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Secondary Adrenal Insufficiency

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https://www.readbyqxmd.com/read/29025209/delayed-diagnosis-of-pituitary-stalk-interruption-syndrome-with-severe-recurrent-hyponatremia-caused-by-adrenal-insufficiency
#1
Kyung Mi Jang, Cheol Woo Ko
Pituitary stalk interruption syndrome (PSIS) involves the occurrence of a thin or absent pituitary stalk, hypoplasia of the adenohypophysis, and ectopic neurohypophysis. Diagnosis is confirmed using magnetic resonance imaging. Patients with PSIS have a variable degree of pituitary hormone deficiency and a wide spectrum of clinical manifestations. The clinical course of the disease in our patient is similar to that of a syndrome of inappropriate antidiuretic hormone secretion. This is thought to be caused by failure in the suppression of vasopressin secretion due to hypocortisolism...
September 2017: Annals of Pediatric Endocrinology & Metabolism
https://www.readbyqxmd.com/read/29020800/an-approach-to-minimising-risk-of-adrenal-insufficiency-when-discontinuing-oral-glucocorticoids
#2
Mathew N Nicholas, Stephanie K Li, Marlene Dytoc
Oral glucocorticoids are commonly used across every field of medicine; however, discontinuing them in patients can be challenging. The risk of acute adrenal crises secondary to glucocorticoid withdrawal can be fatal and arises from chronic suppression of the adrenal glands. Identifying risk factors for adrenal suppression in dermatological patients, such as doses greater than 5 to 7.5 mg of prednisone equivalent, duration of glucocorticoid use greater than 3 weeks, certain medications, and comorbidities, can help risk-stratify patients...
October 1, 2017: Journal of Cutaneous Medicine and Surgery
https://www.readbyqxmd.com/read/29018153/prednisolone-has-the-same-cardiovascular-risk-profile-as-hydrocortisone-in-glucocorticoid-replacement
#3
David J F Smith, Hemanth Prabhudev, Sirazum Choudhury, Karim Meeran
INTRODUCTION: Patients who need glucocorticoid replacement in both primary and secondary adrenal insufficiency have the choice of either once daily prednisolone or thrice daily hydrocortisone. A recent European study found no difference between prednisolone and hydrocortisone users in several markers including glucose, weight, body mass index (BMI), systolic and diastolic blood pressure and waist circumference, although an increase in cholesterol and low density lipoprotein (LDL) was suggested in a subgroup of these patients...
October 10, 2017: Endocrine Connections
https://www.readbyqxmd.com/read/28973656/incidence-of-endocrine-dysfunction-following-the-use-of-different-immune-checkpoint-inhibitor-regimens-a-systematic-review-and-meta-analysis
#4
Romualdo Barroso-Sousa, William T Barry, Ana C Garrido-Castro, F Stephen Hodi, Le Min, Ian E Krop, Sara M Tolaney
Importance: If not promptly recognized, endocrine dysfunction can be life threatening. The incidence and risk of developing such adverse events (AEs) following the use of immune checkpoint inhibitor (ICI) regimens are unknown. Objective: To compare the incidence and risk of endocrine AEs following treatment with US Food and Drug Administration-approved ICI regimens. Data Sources: A PubMed search through July 18, 2016, using the following keywords was performed: "ipilimumab," "MDX-010," "nivolumab," "BMS-963558," "pembrolizumab," "MK-3475," "atezolizumab," "MPDL3280A," and "phase...
September 28, 2017: JAMA Oncology
https://www.readbyqxmd.com/read/28971033/acute-hypophysitis-secondary-to-nivolumab-immunotherapy-in-a-patient-with-metastatic-melanoma
#5
Sugabramya Kuru, Nazia Khan, Hamid Shaaban
The treatment for melanoma is challenging because of its nature of being refractory particularly in metastatic stages. Treatment options include surgical resection of the lesion, radiation therapy, chemotherapy, and immunotherapy. Immunotherapy such as anti-cytotoxic T-lymphocyte antigen-4 and anti-programmed cell death protein 1 (PD-1) are increasingly being used in the treatment of metastatic malignant melanoma. Nivolumab is a PD-1 inhibitor used for the treatment of malignant melanoma. In our case, an 83-year-old patient presented with enlarged inguinal lymphadenopathy 2 years after curative surgical resection of her toes secondary to melanoma...
