scholarly journals Evaluation of procoagulant imbalance in Cushing’s syndrome after short- and long-term remission of disease

2021 ◽  
Author(s):  
E. Ferrante ◽  
A. L. Serban ◽  
M. Clerici ◽  
R. Indirli ◽  
E. Scalambrino ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Control Group ◽  
Cortisol Secretion ◽  
Thrombotic Risk ◽  
Disease Remission ◽  
Short Term Evaluation ◽  
Short And Long Term ◽  
And Gender

Abstract Objective Patients with Cushing’s syndrome (CS) are at high risk of venous thromboembolism related to a hypercoagulability due to procoagulant imbalance. However, whether these alterations are reversible after disease remission is still unclear. The endogenous thrombin potential (ETP) measured with and without the addition of thrombomodulin provides a global representation of coagulation and previous data confirmed hypercoagulable profile in patients with active hypercortisolism. Aim of this study was to assess the short- and long-term modification of ETP in patients with CS after disease remission. Design and methods Nineteen patients with CS for whom surgical remission was achieved, were prospectively evaluated for clinical characteristics, cortisol secretion profile and ETP at different time points: (i) before surgical intervention; (ii) after 6 months and (iii) 5 years from the time of persistent remission. Nineteen healthy subjects matched for age and gender were also evaluated as control group. Results Before surgery, patients showed higher ETP-ratio (with/without thrombomodulin) than controls (0.62 ± 0.09-vs-0.56 ± 0.09, p = 0.034). No significant correlation between ETP-ratio and cortisol secretion was found. 6 months after remission, ETP-ratio was still significantly increased compared to controls (0.64 ± 0.09-vs-0.56 ± 0.09, p = 0.01), but was similar to baseline (0.64 ± 0.09-vs-0.62 ± 0.09, p = 0.87). At 5 years, ETP-ratio showed a significant decrease (0.55 ± 0.14-vs-0.62 ± 0.09, p = 0.02) and was comparable to controls (0.55 ± 0.14-vs-0.56 ± 0.09, p = 0.7). Conclusions Plasma hypercoagulability detected in patients with active hypercortisolism persists at short-term evaluation and seems to be completely reversible after long-term remission of disease. These data, as part of a whole evaluation of thrombotic risk, can contribute to make appropriate therapeutic choice in these patients.

Short and long-term responses to metyrapone in the medical management of 91 patients with Cushing's syndrome

1991 ◽  
Vol 35 (2) ◽  
pp. 169-178 ◽  
Author(s):  
J. A. Verhelst ◽  
P. J. Trainer ◽  
T. A. Howlett ◽  
L. Perry ◽  
Lesley H. Rees ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Medical Management ◽  
Cushing's Syndrome ◽  
Short And Long Term

Growth hormone secretion in primary adrenal Cushing's syndrome is disorderly and inversely correlated with body mass index

2005 ◽  
Vol 288 (1) ◽  
pp. E63-E70 ◽  
Author(s):  
Maarten O. van Aken ◽  
Alberto M. Pereira ◽  
Marijke Frölich ◽  
Johannes A. Romijn ◽  
Hanno Pijl ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Growth Hormone ◽  
Body Mass ◽  
Approximate Entropy ◽  
Cushing's Syndrome ◽  
Control Group ◽  
Cortisol Secretion ◽  
Age And Gender ◽  
Gh Secretion ◽  
And Gender

To evaluate the impact on the somatotropic axis of endogenous cortisol excess in the absence of primary pituitary disease, we investigated spontaneous 24-h growth hormone (GH) secretion in 12 adult patients with ACTH-independent hypercortisolism. Plasma GH concentration profiles (10-min samples) were analyzed by deconvolution to reconstruct secretion and approximate entropy to quantitate orderliness of the release process. Comparisons were made with a body mass index (BMI)-, age-, and gender-matched control group and an age- and gender-matched lean control group. GH secretion rates did not differ from BMI-matched controls but were twofold lower compared with lean subjects, mainly due to a 2.5-fold attenuation of the mean secretory burst mass ( P = 0.001). In hypercortisolemic patients, GH secretion was negatively correlated with BMI ( R = −0.55, P = 0.005) but not cortisol secretion. Total serum IGF-I concentrations were similar in the three groups. Approximate entropy (ApEn) was increased in patients with Cushing's syndrome compared with both control groups (vs. BMI-matched, P = 0.04; vs. lean, P = 0.001), denoting more irregular GH secretion patterns. ApEn in patients correlated directly with cortisol secretion ( R = 0.77, P = 0.003). Synchrony between cortisol and GH concentration series was analyzed by cross-correlation, cross-ApEn, and copulsatility analyses. Patients showed loss of pattern synchrony compared with BMI-matched controls, but copulsatility was unchanged. We conclude that hyposomatotropism in primary adrenal hypercortisolism is only partly explained (∼30%) by increased body weight and that increased GH secretory irregularity and loss of synchrony suggest altered coordinate regulation of GH release.

