Adrenal Function In Patients Research Articles

PRAP study-partial versus radical adrenalectomy in hereditary pheochromocytomas.

Hereditary pheochromocytoma (hPCC) commonly develops bilaterally, causing adrenal insufficiency when standard treatment, radical adrenalectomy (RA), is performed. Partial adrenalectomy (PA) aims to preserve adrenal function, but with higher recurrence rates. This study compares outcomes of PA versus RA in hPCC. Patients with hPCC due to pathogenic variants in RET, VHL, NF1, MAX, and TMEM127 from 12 European centers (1974-2023) were studied retrospectively. Stratified analysis based on surgery type and initial presentation was conducted. The main outcomes included recurrence, adrenal insufficiency, metastasis, and mortality. The study included 256 patients (223 RA, 33 PA). Ipsilateral recurrence rates were 9/223 (4%) after RA versus 5/33 (15%) after PA (P = 0.02). Metastasis and mortality did not differ between groups. Overall, 103 patients (40%) underwent bilateral adrenalectomy either synchronously or metachronously (75 RA, 28 PA). Of these, 46% developed adrenal insufficiency after PA.In total, 191 patients presented with initial unilateral disease, of whom 50 (26%) developed metachronous contralateral disease, most commonly in RET, VHL, and MAX. In patients with metachronous bilateral disease, adrenal insufficiency developed in 3/4 (75%) when PA was performed as the first operation followed by RA, compared to 1/7 (14%) when PA was performed as the second operation after prior RA (P = 0.09). In patients with hPCC undergoing PA, local recurrence rates are higher than after RA, but metastasis and disease-specific mortality are similar. Therefore, PA seems a safe method to preserve adrenal function in patients with hPCC, in cases of both synchronous and metachronous bilateral disease, when performed as a second operation.

Interpretation of fatty acids and adrenal function in Ald-X patients using PRISMA 2020 methodology

X-linked Adrenoleukodystrophy is a hereditary metabolic disorder that causes the accumulation of very long-chain fatty acids in various tissues, primarily affecting the nervous system and adrenal glands. The aim of the study was to interpret very long-chain fatty acids and adrenal function in patients with X-linked Adrenoleukodystrophy using PRISMA 2020 methodology. A systematic literature review and an analysis of a specific clinical case were conducted. A total of 135 records were reviewed, of which 16 relevant articles were selected after applying inclusion and exclusion criteria. The results highlight the complex relationship between VLCFA levels and adrenal function, and the importance of an integrated approach to treatment. It is concluded that further research is essential to better understand this correlation and develop effective therapeutic strategies

Interpretation of fatty acids and adrenal function in Ald-X patients using PRISMA 2020 methodology

X-linked Adrenoleukodystrophy is a hereditary metabolic disorder that causes the accumulation of very long-chain fatty acids in various tissues, primarily affecting the nervous system and adrenal glands. The aim of the study was to interpret very long-chain fatty acids and adrenal function in patients with X-linked Adrenoleukodystrophy using PRISMA 2020 methodology. A systematic literature review and an analysis of a specific clinical case were conducted. A total of 135 records were reviewed, of which 16 relevant articles were selected after applying inclusion and exclusion criteria. The results highlight the complex relationship between VLCFA levels and adrenal function, and the importance of an integrated approach to treatment. It is concluded that further research is essential to better understand this correlation and develop effective therapeutic strategies

Adrenal functional reserve in the full spectrum of chronic kidney disease.

