scholarly journals Assessment of Neuroendocrine Changes and the Hypothalamo-Pituitary Autoimmunity in Patients With COVID-19

2021 ◽  
Author(s):  
Mustafa Sait Gonen ◽  
Annamaria De Bellis ◽  
Emre Durcan ◽  
Giuseppe Bellastella ◽  
Paolo Cirillo ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Dynamic Test ◽  
Total Testosterone ◽  
Healthy Controls ◽  
Acth Stimulation ◽  
Pituitary Dysfunction ◽  
Endocrine Disturbances ◽  
Hypothalamic Pituitary Axis ◽  
Control Study

Abstract Purpose: The SARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, particularly, secondary adrenal insufficiency using a dynamic test and the role of autoimmunity in pituitary dysfunction in the patients with COVID-19.Methods: The single-center, prospective, case-control study included PCR-confirmed COVID-19 patients and healthy controls. Basal hormone levels were measured and ACTH stimulation test was performed. Anti-pituitary (APA) and anti-hypothalamic antibodies (AHA) were also determined. Results: We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. The patients with COVID-19 had lower free T3, IGF-1, total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also, demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. Conclusions: The COVID-19 may result in adrenal insufficiency, so the routine screening of adrenal functions is these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Also, pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormality in COVID-19.

The diagnosis and investigation of adrenal insufficiency in adults

2009 ◽  
Vol 46 (5) ◽  
pp. 351-367 ◽  
Author(s):  
Ian Wallace ◽  
Sean Cunningham ◽  
John Lindsay
Keyword(s):  
Differential Diagnosis ◽  
Adrenal Insufficiency ◽  
Dynamic Testing ◽  
Serum Cortisol ◽  
Evidence Base ◽  
Acth Stimulation ◽  
Accurate Identification ◽  
Testing Protocols ◽  
Pituitary Adrenal Axis

There is considerable variation in the methods used to diagnose and investigate adrenal insufficiency in clinical practice. These include a range of adrenocorticotropin (ACTH) stimulation and other dynamic testing protocols, serum cortisol cut-off values for diagnosis and tests used for differential diagnosis. With the introduction of modern cortisol and ACTH assays, the interpretation of tests used for diagnosis and differential diagnosis has become more complex and requires local validation. This review examines the basis of normal hypothalamic–pituitary–adrenal axis function and adrenal insufficiency states based upon an evidence base accumulated over the past four decades. The role of the laboratory in the differential diagnosis and interpretation based upon assay methodology is discussed. The accurate identification of patients who may benefit from corticosteroid replacement in special settings such as critical illness is challenging and will be explored.

scholarly journals Role of Serum Uric Acid as a Protective Biomarker in Patients with Different Histopathological Grades of Oral Squamous Cell Carcinoma: a Case-Control Study

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Soheila Manifar ◽  
Arezoo Rahimzamani ◽  
Mohammad Shirkhoda ◽  
Mohammad Nikkhah Ghamsari ◽  
Mahin Bakhshi
Keyword(s):  
Squamous Cell Carcinoma ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Acid Level ◽  
Case Control Study ◽  
Serum Uric Acid Level ◽  
Case Control ◽  
Healthy Controls ◽  
Control Study

The antioxidant properties of uric acid may have a protective effect against the formation of oxygen radicals and subsequently against carcinogenicity. The present study aimed at evaluating the serum level of uric acid in patients with oral squamous cell carcinoma (OSCC) with different histopathological grades. In this descriptive-analytical, case-control study, patients with OSCC and healthy controls were selected and matched regarding age and gender. The serum samples were collected from patients (before radiotherapy and chemotherapy) and controls, and their serum uric acid levels were measured enzymatically. Data were analyzed using independent t-test and ANOVA at 0.05 level of significance. The mean serum uric acid level in OSCC patients (4.2±1.5 mg/dL) and healthy controls (4.38±1.22 mg/dL) was not significantly different (P=0.377). No significant association was noted between the histopathological grade of OSCC and mean serum uric acid (P=0.781). The serum uric acid level had a direct significant correlation with age in OSCC patients (P<0.001). The results of this study did not support the role of uric acid as a protective biomarker in OSCC. Further prospective studies are recommended to better elucidate the role of uric acid in the etiology of OSCC.

scholarly journals Neuroendocrine predictors of vasoplegia after cardiopulmonary bypass

2020 ◽  
Author(s):  
D. Pasero ◽  
A. M. Berton ◽  
G. Motta ◽  
R. Raffaldi ◽  
G. Fornaro ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Adrenal Insufficiency ◽  
Low Dose ◽  
Electrolyte Balance ◽  
Acth Stimulation ◽  
Tertiary Referral Center ◽  
Heart Failure Progression ◽  
Stimulation Tests ◽  
Cardiac Intensive Care

