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https://www.readbyqxmd.com/read/29675257/treatment-of-addison-s-disease-during-pregnancy
#1
Diana Oliveira, Adriana Lages, Sandra Paiva, Francisco Carrilho
Addison's disease, or primary adrenocortical insufficiency, is a long-term, potentially severe, rare endocrine disorder. In pregnancy, it is even rarer. We report the case of a 30-year-old pregnant patient with Addison's disease, referred to Obstetrics-Endocrinology specialty consult at 14 weeks gestation. She had been to the emergency department of her local hospital various times during the first trimester presenting with a clinical scenario suggestive of glucocorticoid under-replacement (nausea, persistent vomiting and hypotension), but this was interpreted as normal pregnancy symptoms...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29674485/management-of-endocrine-disease-diagnosis-and-management-of-primary-aldosteronism-the-endocrine-society-guideline-2016-revisited
#2
Tracy Ann Williams, Martin Reincke
The syndrome of primary aldosteronism (PA) is characterized by hypertension with excessive, autonomous aldosterone production and is usually caused by either a unilateral aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH). The diagnostic workup of PA is a sequence of three phases comprising screening tests, confirmatory tests and the differentiation of unilateral from bilateral forms. The latter step is necessary to determine the optimal treatment approach of unilateral laparoscopic adrenalectomy (for patients with unilateral PA) or medical treatment with a mineralocorticoid receptor antagonist (for patients with bilateral PA)...
April 19, 2018: European Journal of Endocrinology
https://www.readbyqxmd.com/read/29674401/licorice-induced-apparent-mineralocorticoid-excess-compounded-by-excessive-use-of-terbutaline-and-high-water-intake
#3
Laust Frisenberg Buhl, Frederik Nørregaard Pedersen, Marianne Skovsager Andersen, Dorte Glintborg
This case highlights the clinical course of a 54-year-old male patient presenting with hypertension and long-term refractory hypokalaemia. He reported long-term malaise, fatigue and physical discomfort. Diarrhoea, vomiting, over-the-counter drugs, dietary supplements and any kind of medical abuse were all denied. Physical examination was normal. Suppressed plasma renin activity along with a low aldosterone level and elevated urinary cortisone/cortisol metabolite excretion ratio raised the suspicion of apparent mineralocorticoid excess (AME)...
April 19, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29672718/mineralocorticoid-receptor-antagonists-in-kidney-transplantation-time-to-consider
#4
Sophie Girerd, Frédéric Jaisser
Although patient survival is significantly improved by kidney transplantation (KT) in comparison with dialysis, it remains significantly lower than that observed in the general population. Graft function is one of the major determinants of patient survival after KT. Mineralocorticoid receptor antagonists (MRAs) could be of particular interest in this population to improve graft function and treat or prevent cardiovascular (CV) complications. In KT, ischaemia/reperfusion injury is a major factor involved in delayed graft function, which is often associated with inferior long-term graft survival...
April 17, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29668907/the-mineralocorticoid-receptor-as-a-modulator-of-innate-immunity-and-atherosclerosis
#5
Charlotte D C C van der Heijden, Jaap Deinum, Leo A B Joosten, Mihai G Netea, Niels P Riksen
The mineralocorticoid receptor (MR) is a member of the nuclear receptor steroid-binding family. The classical MR ligand aldosterone controls electrolyte and fluid homeostasis after binding in renal epithelial cells. However, more recent evidence suggests that activation of extrarenal MRs by aldosterone negatively impacts cardiovascular health independent of its effects on blood pressure: high levels of aldosterone associate with an increased cardiovascular event rate, where MR antagonists exert beneficial effects on cardiovascular mortality...
