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https://www.readbyqxmd.com/read/28820232/recognizing-and-managing-adrenal-disorders-in-the-emergency-department
#1
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/28819949/addison-s-disease-concomitant-with-corticotropin-deficiency-and-pituitary-crh-resistance-a-case-report
#2
Krzysztof C Lewandowski, Katarzyna Malicka, Katarzyna Dąbrowska, Andrzej Lewiński
A 36-year-old woman was found to have a low morning ACTH concentration despite a history of Addison's disease. Past medical history: At the age of 23 years the subject developed Graves's disease, which was treated with radioiodine. At about the same time, she claimed to have two episodes of pancreatitis treated with cholecystectomy. About seven months later she was euthyroid on L-thyroxine (TSH 1.51 mIU/mL) but was admitted with hypotension, hyponatraemia (sodium 109 mmol/L), and low morning cortisol (119 nmol/L)...
2017: Endokrynologia Polska
https://www.readbyqxmd.com/read/28817507/comparison-of-consent-models-in-a-randomized-trial-of-corticosteroids-in-pediatric-septic-shock
#3
Kusum Menon, Katharine O'Hearn, James Dayre McNally, Anand Acharya, Hector R Wong, Margaret Lawson, Tim Ramsay, Lauralyn McIntyre, Elaine Gilfoyle, Marisa Tucci, David Wensley, Ronald Gottesman, Gavin Morrison, Karen Choong
OBJECTIVES: To describe the use of deferred and prior informed consent models in the context of a low additional risk to standard of care, placebo-controlled randomized controlled trial of corticosteroids in pediatric septic shock. DESIGN: An observational substudy of consent processes in a randomized controlled trial of hydrocortisone versus placebo. SETTING: Seven tertiary level PICUs in Canada. PATIENTS: Children newborn to 17 years inclusive admitted to PICU with suspected septic shock between July 2014 and March 2016...
August 16, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28815660/absorption-and-tolerability-of-taste-masked-hydrocortisone-granules-in-neonates-infants-and-children-under-6-years-of-age-with-adrenal-insufficiency
#4
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/28815318/-adrenal-crisis
#5
REVIEW
S Burger-Stritt, S Hahner
Patients with chronic adrenal insufficiency suffer from reduced quality of life and increased mortality. An association between mortality and adrenal crisis is assumed. The frequency of adrenal crisis is about 8/100 patient years. The main causes are infectious disease. Pathophysiology is poorly understood to date. An association with an exaggerated inflammatory response due to a lack of glucocorticoid modulation as well as mineralocorticoid deficiency and diminished adrenomedullary function are discussed. The therapy of adrenal crisis includes prompt parenteral administration of hydrocortisone combined with isotonic saline...
August 16, 2017: Der Internist
https://www.readbyqxmd.com/read/28803907/cu-sensing-transcription-factor-mac1-coordinates-with-the-ctr-transporter-family-to-regulate-cu-acquisition-and-virulence-in-aspergillus-fumigatus
#6
Zhendong Cai, Wenlong Du, Qiuqiong Zeng, Nanbiao Long, Chuanchao Dai, Ling Lu
Copper (Cu) is an essential trace element and is regarded as an important virulence factor in fungal pathogens. Previous studies suggest that a putative Cu-sensing transcription factor Mac1 and the Cu transporter Ctr family play important roles during fungal development and virulence. However, how Cu importers of the Ctr family are involved in the Cu acquisition and what is the functional relationship between them have not been fully investigated yet. Here, we demonstrate that the yeast Mac1 homolog in the opportunistic human pathogen Aspergillus fumigatus is required during colony development under low Cu conditions...
August 10, 2017: Fungal Genetics and Biology: FG & B
https://www.readbyqxmd.com/read/28802067/crh-stimulation-tests-for-the-infants-with-relative-adrenal-insufficiency
#7
Kougoro Iwanaga, Akane Yamamoto, Takashi Matsukura, Fusako Niwa, Masahiko Kawai
BACKGROUND: Very low birth weight (VLBW) infants are considered to be vulnerable to relative adrenal insufficiency (RAI); however, diagnosis is difficult in some clinical settings. Considering this background, it is necessary to establish a diagnosis of RAI in preterm infants. OBJECTIVE: In this study, we attempted to clarify the difference in response to CRH stimulation tests for preterm infants with or without RAI. METHODS: Between June 2009 and December 2015, we performed CRH stimulation tests for preterm infants born at a gestational age of <30 weeks at around two weeks of age...
August 12, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28798409/using-blubber-explants-to-investigate-adipose-function-in-grey-seals-glycolytic-lipolytic-and-gene-expression-responses-to-glucose-and-hydrocortisone
#8
Kimberley A Bennett, Kelly J Robinson, Simon E W Moss, Sebastian Millward, Ailsa J Hall
Adipose tissue is fundamental to energy balance, which underpins fitness and survival. Knowledge of adipose regulation in animals that undergo rapid fat deposition and mobilisation aids understanding of their energetic responses to rapid environmental change. Tissue explants can be used to investigate adipose regulation in wildlife species with large fat reserves, when opportunities for organismal experimental work are limited. We investigated glucose removal, lactate, glycerol and NEFA accumulation in media, and metabolic gene expression in blubber explants from wild grey seals...