Abstract Purpose Vasoplegia often complicates on-pump cardiac surgery. Systemic inflammatory response induced by extracorporeal circulation represents the major determinant, but adrenal insufficiency and postoperative vasopressin deficiency may have a role. Pathophysiological meaning of perioperative changes in endocrine markers of hydro-electrolyte balance has not still fully elucidated. Objectives of the present research study were to estimate the incidence of vasoplegia in a homogeneous cohort of not severe cardiopathic patients, to define the role of presurgical adrenal insufficiency, to evaluate copeptin and NT-proBNP trends in the perioperative. Methods We conducted a prospective cohort study in the cardiac intensive care unit of a tertiary referral center. We evaluated 350 consecutive patients scheduled for cardiac surgery; 55 subjects completed the study. Both standard and low-dose corticotropin stimulation tests were performed in the preoperative; copeptin and NT-proBNP were evaluated in the preoperative (T0), on day 1 (T1) and day 7 (T2) after surgery. Results Nine subjects (16.3%) developed vasoplegic syndrome with longer bypass and clamping time (p < 0.001). Reduced response to low-dose ACTH test was not associated to vasoplegia. Preoperative copeptin > 16.9 pmol/L accurately predicted the syndrome (AUC 0.86, 95% CI 0.73–0.94; OR 1.17, 95% CI 1.04–1.32). An evident correlation was observed at 7 days postoperative between NT-proBNP and copeptin (r 0.88, 95% CI 0.8–0.93; p < 0.001). Conclusion Preoperative impaired response to low-dose ACTH stimulation test is not a risk factor for post-cardiotomic vasoplegia; conversely, higher preoperative copeptin predicts the complication. On-pump cardiac surgery could be an interesting model of rapid heart failure progression.

scholarly journals SUN-173 A Gigantic Uterine Leiomyoma and Big Bilateral Adrenal Myelolipomas as a Result of Untreated Congenital Adrenal Hyperplasia

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Betty La ◽  
Ha Nguyen ◽  
Celestine Tung ◽  
Eugene Choi
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Adrenal Insufficiency ◽  
Adrenal Mass ◽  
Uterine Leiomyoma ◽  
Pelvic Mass ◽  
Treatment Compliance ◽  
Total Testosterone ◽  
Adrenal Hyperplasia ◽  
Acth Stimulation ◽  
Adrenal Masses

Abstract Introduction Patients with untreated congenital adrenal hyperplasia (CAH) can present early with severe symptoms of salt wasting, adrenal insufficiency and hyperandrogenism. Late consequences as a result of long term untreated CAH are rarely seen nowadays. We present a patient who presented with a massive uterine leiomyoma and bilateral adrenal myelolipomas due to longstanding treatment noncompliance. Clinical Case A female was born with ambiguous genitalia and diagnosed with CAH at birth. She was raised as a female and received steroids until age 29 when she stopped taking steroids on her own with the intention of identifying as a male. At age 37, he presented with abdominal distension, vomiting, and hypotension. Physical exam was notable for hypotension, significantly distended abdomen, hirsutism, gynecomastia and clitoromegaly. Labs revealed sodium 126 meq/L (136–145) cortisol 78.5 ug/dL (3.7–19.4), ACTH 166 pg/mL (6–50), 17-hydroxyprogesterone 4356 ng/dL (≤285), androstenedione 7188 ng/dL (35–250), total testosterone 737 ng/dL (2–45), estradiol 142 pg/mL (48–440), aldosterone &lt;1 ng/dL (3–16), renin 0.45 ng/mL/hr (0.25–5.82), metanephrines 56 pg/mL (≤205), normetanephrines 56 pg/mL (≤148). CT abdomen and pelvis revealed a large 31 x 35 x 31 cm pelvic mass, a 5.9 x 2.4 cm right adrenal mass and an 11.8 x 8.8 cm left adrenal mass. The patient underwent total abdominal hysterectomy and bilateral adrenalectomy. Pathology of the pelvic mass was consistent with uterine leiomyoma (gross tumor was 12.4 kg) and pathology of the bilateral adrenal masses were consistent with bilateral adrenal myelolipomas. Discussion Glucocorticoids and mineralocorticoids are the mainstays of treatment in CAH, with the goal of providing adequate replacement while reducing levels of ACTH and adrenal androgens. Persistently elevated levels of ACTH and androgens can lead to many serious sequela, even outside of adrenal insufficiency and virilization. Due to the conversion of androgens to estrogens, untreated females with CAH have significantly elevated levels of both hormones. These high levels of androgens and estrogen can then stimulate growth of estrogen-dependent organs as exemplified by our patient. Chronic ACTH stimulation can cause adrenal hyperplasia, but has also been associated with the development of other adrenal masses including adrenal myelolipomas. Adrenal myelolipomas can become hormonally functional or cause mass effect, hemorrhage, necrosis when reaching a large enough size. Conclusion This case demonstrates the importance of CAH treatment compliance as there are many serious sequela outside of the expected adrenal insufficiency and virilization. Even when the desired effect is virilization with physical male features, other means of hormonal therapy should be considered as there remains the risks of abnormal growth of certain organs sensitive to the excessive hormones.

