.15 ng/ml. Stimulated values are: Normal controls: 207.6 +/- 72.57 ng/ml. Non-reactional: 175.33 +/- 57.07 ng/ml, Reactional: 230 +/- 40.92 ng/ml. Basal serum cortisol in the non-reactional state is slightly lower than in normals but not statistically significant (P greater than 0.1). The basal cortisol in reactional subjects is slightly higher than in normals but not significant statistically (P greater than 0.05). The percentage rise over the basal value after stimulation test is found to be significantly low in both the reactional and non reactional states (P greater than 0.05) and also there is no statistically significant difference between these two groups (p greater than 0.5). Hence it is concluded that the Adrenal cortical reserve is low both in the non-reactional and reactional states of Lepromatous Leprosy.

Adrenal Cortex↗
PubMed1999

Adrenocortical function in critically ill patients 24 h after a single dose of etomidate.

We compared the effects of single doses of etomidate and thiopentone on adrenocortical function in a randomised controlled clinical trial involving 35 critically ill patients who needed a general anaesthetic. Just before induction of anaesthesia, a baseline blood cortisol sample was taken. Twenty-four hours later we performed a short adrenocorticotrophic hormone stimulation test. No patient had a low cortisol level (< 160 nmol.l-1) at any time during the study. Baseline, pre-ACTH and post-ACTH cortisol levels were similar in the two groups. However, significantly more patients in the etomidate group had an ACTH-stimulated cortisol increment < 200 nmol.l-1. The clinical significance of these findings is not clear, but we conclude that single doses of etomidate may interfere with cortisol synthesis for at least 24 h in the critically ill.

Adolescent↗
PubMed1999

The continuous 7-hour intravenous dexamethasone suppression test in the differential diagnosis of ACTH-dependent Cushing's syndrome.

OBJECTIVE: A recent report showing disappointingly low sensitivity and specificity for the oral high dose dexamethasone test in the differential diagnosis of Cushing's syndrome prompted us to re-evaluate the results obtained in our centre using the continuous 7-hour intravenous dexamethasone suppression test for this purpose. PATIENTS: 105 patients with ACTH-dependent Cushing's syndrome were included in this study; 78 with Cushing's disease, 8 with ectopic ACTH-secreting tumours and 19 were classified as 'of unknown aetiology'. RESULTS: In 74/78 (94.9%) of patients with Cushing's disease and in 3/8 (37.5%) patients with the ectopic ACTH syndrome, a plasma cortisol decrease > 190 nmol/l at 7 h as compared to baseline values was achieved in the continuous 7-hour intravenous dexamethasone suppression test. Using a plasma cortisol decrease > 190 nmol/l at 7 h as compared to baseline values as the cut-off value, the sensitivity and specificity of the continuous 7-hour intravenous dexamethasone suppression test for the diagnosis of Cushing's disease in patients with ACTH-dependent Cushing's syndrome were 94.9% and 62.5%, respectively. CONCLUSIONS: In patients with ACTH-dependent Cushing's syndrome with a plasma cortisol decrease > 190 nmol/l at 7 h in the continuous 7-hour intravenous dexamethasone suppression test, additional localizing investigations such as bilateral simultaneous inferior petrosal sinus sampling and/or pentetreotide scintigraphy should be performed when no clearly discernible pituitary adenoma is observed on MRI studies. Patients with ACTH-dependent Cushing's syndrome with a plasma cortisol decrease < 190 nmol/l at 7 h in the continuous 7-hour intravenous dexamethasone suppression test should also undergo bilateral simultaneous inferior petrosal sinus sampling and/or pentetreotide scintigraphy to demonstrate the presence of a nonpituitary source of ACTH overproduction.

ACTH Syndrome, Ectopic↗
PubMed1994

Determination of 17-hydroxycorticosteroids in dialysate solution as a measure of adrenocortical function in hemodialysis patients.

Dialysate contents of 17-hydroxycorticosteroids (17-OHCS) in hemodialysis patients were studied as a potential measure of adrenocortical function. Dialysate 17-OHCS contents after a 2-day interval of hemodialysis in 15 hemodialysis patients were determined. Dialysate 17-OHCS increased after intravenous injection of cortisol the evening prior to hemodialysis (n = 4). Dialysate 17-OHCS content was suppressed, as was plasma cortisol, after a standard dexamethasone (Dex) suppression test (n = 1). Their plasma cortisol was suppressible or nonsuppressible by an overnight Dex suppression test, as reported previously. However, basal dialysate 17-OHCS contents were not different between them, indicating that the nonsuppressible patients with overnight Dex seem not to have hypercortisolism. We conclude that determination of dialysate 17-OHCS seems a useful noninvasive technique for the evaluation of adrenocortical function in hemodialysis patients.

17-Hydroxycorticosteroids↗