Serial Changes in Plasma Total Cortisol, Plasma Free Cortisol, and Tissue Cortisol Activity in Patients With Septic Shock

Shock ◽  
2012 ◽  
Vol 37 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Jeremy Cohen ◽  
Melissa Lassig Smith ◽  
Renae V. Deans ◽  
Carel J. Pretorius ◽  
Jacobus P.J. Ungerer ◽  
...  
Keyword(s):  
Septic Shock ◽  
Total Cortisol ◽  
Free Cortisol

Random serum free cortisol and total cortisol measurements in pediatric septic shock

2018 ◽  
Vol 31 (7) ◽  
pp. 757-762
Author(s):  
Kusum Menon ◽  
Dayre McNally ◽  
Anand Acharya ◽  
Katharine O’Hearn ◽  
Karen Choong ◽  
...  
Keyword(s):  
Septic Shock ◽  
Controlled Trial ◽  
Illness Severity ◽  
Strongly Correlated ◽  
Eligibility Criteria ◽  
Prism Score ◽  
Total Cortisol ◽  
Free Cortisol ◽  
The Relationship ◽  
Strong Agreement

Abstract Background The aim of the study was to examine the relationship between serum total cortisol (TC) and free cortisol (FC) levels in children with septic shock and the relationship of these levels with baseline illness severity. Methods A sub-study of a randomized controlled trial (RCT) of hydrocortisone vs. placebo in pediatric septic shock conducted in seven academic pediatric intensive care units (PICUs) in Canada on children aged newborn to 17 years. Thirty children with septic shock had serum sent for TC and FC measurement within 6 h of meeting the study eligibility criteria. Results Baseline FC and TC levels were strongly correlated with baseline Pediatric Risk of Mortality (PRISM) score (R2=0.759, p<0.001; R2=0.717, p<0.001) and moderately correlated with admission Vasotropic Inotropic Score (VIS) (R2=0.489, p<0.001; R2=0.316, p<0.001). Serum TC levels were highly correlated with FC levels (R2=0.92, p<0.001) and showed strong agreement (R2=0.98, p<0.001 on a Bland-Altman plot). The ratio of FC to TC moderately correlated with TC levels (R2=0.46, p<0.001) but did not correlate with baseline albumin levels (R2=0.19, p=0.13). Conclusions Random TC and FC levels are strongly correlated, show strong agreement and are reflective of illness severity in children with septic shock. As such, isolated FC measurement does not appear to provide added information relative to TC in acutely ill children with septic shock.

Interpretation of Abnormal Dexamethasone Suppression Test is Enhanced With Use of Synchronous Free Cortisol Assessment

2021 ◽  
Author(s):  
Natalia Genere ◽  
Ravinder Jeet Kaur ◽  
Shobana Athimulam ◽  
Melinda A Thomas ◽  
Todd Nippoldt ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
False Positive ◽  
Medical Center ◽  
Dexamethasone Suppression Test ◽  
Total Cortisol ◽  
Normal Ranges ◽  
Free Cortisol ◽  
Suppression Test ◽  
Dexamethasone Suppression ◽  
Positive Results

Abstract Context Interpretation of dexamethasone suppression test (DST) may be influenced by dexamethasone absorption and metabolism and by the altered cortisol binding Objective We aimed to determine the normal ranges of free cortisol during DST in participants without adrenal disorders, and to identify the population of patients where post-DST free cortisol measurements add value to the diagnostic work up. Design and Setting Cross-sectional study conducted in a tertiary medical center Participants Adult volunteers without adrenal disorders (n=168; 47 women on oral contraceptive therapy (OCP), 66 women not on OCP, 55 men) and patients undergoing evaluation for hypercortisolism (n=196; 16 women on OCP) Measurements Post-DST dexamethasone and free cortisol (mass spectrometry) and total cortisol (immunoassay). Main Outcome Measures Reference range for post-DST free cortisol, diagnostic accuracy of post-DST total cortisol. Results Adequate dexamethasone concentrations (≥0.1 mcg/dL) were seen in 97.6% volunteers and 96.3% patients. Only 25.5% of women volunteers on OCP had abnormal post-DST total cortisol (&gt;1.8 mcg/dL). In volunteers, the upper post-DST free cortisol range was 48 ng/dL in men and women not on OCP, and 79 ng/dL in women on OCP. When compared to post-DST free cortisol, diagnostic accuracy of post-DST total cortisol was 87.3% (95%CI 81.7-91.7); all false positive results occurred in patients with post-DST cortisol between 1.8 and 5 mcg/dL. OCP use was the only factor associated with false positive results (21.1% vs 4.9%, p=0.02). Conclusions Post-DST free cortisol measurements are valuable in patients with optimal dexamethasone concentrations and post-DST total cortisol between 1.8 and 5 mcg/dL.

