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Cosyntropin

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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
#1
Tristan Struja, Leonie Briner, Aline Meier, Alexander Kutz, Esther Mundwiler, Andreas Huber, Beat Mueller, Luca Bernasconi, Philipp Schuetz
CONTEXT: ACTH stimulation testing is the current standard for the assessment of 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 (250μg, HDT) or low-dose (1μg, LDT) ACTH testing as part of their diagnostic work-up. Site-specific cut-off levels for AI were <550 in HDT and <500nmol/L in LDT, respectively...
June 14, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28584010/androstenedione-and-17-%C3%AE-hydroxyprogesterone-are-better-indicators-of-adrenal-vein-sampling-selectivity-than-cortisol
#2
Giulio Ceolotto, Giorgia Antonelli, Giuseppe Maiolino, Maurizio Cesari, Giacomo Rossitto, Valeria Bisogni, Mario Plebani, Gian Paolo Rossi
For identification of potentially surgically curable primary aldosteronism, guidelines recommend use of adrenal vein sampling (AVS) that requires selective catheterization of both adrenal veins as verified by using the cortisol-derived selectivity index. Unfortunately, bilaterally selective studies are not obtained under unstimulated conditions in a proportion of the cases ranging between 15% and 50% depending on the cutoff used. We therefore investigated whether 17-α-hydroxyprogesterone and androstenedione, which showed a higher step-up between adrenal vein and inferior vena cava blood than cortisol, can ascertain selectivity when cortisol failed to do so...
June 5, 2017: Hypertension
https://www.readbyqxmd.com/read/28582566/non-classic-congenital-adrenal-hyperplasia-due-to-21-hydroxylase-deficiency-revisited-an-update-with-a-special-focus-on-adolescent-and-adult-women
#3
Enrico Carmina, Didier Dewailly, Héctor F Escobar-Morreale, Fahrettin Kelestimur, Carlos Moran, Sharon Oberfield, Selma F Witchel, Ricardo Azziz
BACKGROUND: Non-classic congenital hyperplasia (NCAH) due to 21-hydroxylase deficiency is a common autosomal recessive disorder characterized by androgen excess. OBJECTIVE AND RATIONALE: We conducted a systematic review and critical assessment of the available evidence pertaining to the epidemiology, pathophysiology, diagnosis and management of NCAH. A meta-analysis of epidemiological data was also performed. SEARCH METHODS: Peer-reviewed studies evaluating NCAH published up to October 2016 were reviewed...
June 5, 2017: Human Reproduction Update
https://www.readbyqxmd.com/read/28576284/congenital-adrenal-hyperplasia
#4
REVIEW
Diala El-Maouche, Wiebke Arlt, Deborah P Merke
Congenital adrenal hyperplasia is a group of autosomal recessive disorders encompassing enzyme deficiencies in the adrenal steroidogenesis pathway that lead to impaired cortisol biosynthesis. Depending on the type and severity of steroid block, patients can have various alterations in glucocorticoid, mineralocorticoid, and sex steroid production that require hormone replacement therapy. Presentations vary from neonatal salt wasting and atypical genitalia, to adult presentation of hirsutism and irregular menses...
May 30, 2017: Lancet
https://www.readbyqxmd.com/read/28530018/performance-of-low-dose-cosyntropin-stimulation-test-handled-via-plastic-tube
#5
Leonard Saiegh, Asala Abu-Ahmad, Mohammad Sheikh-Ahmad, Maria Reut, Limor Chen-Konak, Nizar Jiries, Carmela Shechner
PURPOSE: Studies on 1 μg low-dose test showed that among 1 μg cosyntropin samples pushed through long IV plastic tubing, some adrenocorticotropic hormone dosage was not recovered, and in healthy volunteers it provided subnormal cortisol responses. The aim of the current study is to assess whether there is any loss in adrenocorticotropic hormone 1-24 concentration when pushed through a short plastic tube, and to assess serum and salivary cortisol responses in low-dose test among healthy volunteers, using a similar short plastic tube vs...
