scholarly journals A Comparative Effectiveness Analysis of Alternative Strategies to Assess Hypothalamic-Pituitary-Adrenal Axis Function After Microsurgical Resection of Pituitary Tumors

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1576-1585 ◽  
Author(s):  
Nicholas F. Marko ◽  
Robert J. Weil
Keyword(s):  
Hpa Axis ◽  
Clinical Management ◽  
Comparative Effectiveness ◽  
Management Strategies ◽  
Pituitary Tumors ◽  
Observational Research ◽  
Adrenocorticotrophic Hormone ◽  
Hypothalamic Pituitary Adrenal ◽  
Hormone Stimulation ◽  
Microsurgical Resection

Abstract BACKGROUND: Observational methods can be used in conjunction with the comparative effectiveness research (CER) paradigm to inform decisions between alternative patient management strategies in real-world clinical settings. OBJECTIVE: To present a brief review of current observational research regarding 3 strategies for predicting normal hypothalamic-pituitary-adrenal (HPA) axis function after surgical resection of pituitary tumors and to apply the CER model to compare these management alternatives. METHODS: We designed and conducted 2 prospective observational studies involving 183 patients undergoing microsurgical resection for pituitary tumors. These investigations yielded a comprehensive database comprising longitudinal data from multiple clinical domains. We investigated 3 potential strategies to predict normal postoperative HPA axis function in this cohort, including preoperative adrenocorticotrophic hormone stimulation testing and measurement of serum cortisol levels immediately after surgery or on the first postoperative day. We performed a focused comparative effectiveness review to help inform the decision between the 3 potential clinical management strategies. RESULTS: This investigation illustrates the use of observational research methods in conjunction with CER methodology as one means of informing clinical management decisions. Of the 3 strategies for assessing postoperative HPA axis function studied, preoperative and immediate postoperative adrenocorticotrophic hormone stimulation testing had the highest sensitivity, accuracy, and positive predictive value for normal HPA axis function postoperatively. The preoperative strategy was also the most cost-effective approach (12% reduction vs benchmark). CONCLUSION: The decision to use any of the 3 strategies outlined requires attention to a specific patient's clinical situation, but this decision may be aided by the results of this CER analysis.

Positive relationship between the catecholaminergic turnover and the DST results in depression

1990 ◽  
Vol 20 (3) ◽  
pp. 493-499 ◽  
Author(s):  
M. Maes ◽  
M. Vandewoude ◽  
C. Schotte ◽  
M. Martin ◽  
P. Blockx
Keyword(s):  
Hpa Axis ◽  
Positive Relationship ◽  
Vanillylmandelic Acid ◽  
Adrenocorticotrophic Hormone ◽  
Hypothalamic Pituitary Adrenal ◽  
The Past ◽  
Baseline Cortisol ◽  
Before And After ◽  
Positive Correlations ◽  
Excretion Rates

SynopsisIn the past some workers have reported positive relationships between indices of noradrenaline activity and measures of hypothalamic–pituitary–adrenal (HPA)-axis function. In order to investigate these relations, the authors measured noradrenaline, adrenaline and vanillylmandelic acid (VMA) in 24 h urine samples of 72 depressed females. Serum adrenocorticotrophic hormone (ACTH) and cortisol concentrations were determined before and after administration of 1 mg of dexamethasone. Cortisol non-suppressors exhibited a significantly higher noradrenaline, adrenaline and VMA excretion as compared to cortisol suppressors. We determined significantly positive correlations between the postdexamethasone cortisol values and the excretion rates of noradrenaline and VMA. These indices of noradrenaline activity correlated neither with the baseline cortisol and ACTH nor with the postdexamethasone ACTH values.

Effects of alprazolam on cholecystokinin-tetrapeptide (CCK-4) induced panic and hypothalamic-pituitary-adrenal (HPA) axis activity

2004 ◽  
Vol 36 (05) ◽  
Author(s):  
D Eser ◽  
P Zwanzger ◽  
S Aicher ◽  
C Schüle ◽  
TC Baghai ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Hypothalamic Pituitary Adrenal ◽  
Hpa Axis Activity

scholarly journals Dream Recall/Affect and the Hypothalamic–Pituitary–Adrenal Axis

2021 ◽  
Vol 3 (3) ◽  
pp. 403-408
Author(s):  
Athanasios Tselebis ◽  
Emmanouil Zoumakis ◽  
Ioannis Ilias
Keyword(s):  
Hpa Axis ◽  
Glucocorticoid Receptors ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Free Form ◽  
Dream Recall ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Concise Review ◽  
Pathological Conditions ◽  
Pituitary Adrenal Axis

In this concise review, we present an overview of research on dream recall/affect and of the hypothalamic–pituitary–adrenal (HPA) axis, discussing caveats regarding the action of hormones of the HPA axis (mainly cortisol and its free form, cortisol-binding globulin and glucocorticoid receptors). We present results of studies regarding dream recall/affect and the HPA axis under physiological (such as waking) or pathological conditions (such as in Cushing’s syndrome or stressful situations). Finally, we try to integrate the effect of the current COVID-19 situation with dream recall/affect vis-à-vis the HPA axis.

scholarly journals Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of mRNA COVID-19 Vaccines?

