scholarly journals Assessing adrenal insufficiency of corticosteroid secretion using free versus total cortisol levels in critical illness

2011 ◽  
Vol 37 (12) ◽  
pp. 1986-1993 ◽  
Author(s):  
Nienke Molenaar ◽  
A. B. Johan Groeneveld ◽  
Hilde M. Dijstelbloem ◽  
Margriet F. C. de Jong ◽  
Armand R. J. Girbes ◽  
...  
Keyword(s):  
Critical Illness ◽  
Adrenal Insufficiency ◽  
Total Cortisol ◽  
Cortisol Levels ◽  
Corticosteroid Secretion

scholarly journals Serum and salivary cortisol in the diagnosis of adrenal insufficiency and as a predictor of the outcome in patients with severe sepsis

2011 ◽  
Vol 55 (7) ◽  
pp. 455-459 ◽  
Author(s):  
Rômulo Carvalho Vaz de Mello ◽  
Eduardo F. Sad ◽  
Bertha Coelho Andrade ◽  
Suzane Pretti Figueiredo Neves ◽  
Silvana Maria Elói Santos ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Mortality Rate ◽  
Adrenal Insufficiency ◽  
Critically Ill Patients ◽  
Salivary Cortisol ◽  
Healthy Subjects ◽  
Healthy Controls ◽  
Chemiluminescence Immunoassay ◽  
Total Cortisol ◽  
Cortisol Levels

OBJECTIVES: To compare salivary with serum total cortisol in patients with severe sepsis, postoperative patients and healthy controls. MATERIALS AND METHODS: Serum total cortisol was determined by chemiluminescence immunoassay; salivary cortisol was determined by enzyme immunoassay. RESULTS: In patients with severe sepsis, median concentration of salivary cortisol was 14.0 and 2.6 higher than that of postoperative patients and healthy subjects. In postoperative patients, salivary cortisol was 5.4 times higher than in control patients. Serum total cortisol was also higher in patients with severe sepsis than in controls and postoperative patients. This increment, however, was much lower (2.33 and 1.64, respectively). Patients with a salivary cortisol greater than 7.2 µg/dL had a mortality rate of 80%, a statistically significant result when compared with the group with lower cortisol levels (Z = 2.38 and p < 0.05). CONCLUSIONS: Salivary cortisol in critically ill patients may be a better laboratory indicator of cortisol levels than serum total cortisol.

scholarly journals Dynamic Pituitary–Adrenal Interactions in the Critically Ill after Cardiac Surgery

2019 ◽  
Vol 105 (5) ◽  
pp. 1327-1342 ◽  
Author(s):  
Ben Gibbison ◽  
Daniel M Keenan ◽  
Ferdinand Roelfsema ◽  
Jon Evans ◽  
Kirsty Phillips ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Critical Illness ◽  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Hpa Axis ◽  
Cortisol Secretion ◽  
Acth Secretion ◽  
Total Cortisol ◽  
Male Patients ◽  
Cardiac Critical Care

Abstract Context Patients with critical illness are thought to be at risk of adrenal insufficiency. There are no models of dynamic hypothalamic–pituitary–adrenal (HPA) axis function in this group of patients and thus current methods of diagnosis are based on aggregated, static models. Objective To characterize the secretory dynamics of the HPA axis in the critically ill (CI) after cardiac surgery. Design Mathematical modeling of cohorts. Setting Cardiac critical care unit. Patients 20 male patients CI at least 48 hours after cardiac surgery and 19 healthy (H) male volunteers. Interventions None. Main Outcome Measures Measures of hormone secretory dynamics were generated from serum adrenocorticotrophic hormone (ACTH) sampled every hour and total cortisol every 10 min for 24 h. Results All CI patients had pulsatile ACTH and cortisol profiles. CI patients had similar ACTH secretion (1036.4 [737.6] pg/mL/24 h) compared to the H volunteers (1502.3 [1152.2] pg/mL/24 h; P = .20), but increased cortisol secretion (CI: 14 447.0 [5709.3] vs H: 5915.5 [1686.7)] nmol/L/24 h; P &lt; .0001). This increase in cortisol was due to nonpulsatile (CI: 9253.4 [3348.8] vs H: 960 [589.0] nmol/L/24 h, P &lt; .0001), rather than pulsatile cortisol secretion (CI: 5193.1 [3018.5] vs H: 4955.1 [1753.6] nmol/L/24 h; P = .43). Seven (35%) of the 20 CI patients had cortisol pulse nadirs below the current international guideline threshold for critical illness-related corticosteroid insufficiency, but an overall secretion that would not be considered deficient. Conclusions This study supports the premise that current tests of HPA axis function are unhelpful in the diagnosis of adrenal insufficiency in the CI. The reduced ACTH and increase in nonpulsatile cortisol secretion imply that the secretion of cortisol is driven by factors outside the HPA axis in critical illness.