April 16, 2018: Cardiovascular Research
https://www.readbyqxmd.com/read/29668577/the-use-of-a-novel-non-steroidal-mineralocorticoid-receptor-antagonist-finerenone-for-the-treatment-of-chronic-heart-failure-a-systematic-review-and-meta-analysis
#6
Hui Pei, Wei Wang, Di Zhao, Lei Wang, Guo-Hai Su, Zhuo Zhao
BACKGROUND: The non-steroidal mineralocorticoid receptor antagonist finerenone (BAY 94-8862) has been used to treat chronic heart failure (CHF) with reduced ejection fraction (HFrEF). However, conflicting results were reported for its efficacy and safety. The study aimed to compare the efficacy and safety of finerenone versus spironolactone or eplerenone in patients with chronic heart failure. METHODS: Electronic databases including MEDLINE, EMBASE, and CENTRAL were searched from inception to December 2017 for randomized controlled trials assessing finerenone treatment in patients with chronic heart failure...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29667759/incidence-predictors-and-clinical-management-of-hyperkalaemia-in-new-users-of-mineralocorticoid-receptor-antagonists
#7
Marco Trevisan, Pietro de Deco, Hairong Xu, Marie Evans, Bengt Lindholm, Rino Bellocco, Peter Barany, Tomas Jernberg, Lars H Lund, Juan J Carrero
BACKGROUND: Concerns for hyperkalaemia limit the use of mineralocorticoid receptor antagonists (MRAs). The frequency of MRA-associated hyperkalaemia in real-world settings and the extent of subsequent MRA discontinuation are poorly quantified. METHODS AND RESULTS: Observational study including all Stockholm citizens initiating MRA therapy during 2007-2010. Hyperkalaemias were identified from all potassium (K+ ) measurements in healthcare. MRA treatment lengths and dosages were obtained from complete collection of pharmacy dispensations...
April 18, 2018: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29663559/sex-differences-in-hippocampal-mineralocorticoid-and-glucocorticoid-receptor-mrna-expression-in-response-to-acute-mate-pair-separation-in-zebra-finches-taeniopygia-guttata
#8
Farrah N Madison, Andrew J Kesner, Beau A Alward, Gregory F Ball
Mate separation has been shown to mediate changes in physiological and behavioral processes via activation of the hypothalamo-pituitary-adrenal (HPA) axis in both mammalian and avian species. In order to elucidate the neural mechanisms associated with changes in the HPA axis in response to social stress, we investigated the effects of mate pair separation on circulating corticosterone concentrations as well as gene expression levels of mineralocorticoid receptor (MR), glucocorticoid receptor (GR), and corticotropin releasing hormone (CRH) in the hypothalamus and hippocampus of both male and female zebra finches, a species that forms strong pair bonds...
April 16, 2018: Hippocampus
https://www.readbyqxmd.com/read/29661880/refractory-hypokalemia-from-syndrome-of-apparent-mineralocorticoid-excess-on-low-dose-posaconazole
#9
Travis Wassermann, Eleanor K Reimer, Marie McKinnon, Wendy Stock
A 67-year-old woman with acute myeloid leukemia experienced refractory hypokalemia while taking low-dose posaconazole.….
April 16, 2018: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/29659888/randomized-placebo-controlled-trial-to-evaluate-effects-of-eplerenone-on-metabolic-and-inflammatory-indices-in-hiv
#10
Suman Srinivasa, Kathleen V Fitch, Kimberly Wong, Timothy K O'Malley, Patrick Maehler, Karen L Branch, Sara E Looby, Tricia H Burdo, Edgar L Martinez-Salazar, Martin Torriani, Shannon H Lyons, Julian Weiss, Meghan Feldpausch, Takara L Stanley, Gail K Adler, Steven K Grinspoon
Context: HIV-infected individuals demonstrate unique RAAS physiology, with increased RAAS activation in association with visceral adiposity, insulin resistance, and inflammation. A physiologically-based treatment approach targeting mineralocorticoid receptor (MR) blockade may improve metabolic and inflammatory indices in HIV. Objective: To investigate effects of eplerenone on insulin sensitivity, inflammatory indices and other metabolic parameters in HIV. Design: Six month, double-blind, randomized, placebo-controlled trial...
April 5, 2018: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29655877/endocrine-and-haemodynamic-changes-in-resistant-hypertension-and-blood-pressure-responses-to-spironolactone-or-amiloride-the-pathway-2-mechanisms-substudies
#11
Bryan Williams, Thomas M MacDonald, Steve V Morant, David J Webb, Peter Sever, Gordon T McInnes, Ian Ford, J Kennedy Cruickshank, Mark J Caulfield, Sandosh Padmanabhan, Isla S Mackenzie, Jackie Salsbury, Morris J Brown
BACKGROUND: In the PATHWAY-2 study of resistant hypertension, spironolactone reduced blood pressure substantially more than conventional antihypertensive drugs. We did three substudies to assess the mechanisms underlying this superiority and the pathogenesis of resistant hypertension. METHODS: PATHWAY-2 was a randomised, double-blind crossover trial done at 14 UK primary and secondary care sites in 314 patients with resistant hypertension. Patients were given 12 weeks of once daily treatment with each of placebo, spironolactone 25-50 mg, bisoprolol 5-10 mg, and doxazosin 4-8 mg and the change in home systolic blood pressure was assessed as the primary outcome...