Altered cortisol levels have been associated with an increase in mortality and a decrease in health-related quality of life in patients with chronic kidney disease (CKD); however, adrenal response to adrenocorticotropic hormone (ACTH) stimulation test has not been evaluated in patients with stage 3a to 5 CKD with and without renal replacement therapy (RRT). To evaluate adrenal function in patients with CKD. Adults with CKD underwent a low-dose cosyntropin stimulation test (1 µg synthetic ACTH), with serum cortisol levels being measured at 0, +30 and +60 minutes post-test. Sixty participants with stage 3, 4 and 5 CKD (with and without RRT) were included. None of the patients had adrenal insufficiency (AI). The correlation observed between cortisol concentration at baseline and 30 minutes and 1 hour after stimulation and glomerular filtration rate (GFR) was negative and statistically significant (r: -0.39 [p = 0.002], r: -0.363 [p = 0.004], r: -0.4 [p = 0.002], respectively). Since CKD early stages, cortisol levels increase as GFR decreases. Therefore, we conclude that systematic screening for AI is not necessary in CKD patients.

PSUN24 Adrenal Metastases Treated with Radiotherapy: Development of Adrenal Insufficiency

Abstract Introduction Adrenal metastases are the second most common neoplasms of the adrenal cortex. Adrenal insufficiency (AI) develops when more than 90% of the cortex is destroyed. In patients with adrenal metastases requiring local treatment, stereotactic ablative radiation therapy (SAbR) has been shown to be well tolerated. Yet, data on the development of AI following adrenal SAbR are scarce. Therefore, we aimed to assess the incidence, timing, and factors associated with the development of AI in patients undergoing SAbR for the treatment of adrenal metastases. Utilizing an IRB approved registry protocol, we conducted a retrospective longitudinal follow-up study to characterize 66 patients (73% men; median age 61 years) with adrenal metastases who underwent SabR, followed for median 3.8 years from the initial cancer diagnosis and 11.5 months from SAbR. The diagnosis of primary AI was based on low morning serum cortisol levels (<5 μg/dL) with >2-fold elevated plasma ACTH, or peak cortisol <18 μg/dL post cosyntropin. Primary carcinomas included renal cell (41%), lung (38%), colorectal (9%), melanoma (5%), and others (7%). Twenty-four (38%) patients had bilateral adrenal metastases. At the time of SAbR, 41 (62.1%) patients had uninvolved contralateral adrenal glands, 16 (24.2%) had bilateral adrenal metastases, and 9 (13.6%) had contralateral adrenalectomy prior to SAbR. Nine patients had bilateral SAbR and 9 had SAbR to one adrenal gland in the setting of contralateral adrenalectomy. Most patients (66.7%) underwent 5 SAbR fractions, with a median dose of 800 cGy/fraction. In our cohort, 39/66 (59%) patients underwent comprehensive assessment of adrenal function. Overall, 7 (10.6%) patients developed post-SAbR AI at median time of 4.3 months (range, 0.7-20.2). The incidence of post-SAbR AI was 22.2% (2/9) in patients with prior contralateral adrenalectomy, 18.8% (3/16) with bilateral adrenal metastases, and 0% (0/41) with normal contralateral adrenal gland. A 6-month-AI-free survival rate was 72.7% (95% CI, 37.0-90.3) in patients with bilateral metastases and 64.8% (1.6-73.7) in patients with contralateral adrenalectomy. Post-SAbR median progression-free survival (local disease) was 3.0 years, with 6-month and 1-year survival rates of 82.4% and 75.0%, respectively. Conclusions Our study shows thatpatients with a normal contralateral adrenal gland are unlikely to develop post-SAbR AI. In contrast, AI occurred in ∼ 20% of patients with prior contralateral adrenalectomy or bilateral adrenal metastases. In this high-risk cohort, only 60% of patients underwent assessment of adrenal function. It is crucial to monitor adrenal function in patients undergoing SAbR for adrenal metastasis, especially in those with affected or surgically absent contralateral gland. This study reinforces the importance of a team-based approach to the management of patients with adrenal metastasis to improve patient outcomes. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Is there a role for the adrenal glands in long COVID?

The symptoms of long COVID and chronic adrenal insufficiency have striking similarities. Therefore, we aim to raise awareness of assessing adrenal function in patients with long COVID.

Urinary free cortisol is a reliable index of adrenal cortisol production in patients with liver cirrhosis.

