Hormone Studies in a Case of Virilisation Due to Ovarian Tumour

1985 ◽  
Vol 22 (5) ◽  
pp. 498-501 ◽  
Author(s):  
J A Fleetwood ◽  
M J Watson ◽  
Hilary J Wastell ◽  
Ann Weddell
Keyword(s):  
Mucinous Cystadenoma ◽  
Urinary Free Cortisol ◽  
Ovarian Tumour ◽  
Plasma Testosterone ◽  
Ultrasound Scan ◽  
Ovarian Mass ◽  
Serum Lh ◽  
Free Cortisol ◽  
Before And After ◽  
Leydig Cell Tumour

The investigation is described of a 62-year-old female patient who presented with severe virilisation; her plasma testosterone concentration was grossly elevated at 37–9 nmol/L. Measurement of plasma androstenedione, dehydroepiandrosterone (DHEA) and DHEA-sulphate, urinary 17-oxosteroids and urinary ‘free’ Cortisol suggested an ovarian source of androgens. An ultrasound scan indicated the presence of an ovarian mass which was removed and classified as a Sertoli—Leydig cell tumour (arrhenoblastoma) combined with a mucinous cystadenoma. Following operation plasma testosterone levels returned to normal. The excessive pre-operative testosterone production appeared to have had little effect on the plasma level of SHBG, since levels remained similar before and after removal of the tumour. Serum LH and FSH levels were higher post-operatively.

scholarly journals Partial restoration of GH responsiveness to ghrelin in Cushing's disease after 6 months of ketoconazole treatment: comparison with GHRP-6 and GHRH

2009 ◽  
Vol 161 (5) ◽  
pp. 681-686 ◽  
Author(s):  
Silvia R Correa-Silva ◽  
Sérgio O Nascif ◽  
Patrícia Molica ◽  
Larissa B P C Sá ◽  
José G Vieira ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Urinary Free Cortisol ◽  
Cushing's Disease ◽  
Partial Restoration ◽  
Gh Secretion ◽  
Treatment Comparison ◽  
Time Period ◽  
Free Cortisol ◽  
Before And After ◽  
Serum Gh

ObjectiveIn Cushing's disease (CD), GH responsiveness to several stimuli, including ghrelin, GHRP-6, and GHRH, is blunted. Recovery of GH secretion after remission of hypercortisolism after transsphenoidal surgery, radiotherapy, or adrenalectomy is controversial. There are no studies evaluating the effect of primary clinical treatment with ketoconazole on GH secretion in CD. The aim of this study is to compare ghrelin-, GHRP-6-, and GHRH-induced GH release before and after ketoconazole in CD.DesignGH responses to ghrelin, GHRP-6, and GHRH of eight untreated patients with CD (mean age: 33.8±3.1 years; body mass index: 28.5±0.8 kg/m2) were evaluated before and after 3 and 6 months of ketoconazole treatment, and compared with 11 controls (32.1±2.5; 25.0±0.8).MethodsSerum GH was measured by an immunofluorometric assay and urinary free cortisol (UFC) by liquid chromatography and tandem mass spectrometry.ResultsAfter ketoconazole use, mean UFC decreased significantly (before: 222.4±35.0 μg/24 h; third month: 61.6±10.1; sixth month: 39.1±10.9). Ghrelin-induced GH secretion increased significantly after 6 months (peak before: 6.8±2.3 μg/l; sixth month: 16.0±3.6), but remained lower than that of controls (54.1±11.2). GH release after GHRP-6 increased, although not significantly, while GH responsiveness to GHRH was unchanged.ConclusionsGhrelin-induced GH release increases significantly after 6 months of ketoconazole treatment in CD. This could suggest that a decrease in cortisol levels during this time period can partially restore glucocorticoid-induced GH suppression in CD. GH-releasing mechanisms stimulated by ghrelin/GHS could be more sensitive, as no changes in GHRH-induced GH release were observed.

scholarly journals Bilateral Adrenal Hyperplasia as a Possible Mechanism for Hyperandrogenism in Women With Polycystic Ovary Syndrome

2016 ◽  
Vol 101 (9) ◽  
pp. 3353-3360 ◽  
Author(s):  
Evgenia Gourgari ◽  
Maya Lodish ◽  
Meg Keil ◽  
Ninet Sinaii ◽  
Evrim Turkbey ◽  
...  
Keyword(s):  
Polycystic Ovary ◽  
Hormone Secretion ◽  
Urinary Free Cortisol ◽  
Adrenocortical Function ◽  
High Dose ◽  
High Dose Dexamethasone ◽  
Free Cortisol ◽  
Before And After ◽  
Pcos Group ◽  
Adrenal Volume

