Prediction of the transsphenoidal endoscopic adenomectomy results in patients with cushing’s disease

Introduction. Transsphenoidal adenomectomy (TSA) is the method of choice in the treatment of Cushing’s disease (CD), but remission of hypercorticism cannot be achieved in all patients. The search for predictors of CD remission after TSA remains to be an important challenge in the endocrinology today.Aim. To study the preoperative and postoperative data of patients with CD to identify the predictors of hypercorticism remission after TSA.Materials and methods. 101 patients with confirmed CD after TSA were included. One year after operation all patients were examined for the presence of hypercorticism remission and divided into two groups: with CD remission and its absence. In both groups’ preoperative pituitary magnetic resonance imaging (MRI) data, the results of preoperative high dose dexamethasone suppression test (HDDST) and the results of serum cortisol collected in the morning 2–3 days after surgery were compared.Results. One year after TSA, CD remission was confirmed in 63 patients (62.4%), whereas in 38 patients (37.6%) hypercortisolism persisted. Favorable predictors of CD remission were: the adenoma size > 3 mm without the invasive growth according to pituitary MRI (specificity 82.4%, sensitivity 82.8%), serum cortisol suppression ≥ 74% in preoperative HDDST (specificity 81.5%, sensitivity 86.3%), morning serum cortisol level in 2–3 days after surgery ≤ 388 nmol/l (specificity 79.3%, sensitivity 97.4%).Conclusions. Pituitary MRI data, the results of preoperative HDDST and morning serum cortisol in the 2–3 days after surgery can be used as predictors of CD remission.

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.

Role of Stress Situation at Diabetic Nephropathy Development

Background: Diabetic Nephropathy (DN) is disorder occur in renal nephrons caused by diabetes mellitus (DM) disease . Therefore uncontrol DM consider as high risk factor for developed renal disease , the un-control DM detection by high glycated hemoglobin (HbA1c) level for long periods . Cystatin C is monomeric and non-glycosylated protein many roles in human body such as diagnosis role in renal, heart and neurology diseases . Cortisol is the most important stress hormone ,it’s release from adrenal cortex layer to all cells by blood .The functions of cortisol in cells include: regulation of blood sugar levels, metabolic process , anti-inflammatory, and other functions. Objective of the Study: Explain effect of stress situation on Diabetic Nephropathy disease Materials and Methods: The present study included 40 DM cases group classified into 20 control DM (without DN) and 20 un-control DM (with DN) ,all subjects age in current study was more than 50 years of both genders. The current study focused on psychological situation of all study individuals when sample collection ,and the blood sample usedto measured cortisol ,HbA1c and cystatin c levels Results: This study shows elevation of serum Cystatin C level , serum cortisol level and HbA1c in un-control DM (with DN) group compare with control DM (without DN) group Conclusion: This study confirms that depression can cause elevation of cortiaol level that lead to increase HbA1c level to result un-control DM , that cause early stage of DN . DN detect by elevation of cystatin C level

Occurrence of Adrenal Suppression in Patients Having Sepsis in Indian Population and Impact of Corticosteroid Supplementation on Its Overall Survival

Objective Our aim was to estimate the occurrence of adrenal suppression in critically ill patients with septic shock who have got admission in intensive care unit and to evaluate the effectiveness of hydrocortisone in these patients in relation to mortality of patient, development of septic shock, and effect on total leucocyte count. Methods Serum cortisol was measured in 120 patients with sepsis. Patients with decreased cortisol level were split in to two groups (group A and B). Group A received 50 mg of hydrocortisone 6 hourly and group B was given matching placebo. At day 7, serum cortisol level was estimated for both A and B groups. The results were calculated and compared with relation to incidence of adrenal insufficiency, development of septic shock, effect on total leucocyte count, and survival at 28 days. Results The occurrence of adrenal suppression in patients having sepsis in our study was 44 out of 120 patients, that is, 36.6%. After supplementation of corticosteroid for 7 days the mean value of serum cortisol of group A was 40.38 ± 8.44 µg/dL and group B was 24.30 ± 6.47 µg/dL (p < 0.001). At day 7, in group A, 22.7% developed septic shock, whereas in group B, 36.4% developed septic shock (p < 0.001). In group A and B, mortality rate of the patients at 28 days was 18.2 and 22.7%, respectively. Conclusion Hydrocortisone supplementation in critically ill patients with low random basal serum cortisol level with sepsis does not significantly improve the overall survival.

