THE EFFECT OF REPEATED DEPOT ACTH INJECTIONS ON ARGININE-INDUCED HGH RELEASE IN HEALTHY SUBJECTS AND PATIENTS WITH ADDISON'S DISEASE

The short cosyntropin (synthetic ACTH) test is recognized as the best screening manoeuvre in the assessment of adrenocortical insufficiency. Recent data, however, suggest that i.v. administration of 250 microg cosyntropin could be a pharmacological rather than a physiological stimulus, losing sensitivity for detecting adrenocortical failure. Our objective was to compare 10 vs 250 microg cosyntropin in order to find differences in serum cortisol peaks in healthy individuals, the adrenocortical response in a variety of hypothalamic-pituitary-adrenal axis disorders and the highest sensitivity and specificity serum cortisol cut-off point values. The subjects were 83 healthy people and 37 patients, the latter having Addison's disease (11), pituitary adenomas (7), Sheehan's syndrome (9) and recent use of glucocorticoid therapy (10). Forty-six healthy subjects and all patients underwent low- and standard-dose cosyntropin testing. In addition, 37 controls underwent the low-dose test. On comparing low- and standard-dose cosyntropin testing in healthy subjects there were no statistical differences in baseline and peaks of serum cortisol. In the group of patients, 2 out of 11 cases of Addison's disease showed normal cortisol criterion values during the standard test but abnormal during the low-dose test. In our group of patients and controls, the statistical analysis displayed a better sensitivity of the low-dose vs standard-dose ACTH test at 30 and 60 min. In conclusion, these results suggest that the use of 10 microg rather than 250 microg cosyntropin i.v. in the assessment of suspicious adrenocortical dysfunction gives better results.

Download Full-text

Microsatellite Polymorphism of the MHC Class I Chain-Related (MIC-A and MIC-B) Genes Marks the Risk for Autoimmune Addison’s Disease

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.84.10.6069 ◽

1999 ◽

Vol 84 (10) ◽

pp. 3701-3707 ◽

Cited By ~ 3

Author(s):

Giovanni Gambelunghe ◽

Alberto Falorni ◽

Mehran Ghaderi ◽

Stefano Laureti ◽

Cristina Tortoioli ◽

...

Keyword(s):

Healthy Subjects ◽

Absolute Risk ◽

Central Italy ◽

Addison’S Disease ◽

Class I ◽

Addison's Disease ◽

Specific Marker ◽

Hla Dr ◽

Intron 1 ◽

Hla Dr3

Abstract The major histocompatibility complex class I chain-related MIC-A and MIC-B genes are located on chromosome 6 between the histocompatibility leucocyte antigen (HLA)-B and the B-associated transcript genes. The presence of 21-hydroxylase autoantibodies is a sensitive and specific marker of autoimmune Addison’s disease. We studied the polymorphism of exon 5 of the MIC-A gene, of intron 1 of the MIC-B gene, and of HLA-DRB1, -DQA1, and -DQB1 genes in 28 autoimmune (21-hydroxylase autoantibody positive) Addison’s disease patients and in 75 healthy subjects from central Italy. The MIC-A5.1 allele was significantly more frequent in Addison’s disease patients (79%) than in healthy subjects (36%) [odds ratio (OR) = 6.52, corrected P (Pc) = 0.0015], whereas MIC-A6 was significantly reduced in affected subjects (15% vs. 56%, OR = 0.13, Pc = 0.002). The A5.1/A5.1 genotype had an OR for autoimmune Addison’s disease as high as 18.0 and an absolute risk of 1 per 1131. In the presence of MIC-A5.1, MICB-CA-25 was significantly increased in Addison’s disease patients (25% vs. 4%, OR = 8.0, P = 0.0039, Pc = 0.047). The MICB-CA-17 allele was absent in Addison’s disease patients, but present in more than 25% healthy individuals (OR = 0.10, P = 0.0025, Pc = 0.03). Among HLA-DR and -DQ haplotypes, only DRB1*03-DQA1*0501-DQB1*0201 (DR3/DQ2) was significantly more frequent in Addison’s disease patients than in healthy subjects, but only in the presence of MIC-A5.1. The frequency of MIC-A5.1 was significantly increased in Addison’s disease patients only in the presence of HLA-DR3-DQ2. Our study demonstrates that susceptibility to autoimmune Addison’s disease is linked to the MIC-A microsatellite allele 5.1 and that both MIC-A5.1 and HLA-DR3/DQ2 are necessary to confer increased genetic risk for Addison’s disease.

Download Full-text

Effect of a pre-exercise hydrocortisone dose on short-term physical performance in female patients with primary adrenal failure

Acta Endocrinologica ◽

10.1530/eje-15-0630 ◽

2016 ◽

Vol 174 (1) ◽

pp. 97-105 ◽

Cited By ~ 9

Author(s):

Katerina Simunkova ◽

Nevena Jovanovic ◽

Espen Rostrup ◽

Paal Methlie ◽

Marianne Øksnes ◽

...

