scholarly journals Adrenal Insufficiency in Cirrhosis Patients: Evaluation of 108 Case Series

2017 ◽  
Vol 7 (2) ◽  
pp. 150-153 ◽  
Author(s):  
Hali Rakici
Keyword(s):  
Critical Illness ◽  
Adrenal Insufficiency ◽  
Cortisol Level ◽  
Standard Dose ◽  
Case Series ◽  
Diagnostic Methods ◽  
Decompensated Cirrhosis ◽  
Cross Sectional ◽  
Basal Cortisol ◽  
Wide Range

ABSTRACT Aim Adrenal insufficiency (AI) in cirrhosis is an issue that has recently gained momentum. It can be seen in both stable and critically ill (sepsis, septic shock, and gastrointestinal system bleeding) cirrhotic patients. Its prevalence exists in a wide range since standardization of diagnostic methods is lacking. We aimed to scrutinize this issue in a 108 case series. Materials and methods We studied the presence of AI and its stage in patients with cirrhosis and its complications by using cross-sectional study. Standard-dose short synacthen test (SD-SST) was performed in 108 patients that had Child C decompensated cirrhosis without critical illness and it was aimed to determine the prevalence of AI based on basal cortisol, peak cortisol, and delta cortisol (basal total cortisol minus peak cortisol after stimulation) levels. Results The prevalence of AI in cirrhosis was found to be 25% based on basal cortisol level of <140 nmol/L, 22.2% based on delta cortisol level of <250 nmol/L, and 29.6% based on peak cortisol level of <500 nmol/L. Conclusion Prevalence of AI shows variation in decompensated cirrhosis without critical illness depending on different measures used. More definite results can be obtained when more standardized criteria are widely put into use. How to cite this article Rakici H. Adrenal Insufficiency in Cirrhosis Patients: Evaluation of 108 Case Series. Euroasian J Hepato-Gastroenterol 2017;7(2):150-153.

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

2014 ◽  
Vol 7 ◽  
pp. e2015005 ◽  
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.

scholarly journals Adrenal insufficiency in a woman secondary to standard-dose inhaled fluticasone propionate therapy

2014 ◽  
Vol 2014 ◽  
Author(s):  
Casey M Hay ◽  
Daniel I Spratt
Keyword(s):  
Fluticasone Propionate ◽  
Adrenal Insufficiency ◽  
Cortisol Level ◽  
Standard Dose ◽  
Clinical Signs ◽  
Unknown Origin ◽  
Adrenal Crisis ◽  
List Type ◽  
Morning Cortisol ◽  
Low Serum

Summary A 55-year-old woman with asthma presented with adrenal insufficiency of unknown origin. She was referred to our Division of Reproductive Endocrinology to further evaluate an undetectable morning cortisol level discovered during the evaluation of a low serum DHEA-S level. She was asymptomatic other than having mild fatigue and weight gain. Her medication list included 220 μg of inhaled fluticasone propionate twice daily for asthma, which she was taking as prescribed. On presentation, the undetectable morning cortisol level was confirmed. A urinary measurement of fluticasone propionate 17β-carboxylic acid was markedly elevated. Fluticasone therapy was discontinued and salmeterol therapy initiated with supplemental hydrocortisone. Hydrocortisone therapy was discontinued after 2 months. A repeat urinary fluticasone measurement 4 months after the discontinuation of fluticasone therapy was undetectably low and morning cortisol level was normal at 18.0 μg/dl. Inhaled fluticasone is generally considered to be minimally systemically absorbed. This patient's only clinical evidence suggesting adrenal insufficiency was fatigue accompanying a low serum DHEA-S level. This case demonstrates that adrenal insufficiency can be caused by a routine dose of inhaled fluticasone. Missing this diagnosis could potentially result in adrenal crisis upon discontinuation of fluticasone therapy. Learning points Standard-dose inhaled fluticasone can cause adrenal insufficiency. Adrenal insufficiency should be considered in patients taking, or who have recently discontinued, inhaled fluticasone therapy and present with new onset of nonspecific symptoms such as fatigue, weakness, depression, myalgia, arthralgia, unexplained weight loss, and nausea that are suggestive of adrenal insufficiency. Adrenal insufficiency should be considered in postoperative patients who exhibit signs of hypoadrenalism after fluticasone therapy has been withheld in the perioperative setting. Routine screening for hypoadrenalism in patients without clinical signs or symptoms of adrenal insufficiency after the discontinuation of inhaled fluticasone therapy is not indicated due to the apparently low incidence of adrenal insufficiency caused by fluticasone.

