Clinical features and diagnosis of secondary adrenal insufficiency followed complex treatment nonpituitary brain tumors

BACKGROUND: The most of the current studies include patients who are different by the etiology of secondary adrenal insufficiency (SAI), or investigate SAI among other late effects of the radiation therapy. AIMS: To describe the features of SAI and to select the best method of screening SAI in adult patients followed complex treatment of nonpituitary brain tumors in childhood. MATERIALS AND METHODS: It was the retrospective cross-sectional study. 31 patients after the complex treatment of nonpituitary brain tumors in childhood and 20 healthy volunteers were examined. Age and sex ratio were comparable between the groups. Biochemical and clinical blood tests, levels of cortisol, ACTH, DHEA-C were evaluated. The insulin tolerance test (ITT) was performed for all patients and 11 volunteers. RESULTS: The prevalence of SAI by ITT was 45.2%. The levels of basal cortisol (BC) were significantly higher in patients without SAI in comparison with the SAI group and volunteers (505 [340; 650] vs 323 [233; 382] and 372 [263; 489] nmol / l; pSAI- without_SAI=0.001; pwihtout_SAI-healthy = 0.04). The SAI group had DHEA-C significantly lower than in other groups one (3.1 [1.8; 3.4] vs 5.1 [2.5; 6.4] and 6.8 [4.1; 8.9]; рSAI- without_SAI = 0.036; pSAI-healthy = 0.001). ROC analysis showed that BC and DHEA-S can be used as high-quality screening tests for SAI (AUC = 89.3% and 88.3%). The maximum level of cortisol (656 [608-686] vs 634 [548-677]; p = 1) and the time of its increase (45 and 60 min) did not differ during ITT in patients without SAI and volunteers. Side effects: delayed hypoglycemia occurred in 4/14 patients of the SAI group 4090 minutes late of injection 60-80 ml of 40% glucose solution for stopping hypoglycemia in the test. CONCLUSIONS: 45.2% of patients followed craniospinal irradiation had SAI that is characterized by a decrease in DHEA-C levels. A highly normal level of basal cortisol was observed in 45% of patients without SAI. DHEA-C and blood cortisol can be used for SAI screening.

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Clinical features and practice patterns of treatment for adrenal crisis: a nationwide cross-sectional study in Japan

Acta Endocrinologica ◽

10.1530/eje-16-0803 ◽

2017 ◽

Vol 176 (3) ◽

pp. 329-337 ◽

Cited By ~ 7

Author(s):

Yosuke Ono ◽

Sachiko Ono ◽

Hideo Yasunaga ◽

Hiroki Matsui ◽

Kiyohide Fushimi ◽

...

Keyword(s):

Insulin Therapy ◽

Adrenal Insufficiency ◽

Practice Patterns ◽

Cross Sectional Study ◽

Adrenal Crisis ◽

Sectional Study ◽

Secondary Adrenal Insufficiency ◽

Impaired Consciousness ◽

Cross Sectional ◽

Intravenous Glucocorticoids

Context Adrenal crisis is an endocrine emergency that requires prompt diagnosis and treatment. However, the clinical features and practice patterns of treatment for adrenal crisis are not completely understood. Objective To investigate patient characteristics, comorbidities and treatments of adrenal crisis. Methods We conducted a cross-sectional study of patients who received intravenous glucocorticoids for adrenal crisis at admission from 1 July 2007 to 31 March 2014, using a national inpatient database in Japan. Results Among approximately 34 million inpatients in the database, we identified 799 patients diagnosed with adrenal crisis and coexisting primary or secondary adrenal insufficiency at admission. The median (interquartile range) age was 58 (28–73) years, and the overall in-hospital mortality was 2.4% (19 of 799 patients). The most common comorbidity at admission was infections excluding pneumonia and gastroenteritis (15.0%). There were 68 (8.5%) patients with gastroenteritis, and no deaths occurred among these patients. The patients with secondary adrenal insufficiency showed significantly higher proportions of admission to ICU, extracellular fluid resuscitation, insulin therapy and catecholamine use than the patients with primary adrenal insufficiency. There were no significant between-group differences in mortality rate and variation in intravenous glucocorticoids (short-acting glucocorticoid, hydrocortisone; moderate-acting glucocorticoid, prednisolone or methylprednisolone; long-acting glucocorticoid, dexamethasone or betamethasone). Of the 19 dead patients, 15 were aged above 60 years, 12 had impaired consciousness at admission and 13 received insulin therapy. Conclusions Clinicians should be aware that older patients with impaired consciousness and diabetes mellitus are at relatively high risk of death from adrenal crisis.