August 10, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28794358/the-clinical-and-hormonal-characteristics-of-primary-adrenal-lymphomas-the-necessity-of-early-detection-of-adrenal-insufficiency
#9
Ko Harada, Kosuke Kimura, Masaya Iwamuro, Tomohiro Terasaka, Yoshihisa Hanayama, Eisei Kondo, Eiko Hayashi, Tadashi Yoshino, Fumio Otsuka
Objective To analyze the clinical and endocrine characteristics of patients with primary adrenal lymphoma. Patients We retrospectively reviewed the cases of five patients with primary adrenal lymphoma who were treated in our hospital between April 2004 and March 2015. We investigated the characteristics of the clinical and pathological findings, treatment, prognosis and complications of adrenal insufficiency. Results Adrenal insufficiency, which was confirmed by the laboratory data at the initial presentation, was observed in two cases...
August 10, 2017: Internal Medicine
https://www.readbyqxmd.com/read/28791300/effect-of-glucocorticoids-on-ultrastructure-of-myocardial-muscle-in-the-course-of-experimentally-induced-acute-myocardial-ischemia
#10
Piotr Kuropka, Maciej Dobrzyński, Andrzej Gamian, Kinga Gostomska-Pampuch, Jan Kuryszko, Ireneusz Całkosiński
The search for effective methods of myocardial cytoprotection against ischemia is the most significant issue in modern cardiology and cardiac surgery. Glucocorticoids are deemed very strong modulators of inflammatory response and thus can potentially protect heart muscle from postreperfusion injury and myocardial ischemia during cardiac surgery. Ultrastructural examination of the left ventricle heart samples revealed that the intravenous application of dexamethasone and hydrocortisone proved to exert cytoprotective effect on cardiomyocytes during experimentally induced acute ischemia in rats...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28776753/assessment-of-the-involvement-of-the-macrophage-migration-inhibitory-factor-glucocorticoid-regulatory-dyad-in-the-expression-of-matrix-metalloproteinase-2-during-periodontitis
#11
Josefine Hirschfeld, Mohammed Howait, Alexandru Movila, Marijo Parčina, Isabelle Bekeredjian-Ding, James Deschner, Søren Jepsen, Toshihisa Kawai
Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine and counter-regulator of endogenous glucocorticoids (GCs). It is implicated in acute and chronic inflammatory diseases. This study investigated the role of the MIF-GC regulatory dyad in the expression and release of matrix metalloproteinase-2 (MMP-2) during periodontitis, in vivo and in vitro. In a Mif-knockout (KO) mouse model of ligature-induced periodontitis, gingival tissues and blood were collected and analysed for levels of interleukin-6 (IL-6), MIF, MMP-2, and corticosterone...
August 4, 2017: European Journal of Oral Sciences
https://www.readbyqxmd.com/read/28774370/-recurrent-anorexia-and-pigmentation-of-skin-for-more-than-two-months-in-an-infant
#12
Zhang-Qian Zheng, Bing-Bing Wu, Miao-Ying Zhang, Wei Lu, Fei-Hong Luo
A 2-month-old boy presented with adrenal insufficiency, impaired liver function, hypertriglyceridemia, significantly elevated creatine kinase and electrolyte disturbance. Microarray comparative genomic hybridization (aCGH) analysis test showed a pathogenic 8.7 Mb deletion in the short arm of chromosome X (Xp21.3 - p21.1) and confirmed the diagnosis of complex glycerol kinase deficiency (cGKD). He was treated with hydrocortisone, coenzyme Q10 and L-carnitine and was subsequently followed up for 4 years. His serum cortisol levels returned to normal one week later after treatment, but the serum creatine kinase, triglyceride and aminotransferase levels were progressively increased along with mental retardation and decreased muscular strength...
August 2017: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
https://www.readbyqxmd.com/read/28771930/parental-management-of-adrenal-crisis-in-children-with-congenital-adrenal-hyperplasia
#13
Louise Fleming, Kathleen Knafl, George Knafl, Marcia Van Riper
PURPOSE: Congenital adrenal hyperplasia (CAH) requires parents to inject their child with hydrocortisone intramuscularly during times of illness and adrenal crisis. The purpose of this study was to describe circumstances surrounding adrenal crisis events in children with CAH; to explore parents' perceptions of the consequences of having a child with a life-threatening condition; and to examine a relationship between parents' perceived management ability and the impact CAH has on the family...
August 3, 2017: Journal for Specialists in Pediatric Nursing: JSPN
https://www.readbyqxmd.com/read/28768499/simultaneous-primary-invasive-cutaneous-aspergillosis-in-two-preterm-twins-case-report-and-review-of-the-literature
#14
Floriane Gallais, Julie Denis, Olfa Koobar, Laurence Dillenseger, Dominique Astruc, Raoul Herbrecht, Ermanno Candolfi, Valérie Letscher-Bru, Marcela Sabou
BACKGROUND: Primary invasive cutaneous aspergillosis is a rare fungal infection that occurs mostly in immunocompromised patients. Newborns of very low birth weight present a high risk for this type of infection due to an immaturity of the cutaneous barrier and of the immune system. CASE PRESENTATION: We describe here a case of simultaneous invasive cutaneous aspergillosis in two preterm twins. Two male preterm bichorionic biamniotic twins (A & B) were born at a general hospital by spontaneous normal delivery at 24 weeks and 6 days of gestation...