Reproducibility of the cortisol response to stimulation with a low dose of ACTH(1–24): the effect of basal cortisol levels and comparison of low-dose with high-dose secretory dynamics

1993 ◽  
Vol 136 (1) ◽  
pp. 167-172 ◽  
Author(s):  
S. Crowley ◽  
P. C. Hindmarsh ◽  
J. W. Honour ◽  
C. G. D. Brook
Keyword(s):  
Cortisol Level ◽  
Low Dose ◽  
Standard Dose ◽  
Serum Cortisol ◽  
Cortisol Concentration ◽  
Acth Stimulation ◽  
Basal Cortisol ◽  
Basal Cortisol Level ◽  
Adrenal Response ◽  
Serum Cortisol Concentration

ABSTRACT We compared the reproducibility and repeatability of the acute adrenal response to low doses (90 and 500 ng/1·73 m2) of Synacthen (ACTH(1–24)) with that of the standard dose (250 μg/1·73 m2). We also examined the effect of basal cortisol levels on peak values achieved after stimulation with a low dose. ACTH(1–24) was given to six male volunteers: 90 ng/1·73 m2 twice at 90-min intervals on day 1, and 90 and 500 ng/1·73 m2 once on day 2 and 250 μg/1·73 m2 once on day 3. The rise in serum cortisol concentration with repeated low doses of ACTH was not attenuated (161 ± 49 (s.d.) nmol/l on initial vs 150 ± 41 nmol/l on repeat stimulation; P = 0·5) and this was reproducible (161 ± 49 nmol/l on day 1 vs 148 ± 15 nmol/l on day 2; P = 0·6). A dose of 500 ng ACTH(1–24)/1·73 m2 produced a maximal adrenal response in that the rise in serum cortisol concentration at 20 min was identical with that produced at the same time by the standard dose of 250 μg/1·73 m2. There was a strong positive correlation between the basal cortisol level and peak cortisol concentration after low-dose ACTH stimulation (r = 0·93, P < 0·001) but not between the basal cortisol level and the incremental rise (r= −0·1, P = 0·69). These results suggest that the cortisol response to low-dose ACTH stimulation is reproducible and not attenuated by repeat stimulation at 90-min intervals. The incremental rise in serum cortisol concentration after ACTH stimulation appears constant in these situations and is not influenced by the basal cortisol level. When there is concern that the standard dose may be excessive and mask subtle but important changes in adrenal function, the low dose (500 ng) of ACTH should be used. Journal of Endocrinology (1993) 136, 167–172

scholarly journals Diagnostic performance of basal cortisol level at 0900-1300h in adrenal insufficiency

PLoS ONE ◽  
2019 ◽  
Vol 14 (11) ◽  
pp. e0225255 ◽  
Author(s):  
Worapaka Manosroi ◽  
Mattabhorn Phimphilai ◽  
Jiraporn Khorana ◽  
Pichitchai Atthakomol
Keyword(s):  
Adrenal Insufficiency ◽  
Cortisol Level ◽  
Diagnostic Performance ◽  
Basal Cortisol ◽  
Basal Cortisol Level

Adrenal insufficiency with chronic hyponatraemia and normal basal cortisol level: time to review the investigation of hyponatraemia

2021 ◽  
Author(s):  
Mansukhbhai Shekhda Kalyan ◽  
Maria Darda ◽  
Syed Bitat ◽  
Ali Rathore ◽  
Taofeek Ojewuyi ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Cortisol Level ◽  
Basal Cortisol ◽  
Basal Cortisol Level

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

2019 ◽  
Vol 65 (5) ◽  
pp. 330-340
Author(s):  
Alla E. Yudina ◽  
Maria G. Pavlova ◽  
Vladimir M. Sotnikov ◽  
Alla E. Yudina ◽  
Yulia P. Sych ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Adrenal Insufficiency ◽  
Maximum Level ◽  
Tolerance Test ◽  
Cross Sectional Study ◽  
Screening Tests ◽  
Complex Treatment ◽  
Secondary Adrenal Insufficiency ◽  
Cross Sectional ◽  
Basal Cortisol

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.

scholarly journals Case series of short synacthen tests supports using 9 am cortisol level to exclude adrenal insufficiency

2016 ◽  
Vol 16 (3) ◽  
pp. 299-299
Author(s):  
Bernard Freudenthal ◽  
Daniel Beder ◽  
Arla Ogilvie
Keyword(s):  
Adrenal Insufficiency ◽  
Cortisol Level ◽  
Case Series

scholarly journals Iatrogenic blood loss due to daily laboratory testing and the risk of subsequent anaemia in intensive care unit patients: case series

2021 ◽  
Author(s):  
Kamil Witosz ◽  
Olga Wojnarowicz ◽  
Łukasz J. Krzych
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Blood Loss ◽  
Laboratory Testing ◽  
Case Series ◽  
Study Group ◽  
Icu Patients ◽  
Wide Range ◽  
Median Volume