scholarly journals Adrenal insufficiency in prolonged critical illness

Critical Care ◽  
2008 ◽  
Vol 12 (3) ◽  
pp. R65 ◽  
Author(s):  
Jenn-Yu Wu ◽  
Szu-Chun Hsu ◽  
Shih-Chi Ku ◽  
Chao-Chi Ho ◽  
Chong-Jen Yu ◽  
...  
Keyword(s):  
Critical Illness ◽  
Adrenal Insufficiency

scholarly journals Comparative study of glucagon and insulin tests for diagnostics of secondary adrenal insufficiency and growth hormone deficiency in children and adolescents

2021 ◽  
Vol 66 (6) ◽  
pp. 50-58
Author(s):  
A. V. Vitebskaya ◽  
E. A. Pisareva ◽  
A. V. Popovich
Keyword(s):  
Growth Hormone ◽  
Children And Adolescents ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Early Morning ◽  
Hormone Deficiency ◽  
Secondary Adrenal Insufficiency ◽  
Glucagon Test ◽  
Cortisol Levels ◽  
Glucagon And Insulin

BACKGROUND: Diagnostics of growth hormone deficiency (GHD) and secondary adrenal insufficiency (SAI) is based on estimation of peak GH and cortisol concentrations in provocation tests. Russian consensus on diagnostics and treatment of hypopituitarism in children and adolescences recommends to measure GH and cortisol concentrations in every time-point of insulin test (IT). Glucagon test (GT) is discussed in literature as alternative to IT.AIMS: To estimate the possibility to use provocation GT for diagnostics of SAI and GHD in children and adolescents.MATERIALS AND METHODS: We investigated blood and urine cortisol levels, IT, and GT in 20 patients 6.5–17.8 years (Me 13.0 (10.4; 15.3)) after surgery and/or radiology and/or chemical therapy of head and neck tumors; remission for 0.4–7.5 years (Ме 2.1 (1.5; 5.2)).RESULTS: With cut-off point 550 nmol/L sensitivity and specifity of IT was 100% and 60%, GT — 100% and 53% respectively. Minimal cortisol cut-off level for GT with sensitivity 100% was 500 nmol/L, maximal with specifity 100% — 400 nmol/L.Early morning cortisol levels did not exceed 250 nmol/l in 2 patients with SAI; and were above 500 nmol/l in 8 patients without SAI while primary or repeated examination.GHD was reviled by IT in all patients. Maximal GH concentrations in GT and IT did not differ significantly (p>0.05) but GT results of 4 patients exceeded or met cut-off for this test (7 ng/ml).GT was characterized by less severity compared with IT.CONCLUSIONS: For diagnostics of SAI by GT we can advise cut-off points of cortisol level 500 (sensitivity 100%, specifty 53%) and 400 nmol/L (sensitivity 80%, specifity 100%). Measuring of cortisol levels in 2–3 early morning blood samples allows to exclude or to suspect SAI in half of patients before tests. GH peaks in GT can exceed similarly data in IT that needs future investigation. 

scholarly journals Responses of New World flying squirrels to the acute stress of capture and handling

2015 ◽  
Vol 97 (1) ◽  
pp. 80-88 ◽  
Author(s):  
Lanna M. Desantis ◽  
Jeff Bowman ◽  
Candace V. Lahoda ◽  
Rudy Boonstra ◽  
Gary Burness
Keyword(s):  
Stress Response ◽  
New World ◽  
Binding Capacity ◽  
Biologically Active ◽  
Stress Axis ◽  
Neutrophil Lymphocyte Ratio ◽  
Flying Squirrels ◽  
Physiological Variables ◽  
Total Cortisol ◽  
Cortisol Levels