Keyword(s):

Physical Activity ◽

Aerobic Capacity ◽

Healthy Subjects ◽

Addison’S Disease ◽

Exercise Stress ◽

Addison's Disease ◽

Short Term ◽

Maximal Aerobic Capacity ◽

Post Exercise ◽

Stress Dose

ObjectiveMany patients with primary adrenal insufficiency (Addison's disease) take extra doses of glucocorticoids during stressful events, but a benefit has not been demonstrated in controlled trials. Here, we investigated the effects of a pre-exercise hydrocortisone dose on cardiorespiratory, hormonal and metabolic parameters in response to short-term strenuous physical activity.DesignThis was a randomized placebo-controlled, cross-over clinical trial.ParticipantsTen women with Addison's disease and 10 age-matched healthy females participated in the study.MeasurementsAll women in the study underwent maximal incremental exercise testing. A stress dose of 10 mg hydrocortisone or placebo was given 1 h prior to exercise on two occasions. Blood samples were drawn before, and 0, 15 and 30 min post exercise. Oxygen uptake, maximal aerobic capacity, endocrine and metabolic responses to physical activity, as well as health status by questionnaires were evaluated.ResultsMaximal aerobic capacity and duration of exercise were significantly lower in patients than in healthy subjects and did not improve with the treatment. After an extra hydrocortisone dose serum cortisol was significantly higher than in the healthy subjects (P<0.001). Post-exercise glucose and adrenaline levels were significantly lower and free fatty acids insignificantly higher in patients irrespective of stress dose. Stress dosing did not alter other metabolic or hormonal parameters or quality of life after the exercise.ConclusionsThe patients did not benefit from an extra dose of hydrocortisone in short strenuous exercise. Stress dosing may not be justified in this setting. Whether stress dosing is beneficial in other types of physical activity will have to be examined further.

Download Full-text

The Modern Treatment of Addison's Disease

Medical Clinics of North America ◽

10.1016/s0025-7125(16)35141-0 ◽

1952 ◽

Vol 36 (3) ◽

pp. 721-737 ◽

Cited By ~ 8

Author(s):

Abbie I. Knowlton

Keyword(s):

Addison’S Disease ◽

Addison's Disease ◽

Modern Treatment

Download Full-text

Abstract #115: A Case Report of Overt Addison’s Disease Prsented as Hyperkalemia Caused by Adrenal Tuberculosis

Endocrine Practice ◽

10.1016/s1530-891x(20)42421-8 ◽

2015 ◽

Vol 21 ◽

pp. 8-9

Author(s):

Yunna Jiang ◽

Dana Sanders ◽

Helmut Steinberg

Keyword(s):

Case Report ◽

Addison’S Disease ◽

Addison's Disease

Download Full-text

Cognitive function in patients with primary adrenal insufficiency (Addison's disease)

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0035-1547626 ◽

2015 ◽

Vol 122 (03) ◽

Author(s):

K Schultebraucks ◽

K Wingenfeld ◽

M Quinkler ◽

C Otte

Keyword(s):

Cognitive Function ◽

Adrenal Insufficiency ◽

Addison’S Disease ◽

Addison's Disease ◽

Primary Adrenal Insufficiency

Download Full-text

Addison's disease as a rare cause of chronically elevated transaminases

Zeitschrift für Gastroenterologie ◽

10.1055/s-2004-826909 ◽

2004 ◽

Vol 42 (05) ◽

Author(s):

GC Gurakuqi ◽

V Stadlbauer ◽

H Warnkross ◽

M Trauner

Keyword(s):

Addison’S Disease ◽

Addison's Disease ◽

Elevated Transaminases

Download Full-text

"STEROID-CELL" ANTIBODY IN ENDOCRINE DISEASES

Acta Endocrinologica ◽

10.1530/acta.0.0760729 ◽

1974 ◽

Vol 76 (4) ◽

pp. 729-740 ◽

Cited By ~ 15

Author(s):

Peter Kamp ◽

Per Platz ◽

Jørn Nerup

Keyword(s):

Leydig Cells ◽

Addison’S Disease ◽

Addison's Disease ◽

Hormone Production ◽

Cortical Cells ◽

Endocrine Diseases ◽

Cell Antibody ◽

Indirect Immunofluorescence Technique ◽

Males And Females ◽

Adrenal Cortical Cells

ABSTRACT By means of an indirect immunofluorescence technique, sera from 116 patients with Addison's disease, an equal number of age and sex matched controls and 97 patients with other endocrine diseases were examined for the occurrence of antibody to steroid-producing cells in ovary, testis and adrenal cortex. Fluorescent staining was observed in the theca cells of growing follicles, the theca lutein cells, testicular Leydig cells and adrenal cortical cells, i. e. cells which contain enzyme systems used in steroid hormone production. The "steroid-cell" antibody was present in 24 % of the patients with idiopathic Addison's disease, equally frequent in males and females, and in 17 % of the patients with tuberculous Addison's disease, but was rarely found in controls, including patients with other endocrine diseases. Female hypergonadotrophic hypogonadism made an exception, since the "steroid-cell" antibody was found in about half the cases with this condition.

Download Full-text