THE PLASMA CONCENTRATIONS OF FREE AND PROTEIN-BOUND CORTISOL IN HYPOPROTEINAEMIA

1966 ◽  
Vol 34 (2) ◽  
pp. 265-270 ◽  
Author(s):  
P. J. LEONARD ◽  
P. G. D'ARBELA
Keyword(s):  
Plasma Level ◽  
Cortisol Level ◽  
Plasma Concentrations ◽  
Biochemical Changes ◽  
Striking Similarity ◽  
Control Group ◽  
Absolute Level ◽  
Total Cortisol ◽  
Control Subjects ◽  
Free Cortisol

SUMMARY The plasma level and percentage of bound cortisol were measured in sixteen African subjects with hypoproteinaemia of varying aetiologies. When compared with a control group it was found that the percentage of the steroid bound was significantly reduced but that the total cortisol level did not differ from that found in the control subjects. This resulted in a significant increase in the absolute level of free cortisol in the hypoproteinaemic subjects. Attention is drawn to the striking similarity between many of the physical and biochemical changes seen in kwashiorkor and those found in Cushing's syndrome.

Free Cortisol in Sepsis and Septic Shock

2008 ◽  
Vol 106 (6) ◽  
pp. 1813-1819 ◽  
Author(s):  
Stepani Bendel ◽  
Sari Karlsson ◽  
Ville Pettilä ◽  
Pekka Loisa ◽  
Marjut Varpula ◽  
...  
Keyword(s):  
Septic Shock ◽  
Free Cortisol ◽  
Sepsis And Septic Shock

Different methods to estimate serum free cortisol: a comparison during cortisol tetracosactide testing

2015 ◽  
Vol 53 (9) ◽  
Author(s):  
Julie Brossaud ◽  
Blandine Gatta ◽  
Antoine Tabarin ◽  
Jean-Benoît Corcuff
Keyword(s):  
Intensive Care ◽  
Roc Curves ◽  
Serum Cortisol ◽  
Cortisol Concentration ◽  
University Hospital ◽  
Serum Free ◽  
Concentration Determination ◽  
Total Cortisol ◽  
Free Cortisol ◽  
Before And After

AbstractSerum cortisol is routinely quantified by immunoassays. In intensive care units serum free cortisol (FC) determination has been described as a better indicator of survival than total cortisol (TC). To estimate FC different methods are available including saliva sampling. We compared five methods to estimate FC, before and after an ACTH stimulating test in patients suspected of adrenal insufficiency.Serum and saliva was collected from 130 patients from the Endocrine Department of a university hospital before and after tetracosactide injection for TC determination. FC was estimated: after serum ultrafiltration, quadratic (Coolens’) or cubic (Dorin’s) equations, using TC/cortisol-binding globulin concentrations ratio or using cortisol concentration determination in saliva.FC concentrations obtained by different techniques were significantly correlated and Passing-Bablok regressions showed no deviation from linearity between salFC and filtFC or quadFC. Using the routine assumption that the patients were correctly diagnosed using a post-tetracosactide TC threshold of 550 nmol/L the FC methods generating the best ROC curves wereFC concentrations obtained by different techniques are significantly but not similarly correlated with TC. As,

Serum free cortisol index, free cortisol, and total cortisol in critically ill children

2009 ◽  
Vol 35 (7) ◽  
pp. 1281-1285 ◽  
Author(s):  
Preamrudee Poomthavorn ◽  
Rojjanee Lertbunrian ◽  
Aroonwan Preutthipan ◽  
Arporn Sriphrapradang ◽  
Patcharin Khlairit ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Children ◽  
Serum Free ◽  
Total Cortisol ◽  
Free Cortisol ◽  
Free Cortisol Index

scholarly journals Hypothalamic-pituitary-adrenal axis in lethal canine Staphylococcus aureus pneumonia

2014 ◽  
Vol 307 (11) ◽  
pp. E994-E1008 ◽  
Author(s):  
Irene Cortés-Puch ◽  
Caitlin W. Hicks ◽  
Junfeng Sun ◽  
Steven B. Solomon ◽  
Peter Q. Eichacker ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Septic Shock ◽  
Hpa Axis ◽  
Strong Relationship ◽  
High Dose ◽  
Acth Stimulation ◽  
Hypothalamic Pituitary Adrenal ◽  
Free Cortisol ◽  
Poor Outcomes ◽  
Staphylococcus Aureus Pneumonia