The measurement of total and free cortisol has been studied as a clinical index of adrenal cortisol production in patients with liver cirrhosis. Correlations between free plasma and salivary cortisol have previously been reported in stable cirrhotic patients. Urinary free cortisol constitutes an index of adrenal cortisol production; however, it has never been used in assessing adrenal function in patients with liver cirrhosis. The aim of this observational study was to determine associations between urinary free cortisol, serum total, salivary, measured and calculated plasma free cortisol levels in cirrhotics, determining which of them can be used as an indirect index of free cortisol levels. Moreover, we investigated the potential use of 24 h urinary free cortisol as a prognostic factor for mortality. Seventy-eight outpatients with liver cirrhosis were included. Serum, salivary and urinary free cortisol were measured using the electrochemiluminenscence immunoassay. Plasma free cortisol determination was conducted using a single quadrupole mass spectrometer. The quantification of free cortisol was achieved by determining the signal response on negative ESI-MS mode. Twenty-four hour urinary free cortisol levels correlated with free cortisol determined by mass spectrometer, total cortisol and calculated free cortisol levels. Patients with low levels of urinary free cortisol presented a significantly higher mortality rate compared to those with high levels. The factors associated with death risk were determined by Cox regression. In the multivariate analysis, two models were applied; in the first model, CP score, PVT and urinary free cortisol were found to be significantly related to patients' survival, whereas in the second, MELD score, ascites and urinary free cortisol were independently related to survival. This study suggests that 24 h urinary free cortisol could be considered as a potential index of adrenal cortisol production in patients with liver cirrhosis and it potentially detects patients with a high mortality risk.

Impact of systemic treatments for advanced thyroid cancer on the adrenal cortex.

Fatigue is a frequent adverse event during systemic treatments for advanced thyroid cancer, often leading to reduction, interruption, or discontinuation. We were the first group to demonstrate a correlation between fatigue and primary adrenal insufficiency (PAI). The objective was to assess the entire adrenal function in patients on systemic treatments. ACTH, cortisol and all the hormones produced by the adrenal gland were evaluated monthly in 36 patients (25 on lenvatinib, six on vandetanib, and five on selpercatinib). ACTH stimulation tests were performed in 26 cases. After a median treatment period of 7 months, we observed an increase in ACTH values in 80-100% of patients and an impaired cortisol response to the ACTH test in 19% of cases. Additionally, dehydroepiandrosterone sulphate, ∆-4-androstenedione and 17-OH progesterone levels were below the median of normal values in the majority of patients regardless of the drug used. Testosterone in females and oestradiol in males were below the median of normal values in the majority of patients on lenvatinib and vandetanib. Finally, aldosterone was below the median of the normal values in most cases, whilst renin levels were normal. Metanephrines and normetanephrines were always within the normal range. Replacement therapy with cortisone acetate improved fatigue in 14/17 (82%) patients with PAI. Our data confirm that systemic treatments for advanced thyroid cancer can lead to impaired cortisol secretion. A reduction in the other hormones secreted by the adrenal cortex has been first reported and should be considered in the more appropriate management of these fragile patients.

Fluconazole-Induced adrenal insufficiency following allogeneic hematopoietic cell transplant

Adrenal insufficiency (AI) is a potentially life-threatening endocrine abnormality rarely associated with azole antifungals. Patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) are at high risk of invasive fungal infection and frequently receive azoles. Signs and symptoms of AI, such as gastrointestinal symptoms, lethargy, and electrolyte disturbances frequently overlap with common alloHCT toxicities, such that azole-induced AI may be under-reported in this population. We report the first published case of azole-induced AI following alloHCT. The patient presented with orthostasis and nonspecific gastrointestinal and failure to thrive symptoms in the setting of roughly 6 weeks of fluconazole prophylaxis. The patient was found to have primary AI diagnosed via low serum cortisol and inadequate response to cosyntropin. AI symptoms resolved with hydrocortisone supplementation and recurred upon rechallenge with fluconazole. The patient had fluconazole permanently discontinued with resolution of symptoms. We rate this case as a probable adverse drug reaction on the Naranjo scale. AI may be underreported and misdiagnosed in the alloHCT population given the presence of multiple toxicities with overlapping features. Clinicians must be diligent in investigating adrenal function in patients undergoing alloHCT on azole antifungals who present with symptoms of AI.