The effect of hypnotherapy on exam anxiety among nursing students

Objectives This study examines the effect of hypnotherapy on exam anxiety among first-year nursing students. Nursing students have high tendency to experience stress and anxiety. Anxiety therapy which encompasses mind and body would be helpful for them. Methods Sixty first-year nursing students participated in this interventional study. The hypnotherapy sessions started eight weeks prior to second exam. Outcome of hypnotherapy were assessed by measuring the exam anxiety score using TAI and clinical measurements (serum cortisol and vital signs). The measurements were done twice, there are two exams, where first exam and measurement were 1 day before exam (without hypnotherapy) and the second exam and measurement were 1 day before exam (with hypnotherapy). Results The mean difference of exam anxiety score and serum cortisol level between pre and post hypnotherapy sessions was statistically significant. Conclusions This study found that hypnotherapy is an effective tool in the management of exam anxiety among the nursing students.

A case of pituitary stalk interruption syndrome diagnosed in a 2-year-old child masquerading as syndrome of inappropriate antidiuretic hormone secretion

<p class="abstract">Pituitary stalk interruption syndrome (PSIS) is included under the spectrum of midline abnormalities and is considered as a part of the holoprosencephaly (HPE) wide spectrum. Genetic basis has been identified in few familial cases. PSIS have anterior pituitary hormone deficiencies and a wide spectrum of clinical presentation. The typical clinical manifestations of PSIS are growth retardation, hypoglycemia and delayed puberty. We report a case of PSIS with hyponatremic seizures as initial presentation. Two-year-old girl with growth and development appropriate for age, presented with acute respiratory infection and generalized tonic clonic seizures. There was history of similar illness two weeks prior and was treated for hyponatremia. Child had euvolemic hyponatremia and symptomatic hypoglycemia. Serum cortisol level was observed to be low and thyroid function test was abnormal. MRI brain showed hypoplastic anterior pituitary and ectopic posterior pituitary (hallmark of PSIS) and absent septum pellucidum. Child was treated with hormone replacement therapy with hydrocortisone and thyroxine. Child improved and is on follow up. Clinical suspicion, early diagnosis and treatment prevent worsening of endocrine impairment, permanent short stature and associated morbidities with PSIS.</p>

Quantifying the Impact of Mounted Load Carrying on Equids: A Review

There are approximately 112 million working equids in developing countries, many of which are associated with brick kilns. Brick kilns and overloading are associated with welfare problems in working equids. Understanding equids’ abilities and influencing factors are important for both effective performance and welfare. Traditionally, measurement of the amount of ‘bone’ was used, and more recently, gait symmetry has been identified as a potential marker for loading capacity. Assessment of stride parameters and gait kinematics provides insights into adaptations to loading and may help determine cut-off loads. Physiological factors such as the ability to regain normal heart rates shortly after work is an important tool for equine fitness assessment and a more accurate measure of load-carrying capacity than absolute heart rate. Oxidative stress, plasma lactate, and serum creatine kinase activity are reliable biochemical indicators of loading ability. For monitoring stress, salivary cortisol is superior to serum cortisol level for assessment of hypothalamus-pituitary-adrenal axis and is related to eye temperatures, but this has yet to be interpreted in terms of load-carrying ability in equids. Further research is needed to standardize the evidence-based load-carrying capacity of working horses and donkeys.