May 22, 2017: Endocrine
https://www.readbyqxmd.com/read/28445897/adrenal-vein-catecholamine-levels-and-ratios-reference-intervals-derived-from-patients-with-primary-aldosteronism
#6
Candy W C Sze, Samuel Matthew O'Toole, Roger Kent Tirador, Scott A Akker, Matthew Matson, Leslie Perry, Maralyn Rose Druce, Tanja Dekkers, Jaap Deinum, Jacques W M Lenders, Graeme Eisenhofer, William Martyn Drake
Phaeochromocytoma localisation is generally reliably achieved with modern imaging techniques, particularly in sporadic cases. On occasion, however, there can be diagnostic doubt due to the presence of bilateral adrenal abnormalities, particularly in patients with mutations in genes predisposing them to the development of multiple phaeochromocytomas. In such cases, surgical intervention is ideally limited to large or functional lesions due to the long-term consequences associated with hypoadrenalism. Adrenal venous sampling (AVS) for catecholamines has been used in this situation to guide surgery, although there are few data available to support diagnostic thresholds...
April 26, 2017: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
https://www.readbyqxmd.com/read/28332876/evaluation-and-management-of-adrenal-insufficiency-in-critically-ill-patients-disease-state-review
#7
Amir H Hamrahian, Maria Fleseriu
OBJECTIVE: The definition of normal adrenal function in critically ill patients remains controversial, despite a large body of literature. We review the clinical presentation, diagnosis, and treatment of adrenal insufficiency in critically ill patients and discuss the authors' personal approach to patient management. METHODS: Extensive literature review, guidelines from professional societies, and personal experience. RESULTS: A decrease in cortisol breakdown rather than an increase in cortisol production has been suggested as the main contributor to elevated cortisol levels in critically ill patients...
June 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28288009/update-on-adrenal-insufficiency-diagnosis-and-management-in-pregnancy
#8
Fabienne Langlois, Dawn S T Lim, Maria Fleseriu
PURPOSE OF REVIEW: Adrenal insufficiency in pregnancy, although relatively rare, has significant clinical implications on both maternal and fetal outcomes. Hypothalamo-pituitary-adrenal axis dynamics and physiological changes are complex, thus diagnosis and management of adrenal insufficiency in pregnancy remain challenging. RECENT FINDINGS: Studies consistently demonstrate a rise in total serum cortisol with pregnancy, but less data are available on free cortisol levels...
June 2017: Current Opinion in Endocrinology, Diabetes, and Obesity
https://www.readbyqxmd.com/read/28151588/safety-of-long-term-intranasal-budesonide-delivered-via-the-mucosal-atomization-device-for-chronic-rhinosinusitis
#9
Jamil Manji, Gurkaran Singh, Christopher Okpaleke, Anali Dadgostar, Fahad Al-Asousi, Ameen Amanian, Luis Macias-Valle, Andres Finkelstein, Mark Tacey, Andrew Thamboo, Amin Javer
BACKGROUND: Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP). METHODS: A cross-sectional study of patients with chronic rhinosinusitis (CRS), with or without nasal polyposis, managed with daily nasal budesonide via MAD was conducted at a tertiary rhinology center...
May 2017: International Forum of Allergy & Rhinology
https://www.readbyqxmd.com/read/28024808/total-and-free-cortisol-responses-and-their-relation-to-outcomes-after-cardiopulmonary-bypass-in-infants
#10
Eric L Wald, Carl L Backer, Joseph A Dearani, Zhuo Li, William C Oliver, Sheri S Crow
BACKGROUND: Hypothalamic-pituitary-adrenal (HPA) axis dysfunction may be partially responsible for the hemodynamic instability experienced by infants after cardiopulmonary bypass (CPB). We report the full spectrum of the HPA response surrounding CPB for infant congenital cardiac surgery. METHODS: We enrolled 84 infants who received 1 mg/kg of dexamethasone before initiation of CPB. Total cortisol (TC), free cortisol (FC), adrenocorticotropic hormone (ACTH), and corticosteroid-binding globulin (CBG) were measured at 3 time points: immediately before CPB (TP1), on intensive care unit arrival (TP2), and at 24 hours after surgery (TP3)...