Risk of adrenal insufficiency in patients with polymyalgia rheumatica versus patients with rheumatoid arthritis: A cross-sectional study.

To determine whether patients with polymyalgia rheumatica (PMR) are more susceptible to glucocorticoid-induced adrenal insufficiency, one of the barriers to glucocorticoid tapering strategies, compared to patients with rheumatoid arthritis (RA). This cross-sectional study included PMR and RA patients who underwent adrenocorticotropic hormone (ACTH) tests to assess adrenal function. The eligibility criteria were as follows: previous use of prednisolone (PSL) ≥ 5 mg/day, use of PSL for six consecutive months before ACTH test, and current use of PSL at 5 mg/day or less. The association between disease type (PMR vs. RA) and insufficient adrenal response was assessed using logistic regression models. Twenty-six of 34 (76.5%) patients with PMR and 13 of 37 (35.1%) patients with RA had insufficient adrenal response. Compared to patients with RA, patients with PMR were more likely to have insufficient adrenal response, even after adjusting for age, sex, and PSL dose (adjusted odds ratio, 6.75; 95% confidence interval, 1.78-25.60). Patients with PMR have a higher risk of glucocorticoid-induced adrenal insufficiency than patients with RA. Assessing the adrenal function in patients with PMR will contribute to establishing a more appropriate glucocorticoid reduction strategy.

УРОВЕНЬ КОРТИЗОЛА У ПОТЕНЦИАЛЬНЫХ ДОНОРОВ ОРГАНОВ

Currently, the need for the administration of corticosteroids to restore the normal adrenal function in patients with brain death (BD) in order to condition the functional systems before organ harvesting remains unclear. Objectives. To analyze the level of cortisol in potential donors with brain death before harvesting their organs and tissues for transplantation. Material and methods. A prospective pilot study included 60 patients with brain death. The average age of a patient with brain death was 53.5 (48.5; 58.5) years, males - 32 (53.3%) years, females - 28 (46.7%) years. The causes of brain death were: intracerebral hemorrhage - in 30 (50%) patients, traumatic brain injury - in 10 (16.7%) patients, subarachnoid hemorrhage - in 7 (11.7%) patients, cerebral infarction - in 13 (21.6%) patients. The level of cortisol in the blood was determined by the method of radioimmune assay using a set of reagents UP «PP IBC NAS of Belarus» ( Minsk, Republic of Belarus). Results. The cortisol level in patients with BD was 422.8 (216.7; 687.1) nmol/L. The level of cortisol was lower than the reference values in 11 (18.3%) patients with BD, and higher - in 12 (20%) patients. There were no differences between the groups in terms of cortisol level in the following parameters: arterial blood pressure, heart rate, frequency of vasopressors use, dose of vasopressors, time from the patient’s admission to the moment of BD diagnosis, time of observation of a potential donor between two examinations of the council, the number of organs being harvested for transplantation. Conclusions. In potential donors with brain death with low cortisol level, the indices of arterial blood pressure and the doses of injected vasopressors did not statistically significantly differ from those in donors with normal and elevated cortisol level.

