Comparison of Intraoperative Cortisol Levels after Preoperative Hydrocortisone Administration versus Placebo in Patients with an Intact Hypothalamic-Pituitary-Adrenal Axis Undergoing Endoscopic Transsphenoidal Removal of Non-Functioning Pituitary Adenomas: A Double-Blind Randomized Trial

2019 ◽  
Author(s):  
Hyung-Chul Lee ◽  
Hyun-Kyu Yoon ◽  
Jung Hee Kim ◽  
Yong Hwy Kim ◽  
Hee-Pyoung Park
Keyword(s):  
Randomized Trial ◽  
Pituitary Adenomas ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Double Blind ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Hydrocortisone Administration ◽  
Cortisol Levels ◽  
Pituitary Adrenal Axis ◽  
Non Functioning Pituitary Adenomas

Overt Glucocorticoid Excess Due to Inhaled Corticosteroid Therapy

PEDIATRICS ◽  
1988 ◽  
Vol 81 (3) ◽  
pp. 452-455
Author(s):  
Gregory A. Hollman ◽  
David B. Allen
Keyword(s):  
Triamcinolone Acetonide ◽  
Inhaled Corticosteroids ◽  
Therapeutic Option ◽  
Serum Cortisol ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Systemic Absorption ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Cortisol Levels ◽  
Pituitary Adrenal Axis

Inhaled corticosteroids have become an important therapeutic option in the treatment of childhood asthma. The preparations currently available for pediatric use (beclomethasone dipropionate and triamcinolone acetonide) do not, in general, cause significant hypothalamic-pituitary-adrenal axis suppression and physical signs of glucocorticoid excess have not been described with their use. We report an 8-year-old girl with asthma in whom obesity, hirsutism, and growth retardation developed during treatment with inhaled triamcinolone acetonide alone. Laboratory studies showed suppression of endogenous cortisol production but did not demonstrate suppression of the hypothalamic-pituitary-adrenal axis. Cessation of inhaled triamcinolone acetonide therapy resulted in resolution of obesity and hirsutism, resumption of normal growth, and a return to normal of serum cortisol levels and urinary 17-hydroxycorticosteroid excretion. Careful monitoring of growth velocity and (if clinically indicated) morning serum cortisol levels in asthmatic children using inhaled corticorsteroids will detect the rare instance of glucocorticoid excess resulting from systemic absorption of these drugs.

scholarly journals Toxic stress, health and nutrition among Brazilian children in shelters

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Adriana César da Silveira ◽  
Álvaro Jorge Madeiro Leite ◽  
Poliana Coelho Cabral ◽  
Ariclécio Cunha de Oliveira ◽  
Keciany Alves de Oliveira ◽  
...  
Keyword(s):  
Dental Caries ◽  
Negative Impact ◽  
Cross Sectional Study ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Toxic Stress ◽  
Cross Sectional ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Cortisol Levels ◽  
Pituitary Adrenal Axis

Abstract Background Living in a shelter is an adverse experience that generates toxic stress. This situation can cause the dysregulation of the hypothalamic-pituitary-adrenal axis and exert a negative impact on health.The aim of the present study was to determine the association between toxic stress and social, clinical and nutritional characteristics in children at welfare institutions in a city of northeastern of Brazil. Methods An analytical, cross-sectional study was conducted with male and female children up to 60 months of age who live in shelters. Hair cortisol was used for the assessment of stress (immunoassay). The anthropometric data collected were height for age, body mass index for age, arm circumference for age, and head circumference for age (expressed in z-scores). We also evaluated food intake using markers proposed by the Brazilian Dietary and Nutritional Vigilance Surveillance System as well as the occurrence of dental caries and anemia. Results Sixty-three children one to 60 months of age participated in the present study. Asthma was the most frequent disease (11.1%). The prevalence of short stature, anemia and dental caries in the sample was 22.2, 22.2 and 9.4%, respectively. Cortisol levels ranged from 0.93 pg/mg to 391.29 pg/mg (median: 6.17 pg/mg). Higher cortisol levels were found in children with illnesses (p = 0.012) and those who had been hospitalized after being admitted to the institutions (p = 0.001). Conclusions The majority of children had unhealthy eating behavior. The cortisol concentrations found in the present study were suggestive of dysregulation of the hypothalamic-pituitary-adrenal axis. Hypercortisolism was associated with illness and hospitalization.

scholarly journals Transsphenoidal pituitary adenoma resection: do early post-operative cortisol levels predict permanent long-term hypocortisolism?