Abstract Context: Androgen excess may be adrenal and/or ovarian in origin; we hypothesized that a subgroup of patients with polycystic ovarian syndrome (PCOS) may have some degree of abnormal adrenocortical function. Objective: The objective of the study was to evaluate the pituitary adrenal axis with an oral low- and high-dose dexamethasone-suppression test (Liddle's test) in women with PCOS. Design: This was a case-control study. Setting: The study was conducted at the National Institutes of Health Clinical Center. Participants: A total of 38 women with PCOS and 20 healthy volunteers (HV) aged 16–29 years participated in the study. Main Outcome Measures: Urinary free cortisol (UFC) and 17-hydroxysteroids (17OHS) before and after low- and high-dose dexamethasone and assessment of adrenal volume by computed tomography scan were measured. Results: Twenty-four-hour urinary 17OHS and UFC were measured during day 1 to day 6 of the Liddle's test. Baseline UFC levels were not different between PCOS and HVs; on the day after the completion of high-dose dexamethasone administration (d 6), UFC was higher in the PCOS group (2.0 ± 0.7 μg/m2·d) than the HV group (1.5 ± 0.5) (P = .038). On day 5, 17OHS and UFC were negatively correlated with adrenal volumes (left side, rp = −0.47, P = .009, and rp = −0.61, P < .001, respectively). PCOS patients above the 75th percentile for UFC and/or 17OHS after high-dose dexamethasone (n = 15) had a significantly smaller total adrenal volume (6.9 ± 1.9 cm3 vs 9.2 ± 1.8 cm3, P = .003) when compared with the remaining PCOS patients (n = 22), but they did not have worse insulin resistance or hyperandrogenism. Conclusions: In a subset of young women with PCOS, we detected a pattern of glucocorticoid secretion that mimicked that of patients with micronodular adrenocortical hyperplasia: they had smaller adrenal volumes and higher steroid hormone secretion after dexamethasone compared with the group of PCOS with appropriate response to dexamethasone.

FREE CORTISOL IN OBESITY; EFFECT OF FASTING

1976 ◽  
Vol 81 (2) ◽  
pp. 321-329 ◽  
Author(s):  
A. Galvão-Teles ◽  
Linda Graves ◽  
C. W. Burke ◽  
K. Fotherby ◽  
Russell Fraser
Keyword(s):  
Protein Intake ◽  
Urinary Free Cortisol ◽  
Significant Rise ◽  
Low Protein ◽  
Free Cortisol ◽  
Before And After ◽  
Obese Subjects ◽  
Cortisol Excretion ◽  
Cortisol Levels ◽  
Protein Diets

ABSTRACT Plasma and urinary corticosteroids were measured in 13 obese subjects before and after high and low protein diets, and after fasting. During isocaloric high and low protein diets, urinary 17-oxogenic steroids and to a lesser extent urinary free cortisol excretion rose and fell in parallel with protein intake. Plasma unbound cortisol levels were not much changed by high or low protein intake. However, during 7 to 11 days total fasting, there was a highly significant rise in plasma unbound cortisol at 24.00. A smaller rise occurred at 09.00. The overall effect was a considerable diminution of the day-night variation of plasma unbound cortisol levels during fasting, and a rise in prevailing unbound cortisol levels and urinary free cortisol excretion. In 3 subjects tested these changes were reversed immediately by glucose re-feeding.

Refractory hypokalaemia and hypertension with metabolic alkalosis: an acute presentation of Cushing’s disease secondary to a pituitary macroadenoma

2021 ◽  
Vol 14 (8) ◽  
pp. e244850
Author(s):  
Najeeb Zaheer Shah ◽  
Shah Malik ◽  
Thozhukat Sathyapalan ◽  
Kamrudeen Mohammed
Keyword(s):  
Metabolic Alkalosis ◽  
Adrenocorticotropic Hormone ◽  
Urinary Free Cortisol ◽  
Clinical Findings ◽  
Ultrasound Scan ◽  
Oral Antibiotics ◽  
Acute Presentation ◽  
Intravenous Antibiotics ◽  
Free Cortisol ◽  
Proximal Myopathy