August 2, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28764794/exploration-of-knowledge-and-understanding-in-patients-with-primary-adrenal-insufficiency-a-mixed-methods-study
#15
L M Shepherd, A A Tahrani, C Inman, W Arlt, D M Carrick-Sen
BACKGROUND: Primary adrenal insufficiency (PAI) is a rare and severe condition requiring lifelong steroid replacement. During acute illness or stressful events, it is important to appropriately adjust glucocorticoid dose; failure to do so may lead to an adrenal crisis. The aim of the study was to explore patients PAI knowledge and understanding of the condition, steroid replacement adjustment during acute illness or stress and provided education. METHODS: Ten adult patients with PAI were purposefully recruited from two hospitals in a tertiary NHS Trust in England, UK...
August 1, 2017: BMC Endocrine Disorders
https://www.readbyqxmd.com/read/28762136/predicting-cortisol-exposure-from-paediatric-hydrocortisone-formulation-using-a-semi-mechanistic-pharmacokinetic-model-established-in-healthy-adults
#16
Johanna Melin, Zinnia P Parra-Guillen, Niklas Hartung, Wilhelm Huisinga, Richard J Ross, Martin J Whitaker, Charlotte Kloft
BACKGROUND AND OBJECTIVE: Optimisation of hydrocortisone replacement therapy in children is challenging as there is currently no licensed formulation and dose in Europe for children under 6 years of age. In addition, hydrocortisone has non-linear pharmacokinetics caused by saturable plasma protein binding. A paediatric hydrocortisone formulation, Infacort(®) oral hydrocortisone granules with taste masking, has therefore been developed. The objective of this study was to establish a population pharmacokinetic model based on studies in healthy adult volunteers to predict hydrocortisone exposure in paediatric patients with adrenal insufficiency...
July 31, 2017: Clinical Pharmacokinetics
https://www.readbyqxmd.com/read/28761822/optimization-of-chitosan-and-cellulose-acetate-phthalate-controlled-delivery-of-methylprednisolone-for-treatment-of-inflammatory-bowel-disease
#17
Swati Jagdale, Apoorva Chandekar
Purpose: Inflammatory bowel disease (IBD) is a chronic, relapsing and often life-long disorder. The best way to tackle IBD is to develop a site targeted drug delivery. Methylprednisolone is a potent anti-inflammatory steroid. The relative potency of methylprednisolone to hydrocortisone is at least four is to one. The aim of the present research was to develop a colon targeted drug delivery for treatment of IBD. Methods: Compression coated drug delivery system was designed and optimised. Core tablet contained drug, croscarmellose sodium (CCS-superdisintegrant), avicel (binder) and dicalcium phosphate (diluent)...
June 2017: Advanced Pharmaceutical Bulletin
https://www.readbyqxmd.com/read/28759180/central-hypoadrenocorticism-associated-with-rathke-s-cleft-cyst
#18
Fumika Kawano, Tomoyo Itonaga, Masanori Inoue, Miwako Maeda, Hiroaki Miyahara, Kenji Ihara
Rathke's cleft cysts (RCCs) are non-neoplastic, sellar or suprasellar epithelium-lined cysts originating from Rathke's pouch in the pituitary gland. Patients with RCCs are usually asymptomatic, but some have only been identified when symptoms manifested in middle age. The characteristics of these patients during childhood or adolescence remains unknown. We describe an 18-year-old girl who had occasionally suffered from malicious fatigue in the morning since her early teens. Brain magnetic resonance imaging (MRI) revealed T1 hyperintense/T2 hypointense signals between the anterior and posterior pituitary glands, indicating the presence of RCC...
July 2, 2017: Neuro Endocrinology Letters
https://www.readbyqxmd.com/read/28752430/integrated-gut-and-liver-microphysiological-systems-for-quantitative-in-vitro-pharmacokinetic-studies
#19
Nikolaos Tsamandouras, Wen Li Kelly Chen, Collin D Edington, Cynthia L Stokes, Linda G Griffith, Murat Cirit
Investigation of the pharmacokinetics (PK) of a compound is of significant importance during the early stages of drug development, and therefore several in vitro systems are routinely employed for this purpose. However, the need for more physiologically realistic in vitro models has recently fueled the emerging field of tissue-engineered 3D cultures, also referred to as organs-on-chips, or microphysiological systems (MPSs). We have developed a novel fluidic platform that interconnects multiple MPSs, allowing PK studies in multi-organ in vitro systems along with the collection of high-content quantitative data...
July 27, 2017: AAPS Journal
https://www.readbyqxmd.com/read/28750490/secondary-adrenal-insufficiency-from-the-physiopathology-to-the-possible-role-of-modified-release-hydrocortisone-treatment
#20
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
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