A study of hypothalamic-pituitary-adrenal suppression following curative surgery for Cushing's syndrome due to adrenal adenoma

1987 ◽  
Vol 114 (2) ◽  
pp. 166-170 ◽  
Author(s):  
D. Gordon ◽  
C. G. Semple ◽  
G. H. Beastall ◽  
J. A. Thomson
Keyword(s):  
Cushing’S Syndrome ◽  
Adrenal Adenoma ◽  
Cushing's Syndrome ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Curative Surgery ◽  
Unilateral Adrenalectomy ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Cortisol Responses ◽  
Pituitary Adrenal Axis

Abstract. The hypothalamic-pituitary-adrenal axis was investigated in all six patients requiring glucocorticoid replacement 2.5–11 years after unilateral adrenalectomy for adrenal adenomas causing Cushing's syndrome. The hypothalamic-pituitary-adrenal axis was assessed by insulin induced hypoglycaemia and CRF testing in each patient. Two patients showed normal cortisol and ACTH responses to hypoglycaemia. Two patients showed subnormal cortisol responses to hypoglycaemia in the presence of high or normal basal ACTH concentrations. ACTH concentrations increased with both hypoglycaemia and CRF. Two patients showed subnormal cortisol responses to hypoglycaemia and CRF. One of these patients showed an ACTH rise following hypoglycaemia but not CRF. Defects at either hypothalamic-pituitary or adrenal levels were demonstrated and recovery of the axis appears to commence at the hypothalamic-pituitary level.

Treatment of iatrogenic Cushing’s syndrome: questions of glucocorticoid withdrawal

2007 ◽  
Vol 148 (5) ◽  
pp. 195-202 ◽  
Author(s):  
Péter Igaz ◽  
Károly >Rácz ◽  
Miklós Tóth ◽  
Edit Gláz ◽  
Zsolt Tulassay
Keyword(s):  
Cushing’S Syndrome ◽  
Underlying Disease ◽  
Cushing's Syndrome ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Laboratory Examinations ◽  
High Doses ◽  
Pituitary Adrenal Axis ◽  
Iatrogenic Cushing’S Syndrome

Iatrogenic Cushing’s syndrome is the most common form of hypercortisolism. Glucocorticoids are widely used for the treatment of various diseases, often in high doses that may lead to the development of severe hypercortisolism. Iatrogenic hypercortisolism is unique, as the application of exogenous glucocorticoids leads to the simultaneous presence of symptoms specific for hypercortisolism and the suppression of the endogenous hypothalamic-pituitary-adrenal axis. The principal question of its therapy is related to the problem of glucocorticoid withdrawal. There is considerable interindividual variability in the suppression and recovery of the hypothalamic-pituitary-adrenal axis, therefore, glucocorticoid withdrawal and substitution can only be conducted in a stepwise manner with careful clinical follow-up and regular laboratory examinations regarding endogenous hypothalamic-pituitary-adrenal axis activity. Three major complications which can be associated with glucocorticoid withdrawal are: i. reactivation of the underlying disease, ii. secondary adrenal insufficiency, iii. steroid withdrawal syndrome. Here, the authors summarize the most important aspects of this area based on their clinical experience and the available literature data.

Immune regulation in cushing's syndrome: Relationship to hypothalamic-pituitary-adrenal axis hormones

1996 ◽  
Vol 21 (7) ◽  
pp. 599-608 ◽  
Author(s):  
Ziad Kronfol ◽  
Monica Starkman ◽  
David E. Schteingart ◽  
Vijendra Singh ◽  
Qun Zhang ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Immune Regulation ◽  
Cushing's Syndrome ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Pituitary Adrenal Axis

Cushing's Syndrome and Hypothalamic-Pituitary Adrenal Axis Suppression Induced by Medroxyprogesterone Acetate

1996 ◽  
Vol 33 (3) ◽  
pp. 187-189 ◽  
Author(s):  
K J Malik ◽  
K Wakelin ◽  
S Dean ◽  
D H Cove ◽  
P J Wood
Keyword(s):  
Cushing’S Syndrome ◽  
Medroxyprogesterone Acetate ◽  
Plasma Cortisol ◽  
Cushing's Syndrome ◽  
Adrenocorticotrophic Hormone ◽  
Adrenal Axis ◽  
Synacthen Test ◽  
Cortisol Responses ◽  
Short Synacthen Test ◽  
Pituitary Adrenal Axis

The referral of a patient with features of Cushing's syndrome but with suppressed plasma cortisol and adrenocorticotrophic hormone concentrations prompted us to study the effect of medroxyprogesterone acetate (MPA) therapy on the adrenal axis. 11 women (aged 54–82 years) who were receiving 200–400 mg/day MPA were studied. Of these, four had subnormal plasma cortisol responses to a short synacthen test, and two more had borderline responses (30 min post-synacthen plasma cortisol results of 411 and 511 nmol/L). We conclude that suppression of the adrenal axis occurs relatively frequently in patients on MPA and that such patients should be checked for evidence of suppression before MPA therapy is withdrawn.

scholarly journals Fetal Growth and the Adrenocortical Response to Psychological Stress

2006 ◽  
Vol 91 (5) ◽  
pp. 1868-1871 ◽  
Author(s):  
Alexander Jones ◽  
Keith M. Godfrey ◽  
Peter Wood ◽  
Clive Osmond ◽  
Peter Goulden ◽  
...  
Keyword(s):  
Birth Weight ◽  
Psychological Stress ◽  
Salivary Cortisol ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Fetal Life ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenocortical Activity ◽  
Adrenal Axis ◽  
Cortisol Responses ◽  
Pituitary Adrenal Axis

Context: Experimental studies in animals show that adverse prenatal environments lead to lifelong alterations in the activity of the hypothalamic-pituitary-adrenal axis, which mediates the stress response through secretion of glucocorticoid hormones. The extent to which such prenatal hypothalamic-pituitary-adrenal axis adaptations occur in humans is unknown. Objective: The objective of the study was to determine whether smaller but otherwise healthy term babies are more likely to demonstrate increased glucocorticoid responses to psychological stress in childhood. Design and Participants: This was a cross-sectional study of 68 boys and 72 girls (aged 7–9 yr) who have been followed up since 12 wk gestation when their mothers took part in a study of healthy children born in Southampton, United Kingdom. Main Outcome Measure: Salivary cortisol responses to psychological stress were measured. Results: In boys, birth weight was inversely related to salivary cortisol responses to stress (r = −0.56, P < 0.001) but not morning cortisol levels, whereas in girls, morning peak cortisol was inversely related to birth weight (r = −0.36, P < 0.05). These associations were independent of gestational age and potential confounding factors including obesity, social class, and educational achievement. Conclusions: This study suggests that processes occurring during fetal life, resulting in smaller newborns, have a lasting effect on adrenocortical responses to stress in boys and on basal adrenocortical activity in girls. Given the known associations between small alterations in adrenocortical activity and features of the metabolic syndrome such as raised blood pressure and glucose intolerance, these effects warrant further investigation of their potential impact on the future health of prepubertal children.

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