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Anthony Logaraj, Venessa H M Tsang, Shahrir Kabir, Julian C Y Ip
: Adrenal haemorrhage is a rare cause of adrenal crisis, which requires rapid diagnosis, prompt initiation of parenteral hydrocortisone and haemodynamic monitoring to avoid hypotensive crises. We herein describe a case of bilateral adrenal haemorrhage after hemicolectomy in a 93-year-old female with high-grade colonic adenocarcinoma. This patient's post-operative recovery was complicated by an acute hypotensive episode, hypoglycaemia and syncope, and subsequent computed tomography (CT) scan of the abdomen revealed bilateral adrenal haemorrhage...
2016: Endocrinology, Diabetes & Metabolism Case Reports
Nydia Camelia Rais, Reshma Aziz Merchant, Santhosh Kumar Seetharaman
We report the case of an older lady who was admitted to a tertiary teaching hospital with sub-acute functional decline of two months' duration, which was initially attributed to a concomitant urinary tract infection. Further investigations, however, revealed the diagnosis of pituitary apoplexy with central hypocortisolism. Subsequent treatment with physiological doses of steroids improved patient's function and overall well-being. This report adds to the sparse literature on pituitary apoplexy in the older adults and emphasizes the non-specific presentation of this clinical syndrome...
November 3, 2016: Age and Ageing
L Macfarlane, T Parkin, I Ramsey
The adrenocorticotrophic hormone (ACTH) stimulation test has been widely used and recommended as a monitoring method for dogs receiving trilostane; however, it has never been validated for this purpose. As trilostane is relatively short acting, there could be variation in the results depending on the time since the last dose of trilostane and results may not reflect clinical control. Additionally, tetracosactide (synthetic ACTH) can be expensive in some countries and has had limited availability throughout much of Europe...
November 1, 2016: Veterinary Record
Riikka S K Takala, Riku Kiviranta, Klaus T Olkkola, Tero Vahlberg, Dan Laukka, Anna Kotkansalo, Melissa Rahi, Matti Sankinen, Jussi Posti, Ari Katila, Jaakko Rinne
PURPOSE: The aim was to assess anterior pituitary hormone levels during the acute phase of aneurysmal subarachnoid hemorrhage (aSAH) and analyze the possible association with the clinical condition and outcome. MATERIAL AND METHODS: Forty patients with aSAH whose aneurysm was secured by endovascular coiling were enrolled. Basal secretions of cortisol, testosterone, luteinizing hormone (LH), prolactin (PRL), and sex hormone binding globulin (SHBG) levels were measured up to 14 days after the incident...
October 18, 2016: Endocrine Research
Shilpa Rao, Anita Mahadevan, Tanmoy Maiti, Manish Ranjan, Shivayogi Durgad Shwetha, Arimappamagan Arivazhagan, Jitender Saini
Hypophysitis includes three histopathologically distinct entities - granulomatous, lymphocytic and xanthomatous forms. Etiopathogenesis and the immunological differences among these is not well characterized. This study aims to explore the immunopathogenesis of granulomatous and lymphocytic forms of hypophysitis. Demographic, clinical, endocrine function and radiological features of 33 histologically confirmed cases of hypophysitis were reviewed. Immunophenotyping of inflammatory component was performed in 13/33 cases...
October 5, 2016: APMIS: Acta Pathologica, Microbiologica, et Immunologica Scandinavica
Rebecca Dumbell, Alexei Leliavski, Olga Matveeva, Christopher Blaum, Anthony H Tsang, Henrik Oster
The circadian rhythm of glucocorticoids affects diverse physiological systems, including stress responses and the coordination of rhythmic functions in peripheral and central tissues. Circadian clocks are considered to be important coordinators of glucocorticoid release and loss of the core clock component BMAL1 leads to ablation of behavioural and physiological rhythms, hypocortisolism, impaired ACTH and behavioural stress responses. Transplantation and conditional clock gene knock-down studies in mice suggest an important role of local adrenocortical clock function in this context...
October 3, 2016: Endocrinology
Caroline C de Oliveira, Flávia V Gouveia, Marina C de Castro, Mayra A Kuroki, Lennon C T Dos Santos, Erich T Fonoff, Manoel J Teixeira, José P Otoch, Raquel C R Martinez
The avoidance response is present in pathological anxiety and interferes with normal daily functions. The aim of this article is to shed light on performance markers of active avoidance (AA) using two different rat strains, Sprague-Dawley (SD) and Wistar. Specifically, good and poor performers were evaluated regarding anxiety traits exhibited in the elevated plus maze (EPM) and corticosterone levels and motor activity in the open field test. In addition, the plasma levels of Interleukin-6 (IL-6), Interleukin-1Beta (IL-1beta), Nerve Growth Factor Beta (NGF-beta), Tumor Necrosis Factor-Alpha (TNF-alpha) and cytokine-induced neutrophil chemoattractant 1 (CINC-1) were compared in the good and poor performers to better understand the role of the immunologic system in aversive learning...