Pain Medicine ◽  
2021 ◽  
Vol 22 (4) ◽  
pp. 994-1000
Author(s):  
Haewon Lee ◽  
Jennifer A Punt ◽  
David C Miller ◽  
Ameet Nagpal ◽  
Clark C Smith ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Ribonucleic Acid ◽  
Direct Evidence ◽  
Corticosteroid Injection ◽  
Vaccine Dose ◽  
Hypothalamic Pituitary Adrenal ◽  
Messenger Ribonucleic Acid ◽  
Corticosteroid Injections

Abstract Myth Corticosteroid injection for the treatment of pain and inflammation is known to decrease the efficacy of the messenger ribonucleic acid (mRNA) vaccines for coronavirus disease 2019 (COVID-19). Fact There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine. However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to a COVID-19 mRNA vaccine dose and no less than 1 week following a COVID-19 mRNA vaccine dose, whenever possible.

scholarly journals Genes and hormones of the hypothalamic–pituitary–adrenal axis in post-traumatic stress disorder. What is their role in symptom expression and treatment response?

2021 ◽  
Author(s):  
Susanne Fischer ◽  
Tabea Schumacher ◽  
Christine Knaevelsrud ◽  
Ulrike Ehlert ◽  
Sarah Schumacher
Keyword(s):  
Hpa Axis ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Alternative Treatments ◽  
Hypothalamic Pituitary Adrenal ◽  
Post Traumatic

Abstract Background Less than half of all individuals with post-traumatic stress disorder (PTSD) remit spontaneously and a large proportion of those seeking treatment do not respond sufficiently. This suggests that there may be subgroups of individuals who are in need of augmentative or alternative treatments. One of the most frequent pathophysiological findings in PTSD is alterations in the hypothalamic–pituitary–adrenal (HPA) axis, including enhanced negative feedback sensitivity and attenuated peripheral cortisol. Given the role of the HPA axis in cognition, this pattern may contribute to PTSD symptoms and interfere with key processes of standard first-line treatments, such as trauma-focused cognitive behavioural therapy (TF-CBT). Methods This review provides a comprehensive summary of the current state of research regarding the role of HPA axis functioning in PTSD symptoms and treatment. Results Overall, there is preliminary evidence that hypocortisolaemia contributes to symptom manifestation in PTSD; that it predicts non-responses to TF-CBT; and that it is subject to change in parallel with positive treatment trajectories. Moreover, there is evidence that genetic and epigenetic alterations within the genes NR3C1 and FKBP5 are associated with this hypocortisolaemic pattern and that some of these alterations change as symptoms improve over the course of treatment. Conclusions Future research priorities include investigations into the role of the HPA axis in day-to-day symptom variation, the time scale in which biological changes in response to treatment occur, and the effects of sex. Furthermore, before conceiving augmentative or alternative treatments that target the described mechanisms, multilevel studies are warranted.

scholarly journals Endocrine and Electrolyte Balances during Periovulatory Period in Cycling Mares

Animals ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 520 ◽  
Author(s):  
Katiuska Satué ◽  
Esterina Fazio ◽  
Ana Muñoz ◽  
Pietro Medica
Keyword(s):  
Estrous Cycle ◽  
Hpa Axis ◽  
Adrenocorticotropic Hormone ◽  
Venous Blood ◽  
Competitive Elisa ◽  
Direct Relation ◽  
Plasma Acth ◽  
Blood Samples ◽  
Hypothalamic Pituitary Adrenal ◽  
Stimulation Of

In cycling females, the periovulatory period is characterized by stimulation of the hypothalamic pituitary adrenal (HPA) axis. The aim of present study was to analyze the pattern and interrelationships among adrenocorticotropic hormone (ACTH), cortisol (CORT), aldosterone (ALD) and electrolytes (sodium—Na+, potassium—K+ and chloride—Cl−) during periovulatory period in cycling mares. Venous blood samples were obtained daily from a total of 23 Purebred Spanish broodmares, aged 7.09 ± 2.5 years, from day −5 to day +5 of estrous cycle, considering day 0, the day of ovulation. Plasma ACTH was measured by a fluorescent immunoassay kit, serum CORT and ALD by means of a competitive ELISA immunoassay, and plasma Na+, K+ and Cl− were quantified by an analyzer with selective electrodes for the three ions. ACTH showed higher concentrations at day 0 compared to days −5 to −1 and +1 to +3 (p < 0.05). CORT showed higher concentrations at day 0 compared to days −5 to −2 and +1 to +5 (p < 0.05). ALD showed higher concentrations at day 0 compared to days −5 to −2 (p < 0.05) and +2 (p < 0.05). Na+ and Cl− showed higher concentrations at day 0, compared to day −5 and +5. K+ showed lower concentrations at day 0 compared to day +1 (p < 0.05). The significant correlations obtained between ACTH and CORT (r = 0.20) and between ACTH and ALD (r = 0.32) suggest that although ACTH may have an effect both on CORT and ALD, there are other very important determinants that could be considered. Hence, it is possible to presume that the pituitary adrenocortical response and ALD may be involved in the ovulatory mechanisms without a direct relation with electrolyte pattern.

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