May 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27888772/adrenocortical-sensitivity-moderated-by-ongoing-stress-predicts-drinking-intensity-in-alcohol-dependent-men
#11
Bryon Adinoff, David Leonard, Julianne Price, Martin A Javors, Robrina Walker, E Sherwood Brown, Hong Xiao, Uma Rao
Allostatic load from both environmental stressors and persistent glucocorticoid secretion has been associated with disease severity in alcohol dependence. Heightened relapse risk and/or drinking severity, in particular, may be a reaction to alcohol- and withdrawal-induced changes in physiological stress response systems coupled with ongoing life stress, although their shared contributions upon drinking severity have not been assessed. To investigate the combined contribution of hypothalamic-pituitary-adrenal (HPA) reactivity and environmental stressors (e...
February 2017: Psychoneuroendocrinology
https://www.readbyqxmd.com/read/27878800/a-single-centre-experience-of-the-implementation-of-adrenal-vein-sampling-procedure-the-impact-on-the-diagnostic-work-up-in-primary-aldosteronism
#12
Jacek Kądziela, Aleksander Prejbisz, Ilona Michałowska, Sylwia Kołodziejczyk-Kruk, Leo Schultze Kool, Marek Kabat, Hanna Janaszek-Sitkowska, Sadegh Toutounchi, Zbigniew Gałązka, Urszula Ambroziak, Tomasz Bednarczuk, Dorota Ptasińska-Wnuk, Michał Hoffmann, Magdalena Januszewicz, Andrzej Januszewicz, Adam Witkowski
BACKGROUND: Primary aldosteronism is one of the most common causes of secondary hypertension. Adrenal vein sampling (AVS) remains a "gold standard" procedure in differentiation between unilateral (adenoma) and bilateral (hyperplasia) disease. AIM: The aim of this study was to present our single-centre experience in establishing and implementating the AVS procedure. METHODS: All patients had primary aldosteronism confirmed in a salt-infusion test...
2017: Kardiologia Polska
https://www.readbyqxmd.com/read/27861246/adrenal-venous-sampling-in-primary-aldosteronism-multinomial-regression-modeling-to-detect-aldosterone-secretion-lateralization-when-right-adrenal-sampling-is-missing
#13
Camille Durivage, Rémi Blanchette, Gilles Soulez, Miguel Chagnon, Patrick Gilbert, Marie-France Giroux, Isabelle Bourdeau, Vincent L Oliva, André Lacroix, Eric Therasse
OBJECTIVE: Difficulty to recognize or canulate the right adrenal vein is the most frequent cause of adrenal venous sampling (AVS) failure. We aimed to assess multinomial regression modeling (MRM) of peripheral and left adrenal vein samplings to detect lateralization of aldosterone secretion when the right AVS is missing. METHODS: Simultaneous bilateral AVS samplings were performed before (basal) and after intravenous cosyntropin injection in 188 consecutive patients between December 1989 and September 2015...
February 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/27852811/adrenal-function-in-cats-with-cholestatic-liver-disease
#14
Faith I Buckley, Orla Mahony, Cynthia R L Webster
Cats with cholestatic liver disease experience significant morbidity and mortality when they undergo invasive procedures under anesthesia. Although inadequate adrenal response might account for these outcomes, adrenal function in cats with cholestatic liver disease has not been documented, to our knowledge. The goal of our study was to describe adrenal function in these cats. Twenty-seven cats with a serum bilirubin >230 µmol/L (3 mg/dL) and serum alanine aminotransferase >2 times the upper limit of normal had pre- and 60-min post-adrenocorticotropic hormone (ACTH) cortisol analysis after administration of 5 µg/kg cosyntropin intravenously...
January 2017: Journal of Veterinary Diagnostic Investigation
https://www.readbyqxmd.com/read/27798546/evaluation-of-early-corticosteroid-therapy-in-management-of-pediatric-septic-shock-in-pediatric-intensive-care-patients-a-randomized-clinical-study
#15
RANDOMIZED CONTROLLED TRIAL
Ahmed El-Nawawy, Doaa Khater, Heba Omar, Yasser Wali
BACKGROUND: Septic shock is a major healthcare problem. Adrenal insufficiency (AI) in children with septic shock is a recognized complication, yet is controversial regarding its management and effect on mortality. According to the current guidelines, children with risk factors for AI should receive a stress dose of steroids in step 3 of treatment. This study aimed to evaluate and compare early corticosteroid therapy with the traditional use of steroids among pediatric septic shock patients...