New Horizons: Novel adrenal regenerative therapies

In this narrative review, the authors discuss the potential role of novel regenerative therapies for the treatment of adrenal insufficiency, including gene therapy and cell replacement strategies. More specifically, the authors discuss the heterogeneity in adrenal function in patients with Addison disease, including numerous case reports of spontaneous remission. The authors cite recent studies showing that, shortly after the onset of Addison disease, residual adrenal function might be restored using B-lymphocyte-depleting immunotherapy and ACTH treatment. The rationale is that ACTH stimulates the differentiation of the persisting progenitor or stem cells, while B-cell depletion prevents destruction of the newly differentiated cells (1). Furthermore, the cell turnover of the adrenal cortex limits the time-span of the effectiveness of gene therapy (2). A more promising strategy is adrenal cell transplantation, which is potentially curative. Research foci in this strategy include alternative cell sources, novel biomaterials that have been developed to improve cell viability of engineered cells upon implantation, and cellular therapies based on pluripotent stem cells (3).

Predictive Accuracy of Delta Cortisol on Recovery of Adrenal Function in Patients With Drug Induced Cushing’s Syndrome With Secondary Adrenal Insufficiency

There is a growing concern upon the finding of many drug induced Cushing’s syndrome because of inadvertent use of glucocorticoids (GC) either prescribed or as alternative medicine in Myanmar. These patients are presenting with diversity of clinical problems ranging from hypertension, diabetes to acute adrenal crisis due to hypothalamic-pituitary-adrenal (HPA) axis suppression and secondary adrenal insufficiency (AI). The present study aimed to assess the delta cortisol (the degree of cortisol increments) during the first short Synacthen test (SST) as a factor predictive of adrenal function recovery in patients with drug induced Cushing’ syndrome with secondary AI and to determine the proportion of patients who recovered from AI within six-month follow-up. This was a hospital based prospective analytical study that enrolled a total of 52 patients with drug induced Cushing’s syndrome with secondary AI from January 2018 to June 2019. Secondary AI is defined by morning basal serum cortisol ≤ 400 nmol/L with Synacthen stimulated peak cortisol level ≤ 550 nmol/L and serum ACTH < 60 pg/ml. The follow-up SSTs were performed at three-month and six-month after first SST, and the patients with morning basal serum cortisol > 400 nmol/L (or) Synacthen stimulated peak serum cortisol > 550 nmol/L during follow-up SSTs are defined as recovered adrenal function group. In this study, a total of 52 patients were treated with modified regimen of physiological dose of prednisolone with tapering schedule or stress dose GC based on the basal serum cortisol levels up to six months. Among them, nearly half (n=25 / 48.1%) of the patients with drug induced Cushing’s syndrome with secondary AI achieved normal adrenal function within six-month follow-up. It was found that mean values for delta cortisol were not statistically significant between recovered and non-recovered groups, 118.6 nmol/L (SD 72.3) and 97.2 nmol/L (SD 64.2) respectively. The delta cortisol during the first SST could not predict strongly (AUC - 0.6, 95% CI - 0.44 to 0.76, P = 0.2) the recovery of adrenal function in patients with drug induced Cushing’s syndrome with secondary AI and it was inconsistent with previous studies. The older age of the patients, oral route of administration of drugs causing Cushing’s syndrome and comorbid hypertension were found to be more significant in the non-recovered group. In conclusion, the present study did not support the evidence that the delta cortisol during the first SST could predict adrenal function recovery in patients with drug induced Cushing’ syndrome with secondary AI. Reference: (1) Baek et al., 2016; Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary AI. Endocrinol Metab.31, pp. 153–160. (2) Pofi et al., 2018; The Short Synacthen Test Can Be Used to Predict Recovery of HPA Axis Function. J Clin Endocrinol Metab.103(8), pp. 3050–3059.