Approach to the Patient with Subclinical Cushing’s Syndrome

2020 ◽  
Vol 26 (43) ◽  
pp. 5584-5590
Author(s):  
Miomira Ivović ◽  
Ljiljana V. Marina ◽  
Antoan S. Šojat ◽  
Milina Tančić-Gajić ◽  
Zorana Arizanović ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Cortisol Secretion ◽  
Subclinical Cushing’S Syndrome ◽  
Number Of Patients ◽  
Health Quality ◽  
Health Quality Of Life

A growing number of patients with adrenal incidentalomas and subclinical Cushing’s syndrome (SCS) led to an increasing number of different guidelines, and diagnostic and treatment recommendations. Excess cortisol secretion in patients with SCS is associated with several comorbidities, such as hypertension, dyslipidemia, type 2 diabetes mellitus, and obesity, which in the long-term increase mortality of these patients. Subtle cortisol secretion affects bone health, quality of life and causes depression, but due to the unapparent clinical features, patients with SCS are often at risk between over and under treatment. This narrative review aimed to summarize the latest recommendations on the approach to the patient with subclinical Cushing’s syndrome.

scholarly journals Irregular and Frequent Cortisol Secretory Episodes with Preserved Diurnal Rhythmicity in Primary Adrenal Cushing’s Syndrome

2005 ◽  
Vol 90 (3) ◽  
pp. 1570-1577 ◽  
Author(s):  
M. O. van Aken ◽  
A. M Pereira ◽  
S. W. van Thiel ◽  
G. van den Berg ◽  
M. Frölich ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Approximate Entropy ◽  
Cushing's Syndrome ◽  
Cortisol Secretion ◽  
Adrenal Hyperplasia ◽  
Age And Gender ◽  
Pulsatile Secretion ◽  
Event Frequency ◽  
And Gender ◽  
Diurnal Rhythmicity

To evaluate the pathophysiology of altered cortisol secretion in patients with primary adrenal hypercortisolism, cortisol secretion was investigated in 12 patients, seven with a unilateral adenoma and five with ACTH-independent macronodular adrenal hyperplasia compared with age- and gender-matched controls and with patients with pituitary-dependent hypercortisolism. Pulsatile secretion was increased 2-fold (P = 0.04), attributable to increased event frequency (P = 0.002). All patients showed a significant diurnal rhythm with a delay in phase shift of 3 h (P = 0.01). Approximate entropy ratio, a feedback-sensitive measure, was increased compared with controls (P = 0.00003) but similar to that of pituitary-dependent hypercortisolism (P = 0.77), denoting loss of autoregulation. Cortisol burst-mass tended to be smaller in patients with ACTH-independent macronodular adrenal hyperplasia than in unilateral adenoma (P = 0.06). In conclusion, increased cortisol secretion in patients with primary adrenal Cushing’s syndrome is caused by amplified pulsatile secretion via event frequency modulation. We speculate that partial preservation of secretory regularity and diurnal rhythmicity point to incomplete autonomy of these tumors.

scholarly journals Impaired quality of life in patients in long-term remission of Cushing's syndrome of both adrenal and pituitary origin: a remaining effect of long-standing hypercortisolism?

2012 ◽  
Vol 167 (5) ◽  
pp. 687-695 ◽  
Author(s):  
M A E M Wagenmakers ◽  
R T Netea-Maier ◽  
J B Prins ◽  
T Dekkers ◽  
M den Heijer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Group ◽  
Cushing’S Syndrome ◽  
Negative Influence ◽  
Cushing's Syndrome ◽  
Control Group ◽  
Cross Sectional ◽  
Impaired Quality

Objective The determinants that cause impaired quality of life (QOL) in patients in long-term remission of Cushing's syndrome (CS) are unknown. The aim of this study was to get more insight into the patient and disease characteristics related to impaired QOL in these patients. Design Cross-sectional study. Methods The QOL of 123 patients in remission of CS (age 52.2±12.0 years, 106 women, duration of remission 13.3±10.4 years, 80% pituitary CS), assessed with seven validated questionnaires, was compared with the QOL of an age- and sex-matched control group (n=105). To investigate the influence of the aetiology of CS on QOL, patients in remission of pituitary and adrenal CS were compared. Furthermore, the influence of hormonal deficiencies, treatment strategy, duration of remission, gender and age on QOL was investigated. Results QOL in the total patient group and each patient subgroup was significantly worse on practically all dimensions of questionnaires compared with the control group (P<0.05), except for patients in remission of pituitary CS without hormonal deficiencies who had an impaired QOL on 50% of the QOL dimensions. Subgroup analysis revealed no difference in QOL between different patient groups, especially no difference between patients in remission of adrenal and pituitary CS. Female gender and a shorter duration of remission had a negative influence on QOL in the patient group. Conclusions QOL remains impaired in patients in long-term remission of CS regardless of aetiology, presence of hormonal deficiencies and treatment strategies. More research is needed to establish the causes.