2021 ◽  
Author(s):  
Vicki M. Butenschoen ◽  
Alexander von Werder ◽  
Stefanie Bette ◽  
Veronika Schmette ◽  
Nina Schwendinger ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Early Morning ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Hormone Substitution ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Cortisol Levels ◽  
Pituitary Adrenal Axis

AbstractTranssphenoidal surgery provides a minimal invasive treatment for pituitary adenoma. Our aim is to evaluate the endocrinological outcomes after adenoma resection focusing on the corticotroph function, and to identify prognostic factors for an impaired hypothalamic–pituitary–adrenal-axis function (HPA) and the reliability of postoperative early morning serum cortisol measurements. We performed a retrospective analysis of all patients treated for pituitary adenoma from April 2006 to January 2019 in our neurosurgical department. Pituitary function was assessed pre- and postoperatively as well as at 6 weeks to 12 weeks and at 1-year follow-up. Two hundred eleven patients were included. Nine percent of the patients recovered from a preoperative adrenal insufficiency, 10.4% developed a new need for hormone substitution, and a long-term deficiency of the hypothalamic–pituitary–adrenal-axis was observed in 30.9%. Cortisol measurements 5 days after surgery had a lower area under the curve (AUC) than cortisol levels detected after 6 to 12 weeks (AUC 0.740 vs. AUC 0.808) in predicting an intact corticotrope function. The cut-off value determined for cortisol measured after 6 weeks was 6.95 µg/dl (sensitivity of 94%, specificity of 68%). Postoperative early morning cortisol levels seem to be less sensitive and specific in predicting long-term corticotroph function than measurements after 6 weeks and 1 year, emphasizing the importance of endocrine follow-up testing.

Effect of dopamine, dopamine D-1 and D-2 receptor modulation on ACTH and cortisol levels in normal men and women

1990 ◽  
Vol 122 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Søren Boesgaard ◽  
Claus Hagen ◽  
Anders Nyboe Andersen ◽  
Mogens Fenger ◽  
Ebbe Eldrup
Keyword(s):  
Normal Subjects ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Receptor Modulation ◽  
Cortisol Levels ◽  
Normal Women ◽  
Normal Men ◽  
Pituitary Adrenal Axis ◽  
Placebo Infusion

Abstract. The regulation of the hypothalamic-pituitary-adrenal axis by dopamine is not fully understood. Therefore, we have studied the effect of dopamine, metoclopramide, a D-2 receptor antagonist, and fenoldopam, a specific D-1 receptor agonist, on ACTH and cortisol levels in normal subjects. Normal women received 5-h infusions of either glucose (N = 6) or dopamine at rates of 0.04 (N = 6), 0.4 (N = 6) and 4.0 μg · kg−1· min−1 (N = 8). After 3 h, 10 mg metoclopramide was given iv. No intergroup differences regarding ACTH and cortisol levels were observed (p>0.05). In a second study six women received dopamine (4.0 μg·kg−1·min−1) or glucose for 18 h. During the infusions cortisol and ACTH levels were similar on the two study days. Administration of metoclopramide (10 mg) after 17 h induced a significant increase in cortisol levels during dopamine infusion (p<0.05), whereas no effect was observed during placebo infusion. ACTH levels were unaffected by metoclopramide. In a third study, 9 normal women and 9 normal men received fenoldopam (0.5 μg·kg −1·min−) or placebo infusions for 3 h. In males, median ACTH and cortisol levels were significantly lower (p<0.05) during fenoldopam compared with placebo infusion. In contrast, fenoldopam did not affect ACTH and cortisol levels in normal women. The results suggest that the effect of dopamine D-1 receptor stimulation on ACTH and cortisol secretion is mainly at the hypothalamic level and that this effect is sex-dependent. In addition, we hypothesize that raised dopaminergic activity for a prolonged period of time may have an inhibitory effect on the hypothalamic-pituitary-adrenal axis. This may be triggered by low estrogen levels.

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