Septo-Optic Dysplasia Diagnosed in a Newborn Infant with Normoglycemia: The Importance of Thorough Physical Examination

A newborn male infant was admitted to the neonatal intensive care unit due to suspected sepsis. He was clinically stable with normal electrolyte levels on admission. However, he was noted to have micropenis and bilateral nonpalpable testes. Ultrasound imaging confirmed the presence of both gonads in the inguinal canal, with no Müllerian structures visualized. Laboratory examination revealed an undetectable random plasma cortisol level; subsequent ACTH stimulation testing confirmed adrenal insufficiency. Further testing revealed additional pituitary hormone deficiencies, and the infant was started on multiple hormone replacement therapies. Magnetic resonance imaging identified absent septum pellucidum, pointing of the frontal horns, and optic nerve hypoplasia. A diagnosis of septo-optic dysplasia was made based on this combination of findings. This case highlights the importance of thorough physical examination in newborn infants, which may reveal the only sign of underlying pathology in the absence of other concerning findings.

Adaptogens as anti-stress agents in reducing increased plasma cortisol level during stress

The stress response involves the activation of both the sympathetic-adrenal response and the hypothalamic-pituitary-adrenal axis. During times of increased stress, the adrenal gland is stimulated to produce increased levels of hormones. Cortisol, the main hormone involved in the stress response, is secreted in increased amounts within minutes of a perceived stressor. Cortisol secretion can increase as much as 20-fold and has several important physiological effects. Short-term surges in cortisol levels can suppress inflammation and at the same time suppress immune function. Though inflammation control is important, surges of sustained levels of cortisol are not healthy and ultimately lead to premature aging, degenerative disease, and increased susceptibility to cancer. Studies show that psycho-social stress activates the hypothalamus-pituitary-adrenal axis causing an increase in morning cortisol levels, which correlated to the subjects reports of increased fatigue and anxiety. Although this stress response is important for survival during an acute stressor, prolonged activation of the stress response may lead to adrenal exhaustion in which cortisol levels drop to insufficient levels resulting in fatigue or illness. Many herbs have been shown to impact adrenal function. Adaptogens are plants that produce a non-specific response improving the physiological resistance to stressors. These herbs are often used in the context of adrenal support formulas to balance adrenal hormone levels. It is believed that adaptogenic herbs can increase low levels of adrenal hormone or decrease levels that are elevated. Additionally, these herbs provide balancing activity on many body systems that are impacted by stress, such as the immune response and blood sugar control.In the present study, we have evaluated the efficacy of ethanolic extract of Ocimum sanctum 47mg/kg p.o, Withania somnifera 23 mg/kg p.o and Bacopa monnieri 23 mg/kg p.o on plasma cortisol level in mice subjected to swim endurance test and cold restraint stress. The standard group was administered water-soluble root powder of Panax ginseng 100 mg/kg p.o and the stress control group was administered distilled water orally for 7 days. It was found that mice pretreated with ethanolic extracts of Ocimum sanctum, Withania somnifera and Bacopa monnieri showed a fall in the plasma cortisol level. The standard group also showed a significant decrease in the plasma cortisol level compared to the stress and normal control groups.

Application of Polystyrene Nanofiber in Detection of Anxiety-Related Bio-Marker Cortisol