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Secondary Adrenal Insufficiency: A Cross-sectional Study of Nasopharyngeal Carcinoma Patients after Treatment with Intensity-modulated Radiotherapy

Hong Kong Journal of Radiology ◽

10.12809/hkjr1816827 ◽

2018 ◽

pp. 99-106

Author(s):

DCW Chan ◽

◽

CY Lui ◽

KT Yuen ◽

CH Kwok ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Adrenal Insufficiency ◽

Intensity Modulated Radiotherapy ◽

Cross Sectional Study ◽

Sectional Study ◽

Secondary Adrenal Insufficiency ◽

Cross Sectional ◽

Intensity Modulated

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THE FREQUENCY OF ADRENAL INSUFFICIENCY IN ADOLESCENTS AND YOUNG ADULTS WITH THALASSEMIA MAJOR VERSUS THALASSEMIA INTERMEDIA IN IRAN

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2015.005 ◽

2014 ◽

Vol 7 ◽

pp. e2015005 ◽

Cited By ~ 4

Author(s):

Sara Matin ◽

Masoud Ghanei Jahromi ◽

Zohreh Karemizadeh ◽

Sezaneh Haghpanah ◽

Vincenzo De Sanctis ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Standard Dose ◽

Serum Cortisol ◽

Thalassemia Major ◽

Cross Sectional Study ◽

Cortisol Response ◽

Acth Stimulation ◽

Cross Sectional ◽

Basal Cortisol ◽

The Mean

Background: Endocrine dysfunction is not uncommon complication in patients with transfusion dependent thalassemia and is thought to occur as a consequence of excessive iron overload. The main objective of this study is to determine the frequency of adrenal insufficiency in patients with thalassemia major and thalassemia intermediate. Methods: This cross-sectional study was done at the Shiraz University of Medical Sciences, Shiraz, Southern Iran, in 2013. One hundred and ninety patients were divided into two groups; thalassemia major(TM) and thalassemia intermediate (TI) groups. We measured 8 AM serum cortisol, ACTH and ferritin concentrations in all patients. Results: The mean age of the TM and TI group were 22.5±5.7 and 23.8±6 years, respectively. 90 patients (47.4%) were splenectomized, 34 (36.2%) with TM and 56 (58.2%) with TI (p : 0.001). The mean serum ferritin levels were 3056.5±2306 and 666.2±616.5 in TM and TI respectively (p: 0.001). Three patients with TM (1.6%) had low basal cortisol and ACTH levels. However their cortisol response to ACTH stimulation was normal. Conclusions: Low basal concentrations of cortisol and ACTH occurred in 1.6% of our adolescents young adult patients with TM suggesting a central defect of cortisol secretion at the basal state. However, cortisol response to standard – dose ACTH was normal in all patients with TM and TI.

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Correlation of Glycemic Control Parameters in Non-Diabetic Persons with Cardiovascular Risk Scores - Results from a Cross- Sectional Study

Revista de Chimie ◽

10.37358/rc.17.1.5399 ◽

2017 ◽

Vol 68 (1) ◽

pp. 108-110

Author(s):

Gina Botnariu ◽

Norina Forna ◽

Alina Popa ◽

Raluca Popescu ◽

Alina Onofriescu ◽

...

