Urinary-free cortisol in depressed patients and controls: relationship to urinary indices of noradrenergic function

SynopsisWe measured urinary outputs of urinary-free cortisol in 28 medication-free depressed patients and 32 normal controls. Depressed patients had significantly greater urinary outputs of urinary-free cortisol than controls. Also, there were significant correlations among depressed patients, but not among controls, between urinary-free cortisol and urinary outputs of norepinephrine and its metabolite vanillylmandelic acid (VMA). These urinary data extend recent findings suggesting that dysregulation of both the hypothalamic-pituitary-adrenal axis and noradrenergic system occur together in depression.

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Accuracy of several parameters of hypothalamic–pituitary–adrenal axis activity in predicting before surgery the metabolic effects of the removal of an adrenal incidentaloma

Acta Endocrinologica ◽

10.1530/eje-10-0602 ◽

2010 ◽

Vol 163 (6) ◽

pp. 925-935 ◽

Cited By ~ 45

Author(s):

Cristina Eller-Vainicher ◽

Valentina Morelli ◽

Antonio Stefano Salcuni ◽

Claudia Battista ◽

Massimo Torlontano ◽

...

Keyword(s):

Adrenal Incidentaloma ◽

Serum Cortisol ◽

Urinary Free Cortisol ◽

Hypothalamic Pituitary Adrenal Axis ◽

Metabolic Effects ◽

Hypothalamic Pituitary Adrenal ◽

Adrenal Axis ◽

Free Cortisol ◽

Metabolic Outcome ◽

Pituitary Adrenal Axis

ContextIt is unknown whether the metabolic effects of the removal of an adrenal incidentaloma (AI) can be predicted by the assessment of cortisol hypersecretion before surgery.ObjectiveTo evaluate the accuracy of several criteria of hypothalamic–pituitary–adrenal axis activity in predicting the metabolic outcome after adrenalectomy.DesignRetrospective longitudinal study.PatientsIn 55 surgically treated AI patients (Group 1) before surgery and in 53 nontreated AI patients (Group 2) at the baseline, urinary free cortisol (UFC), cortisol after 1 mg overnight dexamethasone-suppression test (1 mg-DST), ACTH, and midnight serum cortisol (MSC) were measured. In Groups 1 and 2, metabolic parameters were evaluated before and 29.6±13.8 months after surgery and at the baseline and after 35.2±10.9 months respectively.Main outcome measuresThe improvement/worsening of weight, blood pressure, glucose, and cholesterol levels (endpoints) was defined by the presence of a >5% weight decrease/increase and following the European Society of Cardiology or the ATP III criteria respectively. The accuracy of UFC, 1 mg-DST, ACTH, and MSC, singularly taken or in combination, in predicting the improvement/worsening of ≥2 endpoints was calculated.ResultsThe presence of ≥2 among UFC>70 μg/24 h (193 nmol/l), ACTH<10 pg/ml (2.2 pmol/l), 1 mg-DST>3.0 μg/dl (83 nmol/l) (UFC–ACTH–DST criterion) had the best accuracy in predicting the endpoints' improvement (sensitivity (SN) 65.2%, specificity (SP) 68.8%) after surgery. In the nontreated AI patients, this criterion predicted the worsening of ≥2 endpoints (SN 55.6%, SP 82.9%).ConclusionsThe UFC–ACTH–DST criterion seems to be the best for predicting the metabolic outcome in surgically treated AI patients.

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Effect of Inhaled Beclomethasone Dipropionate on Hypothalamic-Pituitary-Adrenal Axis Function in Children with Asthma

PEDIATRICS ◽

10.1542/peds.72.1.60 ◽

1983 ◽

Vol 72 (1) ◽

pp. 60-64

Author(s):

David E. Goldstein ◽

Peter König

Keyword(s):

Beclomethasone Dipropionate ◽

Serum Cortisol ◽

Urinary Free Cortisol ◽

Hypothalamic Pituitary Adrenal Axis ◽

Hypothalamic Pituitary Adrenal ◽

Adrenal Axis ◽

Normal Limits ◽

Free Cortisol ◽

Significant Difference ◽

Pituitary Adrenal Axis

The hypothalamic-pituitary-adrenal axis was investigated in 15 asthmatic children treated with inhaled beclomethasone dipropionate (mean 490 µg/day) and 11 asthmatic control subjects receiving no corticosteroid therapy. Measurements of 24-h urinary free cortisol and 17 hydroxy corticosteroids, serum cortisol, response to ACTH, and the oral metyrapone test showed no significant difference between the two groups. All the patients' results were within normal limits, and carbohydrate metabolism, as shown by blood glucose and hemoglobin A1c, was not affected by beclomethasone therapy. Thus, in the above dose, inhaled beclomethasone does not cause suppression of the hypothalamic--pituitary-adrenal axis.

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