July 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28945828/two-cases-of-late-onset-secondary-adrenal-insufficiency-after-discontinuation-of-nivolumab
#6
K Otsubo, K Nakatomi, R Furukawa, K Ashida, Y Yoneshima, Y Nakanishi, I Okamoto
No abstract text is available yet for this article.
August 31, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/28944123/preventing-cushing-iatrogenic-cushing-syndrome-due-to-ritonavir-fluticasone-interaction
#7
Fasil Tiruneh, Ahmad Awan, Abiot Didana, Saumil Doshi
Ritonavir is commonly used in low doses to boost plasma levels of protease inhibitors in patients with human immunodeficiency virus (HIV) infections. It is also a potent inhibitor of cytochrome P450. We present a 50-year-old African American male with past medical history of HIV on highly active antiretroviral therapy (HAART), which also included ritonavir and long standing asthma that has been treated with inhaled fluticasone, who presented with back pain. He had central obesity, prominent abdominal striae and wasted extremities on physical examination...
July 17, 2017: Curēus
https://www.readbyqxmd.com/read/28933807/recognizing-and-managing-adrenal-disorders-in-the-emergency-department-digest
#8
Amy Cutright, Stephen Ducey, Claudia L Barthold, Jeremy Kim
Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement...
September 22, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28913704/impact-of-etiology-age-and-gender-on-onset-and-severity-of-hyponatremia-in-patients-with-hypopituitarism-retrospective-analysis-in-a-specialised-endocrine-unit
#9
Dragana Miljic, Mirjana Doknic, Marko Stojanovic, Marina Nikolic-Djurovic, Milan Petakov, Vera Popovic, Sandra Pekic
BACKGROUND: Hyponatremia can unmask hypopituitarism and secondary adrenal insufficiency. This is important, since the need to screen for steroid deficiency, in patients with hyponatremia is often neglected. PATIENTS AND METHODS: In a retrospective study, twenty-five patients (13f/12m, age 58.9 ± 18.6 years) with hyponatremia (119.7 ± 10.5 mmol/L) were identified among 260 in-patients treated for hypopituitarism in our specialized endocrine unit, over the last decade...
September 14, 2017: Endocrine
https://www.readbyqxmd.com/read/28895486/iatrogenic-adrenal-insufficiency-secondary-to-combination-therapy-with-elvitegravir-cobicistat-tenofovir-disoproxil-fumarate-emtricitabine-and-interlaminar-triamcinolone-injection-in-an-aids-patient
#10
Chanie Wassner, Sutapa Maiti, Kurt Kodroff, Henry Cohen
We report the first identified case of suspected iatrogenic adrenal insufficiency after an interlaminar injection of triamcinolone acetonide while on concomitant Stribild (elvitegravir 150 mg/cobicistat 150 mg/tenofovir disoproxil fumarate 300 mg/emtricitabine 200 mg [EVG/c/TDF/FTC]). A 49-year-old female with HIV on EVG/c/TDF/FTC therapy presented to our endocrinology clinic to be evaluated for suspected Cushing syndrome. Prior to presentation, the patient had been given 2 interlaminar spinal injections of triamcinolone...
January 1, 2017: Journal of the International Association of Providers of AIDS Care
https://www.readbyqxmd.com/read/28877961/adrenal-insufficiency-is-seen-in-more-than-one-third-of-patients-during-ongoing-low-dose-prednisolone-treatment-for-rheumatoid-arthritis
#11
MULTICENTER STUDY
Stina Willemoes Borresen, Marianne Klose, Bo Baslund, Åse Krogh Rasmussen, Linda Hilsted, Lennart Friis-Hansen, Henning Locht, Annette Hansen, Merete Lund Hetland, Magnus Christian Lydolph, Ulla Feldt-Rasmussen
OBJECTIVE: Patients receiving long-term glucocorticoid treatment are at risk of developing adrenal insufficiency during treatment. We investigated the prevalence of prednisolone-induced adrenal insufficiency in the particular clinical situation where patients receive ongoing low-dose (5 mg/day) prednisolone treatment, a dose by itself too low to cover glucocorticoid needs during stress. DESIGN AND METHODS: Cross-sectional study in 42 patients with rheumatoid arthritis (29 women, aged 36-86 years) treated with 5 mg prednisolone/day, who had received prednisolone for ≥6 months (median: 66, range: 6-444 months)...