Introduction: Anaemia is associated with a wide range of negative outcomes. Diagnostic blood loss (DBL) may contribute to its occurrence. We aimed to evaluate DBL and its impact on haemoglobin (HGB) concentration and developing anaemia in the intensive care unit (ICU) patients. Methods: A study group comprised of 36 adult ICU patients. DBL during 7 consecutive, post-admission days was calculated. Anaemia occurrence was assessed using the WHO thresholds. Data on HGB and haematocrit (HCT) was subjected to analysis. Results: Upon admission, 24 (67%) patients were diagnosed with anaemia, on the eighth day 29 (80%) subjects (with 6 new cases). The median volume of blood collected was 143.15 mL (IQR 121.4–161.65) per week. No differences in DBL were found between the subjects with newly developed anaemia and their counterparts (p=0.4). The median drop of HGB (HbΔ) was 18 gL–1 (IQR 5–28) and the median drop of haematocrit (HtΔ) was 4.55% (IQR 1.1–7.95). There was no correlation between neither HbΔ and DBL (p=0.8) nor HtΔ and DBL (p=0.7). There were also no differences in HbΔ/HtΔ when age, gender or the primary critical illness were taken into account for the analysis (p>0.05 for all). The 7-day fluid balance was associated with haemoglobin drop (R=0.45; p=0.006). Conclusions: Anaemia is frequent in ICU patients. Diagnostic blood loss in our institution is acceptable and seems to protect patients against significant iatrogenic blood loss and subsequent anaemia. Dilutional anaemia may interfere with the results so before-after interventional research is needed to explore this interesting topic.

scholarly journals Evaluation of adrenal reserve in patients with differential thyroid cancer receiving thyroid hormone suppression therapy- case-control comparative study

2021 ◽  
Author(s):  
Muhammet Cuneyt Bilginer ◽  
Abbas Ali Tam ◽  
Sevgul Faki ◽  
Nagihan Bestepe ◽  
Fatma Dilek Dellal ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Adrenal Insufficiency ◽  
Patient Group ◽  
Standard Dose ◽  
Serum Cortisol ◽  
Control Group ◽  
Cortisol Response ◽  
Acth Stimulation ◽  
Tsh Suppression ◽  
Basal Cortisol

Abstract Background Patients with differentiated thyroid cancer (DTC) are exposed to subclinical exogenous hyperthyroidism for the suppression of thyroid-stimulating hormone (TSH). In this study, we aimed to evaluate the adrenal reserve in DTC patients receiving suppression therapy. Materials and Methods The study included 55 DTC patients on suppression therapy and 32 healthy volunteers. Basal serum cortisol of all participants and adrenocorticotropic hormone (ACTH) of the patient group were measured. A standard-dose ACTH test (0.25 mg) was performed in patients with a basal cortisol < 14.5 mcg/dL. Results In the patient group, TSH was lower, free thyroxine (fT4) was higher, and free triiodothyronine (fT3) was similar to those of the control group (p < 0.01, p < 0.01, p = 0.140, respectively). The serum cortisol of the patient group was significantly lower than the control group (12.14 ± 5.12 mcg/dL vs 18.00 ± 5.56 mcg/dL, p < 0.001). 34 (61.8%) patients with DTC had a basal cortisol < 14.5 mcg/dL. Prolonged TSH suppression (≥ 5 years vs < 5 years) was associated with lower basal cortisol (7.46 ± 2.63 mcg/dL vs 9.48 ± 2.65 mcg/dL, p = 0.022). The ACTH stimulation test showed that 2 (5.8%) patients had a cortisol response < 18 mcg/dL. The rate of adrenal insufficiency was 3.6% in DTC patients. A moderate negative correlation was found between ACTH and fT3 of patients with low basal cortisol (r = − 0.358, p = 0.038) Conclusion Patients with DTC receiving TSH suppression therapy are at risk for adrenal insufficiency. The duration and severity of suppression might increase this possibility. Dynamic testing with synthetic ACTH can be used to reveal insufficient cortisol response in case of clinical suspicion.

DIAGNOSTIC ACCURACY OF BASAL CORTISOL LEVEL TO PREDICT ADRENAL INSUFFICIENCY IN COSYNTROPIN TESTING: RESULTS FROM AN OBSERVATIONAL COHORT STUDY WITH 804 PATIENTS

2017 ◽  
Vol 23 (8) ◽  
pp. 949-961 ◽  
Author(s):  
Tristan Struja ◽  
Leonie Briner ◽  
Aline Meier ◽  
Alexander Kutz ◽  
Esther Mundwiler ◽  
...  
Keyword(s):  
Cohort Study ◽  
Diagnostic Accuracy ◽  
Adrenal Insufficiency ◽  
Cortisol Level ◽  
Observational Cohort Study ◽  
Basal Cortisol ◽  
Basal Cortisol Level ◽  
Observational Cohort
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