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https://www.readbyqxmd.com/read/28332876/evaluation-and-management-of-adrenal-insufficiency-in-critically-ill-patientsdisease-state-review
#1
Amir H Hamrahian, Maria Fleseriu
Definition of normal adrenal function in critically ill patients remains controversial, despite a large body of literature. Furthermore, evaluation of adrenal function in these patients is complex. 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. The concept of relative adrenal insufficiency has multiple pathophysiological flaws and is not supported by current evidence. Patients with septic shock who are pressor-dependent or refractory to fluid resuscitation should receive a short course of hydrocortisone regardless of their serum cortisol levels or their response to a Cosyntropin stimulation test (CST)...
March 23, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28288009/update-on-adrenal-insufficiency-diagnosis-and-management-in-pregnancy
#2
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...
March 10, 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
#3
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...
February 2, 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
#4
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)...
November 21, 2016: 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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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...
September 16, 2016: Hormone Research in Pædiatrics
https://www.readbyqxmd.com/read/27537994/adrenal-suppression-with-chronic-topical-corticosteroid-use-in-psoriasis-patients
#13
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
#14
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
https://www.readbyqxmd.com/read/27425787/comparison-of-2-doses-for-acth-stimulation-testing-in-dogs-suspected-of-or-treated-for-hyperadrenocorticism
#15
C Aldridge, E N Behrend, R J Kemppainen, T M Lee-Fowler, L G Martin, C R Ward, D Bruyette, J Pannu, P Gaillard, H P Lee
BACKGROUND: Lowering the cosyntropin dose needed for ACTH stimulation would make the test more economical. OBJECTIVES: To compare the cortisol response to 1 and 5 μg/kg cosyntropin IV in dogs being screened for hyperadrenocorticism (HAC) and in dogs receiving trilostane or mitotane for pituitary-dependent HAC. ANIMALS: Healthy dogs (n = 10); client-owned dogs suspected of having HAC (n = 39) or being treated for pituitary-dependent HAC with mitotane (n = 12) or trilostane (n = 15)...
September 2016: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/27259503/enhanced-cosyntropin-stimulation-test-performance-enabled-by-electronic-medical-record
#16
Anat Ben-Shlomo, Joseph Guzman, James Mirocha
PURPOSE: To improve performance of the cosyntropin stimulation test (CST) used for diagnosis of adrenal-cortisol insufficiency by implementing an electronic medical record (EMR) system protocol. METHODS: We implemented a SmartForm protocol of the validated CST in our EMR system (CS-Link™, EPIC) system and compared medical staff test performance before and after protocol implementation. RESULTS: Correct performance of the CST improved significantly after EMR implementation...
October 2016: Pituitary
https://www.readbyqxmd.com/read/27119749/diagnostic-criteria-for-adrenal-venous-sampling
#17
Olivier Steichen, Laurence Amar
PURPOSE OF REVIEW: Primary aldosteronism accounts for 3 to 5% of all hypertension cases. Unilateral aldosterone hypersecretion can be treated with adrenalectomy. Guidelines for primary aldosteronism management recommend adrenal vein sampling (AVS) to ascertain unilateral primary aldosteronism before surgery. Many different protocols are used to perform AVS and for the interpretation of its results, but without hard evidence of why one should be given preference. Experts have proposed recommendations to guide clinical practice and the grounds for future research to address this situation...
June 2016: Current Opinion in Endocrinology, Diabetes, and Obesity
https://www.readbyqxmd.com/read/27015690/intravenous-cosyntropin-versus-epidural-blood-patch-for-treatment-of-postdural-puncture-headache
#18
Steven R Hanling, Joseph E Lagrew, Derrick H Colmenar, Albin S Quiko, Carol A Drastol
OBJECTIVE: This study evaluated the efficacy of IV cosyntropin as an alternative to epidural blood patch (EBP) for refractory or severe post-dural puncture headache (PDPH). METHODS: Twenty-eight patients were randomized to receive EBP or intravenous cosyntropin after diagnosis with post-dural puncture headache. Efficacy was evaluated immediately after treatment and at 1 day, 3 days, and 7 days following treatment using self-reported verbal reported scores for pain and function related to their headache on a 10-point scale using two-way repeated measures analysis of variance (ANOVA) with multiple comparisons...
March 25, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/26975712/adrenal-venous-sampling-in-patients-with-positive-screening-but-negative-confirmatory-testing-for-primary-aldosteronism
#19
MULTICENTER STUDY
Hironobu Umakoshi, Mitsuhide Naruse, Norio Wada, Takamasa Ichijo, Kohei Kamemura, Yuichi Matsuda, Yuichi Fujii, Tatsuya Kai, Tomikazu Fukuoka, Ryuichi Sakamoto, Atsushi Ogo, Tomoko Suzuki, Kazutaka Nanba, Mika Tsuiki
Adrenal venous sampling is considered to be the most reliable diagnostic procedure to lateralize aldosterone excess in primary aldosteronism (PA). However, normative criteria have not been established partially because of a lack of data in non-PA hypertensive patients. The aim of the study was to investigate aldosterone concentration and its gradient in the adrenal vein of non-PA hypertensive patients. We retrospectively studied the results of cosyntropin-stimulated adrenal venous sampling in 40 hypertensive patients who showed positive screening testing but negative results in 2 confirmatory tests/captopril challenge test and saline infusion test...
May 2016: Hypertension
https://www.readbyqxmd.com/read/26879335/safety-analysis-of-long-term-budesonide-nasal-irrigations-in-patients-with-chronic-rhinosinusitis-post-endoscopic-sinus-surgery
#20
Ethan Soudry, Jane Wang, Reza Vaezeafshar, Laurence Katznelson, Peter H Hwang
BACKGROUND: Although the safety of topical nasal steroids is well established for nasal spray forms, data regarding the safety of steroid irrigations is limited. We studied the effect of long-term budesonide nasal irrigations (>6 months) on hypothalamic-pituitary-adrenal axis (HPAA) function and intraocular pressure (IOP) in patients post-endoscopic sinus surgery. METHODS: This was retrospective case series. Adrenal function was assessed by using the high-dose cosyntropin stimulation test...
June 2016: International Forum of Allergy & Rhinology
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