A 68-year-old woman presented with right arm cellulitis, not responsive to oral antibiotics. Intravenous antibiotics were commenced, and an ultrasound scan confirmed a collection that was surgically drained. She developed refractory hypokalaemia with normal magnesium, no gastrointestinal losses and no iatrogenic cause. She was hypertensive, hyperglycaemic, alkalotic, clinically obese with proximal myopathy and skin bruising. These clinical findings and refractory hypokalaemic hypertension with metabolic alkalosis raised a suspicion of Cushing’s syndrome (CS). 24-hour urinary free cortisol (24 hours) was grossly raised on two occasions. The adrenocorticotropic hormone (ACTH) was significantly raised at 154 ng/L, confirming ACTH-dependant CS. A CT scan of the thorax, abdomen and pelvis excluded an ectopic source of hypercortisolaemia. MRI pituitary revealed an invasive macroadenoma. Treatment with endoscopic debulking resulted in the resolution of hypokalaemia and metabolic alkalosis with significant improvement in hyperglycaemia and hypertension.

How useful is 24 hour Urinary Free Cortisol as a screening tool for Cushing's syndrome?

2018 ◽  
Author(s):  
Ahmed Hanafy ◽  
Chinnadorai Rajeswaran ◽  
Saad Saddiq ◽  
Warren Gillibrand ◽  
John Stephenson
Keyword(s):  
Cushing’S Syndrome ◽  
Screening Tool ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Free Cortisol

A Comparative Study of Urinary 17-Hydroxycorticosteroids, Urinary Free Cortisol, and the Integrated Concentration of Plasma Cortisol*

1980 ◽  
Vol 51 (5) ◽  
pp. 1099-1101 ◽  
Author(s):  
ZVI ZADIK ◽  
LUIZ DE LACERDA ◽  
LUIZ A. H. DE CARMARGO ◽  
BRUCE P. HAMILTON ◽  
CLAUDE J. MIGEON ◽  
...  
Keyword(s):  
Comparative Study ◽  
Plasma Cortisol ◽  
Urinary Free Cortisol ◽  
Free Cortisol

THE EFFECTS OF DEXAMETHASONE AND ANDROGENS ON SEXUAL RECEPTIVITY OF FEMALE RHESUS MONKEYS

1971 ◽  
Vol 51 (3) ◽  
pp. 575-588 ◽  
Author(s):  
B. J. EVERITT ◽  
J. HERBERT
Keyword(s):  
Rhesus Monkeys ◽  
Testosterone Propionate ◽  
Secretory Activity ◽  
Urinary Free Cortisol ◽  
Sexual Receptivity ◽  
Adrenal Androgens ◽  
Electrolyte Metabolism ◽  
Free Cortisol ◽  
Female Rhesus ◽  
The Central Nervous System

SUMMARY The effect of dexamethasone, given either alone or together with testosterone propionate or androstenedione, was studied in nine female rhesus monkeys (paired with three males) by making quantitative observations on behaviour in the laboratory. Dexamethasone (0·5 mg/kg/day) given to oestrogen-treated ovariectomized female monkeys made them sexually unreceptive, and there was an associated decline in the level of the male's mounting activity. Testosterone propionate (100 or 200 μg/day) reversed completely the effects of dexamethasone on sexual behaviour. Androstenedione (100, 200 or 400 μg/day) had similar, but less marked, effects whereas cortisol (10 mg/day) or progesterone (100, 200 or 500 μg/day) were ineffective. Treating a female with testosterone prevented dexamethasone from reducing sexual receptivity. Parallel determinations of urinary free cortisol showed that the dexamethasone had suppressed the secretory activity of the adrenal cortex. There were no consistent changes, under any treatment, in the females' vaginal epithelia, sexual skins or clitorides, or in their water or electrolyte metabolism. These findings indicate that adrenal androgens regulate sexual receptivity in these female primates, probably by an action on the central nervous system.

scholarly journals Relationships Between 24-Hour Urinary Free Cortisol Concentrations and Metabolic Syndrome in Obese Children

2014 ◽  
Vol 99 (7) ◽  
pp. 2391-2399 ◽  
Author(s):  
Thomas Reinehr ◽  
Alexandra Kulle ◽  
Barbara Wolters ◽  
Caroline Knop ◽  
Nina Lass ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Urinary Free Cortisol ◽  
Obese Children ◽  
Free Cortisol
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