2016: Frontiers in Behavioral Neuroscience
K M Lommerse, F N Dijkstra, A J P Boeke, E M W Eekhoff, G E Jacobs
This clinical case presentation describes the disease trajectory in two patients who presented with psychiatric symptoms as a result of abnormal serum glucocorticoid levels. One case involves a 58-year-old man with hypercortisolism, the other case concerns a 55-year-old woman with hypocortisolism. In both cases there was a considerable diagnostic delay in recognizing the underlying adrenal gland pathology. Abnormal glucocorticoid levels, caused by endocrine disorders, often results in psychiatric symptoms. Delay in diagnosis may have adverse consequences...
2016: Nederlands Tijdschrift Voor Geneeskunde
Masahiro Oishi, Yasuhiko Hayashi, Issei Fukui, Daisuke Kita, Tadao Miyamori, Mitsutoshi Nakada
BACKGROUND: Xanthomatous hypophysitis (XH) is an extremely rare form of primary hypophysitis characterized by infiltration of the pituitary gland by mixed types of inflammatory cells, including foamy cells, plasma cells, and small mature lymphocytes. XH manifests as varying degrees of hypopituitarism. Although several previous reports have denied a possible contribution of autoimmune mechanism, the exact pathogenesis of XH remains unclear. CASE DESCRIPTION: We describe the case of a 72-year-old woman with a history of rheumatoid arthritis and Sjögren's syndrome who presented with panhypopituitarism and diabetes insipidus...
2016: Surgical Neurology International
Peter Kühnen, Karine Clément, Susanna Wiegand, Oliver Blankenstein, Keith Gottesdiener, Lea L Martini, Knut Mai, Ulrike Blume-Peytavi, Annette Grüters, Heiko Krude
Patients with rare defects in the gene encoding proopiomelanocortin (POMC) have extreme early-onset obesity, hyperphagia, hypopigmentation, and hypocortisolism, resulting from the lack of the proopiomelanocortin-derived peptides melanocyte-stimulating hormone and corticotropin. In such patients, adrenal insufficiency must be treated with hydrocortisone early in life. No effective pharmacologic treatments have been available for the hyperphagia and obesity that characterize the condition. In this investigator-initiated, open-label study, two patients with proopiomelanocortin deficiency were treated with setmelanotide, a new melanocortin-4 receptor agonist...
July 21, 2016: New England Journal of Medicine
Martin Maripuu, Mikael Wikgren, Pontus Karling, Rolf Adolfsson, Karl-Fredrik Norrback
BACKGROUND: Cardiovascular disease (CVD) is one of the main causes of excess deaths in affective disorders. Affective disorders are associated with increased frequencies of CVD risk-factors such as obesity, dyslipidemia, and metabolic syndrome. Stress-induced chronic cortisol excess has been suggested to promote obesity and metabolic syndrome. Chronic stress with frequent or persisting hypothalamic-pituitary-adrenal-axis (HPA-axis) hyperactivity may, over time, lead to a state of low HPA-axis activity, also denoted hypocortisolism...
November 1, 2016: Journal of Affective Disorders
Allison J Pollock, Tasa S Seibert, Cristiana Salvatori, Patrizio Caturegli, David B Allen
BACKGROUND/AIMS: Autoimmune hypophysitis (AH) is a rare inflammatory disease of the pituitary gland causing varying degrees of hypopituitarism and/or sellar compression. Cranial MRI remains the best noninvasive tool to diagnose AH, although a diagnosis of certainty requires pituitary biopsy. The objective of this study was to assess the utility of detecting pituitary antibodies for the diagnosis of AH. METHODS: A 15-year-old female with Turner syndrome (TS), hypothyroidism, and ovarian failure presented acutely with hypocortisolism...
June 30, 2016: Hormone Research in Pædiatrics
Seung Hun Lee, Kee-Ho Song, Jinju Kim, Sooyoun Park, Seong Hee Ahn, Hyeonmok Kim, Yoon Young Cho, Sunghwan Suh, Beom-Jun Kim, Jae Hyeon Kim, Jung-Min Koh
OBJECTIVE: There is no consensus on the biochemical diagnostic criteria for subclinical hypercortisolism (SH). Using parameters related to the hypothalamic-pituitary-adrenal axis, we aimed to develop a diagnostic model of SH for predicting postsurgical hypocortisolism and metabolic complications. DESIGN: Prospective and cross-sectional, observational, multicentre study in Korea. METHODS: After exclusion of overt Cushing's syndrome, adrenal incidentaloma (AI) patients who underwent unilateral adrenalectomy (n = 99) and AI patients (n = 843) were included...