October 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28871578/secondary-adrenal-insufficiency-following-nivolumab-therapy-in-a-patient-with-metastatic-renal-cell-carcinoma
#12
Toshiro Seki, Atsushi Yasuda, Masayuki Oki, Natsumi Kitajima, Atsushi Takagi, Nobuyuki Nakajima, Akira Miyajima, Masafumi Fukagawa
Currently, nivolumab (an anti-programmed cell death-1 receptor monoclonal antibody) is available for many types of advanced cancers in Japan. However, there have been few detailed case reports about endocrine-related adverse events of this therapy. Here, we report a patient with metastatic renal cell carcinoma who presented with secondary adrenal insufficiency following nivolumab therapy. Endocrinological assessment by rapid adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) tests revealed that the patient's disorder was a secondary adrenal insufficiency due to pituitary dysfunction...
September 20, 2017: Tokai Journal of Experimental and Clinical Medicine
https://www.readbyqxmd.com/read/28820232/recognizing-and-managing-adrenal-disorders-in-the-emergency-department
#13
Amy Cutright, Stephen Ducey, Claudia L. Barthold
Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement...
September 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28815660/absorption-and-tolerability-of-taste-masked-hydrocortisone-granules-in-neonates-infants-and-children-under-6%C3%A2-years-of-age-with-adrenal-insufficiency
#14
Uta Neumann, Martin J Whitaker, Susanna Wiegand, Heiko Krude, John Porter, Madhu Davies, Dena Digweed, Bernard Voet, Richard J Ross, Oliver Blankenstein
OBJECTIVES: There is no licensed, dose-appropriate formulation of hydrocortisone for children with adrenal insufficiency (AI) and patients rely on compounded adult medication. The aim of this study was to evaluate the absorption, palatability and safety of Infacort(®) , an immediate-release, granule formulation of hydrocortisone with taste masking. STUDY DESIGN: Single site with satellites attended by a "flying" doctor from investigator site. Open-label, single-dose study in three consecutive child cohorts (n = 24) with AI; Cohort 1, children aged 2 to <6 years (n = 12); Cohort 2, infants aged 28 days to <2 years (n = 6); Cohort 3, neonates aged 1 to <28 days (n = 6)...
August 16, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28812008/evaluation-of-adrenal-function-in-nonhospitalized-patients-with-cirrhosis
#15
Maryam Moini, Mitra Yazdani Sarvestani, Mesbah Shams, Masood Nomovi
BACKGROUND: Patients with cirrhosis and advancing hepatic insufficiency may show various degrees of other organ malfunction, including brain, kidney, and lung. Several studies have also shown a high prevalence of adrenal insufficiency in cirrhotic patients that may cause hemodynamic instability. MATERIALS AND METHODS: In this study we prospectively evaluated adrenal function in a population of nonhospitalized cirrhotic patients. Categorization of liver disease severity was done according to model for end-stage liver disease (MELD) score...
2017: Canadian Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28750490/secondary-adrenal-insufficiency-from-the-physiopathology-to-the-possible-role-of-modified-release-hydrocortisone-treatment
#16
Rosa M Paragliola, Salvatore M Corsello
Central adrenal insufficiency represents a life-threatening disorder that results from a reduced cortisol production due to an impairment production of adrenocorticotropic hormone. In particular, secondary AI results from pituitary disease that impedes the release of ACTH, while tertiary adrenal insufficiency is caused from an impaired synthesis of corticotropin-releasing hormone. Central adrenal insufficiency has an estimated prevalence of 150-280 per million, resulting more common than primary AI. Prompt diagnosis and management of this condition is crucial, but the diagnostic investigation can often be challenging, in particular in cases of recent onset of secondary adrenal insufficiency...