scholarly journals Clinical characteristics and outcomes of COVID-19 long-term nucleic acid positive patients

2021 ◽  
pp. 1-10
Author(s):  
Xuan Zhu ◽  
Xinxin Zhu ◽  
Min Wang ◽  
Fang Yang ◽  
Zhibing Sun ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Clinical Characteristics ◽  
Clinical Symptoms ◽  
Control Group ◽  
Viral Shedding ◽  
Imaging Characteristics ◽  
And Gender ◽  
Acid Test ◽  
Pulmonary Ct

OBJECTIVE: This study aimed to investigate the clinical characteristics and outcomes of coronavirus disease-19 (COVID-19) long-term nucleic acid positive patients (hereinafter referred to as CLTAPs). METHODS: Patients were recruited from the Xiaogan Central Hospital between 16 January 2020 and 28 March 2020. Among the 562 cases of patients with laboratory-identified COVID-19 infection by real-time polymerase chain reaction (qtPCR), 19 cases of COVID-19 patients with more than 41 days from the first to the last time of nucleic acid test were selected as the study group, and 76 cases of age- and gender-matched COVID-19 patients were selected as the control group (hereinafter referred to as C-CLTAPs). Demographic characteristics, clinical symptoms, laboratory examination and computed tomography (CT) imaging characteristics were retrospectively analyzed. RESULTS: On admission, among the 562 cases of patients with COVID-19, there were 398 cases of ordinary COVID-19 patients, 99 cases of severe COVID-19 patients and 99 cases of critical COVID-19 patients. CLTAPs had milder clinical symptoms and longer viral shedding time in comparison to C-CLTAPs. Compared to C-CLTAPs, CLTAPs had a lower infection index at admission. CLTAPs used less oxygen therapy and a higher proportion of hydroxychloroquine treatment in comparison to C-CLTAPs. In comparison to C-CLTAPs, CLTAPs showed slower pulmonary CT progression and faster pulmonary CT absorption. CONCLUSION: In this study, out of the 562 cases, we found 19 CLTAPs. The clinical differences between CLTAPs and C-CLTAPs were compared and analyzed. We hope that these finding can provide a theoretical basis for the treatment of CLTAPs.

Time-Dependent Changes in Excitability After One-Trial Conditioning of Hermissenda

1997 ◽  
Vol 78 (6) ◽  
pp. 3460-3464 ◽  
Author(s):  
Terry Crow ◽  
Vilma Siddiqi
Keyword(s):  
Time Dependent ◽  
Control Group ◽  
Type B ◽  
Control Groups ◽  
Phototactic Behavior ◽  
Parallel Processes ◽  
Short And Long Term ◽  
A Site ◽  
Different Levels

Crow, Terry and Vilma Siddiqi. Time-dependent changes in excitability after one-trial conditioning of Hermissenda. J. Neurophysiol. 78: 3460–3464, 1997. The visual system of Hermissenda has been studied extensively as a site of cellular plasticity produced by classical conditioning. A one-trial conditioning procedure consisting of light paired with the application of serotonin (5-HT) to the exposed, but otherwise intact, nervous system produces suppression of phototactic behavior tested 24 h after conditioning. Short- and long-term enhancement (STE and LTE) of excitability in identified type B photoreceptors is a cellular correlate of one-trial conditioning. LTE can be expressed in the absence of STE suggesting that STE and LTE may be parallel processes. To examine the development of enhancement, we studied its time-dependent alterations after one-trial conditioning. Intracellular recordings from identified type B photoreceptors of independent groups collected at different times after conditioning revealed that enhanced excitability follows a biphasic pattern in its development. The analysis of spikes elicited by 2 and 30 s extrinsic current pulses at different levels of depolarization showed that enhancement reached a peak 3 h after conditioning. From its peak, excitability decreased toward baseline control levels 5–6 h after conditioning followed by an increase to a stable plateau at 16 to 24 h postconditioning. Excitability changes measured in cells from unpaired control groups showed maximal changes 1 h posttreatment that rapidly decremented within 2 h. The conditioned stimulus (CS) elicited significantly more spikes 24 h postconditioning for the conditioned group as compared with the unpaired control group. The analysis of the time-dependent development of enhancement may reveal the processes underlying different stages of memory for this associative experience.

