About pituitary-adrenocortical insufficiency and its elimination during surgery for cancer

One of the urgent problems of modern practice is the study of endocrine changes arising in the body in connection with surgical intervention, on the basis of which it is possible to rationally intervene in the dynamics of hormonal disorders for therapeutic and prophylactic purposes.

Study of Effect of Whitening Creams on Serum Basal Cortisol level In Egyptian Females

Objective The aim of the present study is to evaluate the relationship between practice of whitening creams (Topical Corticosteroids) and serum cortisol level in a sample of healthy females at Ain- shams University Teaching hospital. Background Topical corticosteroids (TCs) are widely used as depigmenting agents alone or in combination with other fairness creams. Secondary adrenocortical insufficiency occurs due to deficiency of corticotropin (adrenocorticotropic hormone) [ACTH] in the pituitary gland. With low levels of corticotropin, cortex layer in the adrenal gland is not sufficiently stimulated to release adequate amount of cortisol. Excessive glucocorticoid therapy is the primary cause of adrenocortical insufficiency. Methods we recruited 45 subjects practice whitening creams (TCs) for three months or more; matched with a healthy control group consists of 45 participants. Early morning basal serum cortisol level (8:00 am) done by one-step competitive immunoassay using Beckman Coulter device. Cortisol ELISA Kit provided by CALBIOTECH, Inc (Co_103S). Results Early morning serum cortisol level was statistically insignificant among subjects practice whitening creams in combination with TCs vs. healthy controls (p value 0.307). However, there were 7 out of 45 participants in the study group (15.6%) had low serum cortisol level (<5ug/dl) with highly statistically significant difference regarding whitening creams usage methods. In comparison and data analysis between subjects of the study group regarding practice duration, used quantity, application frequency, and method of exposure, there was high statistically significant difference between subjects with normal cortisol level vs. subjects with low cortisol level (p value <0.001). There were, no significant difference found regarding BMI, and arterial blood pressure between study group and controls. Conclusion Whitening creams abuse especially high potency TCs is a common phenomenon that may induce several local and systemic complications including adrenal gland insufficiency.

Modelling Hydrocortisone Pharmacokinetics on a Subcutaneous Pulsatile Infusion Replacement Strategy in Patients with Adrenocortical Insufficiency

In the context of glucocorticoid (GC) therapeutics, recent studies have utilised a subcutaneous hydrocortisone (HC) infusion pump programmed to deliver multiple HC pulses throughout the day, with the purpose of restoring normal circadian and ultradian GC rhythmicity. A key challenge for the advancement of novel HC replacement therapies is the calibration of infusion pumps against cortisol levels measured in blood. However, repeated blood sampling sessions are enormously labour-intensive for both examiners and examinees. These sessions also have a cost, are time consuming and are occasionally unfeasible. To address this, we developed a pharmacokinetic model approximating the values of plasma cortisol levels at any point of the day from a limited number of plasma cortisol measurements. The model was validated using the plasma cortisol profiles of 9 subjects with disrupted endogenous GC synthetic capacity. The model accurately predicted plasma cortisol levels (mean absolute percentage error of 14%) when only four plasma cortisol measurements were provided. Although our model did not predict GC dynamics when HC was administered in a way other than subcutaneously or in individuals whose endogenous capacity to produce GCs is intact, it was found to successfully be used to support clinical trials (or practice) involving subcutaneous HC delivery in patients with reduced endogenous capacity to synthesize GCs.

Autoimmune Polyendocrinopathy–Candidiasis–Ectodermal Dystrophy in Two Siblings: Same Mutations but Very Different Phenotypes

Autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy (APECED), caused by mutations in the AIRE gene, is mainly characterized by the triad of hypoparathyroidism, primary adrenocortical insufficiency and chronic mucocutaneous candidiasis, but can include many other manifestations, with no currently clear genotype–phenotype correlation. We present the clinical features of two siblings, a male and a female, with the same mutations in the AIRE gene associated with two very different phenotypes. Interestingly, the brother recently experienced COVID-19 infection with pneumonia, complicated by hypertension, hypokalemia and hypercalcemia. Although APECED is a monogenic disease, its expressiveness can be extremely different. In addition to the genetic basis, epigenetic and environmental factors might influence the phenotypic expression, although their exact role remains to be elucidated.

Addison’s disease presenting only with hyperpigmentation – A rare case report

Addison’s disease or chronic adrenocortical insufficiency, can remain unrecognized for a long time. It usually presents with non-specific symptoms, which are often ignored or misdiagnosed as a sign of other more common diseases. In this case report we focused on subtle findings of diffuse hyperpigmentation. We present a study on 2 skin biopsies from a 38-year-old woman in whom hyperpigmentation lesions were first found on the face and after two months, in the oral cavity. Addison’s disease usually presents with non-specific symptoms and this can be a rare case because it presents with hyperpigmentation as its only sign and has no other clinical symptoms.There are a few diagnosed cases of this disease with hyperpigmentation only.