Keyword(s):

Cardiovascular Risk ◽

Glycemic Control ◽

Tolerance Test ◽

Cross Sectional Study ◽

Risk Scores ◽

Oral Glucose ◽

Cross Sectional ◽

University Of Edinburgh ◽

Fasting Glycaemia ◽

The University

To assess the correlation between main parameters of glycemic control and cardiovascular risk scores in non-diabetic persons. Risk scores were calculated by using the University of Edinburgh Risk Calculator. Risk scores are used to estimate the probability of cardiovascular disease in individuals who have not already developed major atherosclerotic disease. We correlated the results of these scores with the parameters that describes the glycaemic profile: preprandial glicaemia, HbA1c and 1 hour and 2 h post-prandial glycaemia, determined during Oral Glucose Tolerance Test (OGTT).Both fasting glycaemia and HbA1c significantly correlated with cardiovascular risk scores calculated for a period of 10 years. The recorded post-prandial glycaemic values at 1h and 2h after glucose loading didn�t significantly correlate with calculated scores, in the study group. The observed correlations underline the importance of glycaemia in the pathogenesis of cardiovascular diseases.

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Clinical Utility of the Ankle-Brachial Index and Toe Brachial Index in Patients with Diabetic Foot Ulcers

Current Diabetes Reviews ◽

10.2174/1573399815666190531093238 ◽

2020 ◽

Vol 16 (3) ◽

pp. 270-277 ◽

Cited By ~ 1

Author(s):

Mutasem Ababneh ◽

Mousab Y. Al Ayed ◽

Asirvatham A. Robert ◽

Mohamed A. Al Dawish

Keyword(s):

Diabetic Foot ◽

Statistical Significance ◽

Ankle Brachial Index ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

Cross Sectional Study ◽

Screening Tests ◽

Cross Sectional ◽

Toe Brachial Index

Background: This cross sectional study investigated the clinical use of the ankle-brachial index (ABI) and toe brachial index (TBI) in 91 type 2 diabetic foot ulcer patients who visited the diabetic foot clinic, Prince Sultan Military Medical City, Saudi Arabia during July 2017 and January 2018. Materials and Methods: The ABI and TBI facilitated the detection of peripheral arterial disease (PAD) and the patients’ medical records were used to collect the clinical and demographic variables. The variables of duration (p = 0.047) and treatment (p = 0.046) of the ABI showed significant differences. Age (p = 0.034) and duration (p = 0.001) were the factors related to the diagnosis of TBI by the “χ2” test. Results: From the TBI, 26.4% of the patients were found to have PAD, while the ABI showed that 21.8% of patients had the condition. However, no statistical significance was noted. From the regression analysis, the variable duration of diabetes (≥ 20 years of age) was recognized as an independent risk factor for TBI. Conclusion: In conclusion, it is recommended both the ABI and TBI to be used as screening tests for PAD in diabetic foot ulcer patients.

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MicroRNAs-1299, -126-3p and -30e-3p as Potential Diagnostic Biomarkers for Prediabetes

Diagnostics ◽

10.3390/diagnostics11060949 ◽

2021 ◽

Vol 11 (6) ◽

pp. 949

Author(s):

Cecil J. Weale ◽

Don M. Matshazi ◽

Saarah F. G. Davids ◽

Shanel Raghubeer ◽

Rajiv T. Erasmus ◽

...

Keyword(s):