Reduced volume and increased training intensity elevate muscle Na+-K+pump α2-subunit expression as well as short- and long-term work capacity in humans

2009 ◽  
Vol 107 (6) ◽  
pp. 1771-1780 ◽  
Author(s):  
Jens Bangsbo ◽  
Thomas P. Gunnarsson ◽  
Jesper Wendell ◽  
Lars Nybo ◽  
Martin Thomassen
Keyword(s):  
Endurance Training ◽  
Muscle Protein ◽  
Work Capacity ◽  
Control Group ◽  
Muscle Adaptations ◽  
Subunit Expression ◽  
Short And Long Term ◽  
And Performance ◽  
Trained Runners

The present study examined muscle adaptations and alterations in work capacity in endurance-trained runners as a result of a reduced amount of training combined with speed endurance training. For a 6- to 9-wk period, 17 runners were assigned to either a speed endurance group with a 25% reduction in the amount of training but including speed endurance training consisting of six to twelve 30-s sprint runs 3–4 times/wk (SET group n = 12) or a control group ( n = 5), which continued the endurance training (∼55 km/wk). For the SET group, the expression of the muscle Na+-K+pump α2-subunit was 68% higher ( P < 0.05) and the plasma K+level was reduced ( P < 0.05) during repeated intense running after 9 wk. Performance in a 30-s sprint test and the first of the supramaximal exhaustive runs was improved ( P < 0.05) by 7% and 36%, respectively, after the speed endurance training period. In the SET group, maximal O2uptake was unaltered, but the 3-km (3,000-m) time was reduced ( P < 0.05) from 10.4 ± 0.1 to 10.1 ± 0.1 min and the 10-km (10,000-m) time was improved from 37.3 ± 0.4 to 36.3 ± 0.4 min (means ± SE). Muscle protein expression and performance remained unaltered in the control group. The present data suggest that both short- and long-term exercise performances can be improved with a reduction in training volume if speed endurance training is performed and that the Na+-K+pump plays a role in the control of K+homeostasis and in the development of fatigue during repeated high-intensity exercise.

scholarly journals Glucocorticoid receptor polymorphisms modulate cardiometabolic risk factors in patients in long-term remission of Cushing’s syndrome

Endocrine ◽  
2016 ◽  
Vol 53 (1) ◽  
pp. 63-70 ◽  
Author(s):  
Sean H. P. P. Roerink ◽  
M. A. E. M. Wagenmakers ◽  
J. W. A. Smit ◽  
E. F. C. van Rossum ◽  
R. T. Netea-Maier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Glucocorticoid Receptor ◽  
Cushing’S Syndrome ◽  
Cardiometabolic Risk ◽  
Cushing's Syndrome ◽  
Cardiometabolic Risk Factors ◽  
Glucocorticoid Receptor Polymorphisms

scholarly journals Efficacy of a bystander intervention for preventing dating violence in Brazilian adolescents: short-term evaluation

2019 ◽  
Vol 32 (1) ◽  
Author(s):  
Karine Brito dos Santos ◽  
Sheila Giardini Murta ◽  
Luis Gustavo do Amaral Vinha ◽  
Juliana Silva de Deus
Keyword(s):  
Romantic Relationships ◽  
Dating Violence ◽  
Control Group ◽  
Short Term ◽  
Brazilian Sample ◽  
Post Test ◽  
Short Term Evaluation ◽  
Term Evaluation ◽  
Brazilian Culture

Abstract Peers are the preferred source of help for Brazilian adolescents who experience dating violence. However, they are not always the best informants for effective responses for dealing with situations of violence in romantic relationships among peers. This experimental study aimed to evaluate the short-term efficacy of three aspects of a peer- and bystander approach-based intervention: the intent to offer help, empathy, and bystander attitudes in response to dating violence in a Brazilian sample of adolescents. The study’s participants were 33 adolescents randomized in two groups: experimental group (EG, n = 14) and control group (CG, n = 19). The EG underwent three weekly intervention sessions of 90 min each on the healthy versus violent romantic relationships, the quality of friendship in the peer network, and the role of the bystander, while the CG received no intervention. Evaluations were performed 1 week before and two and half months after the intervention. Statistically significant differences between EG and CG at post-test were not found in intention to help, empathy, and bystander attitudes. Future studies should include evaluations of larger samples and mid- and long-term follow-ups to identify patterns of change over the long term as well as examine barriers to utilization of bystander behaviors by adolescents in Brazilian culture.

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