This work aimed to explore the correlation between plasma cortisol level and the occurrence of anxiety through the polystyrene (PS) nano-fiber solid phase extraction technology. The PS nano-fibers were prepared, and its characterization was performed to detect its adsorption selectivity and blood compatibility. 32 anxiety patients treated in the hospital were recruited as the research subjects, with another 35 mentally healthy people as controls. The Hamilton Anxiety (HAMA) Scale, Symptom checklist-90 (SCL-90) scale, and Eysenck personality questionnaire (EPQ) were used to analyze the anxiety degree, psychological disorder degree, and personality of the two groups. The plasma cortisol level was detected by PS nano-fiber solid phase extraction technology. Finally, the Pearson correlation test was performed to analyze the correlation between the plasma cortisol level and the scores of HAMA scale, SCL-90 scale, and EPQ scale in anxiety patients. It was revealed that the HAMA scale and SCL-90 scale scores of anxiety patients were superior to those of healthy subjects (P < 0.05). The “neuroticism” factor score in EPQ were obviously higher than that of healthy subjects (P < 0.05). The diameter of the prepared PS nano-fiber was within 200~900 nm, with a small specific surface area (BET), pore volume, and pore size, and the cellular structure was noted on the fiber surface. The PS nano-fiber demonstrated relatively good adsorption performance for benzene hydrocarbon compounds and had excellent anti-protein adsorption capacity. It was found that the plasma cortisol level of anxiety patients was higher than that of healthy subjects (P < 0.05), and the plasma cortisol level was positively correlated with HAMA scale, SCL-90 scale, and EPQ scale scores (r = 0.996, 0.993, and 0.971, respectively; P < 0.05). In conclusion, the PS nano-fiber solid phase extraction technology can be applied to identify the plasma cortisol level, which was with a good anti-interference property. An increased plasma cortisol level can be used as an indicator for auxiliary diagnosis of anxiety.

Relationship between plasma cortisol level and bodyweight and antler size in farmed fallow deer

The aim of this study was to demonstrate the relationship between the plasma cortisol level and bodyweight and antler size in farmed male fallow deer (Dama dama) of various ages. The study involved 33 animals divided into three age groups: one year old, three years old, and older. Their bodyweight was measured and blood samples were taken twice a year during antler growth (May) and before the rut (September). Whole antlers were collected in September to measure their length and weight. The plasma cortisol concentration was determined with an immunoenzymatic method. The correlations between cortisol level and bodyweight were significant and positive in both May and September (P ≤0.05). There was a negative correlation between weight gain and change in cortisol levels (P ≤0.05). Thus, fallow deer with large seasonal changes in cortisol gained less weight from May to September. The results of the present study indicated that calmer animals with lower cortisol fluctuations should be selected for breeding, which would contribute to greater stability of weight gain.

Characteristics of adrenal insufficiency in hemodialysis patients

Background Adrenal insufficiency causes abnormal subjective symptoms such as general fatigue, signs such as hypotension, and abnormalities such as hypoglycemia and leads to poor prognosis. However, all these are also observed in hemodialysis (HD) patients without adrenal insufficiency. The morphology of the adrenal glands in HD patients with adrenal insufficiency is unclear. Therefore, this study was performed to clarify the characteristics of adrenal insufficiency in HD patients. Methods Seventeen HD patients who had abnormal subjective symptoms and test results indicating adrenal insufficiency and whose serum cortisol levels were less than 18 μg/dL were recruited. Results Seven HD patients were diagnosed with adrenal insufficiency. No significant differences were found about abnormal subjective symptoms and images between patients with and without adrenal insufficiency. The levels of serum cortisol and serum cholinesterase were significantly lower in patients with adrenal insufficiency than in those without adrenal insufficiency. A plasma cortisol level of 8.45 μg/dL showed the highest sensitivity and specificity in the receiver operating characteristic curve. The serum cortisol levels were significantly and negatively associated with the plasma ferritin levels in patients with adrenal insufficiency. Multiple linear regression analyses revealed that the serum cortisol levels showed a significant negative association with the plasma ferritin levels after adjustments. Conclusions It is difficult to infer adrenal insufficiency in HD patients by subjective symptoms and images of the adrenal glands. Adrenal insufficiency correlates with nutritional and inflammatory status, and the levels of serum cholinesterase and plasma ferritin might reflect their corresponding status.

Evaluation of Hormone-Induced Stress Responses Using Endogenous Cortisol in Carp (Cyprinus carpio)