The clinical significance and even existence of critical illness-related corticosteroid insufficiency is controversial. Here, hypothalamic-pituitary-adrenal (HPA) function was characterized in severe canine Staphylococcus aureus pneumonia. Animals received antibiotics and titrated life-supportive measures. Treatment with dexamethasone, a glucocorticoid, but not desoxycorticosterone, a mineralocorticoid, improves outcome in this model. Total and free cortisol, adrenocorticotropic hormone (ACTH). and aldosterone levels, as well as responses to exogenous ACTH were measured serially. At 10 h after the onset of infection, the acute HPA axis stress response, as measured by cortisol levels, exceeded that seen with high-dose ACTH stimulation but was not predictive of outcome. In contrast to cortisol, aldosterone was largely autonomous from HPA axis control, elevated longer, and more closely associated with survival in early septic shock. Importantly, dexamethasone suppressed cortisol and ACTH levels and restored ACTH responsiveness in survivors. Differing strikingly, nonsurvivors, sepsis-induced hypercortisolemia, and high ACTH levels as well as ACTH hyporesponsiveness were not influenced by dexamethasone. During septic shock, only serial measurements and provocative testing over a well-defined timeline were able to demonstrate a strong relationship between HPA axis function and prognosis. HPA axis unresponsiveness and high aldosterone levels identify a septic shock subpopulation with poor outcomes that may have the greatest potential to benefit from new therapies.

Effects of stall dimensions on the welfare of pregnant sows

2011 ◽  
Vol 51 (5) ◽  
pp. 471 ◽  
Author(s):  
J. L. Barnett ◽  
P. H. Hemsworth ◽  
K. L. Butler ◽  
B. N. Schirmer ◽  
S. S. Borg ◽  
...  
Keyword(s):  
Stress Responses ◽  
Social Behaviour ◽  
Present Experiment ◽  
Negative Control ◽  
Control Treatment ◽  
Scientific Validity ◽  
Acth Challenge ◽  
Total Cortisol ◽  
Biological Variables ◽  
Free Cortisol

The welfare of sows in gestation accommodation, and in particular the use of gestation stalls, is a major issue of concern among the animal-welfare community and pig producers. The objective of the present experiment was to investigate the effects of width (0.6 m v. 0.75 m) and length (2.0 m v. 2.2 m v. 2.4 m) of gestation stalls, plus a tether-stall negative-control treatment, on sow welfare measured via parameters of behaviour, stress physiology, immunology and gait score. The research involved 56 multiparous sows, housed alongside 56 non-experimental sows that were included to facilitate measurement of social behaviour. Posture and social behaviour were recorded after 7 weeks in treatment and animals were surgically catheterised in Week 8 for blood sampling, to measure daytime profiles of cortisol concentrations and responses to an adrenocorticotropic hormone (ACTH) challenge. The cell-mediated immune response to a bean extract was examined in Week 9. Sows spent more time standing during 2 h in the morning in 0.75-m- than 0.6-m-wide stalls (P < 0.05). This effect was greatest in 2.0-m-long stalls. Although the angle of head turn by sows was greater in 0.75-m- than 0.6-m-wide stalls (P < 0.001), social interactions were unaffected by stall dimensions. Sows in 0.6-m-wide stalls had lower total (P < 0.01) and free (P < 0.001) cortisol concentrations, reduced responsiveness to ACTH (P < 0.05) and increased immunoresponsiveness (P < 0.05) than did the sows housed in 0.75-m-wide stalls. There was no effect of stall length on total cortisol concentrations; however, free cortisol concentrations were greater in 2.4-m than in both 2.0- and 2.2-m treatments (P < 0.05). Sows in 2.2-m-long stalls showed significantly lower responsiveness to ACTH (P < 0.01), and greater immunoresponsiveness (P < 0.05) than did the sows in 2.0- and 2.4-m-long stalls. There were no interactions between stall width and length. The results indicated lower stress responses in both 0.6-m-wide and to some extent in 2.2-m-long stalls. Although these effects are not intuitively obvious, it is suggested that within the stall dimensions studied, 0.6 m × 2.2 m stalls will minimise stress effects. The opportunity was taken in the present experiment to test the scientific validity of these welfare measures by examining how well the measures predict the welfare status of the animal. Tethers and stalls are expected to provide variation in the welfare status of sows due to variation in the level of restriction and it was found that for four of the six biological variables (basal free and total cortisol concentrations, cortisol response following ACTH injection and deteriorated gait), expected differences were detected for sows housed in stalls (0.6-m width, 2.0-m length) and tethers.

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