June 24, 2016: Clinical Endocrinology
Pedro Marques, Ashley Grossman
Autoimmune hypophysitis has been described in patients on ipilimumab, a humanised monoclonal antibody increasingly used in the treatment of metastatic melanoma. A 67-year-old woman presented with severe fatigue, nausea and headaches following the third dose of ipilimumab, which was being given as treatment for metastatic melanoma (four administrations at three-weekly intervals). Hormonal evaluation confirmed hypocortisolism, with low gonadotrophins and a low thyroid-stimulating hormone with normal free T4 (she was on long-standing levothyroxine because of past surgery for a multinodular goitre)...
November 2015: Acta Médica Portuguesa
Alain Woda, Pascale Picard, Frédéric Dutheil
Many dysfunctional and chronic pain conditions overlap. This review describes the different modes of chronic deregulation of the adaptive response to stress which may be a common factor for these conditions. Several types of dysfunction can be identified within the hypothalamo-pituitary-adrenal axis: basal hypercortisolism, hyper-reactivity, basal hypocortisolism and hypo-reactivity. Neuroactive steroid synthesis is another component of the adaptive response to stress. Dehydroepiandrosterone (DHEA) and its sulfated form DHEA-S, and progesterone and its derivatives are synthetized in cutaneous, nervous, and adipose cells...
September 2016: Psychoneuroendocrinology
Lisanne C C J Smans, Pierre M J Zelissen
The diagnosis of adrenal insufficiency (AI) is a challenge. Most signs and symptoms are nonspecific and vary considerably depending upon the underlying cause and degree of AI. Identification of AI is crucial because the disease may be life-threatening if left unrecognized. The diagnostic evaluation consists of three steps. The first step is establishing the presence of hypocortisolism. The second step is establishing the level of hypothalamus-pituitary-adrenal axis dysfunction. The third and final step is searching for the exact cause of AI by additional laboratory and imaging techniques...
2016: Frontiers of Hormone Research
Maki Yamashita, Kazunori Kageyama, Hiroshi Murakami, Aya Sugiyama, Miyuki Yanagimachi, Eri Sato, Shingo Murasawa, Jun Matsui, Naoki Tamasawa, Makoto Daimon
Adrenal insufficiency may occur in patients with liver cirrhosis. The assessment of hypothalamus-pituitary-adrenal function is important in such patients, but there is no consensus as to how it should be performed. We herein report the results of our evaluation of the adrenal function in two patients with hypocortisolism accompanied by liver cirrhosis. The patients lacked the typical features of hypocortisolism. One was diagnosed with hypocortisolism accompanied by liver cirrhosis while the other had secondary adrenal insufficiency caused by a hypothalamic disorder...
2016: Internal Medicine
Junxiang Peng, Mingxing Qiu, Songtao Qi, Danling Li, Yuping Peng
OBJECTIVES: The objective of this study was to characterize hypopituitarism in adult males with prolactinomas. PATIENTS AND METHODS: We retrospectively analyzed the records of 102 consecutive patients, classified under three categories based on adenoma size at diagnosis: 1.0-2.0cm (group A), 2.1-4.0cm (group B), and >4.0cm (group C). Further, 76 patients had successful outcomes at follow-up. We compared different forms of pituitary hormone dysfunction (growth hormone deficiency, hypogonadism, hypothyroidism, and hypocortisolism) based on the maximal adenoma diameter...
May 2016: Clinical Neurology and Neurosurgery
Nilesh Lomte, Tushar Bandgar, Shruti Khare, Swati Jadhav, Anurag Lila, Manjunath Goroshi, Rajeev Kasaliwal, Kranti Khadilkar, Nalini S Shah
BACKGROUND: Bilateral adrenal masses may have aetiologies like hyperplasia and infiltrative lesions, besides tumours. Hyperplastic and infiltrative lesions may have coexisting hypocortisolism. Bilateral tumours are likely to have hereditary/syndromic associations. The data on clinical profile of bilateral adrenal masses are limited. AIMS: To analyse clinical, biochemical and radiological features, and management outcomes in patients with bilateral adrenal masses...
March 2016: Endocrine Connections
Rosin Varghese, Medha Rajappa, Laxmisha Chandrashekar, Shivanand Kattimani, Mony Archana, Malathi Munisamy, Gunaseelan Revathy, Devinder Mohan Thappa
BACKGROUND: Chronic urticaria (CU) is an immune-mediated disease characterized by wheals for at least 6 weeks. The role of stress and the correlation of stress, hypocortisolism, and inflammatory markers are not well understood. OBJECTIVES: To estimate C-reactive protein (CRP), interleukin (IL)-18, and cortisol levels in patients with CU and to explore their association with disease severity and stress. METHODS: Forty-five patients with CU and 45 age- and sex-matched healthy controls were recruited for this cross-sectional study...
April 2016: Annals of Allergy, Asthma & Immunology
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