April 11, 2018: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/29629731/the-effect-of-mineralocorticoid-receptor-antagonists-on-recruitment-and-function-of-endothelial-progenitor-cells-in-patients-with-congestive-heart-failure
#12
Amos Levi, Dorit Leshem-Lev, Adaya Weissler-Snir, Tal Hasin, Israel Mats, Daniel Murninkas, Ran Kornowski, Eli I Lev, Tuvia Ben-Gal
BACKGROUND: Circulating endothelial progenitor cells have an important role in the process of vascular repair. Impaired recruitment and function of endothelial progenitor cells is related to the pathophysiology of congestive heart failure. Endothelial progenitor cells have been shown to express the mineralocorticoid receptor. OBJECTIVES: To investigate the effect of mineralocorticoid receptor antagonists on endothelial progenitor cells in patients with heart failure...
April 2018: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/29626018/drug-therapies-in-chronic-heart-failure-a-focus-on-reduced-ejection-fraction
#13
Helena Bolam, Geraint Morton, Paul R Kalra
There are multiple evidence-based drug treatments for chronic heart failure (HF), both disease-modifying agents and those for symptom control. The majority of the evidence base supports drugs used in HF with reduced left ventricular ejection fraction. The mainstay of disease modification involves manipulation of neurohormonal activation that occurs in HF. In addition to established angiotensin-converting enzyme inhibitors, beta blockers and mineralocorticoid receptor antagonists (MRAs), newer agents are now available such as the angiotensin receptor neprilysin inhibitors...
March 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/29622372/treatment-of-unruptured-cerebral-aneurysms-with-the-mineralocorticoid-receptor-blocker-eplerenone-pilot-study
#14
Shinji Nagahiro, Yoshiteru Tada, Junichiro Satomi, Tomoya Kinouchi, Kazuyuki Kuwayama, Kenji Yagi, Kohei Nakajima, Nobuhisa Matsushita, Takeshi Miyamoto, Tadashi Yamaguchi, Kenji Shimada, Masaaki Korai, Hideo Mure, Yoshihiro Okayama, Takashi Abe, Masafumi Harada, Keiko T Kitazato, Yasuhisa Kanematsu
BACKGROUND: Currently there are no pharmacological therapies for patients with unruptured cerebral aneurysms. Elsewhere we showed that the mineralocorticoid receptor antagonist eplerenone prevented the formation of cerebral aneurysms in our ovariectomized hypertensive aneurysm rat model. The current pilot study evaluated whether it can be used to prevent the growth and rupture of cerebral aneurysms in hypertensive patients. METHODS: Between August 2011 and May 2014, we enrolled 82 patients with 90 aneurysms in an open-label uncontrolled clinical trial...
April 2, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29621713/analysis-of-endocrine-activity-in-drinking-water-surface-water-and-treated-wastewater-from-six-countries
#15
Frederic D L Leusch, Peta A Neale, Charlotte Arnal, Natalie H Aneck-Hahn, Patrick Balaguer, Auguste Bruchet, Beate I Escher, Mar Esperanza, Marina Grimaldi, Gaela Leroy, Marco Scheurer, Rita Schlichting, Merijn Schriks, Armelle Hebert
The aquatic environment can contain numerous micropollutants and there are concerns about endocrine activity in environmental waters and the potential impacts on human and ecosystem health. In this study a complementary chemical analysis and in vitro bioassay approach was applied to evaluate endocrine activity in treated wastewater, surface water and drinking water samples from six countries (Germany, Australia, France, South Africa, the Netherlands and Spain). The bioassay test battery included assays indicative of seven endocrine pathways, while 58 different chemicals, including pesticides, pharmaceuticals and industrial compounds, were analysed by targeted chemical analysis...