July 27, 2017: Minerva Endocrinologica
https://www.readbyqxmd.com/read/28730418/total-and-free-cortisol-levels-during-1-%C3%AE-g-25-%C3%AE-g-and-250-%C3%AE-g-cosyntropin-stimulation-tests-compared-to-insulin-tolerance-test-results-of-a-randomized-prospective-pilot-study
#17
Seenia Peechakara, James Bena, Nigel J Clarke, Michael J McPhaul, Richard E Reitz, Robert J Weil, Pablo Recinos, Laurence Kennedy, Amir H Hamrahian
PURPOSE: The appropriate cosyntropin dose during cosyntropin stimulation tests remains uncertain. We conducted a prospective, randomized pilot study to compare 1 μg IV low dose cosyntropin test, 25 μg IM medium dose cosyntropin test, and 250 μg IM standard dose cosyntropin test to evaluate secondary adrenal insufficiency. Insulin tolerance test was used as the gold standard. METHOD: The study included patients with hypothalamic/pituitary disease (n  = 10) with at least one pituitary axis deficiency other than ACTH deficiency and controls (n  = 12)...
July 20, 2017: Endocrine
https://www.readbyqxmd.com/read/28686664/somatosensory-function-in-patients-with-secondary-adrenal-insufficiency-treated-with-two-different-doses-of-hydrocortisone-results-from-a-randomized-controlled-trial
#18
RANDOMIZED CONTROLLED TRIAL
Jorien Werumeus Buning, Karl-Heinz Konopka, Pauline Brummelman, Janneke Koerts, Robin P F Dullaart, Gerrit van den Berg, Melanie M van der Klauw, Oliver Tucha, Bruce H R Wolffenbuttel, André P van Beek
BACKGROUND: Low cortisol levels are associated with several functional pain syndromes. In patients with secondary adrenal insufficiency (SAI), the lack in endogenous cortisol production is substituted by the administration of oral hydrocortisone (HC). Our previous study showed that a lower dose of HC led to an increase in reported subjective pain symptoms. Whether different doses of HC substitution alter somatosensory functioning in SAI patients has not been established yet. METHODS: In this randomized double blind cross-over trial, forty-six patients with SAI participated...
2017: PloS One
https://www.readbyqxmd.com/read/28661901/long-term-and-late-treatment-consequences-endocrine-and-metabolic-effects
#19
Thang S Han, Helena K Gleeson
PURPOSE OF REVIEW: Cancer therapies often result in the 'late effect of cancer treatment' whereby secondary health complications emerge years after radiotherapy and chemotherapy. This review focuses on endocrine and metabolic consequences in adult cancer survivors as late treatment effects. RECENT FINDINGS: Endocrine and metabolic disorders are among the most common late effects. Endocrine disorders include hypopituitarism, which leads to growth hormone deficiency, hypogonadism, adrenal insufficiency and hypothyroidism and related clinical manifestations...
September 2017: Current Opinion in Supportive and Palliative Care
https://www.readbyqxmd.com/read/28614010/diagnostic-accuracy-of-basal-cortisol-level-to-predict-adrenal-insufficiency-in-cosyntropin-testing-results-from-an-observational-cohort-study-with-804-patients
#20
Tristan Struja, Leonie Briner, Aline Meier, Alexander Kutz, Esther Mundwiler, Andreas Huber, Beat Mueller, Luca Bernasconi, Philipp Schuetz
OBJECTIVE: Adrenocorticotrophic hormone (ACTH) stimulation testing is the current standard for assessing primary and secondary adrenal insufficiency (AI). We aimed to investigate the value of basal cortisol level for prediction of AI. METHODS: We retrospectively analyzed 804 consecutive patients who had high-dose (250 μg, HDT) or low-dose (1 μg, LDT) ACTH testing as part of their diagnostic work-up. Site-specific cut-off levels for AI were <550 in and <500 nmol/L in HDT and LDT, respectively...
August 2017: Endocrine Practice
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