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Predictive Ability ◽

Roc Curves ◽

Tolerance Test ◽

Cross Sectional Study ◽

Oral Glucose ◽

Cross Sectional ◽

Receiver Operating

This cross-sectional study investigated the association of miR-1299, -126-3p and -30e-3p with and their diagnostic capability for dysglycaemia in 1273 (men, n = 345) South Africans, aged >20 years. Glycaemic status was assessed by oral glucose tolerance test (OGTT). Whole blood microRNA (miRNA) expressions were assessed using TaqMan-based reverse transcription quantitative-PCR (RT-qPCR). Receiver operating characteristic (ROC) curves assessed the ability of each miRNA to discriminate dysglycaemia, while multivariable logistic regression analyses linked expression with dysglycaemia. In all, 207 (16.2%) and 94 (7.4%) participants had prediabetes and type 2 diabetes mellitus (T2DM), respectively. All three miRNAs were significantly highly expressed in individuals with prediabetes compared to normotolerant patients, p < 0.001. miR-30e-3p and miR-126-3p were also significantly more expressed in T2DM versus normotolerant patients, p < 0.001. In multivariable logistic regressions, the three miRNAs were consistently and continuously associated with prediabetes, while only miR-126-3p was associated with T2DM. The ROC analysis indicated all three miRNAs had a significant overall predictive ability to diagnose prediabetes, diabetes and the combination of both (dysglycaemia), with the area under the receiver operating characteristic curve (AUC) being significantly higher for miR-126-3p in prediabetes. For prediabetes diagnosis, miR-126-3p (AUC = 0.760) outperformed HbA1c (AUC = 0.695), p = 0.042. These results suggest that miR-1299, -126-3p and -30e-3p are associated with prediabetes, and measuring miR-126-3p could potentially contribute to diabetes risk screening strategies.

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Impact of glucagon response on early‐postprandial glucose excursions irrespective of residual β‐cell function in type 1 diabetes: A cross‐sectional study using a mixed‐meal tolerance test

Journal of Diabetes Investigation ◽

10.1111/jdi.13486 ◽

2020 ◽

Author(s):

Ayako Ito ◽

Ichiro Horie ◽

Masaki Miwa ◽

Ayaka Sako ◽

Tetsuro Niri ◽

...

Keyword(s):

Cell Function ◽

Postprandial Glucose ◽

Tolerance Test ◽

Cross Sectional Study ◽

Sectional Study ◽

Β Cell ◽

Mixed Meal ◽

Cross Sectional ◽

Β Cell Function

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Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies

Acta Endocrinologica ◽

10.1530/eje-09-0884 ◽

2010 ◽

Vol 162 (3) ◽

pp. 597-602 ◽

Cited By ~ 146

Author(s):

Stefanie Hahner ◽

Melanie Loeffler ◽

Benjamin Bleicken ◽

Christiane Drechsler ◽

Danijela Milovanovic ◽

...

Keyword(s):

Risk Factors ◽

Adrenal Insufficiency ◽

Educational Status ◽

Cross Sectional Study ◽

Sudden Onset ◽

Stressful Events ◽

Adrenal Crisis ◽

Cross Sectional ◽

Crisis Prevention ◽

Dhea Treatment

ObjectiveAdrenal crisis (AC) is a life-threatening complication of adrenal insufficiency (AI). Here, we evaluated frequency, causes and risk factors of AC in patients with chronic AI.MethodsIn a cross-sectional study, 883 patients with AI were contacted by mail. Five-hundred and twenty-six patients agreed to participate and received a disease-specific questionnaire.ResultsFour-hundred and forty-four datasets were available for analysis (primary AI (PAI), n=254; secondary AI (SAI), n=190). Forty-two percent (PAI 47% and SAI 35%) reported at least one crisis. Three hundred and eighty-four AC in 6092 patient years were documented (frequency of 6.3 crises/100 patient years). Precipitating causes were mainly gastrointestinal infection and fever (45%) but also other stressful events (e.g. major pain, surgery, psychic distress, heat and pregnancy). Sudden onset of apparently unexplained AC was also reported (PAI 6.6% and SAI 12.7%). Patients with PAI reported more frequent emergency glucocorticoid administration (42.5 vs 28.4%, P=0.003). Crisis incidence was not influenced by educational status, body mass index, glucocorticoid dose, DHEA treatment, age at diagnosis, hypogonadism, hypothyroidism or GH deficiency. In PAI, patients with concomitant non-endocrine disease were at higher risk of crisis (odds ratio (OR)=2.02, 95% confidence interval (CI) 1.05–3.89, P=0.036). In SAI, female sex (OR=2.18, 95% CI 1.06–4.5, P=0.035) and diabetes insipidus (OR=2.71, 95% CI 1.22–5.99, P=0.014) were associated with higher crisis incidence.ConclusionAC occurs in a substantial proportion of patients with chronic AI, mainly triggered by infectious disease. Only a limited number of risk factors suitable for targeting prevention of AC were identified. These findings indicate the need for new concepts of crisis prevention in patients with AI.

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