Long-Term Corticotroph Function Following Cure of Cushing’s Syndrome

Introduction: Hyper- and hypofunction of the hypothalamic-pituitary-adrenal (HPA) axis in Cushing’s syndrome (CS) and Addison’s disease (AD) is associated with disturbances of classical feedback mechanisms. Time to recovery of adrenal function after CS remission depends on the etiology of CS and is longest after adrenal CS. To date there are no data on the recovery of corticotroph function following CS remission, and the synacthen test is recommended for testing adrenal function in patients with hypopituitarism. Aim Here we aim to test corticotroph function after long-term cure of Cushing’s syndrome following bilateral adrenalectomy (BADx), compared to patients with primary glucocorticoid deficiency due the presence of 21-hydroxylase antibodies or adrenoleucodystrophy, a pathophysiological model of glucocorticoid and mineralocorticoid deficiency. Methods: We retrospectively evaluated data from patients with CS and AD attending our endocrine department between 2000 and 2020, using the following inclusion criteria: BADx performed for pituitary/ectopic/adrenal or occult CS or primary adrenal insufficiency confirmed either by the presence of 21-hydroxylase antibodies or genetically in adrenoleucodystrophy. Results: Full data were available for 93 patients: 43 patients with BADx due to CS (18 patients with pituitary CS, 14 patients with adrenal CS and 11 patients with ectopic/occult CS, F:M 29:14, mean age at BADx 45.4 years age range 13-74 years) and 50 patients with AD (47 cases with positive 21-hydroxylase antibodies, 3 cases with adrenoleucodystrophy, F:M ratio 27:23, mean age at diagnosis 35 years, age range 6-57 years). The observation period was 537.5 patient-years after BADx (mean 12.5 years, range 1-38 years) and 647 patient-years following AD diagnosis (mean 14.2 years, range 1-46 years). At the last visit, there were no differences between the hormone substitution regimes between the groups. ACTH concentrations during the whole observation period and also at the last visit were lowest in patients with adrenal CS (56.5 pg/ml) when compared to patients with AD (487 pg/ml, p<0.001), or with patients with pituitary CS (377.5 pg/mL, p=0.011). ACTH values in patients with AD in long-term follow-up were significantly higher when compared to all patients with CS (141 pg/mL, p<0.001). Conclusion: These data highlight a long-term defective corticotroph function in patients with CS following BADx. Low ACTH concentrations long term after BADx for adrenal CS corroborate that corticotroph function fails to recover after CS cure. In the light of these findings, the utility of the synacthen test for excluding secondary/tertiary adrenal insufficiency following CS remission is disputable and remains to be evaluated in future studies dedicated to CS cohorts.

ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ ЩИТОВИДНОЙ ЖЕЛЕЗЫ И НАДПОЧЕЧНИКОВ У ПАЦИЕНТОВ С ПСОРИАЗОМ

The article defines the characteristic features of thyroid and adrenal function in patients with psoriasis, taking into account the pituitary regulation and streptococcal association of dermatosis. Patients with psoriasis, regardless of the form of dermatosis and microbial association, experience a non-thyroid syndrome with a high T3 concentration, increased glucocorticoid and mineralocorticoid function of the adrenal glands.

Recovery of hypothalamic-pituitary-adrenal axis in paediatric Cushing disease.

The postoperative period of Cushing disease (CD) is complicated by a phase of adrenal insufficiency (AI). Factors that influence the duration of AI and its prognostic significance for CD recurrence in children have not been extensively studied. We investigated whether clinical or biochemical factors contribute to the duration of AI, and the correlation of the recovery process with the risk for recurrence. Patients with paediatric-onset CD who were followed up for at least 3months after transsphenoidal surgery (TSS) (n=130) were included in the study. Multivariable Cox proportional hazards analysis was used to assess the association of biochemical and clinical factors with the duration of AI. Overall, 102 patients recovered adrenal function during their follow-up. Median time to recovery was 12.7months [95% confidence intervals (CI): 12.2-13.4]. On multivariable analysis, clinical (age, gender, disease duration, puberty stage, BMI z-score, tumour size, invasion of the cavernous sinus and year of surgery) and biochemical (midnight cortisol and morning ACTH) factors did not correlate with the time to recovery, except for increase in recovery time noted with increase in urinary free cortisol (UFC) [hazard ratio (HR): 0.94; 95% CI: 0.89-0.99]. Among patients who eventually recovered adrenal function, the risk for CD recurrence was associated with the time to recovery (HR: 0.86; 95% CI: 0.75-0.99). Recovery of adrenal function in patients with CD after TSS may not be associated with most clinical and biochemical factors in the preoperative period except for total cortisol excretion. Earlier recovery is associated with higher risk for recurrence, which has implications for the patients' follow-up and counselling.