With stress studies in fish it is often difficult to determine the degree of response to various stressors, and the interpretation of this influence is usually based on an increase in endogenous cortisol levels. Simulation of stress with synthetic corticosteroids is widely used in ichthyological practice, which raises the question of whether endogenous cortisol is the most appropriate parameter for measuring stress levels in such studies. This work presents the dynamics of the plasma cortisol level in simulating acute and chronic stress in 24 carps by a single injection of dexamethasone in the first experimental group and betamethasone in the second experimental group, in comparison with the control group (without injection) for 21 days. The analysis was performed before injection, as well as after 7, 14 and 21 days of treatment. The hormonal response was compared with that of fish stressed by natural factors (hypoxia). It was found that betamethasone inactivates the production of endogenous cortisol during all subsequent days of the experiment after injection from 353.68±66.39 ng/ml to 7.28±1.27 ng/ml by day 21, while the effect of dexamethasone caused multidirectional fluctuations in its level: from 346.25±43.16 ng/ml to 242.25±58.49 ng/ml on the 7th day, 388.25±37.51 ng/ml on the 14th day and 264.25±21.21 ng/ml on day 21 compared with smooth dynamics in control fish: 376.25±44.04 ng/ml, 366.75±42.82 ng/ml, 335.33±8.57 ng/ml and 366.00±89.22 ng/ml, respectively. It was concluded that measuring the level of endogenous cortisol is not recommended when assessing the degree of stress imitation by these hormones, and in studies of this type it is necessary to search for other indicators. Keywords: carp, cortisol, stress, dexamethasone, betamethasone, hormone

The Adrenal Cortex, an Underestimated Site of SARS-CoV-2 Infection

BackgroundThe majority of the critically ill patients may have critical illness-related corticosteroid insufficiency (CIRCI). The therapeutic effect of dexamethasone may be related to its ability to improve cortical function. Recent study showed that dexamethasone can reduce COVID-19 deaths by up to one third in critically ill patients. The aim of this article is to investigate whether SARS-CoV-2 can attack the adrenal cortex to aggravate the relative adrenal insufficiency.MethodsWe summarized the clinical features of COVID-19 reported in currently available observational studies. ACE2 and TMPRSS2 expression was examined in human adrenal glands by immunohistochemical staining. We retrospectively analyzed serum cortisol levels in critically ill patients with or without COVID-19.ResultsHigh percentage of critically ill patients with SARS-COV-2 infection in the study were treated with vasopressors. ACE2 receptor and TMPRSS2 serine protease were colocalized in adrenocortical cells in zona fasciculata and zona reticularis. We collected plasma cortisol concentrations in nine critically ill patients with COVID-19. The cortisol levels of critically ill patients with COVID-19 were lower than those in non-COVID-19 critically ill group. Six of the nine COVID-19 critically ill patients had random plasma cortisol concentrations below 10 µg/dl, which met the criteria for the diagnosis of CIRCI.ConclusionWe demonstrate that ACE2 and TMPRSS2 are colocalized in adrenocortical cells, and that the cortisol levels are lower in critically ill patients with COVID-19 as compared to those of non-COVID-19 critically ill patients. Based on our findings, we recommend measuring plasma cortisol level to guide hormonal therapy.

Regulation of Cortisol in Patients Undergoing Total Joint Arthoplasty

Osteoarthritis is a condition in which joint cartilage and bone degenerate progressively over time. Total joint arthroplasty is a definitive treatment. Cortisol is a hormone that is associated with pain and inflammation. This study aims to investigate the cortisol levels in patients undergoing total joint arthroplasty. Plasma samples were collected from 71 total joint arthroplasty (TJA) patients at baseline (pre-surgery), 24 hours post-operation, and 5 days post-operation. Cortisol levels were measured in each sample using a commercially available ELISA kit. All results were compiled as group means ± SD. The plasma cortisol level at baseline were 218.5 ± 12 ng/mL. The 24-hour post-surgical samples showed a marked increase in cortisol levels 240.7 ± 15 ng/mL. The blood samples drawn at the 5th day after surgery showed a downward trend (74 ± 12 ng/mL). At 5 days post-operation, cortisol levels were significantly lower than at baseline or 24 hours post-operation. These results point to the fact that prior to surgery, the patient’s emotional stress contributes to increased serum cortisol levels. The higher level of cortisol persists at 24 hours post-operation due to inflammation from the procedure. This data also suggests that at 5 days post-operation, the inflammatory response from the surgery and emotional stress subside, resulting in a near normalization of the cortisol levels. Cortisol is a hormone that plays a major role in the body’s response to surgery. The relevance between cortisol and different points in the surgical timeline has the potential to prognosticate and improve recovery measures.