February 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/27797844/bilateral-primary-adrenal-lymphoma-with-adrenal-insufficiency
#16
Aishah Ekhzaimy, Ahmad Mujamammi
Primary adrenal lymphoma is an extremely rare condition. We describe a case of bilateral adrenal lymphoma in a man aged 55 years who was admitted to our hospital. He had a 3-month history of left flank pain, nausea and vomiting with weight loss. A CT scan at a private hospital revealed bilateral large adrenal masses; the patient was referred to our centre based on these findings. He was evaluated for pheochromocytoma by an endocrinology team; however, all findings were negative. In addition, a cosyntropin stimulation test indicated adrenal insufficiency...
October 26, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27779350/adrenal-insufficiency-in-neonates-after-cardiac-surgery-with-cardiopulmonary-bypass
#17
Jack H Crawford, Matthew S Hull, Santiago Borasino, Brad L Steenwyk, Kristal M Hock, Kevin Wall, Jeffrey A Alten
BACKGROUND: Cardiopulmonary bypass (CPB) may lead to adrenal insufficiency (AI). Emerging evidence supports association of AI with morbidity after cardiac surgery. AIMS: The aim of this study was to define AI incidence in neonates undergoing complex cardiac surgery with CPB and its association with intraoperative post-CPB outcomes. METHODS: Forty subjects enrolled in a prior randomized control trial who received preoperative methylprednisolone as part of our institutional neonatal bypass protocol were included...
January 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27631398/myxedema-coma-secondary-to-central-hypothyroidism-a-rare-but-real-cause-of-altered-mental-status-in-pediatrics
#18
Michael D Thompson, Rohan K Henry
BACKGROUND: Myxedema coma (MC), a medical emergency defined as severe hypothyroidism leading to altered mental status, is more common in older women with hypothyroidism. METHODS/RESULTS: A 7-year-old Caucasian male with chromosome 1q deletion presented with altered mental status preceded by milestone regression. His presenting labs results were: thyroid-stimulating hormone (TSH) 0.501 μIU/ml and free thyroxine (T4) <0.5 ng/dl. His morning cortisol level was 8...
2017: Hormone Research in Pædiatrics
https://www.readbyqxmd.com/read/27537994/adrenal-suppression-with-chronic-topical-corticosteroid-use-in-psoriasis-patients
#19
Lisa H Lam, Jeffrey L Sugarman
BACKGROUND: Topical corticosteroids (TCS) are typically used for extended periods of time for chronic skin conditions, including psoriasis. Chronic TCS use may result in side effects similar to those of systemic corticosteroids. Patients may have subclinical adrenal suppression and be unaware of their risk in the case of serious trauma.<BR /> OBJECTIVE: The objective of this study was to investigate the real world effects of chronic TCS use and its effects on adrenal suppression in a chronic disease such as psoriasis...
August 1, 2016: Journal of Drugs in Dermatology: JDD
https://www.readbyqxmd.com/read/27474252/reassessment-of-the-cosyntropin-stimulation-test-in-the-confirmatory-diagnosis-and-subtype-classification-of-primary-aldosteronism
#20
Hironobu Umakoshi, Yang Xiaomei, Takamasa Ichijo, Kohei Kamemura, Yuichi Matsuda, Yuichi Fujii, Tatsuya Kai, Tomikazu Fukuoka, Ryuichi Sakamoto, Atsushi Ogo, Tomoko Suzuki, Tatsuki Ogasawara, Mika Tsuiki, Mitsuhide Naruse
OBJECTIVE: Although corticotropin is a representative secretagogue of aldosterone, the utility of the cosyntropin stimulation test (C-ST) in diagnosing primary aldosteronism (PA) has not been elucidated. Aim of the study was to evaluate the clinical utility of C-ST for confirmatory testing and subtype classification of PA. DESIGN, SETTING AND PATIENTS: In this retrospective study, we identified patients with hypertension and positive case-detection results for PA who underwent C-ST and saline infusion testing (SIT) between 2006 and 2013 at eight referral centres in Japan...
July 30, 2016: Clinical Endocrinology
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