Incidence of Adrenal Insufficiency and Cushing's Syndrome After Long-Term Epidural Steroid Injections Over Six Months or Longer: A Preliminary Study.

PurposeEndocrinological complications of an epidural steroid injection (ESI) are rare but dangerous. Nevertheless, despite the associated risks, repeated long-term ESIs are indispensable in some clinical situations. However, only a few reports to date have assessed the safety of this procedure. In this study, we evaluate the incidence of adrenal insufficiency (AI) and Cushing’s syndrome after long-term ESIs.MethodsThis clinical observational study enrolled herniated nucleus pulposus or spinal stenosis patients who had received ESIs over a period of six months or longer. The adrenocorticotropic hormone (ACTH) stimulation test was performed to confirm AI and the late-night salivary cortisol (LNSC) test was performed to diagnose Cushing’s syndrome. To evaluate the hypothalamus pituitary adrenal axis suppression, salivary cortisol (SC) levels were measured on days 0, 1, 7, 21, 28, 35, and 42.ResultsThis study included 17 patients. Among these, two patients (11.8%) developed AI, but no cases of Cushing’s syndrome were reported. There was no predictor for the development of AI. The SC levels tended to increase with time after an ESI (β = 0.003). The slope of the mixed effect model between the AI and non-AI groups showed a significant difference (p value = 0.015). However, the differences in mean SC levels at each time point between the two groups were not significant (adjusted p value = 0.053).ConclusionLong-term ESI use may be associated with AI development. An unexpected adrenal crisis due to AI could be life threatening. Therefore, regular monitoring of adrenal function in patients who have received long-term ESIs may be prudent.

A study of serum cortisol levels in acute head injury patients.

Introduction Adrenal insufficiency has a great impact on the prognosis of patients with traumatic brain injury. In healthy persons during normal day-to-day activity, the concentration of plasma cortisol is high in the morning, decreases during the day and rises again during night. But this diurnal rhythm is abolished in long-term unconscious patients and in those with disturbed sleep cycles. In addition, patients with central nervous system disease, who are conscious but have lesions in the temporal lobe, and the pretectal or hypothalamus area, demonstrate abnormal rhythms. Methods This cross-sectional study recruited 33 consecutive patients attending emergency medical departments of Prathima Institute of Medical Sciences Hospital between July 2017 and April 2018 with mild to severe traumatic head injury within 6 h of injury. The selected patients were mainly divided into three groups depending on the Glasgow Coma Scale (GCS) [mild head injury (14-15); moderate head injury (9-13); severe head injury (3-8)]. In each group, 11 patients were selected. GCS was calculated at the time of admission. The adrenal function of the patients was assessed by using the serum cortisol tests. Results In this comparative study of acute head injury among three groups, males are more prone to injury than females, with 81%, 90% and 72% in mild, moderate and severe injuries, respectively. The result mainly shows that the mean cortisol levels estimated were significantly increased in mild head injury and were with greater increase in cases of moderate & severe head injuries. Statistically significant positive correlation was observed between serum cortisol & GCS levels. Conclusions In this study of serum cortisol levels in head injury patients, we observed that there is increase in the serum cortisol level immediately after trauma. The increase is linearly related with the severity of head injury. Hence performing serum cortisol test is recommended for the assessment of adrenal function in patients with traumatic head injury.

Adrenal function in patients receiving rifampin-based anti-tuberculosis regimens: A cross-sectional study in Iran.

Adrenal function in patients receiving rifampin-based anti-tuberculosis regimens: A cross-sectional study in Iran.

30-Year-Old Woman With Intractable Vomiting

30-Year-Old Woman With Intractable Vomiting