March 27, 2018: Water Research
https://www.readbyqxmd.com/read/29617893/serum-cortisol-and-cortisone-as-potential-biomarkers-of-partial-11%C3%AE-hydroxysteroid-dehydrogenase-type-2-deficiency
#16
Cristian A Carvajal, Alejandra Tapia-Castillo, Carolina P Valdivia, Fidel Allende, Sandra Solari, Carlos F Lagos, Carmen Campino, Alejandro Martínez-Aguayo, Andrea Vecchiola, Constanza Pinochet, Claudia Godoy, Virginia Iturrieta, Rene Baudrand, Carlos E Fardella
Background: Pathogenic variations in HSD11B2 gene triggers the apparent mineralocorticoid excess syndrome (AME). There is scarce information regarding the phenotypes of subjects carrying heterozygous pathogenic variants in HSD11B2 gene. We investigated if serum cortisol/cortisone(F/E) ratio and cortisone are useful for identifying partial 11βHSD2 deficiency in those heterozygous subjects. Methods: We studied two patients diagnosed with AME and their families carrying either D223N or R213C mutation...
March 30, 2018: American Journal of Hypertension
https://www.readbyqxmd.com/read/29614900/mineralocorticoid-and-glucocorticoid-receptor-mediated-control-of-genomic-responses-to-stress-in-the-brain
#17
Karen R Mifsud, Johannes M H M Reul
Successful coping with stressful events involves adaptive and cognitive processes in the brain that make the individual more resilient to similar stressors in the future. Stressful events result in the secretion of glucocorticoids (GCs) from the adrenal glands into the blood stream. Early work proved instrumental for developing the concept that these hormones act in the brain to coordinate physiological and behavioral responses to stress through binding to two different GC-binding receptors. Once activated these receptors translocate to the nucleus where they act on target genes to facilitate (or sometimes inhibit) transcription...
April 4, 2018: Stress: the International Journal on the Biology of Stress
https://www.readbyqxmd.com/read/29608891/change-of-the-5%C3%AE-5%C3%AE-ratio-of-urinary-steroid-metabolites-in-benign-prostatic-hyperplasia-patients-treated-with-dutasteride
#18
Takahiro Maeda, Eiji Kikuchi, Masanori Hasegawa, Keiko Homma, Yota Yasumizu, Seiya Hattori, Takeo Kosaka, Kazunobu Shinoda, Akira Miyajima, Mototsugu Oya
BACKGROUND: The effects of the administration of dutasteride (DUT) on steroid metabolite pathways in BPH patients have not been examined. METHODS: Urine and blood samples as well as clinical parameters were prospectively collected after the administration of DUT to 60 BPH patients, and after its withdrawal in another set of 25 BPH patients. Urine samples were assessed using gas chromatography/mass spectrometry for the urinary steroid profile (USP), which simultaneously measures 63 steroid metabolites...
March 30, 2018: Clinical Biochemistry
https://www.readbyqxmd.com/read/29607790/protective-effects-of-diuretics-against-development-of-cardiovascular-disease-in-patients-with-chronic-kidney-disease-systematic-review
#19
Akinori Aomatsu, Susumu Ookawara, Kenichi Ishibashi, Yoshiyuki Morishita
Cardiovascular disease is one of the most important risk factors for mortality and morbidity in patients with chronic kidney disease (CKD). This systematic review focuses on the protective effects of diuretics against the development of cardiovascular disease in patients with CKD. Among various kinds of diuretics, spironolactone, a mineralocorticoid receptor antagonist, has been shown to have protective effects against cardiovascular disease in patients with all stages of CKD, including pre-dialysis, hemodialysis, and peritoneal dialysis...
April 2, 2018: Cardiovascular & Hematological Agents in Medicinal Chemistry
https://www.readbyqxmd.com/read/29606180/associations-of-prenatal-depressive-symptoms-with-dna-methylation-of-hpa-axis-related-genes-and-diurnal-cortisol-profiles-in-primary-school-aged-children
#20
Valeska Stonawski, Stefan Frey, Yulia Golub, Nicolas Rohleder, Jennifer Kriebel, Tamme W Goecke, Peter A Fasching, Matthias W Beckmann, Johannes Kornhuber, Oliver Kratz, Gunther H Moll, Hartmut Heinrich, Anna Eichler
Epigenetic DNA modifications in genes related to the hypothalamic-pituitary-adrenal (HPA) axis are discussed as a mechanism underlying the association between prenatal depression and altered child HPA activity. In a longitudinal study, DNA methylation changes related to prenatal depressive symptoms were investigated in 167 children aged 6 to 9 years. At six candidate genes, 126 cytosine-guanine dinucleotides were considered without correcting for multiple testing due to the exploratory nature of the study. Further associations with the basal child HPA activity were examined...
April 2, 2018: Development and Psychopathology
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