Prolonged Adrenal Insufficiency After the Discontinuation of Mitotane Therapy

2020 ◽  
Vol 20 (3) ◽  
pp. 485-487 ◽  
Author(s):  
Leonardo Muratori ◽  
Anna Pia ◽  
Giuseppe Reimondo ◽  
Chiara Pisano ◽  
Anna La Salvia ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Radical Resection ◽  
Severe Allergic Reaction ◽  
Retrospective Case ◽  
Free Survival ◽  
Long Time ◽  
Almost All ◽  
Control Study

Introduction:: Adrenocortical carcinoma (ACC) is a rare neoplasm characterized by a high risk of recurrence after radical resection. The role of adjuvant systemic therapy in radically resected patients is unclear. Mitotane, a steroidogenesis inhibitor, is the only drug approved for the systemic treatment of advanced ACC. In 2007, a retrospective case-control study provided the evidence that mitotane, administered for two years after successful surgery, could prolong recurrence-free survival. Adrenal insufficiency (AI), which occurs in almost all patients during the first 12 months of treatment, is an expected side effect of mitotane and requires steroid replacement therapy. Due to its long halflife, mitotane-induced AI persists several months after treatment discontinuation and is managed by cautious tapering of glucocorticoid replacement therapy. Results:: We report a case of symptomatic AI diagnosed after a severe allergic reaction occurring three years after the discontinuation of adjuvant mitotane therapy. Conclusions:: The case suggests that mitotane-induced AI should be monitored for a long time to asses full recovery of adrenal function, in order to prevent adrenal crises.

The Role of Vitamin B6 in Reducing Serum Prolactin in Comparison to Cabergoline

2019 ◽  
Vol 10 (01) ◽  
Author(s):  
Suha J. Witwit
Keyword(s):  
Prolactin Level ◽  
Vitamin B6 ◽  
Reproductive Age ◽  
Serum Prolactin ◽  
Polycystic Ovaries ◽  
Endocrine Disorder ◽  
Hypothalamic Pituitary Axis

Hyperprolactinemia is a common endocrine disorder of hypothalamic-pituitary axis. It affect about 4-17% of women in reproductive age and about 3-10% of patients with polycystic ovaries. Vitamin B6 is an effective prolactin inhibitor that is extremely cheap and safe.it exerts hypothalamic dopaminergic effect which causes a significant reduction in prolactin level. The aim of the study is To evaluate the effectiveness of vitamin B6 in reducing serum prolactin in Hyperprolactinemic patient. Compare this effect to that of cabergoline.

The Role of IL-1, IL-6, TNF-α and MIF in Relative Adrenal Insufficiency in Septic Shock: A Study in Piglet Model

2018 ◽  
Author(s):  
Bina Akura ◽  
Jose Batubara ◽  
Zakiudin Munasir ◽  
Gunati unknown ◽  
Joedo Prihartono ◽  
...  
Keyword(s):  
Septic Shock ◽  
Adrenal Insufficiency ◽  
Relative Adrenal Insufficiency ◽  
Tnf Α

scholarly journals Altered DNA methylation pattern reveals epigenetic regulation of Hox genes in thoracic aortic dissection and serves as a biomarker in disease diagnosis

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Peiru Liu ◽  
Jing Zhang ◽  
Duo Du ◽  
Dandan Zhang ◽  
Zelin Jin ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Aortic Dissection ◽  
Epigenetic Regulation ◽  
Heart Development ◽  
Type A ◽  
Methylation Pattern ◽  
Healthy Controls ◽  
Global Methylation ◽  
Thoracic Aortic Dissection

Abstract Background Thoracic aortic dissection (TAD) is a severe disease with limited understandings in its pathogenesis. Altered DNA methylation has been revealed to be involved in many diseases etiology. Few studies have examined the role of DNA methylation in the development of TAD. This study explored alterations of the DNA methylation landscape in TAD and examined the potential role of cell-free DNA (cfDNA) methylation as a biomarker in TAD diagnosis. Results Ascending aortic tissues from TAD patients (Stanford type A; n = 6) and healthy controls (n = 6) were first examined via whole-genome bisulfite sequencing (WGBS). While no obvious global methylation shift was observed, numerous differentially methylated regions (DMRs) were identified, with associated genes enriched in the areas of vasculature and heart development. We further confirmed the methylation and expression changes in homeobox (Hox) clusters with 10 independent samples using bisulfite pyrosequencing and quantitative real-time PCR (qPCR). Among these, HOXA5, HOXB6 and HOXC6 were significantly down-regulated in TAD samples relative to controls. To evaluate cfDNA methylation pattern as a biomarker in TAD diagnosis, cfDNA from TAD patients (Stanford type A; n = 7) and healthy controls (n = 4) were examined by WGBS. A prediction model was built using DMRs identified previously from aortic tissues on methylation data from cfDNA. Both high sensitivity (86%) and specificity (75%) were achieved in patient classification (AUC = 0.96). Conclusions These findings showed an altered epigenetic regulation in TAD patients. This altered epigenetic regulation and subsequent altered expression of genes associated with vasculature and heart development, such as Hox family genes, may contribute to the loss of aortic integrity and TAD pathogenesis. Additionally, the cfDNA methylation in TAD was highly disease specific, which can be used as a non-invasive biomarker for disease prediction.

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