Abstract Northern ( Glaucomys sabrinus ) and southern ( G. volans ) flying squirrels have glucocorticoid (GC; stress hormone) levels higher than most vertebrates but virtually no binding capacity for these GCs via the carrier protein, corticosteroid-binding globulin. Thus, their total GCs are essentially all free and biologically active. However, the GC estimates come from blood samples taken after squirrels had been in live traps, and thus in a stress-induced state. Obtaining baseline values for physiological variables is valuable for assessing the response of vertebrates to stressors in their environment. We compared baseline plasma total cortisol levels (within 3min of capture) to stress-induced levels (after 30min of trap restraint) in both flying squirrel species. We recorded baseline cortisol levels that were some of the highest ever reported for mammals, indicating their stress axes operate at a higher set point than most other species. As part of the stress response, we also measured 4 indices in addition to cortisol. Total cortisol and free fatty acids increased in both species, as predicted. In contrast with our predictions, blood glucose and neutrophil/lymphocyte ratio showed no overall change, and hematocrit decreased significantly. New World flying squirrels therefore appear to have a stress response that differs from many other mammals. The selective forces driving the physiology of these animals remain elusive, but this lineage may provide an interesting comparative system for the study of stress axis function and its evolution among vertebrates.

scholarly journals MECHANISMS IN ENDOCRINOLOGY: New concepts to further unravel adrenal insufficiency during critical illness

2016 ◽  
Vol 175 (1) ◽  
pp. R1-R9 ◽  
Author(s):  
Eva Boonen ◽  
Greet Van den Berghe
Keyword(s):  
Critical Illness ◽  
Adrenal Insufficiency ◽  
Feedback Inhibition ◽  
High Plasma ◽  
Future Research ◽  
Relative Adrenal Insufficiency ◽  
New Concepts ◽  
High Incidence ◽  
Circulating Levels ◽  
New Framework

The concept of ‘relative’ adrenal insufficiency during critical illness remains a highly debated disease entity. Several studies have addressed how to diagnose or treat this condition but have often yielded conflicting results, which further fuelled the controversy. The main reason for the controversy is the fact that the pathophysiology is not completely understood. Recently, new insights in the pathophysiology of the hypothalamic–pituitary–adrenal axis response to critical illness were generated. It was revealed that high circulating levels of cortisol during critical illness are explained more by reduced cortisol breakdown than by elevated cortisol production. Cortisol production rate during critical illness is less than doubled during the day but lower than in healthy subjects during the night. High plasma cortisol concentrations due to reduced breakdown in turn reduce plasma ACTH concentrations via feedback inhibition, which with time may lead to an understimulation and hereby a dysfunction of the adrenal cortex. This could explain the high incidence of adrenal insufficiency in the prolonged phase of critical illness. These novel insights have created a new framework for the diagnosis and treatment of adrenal failure during critical illness that has redirected future research.

Corticosteroid-binding globulin levels in North American sciurids: implications for the flying squirrel stress axis

2018 ◽  
Vol 96 (10) ◽  
pp. 1090-1096 ◽  
Author(s):  
Lanna M. Desantis ◽  
Jeff Bowman ◽  
Erin Faught ◽  
Rudy Boonstra ◽  
Mathilakath M. Vijayan ◽  
...  
Keyword(s):  
New World ◽  
Stress Axis ◽  
Glaucomys Sabrinus ◽  
Evolutionary Time ◽  
Glaucomys Volans ◽  
Flying Squirrels ◽  
Total Cortisol ◽  
Corticosteroid Binding Globulin ◽  
Tree Squirrels ◽  
Cortisol Levels

Corticosteroid-binding globulin (CBG) helps to regulate tissue bioavailability of circulating glucocorticoids (GCs), and in most vertebrates, ≥80%–90% of GCs bind to this protein. New World flying squirrels have higher plasma total cortisol levels (the primary corticosteroid in sciurids) than most vertebrates. Recent research suggests that flying squirrels have either low amounts of CBG or CBG molecules that have a low binding affinity for cortisol, as this taxon appears to exhibit very low proportions of cortisol bound to CBG. To test whether CBG levels have been adjusted over evolutionary time, we assessed the levels of this protein in the plasma of northern (Glaucomys sabrinus (Shaw, 1801)) and southern (Glaucomys volans (Linnaeus, 1758)) flying squirrels using immunoblotting, and compared the relative levels among three phylogenetically related species of sciurids. We also compared the pattern of CBG levels with cortisol levels for the same individuals. Flying squirrels had higher cortisol levels than the other species, but similar levels of CBG to their closest relatives (tree squirrels). We conclude that CBG levels in flying squirrels have not been adjusted over evolutionary time, and thus, the uncoupling of CBG levels from cortisol concentrations may represent an evolutionary modification in the lineage leading to New World flying squirrels.

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