Assessment Of Adrenal Function Research Articles

Assessment of adrenal function after prednisolone treatment in patients with polymyalgia rheumatica and/or giant cell arteritis - Data from the double edge-replace study

Assessment of adrenal function after prednisolone treatment in patients with polymyalgia rheumatica and/or giant cell arteritis - Data from the double edge-replace study

Factors Associated with Reproductive Success in Captive Vancouver Island Marmots (Marmota vancouverensis)

The Vancouver Island marmot (Marmota vancouverensis) is Canada’s most endangered endemic mammal. In 1997, a conservation breeding-for-release program was established to supplement wild marmot populations. Retrospective analyses of captive breeding studbook records since 2000 indicate the age of the sire and the dam significantly impacted the odds of successfully weaning a litter. Dams and sires between 5 and 7 years of age had more than double the odds of reproductive success compared to older animals. Successful reproduction by the dam in the previous year also doubled the odds of successfully weaning a litter in subsequent years. Assessment of adrenal function via fecal glucocorticoid analyses indicated established breeding pairs had decreased stress compared to new pairs (5.74 ± 0.28 ng/g vs. 7.60 ± 0.34 ng/g; p < 0.0001). Pairs that were ultimately successful at weaning pups in a breeding season had decreased stress compared to unsuccessful pairs (6.05 ± 0.34 ng/g vs. 7.22 ± 0.28 ng/g; p = 0.0006). These endocrine results suggest social buffering via familiarity and breeding/pair bond formation may be decreasing stress in established and successful pairs, respectively. The results of this study will be used to assist in the captive breeding management of this species to optimise numbers of animals produced to supplement the wild populations.

Assessment of adrenal function in a large series of patients confirms that adrenal insufficiency is a common cause of fatigue during treatment with multikinase inhibitors (MKIS)

Assessment of adrenal function in a large series of patients confirms that adrenal insufficiency is a common cause of fatigue during treatment with multikinase inhibitors (MKIS)

Assessment of Adrenal Function in Chronic Hepatitis C Patients

Assessment of Adrenal Function in Chronic Hepatitis C Patients

Assessment of Adrenal Function in Chronic Hepatitis C Patients

Assessment of Adrenal Function in Chronic Hepatitis C Patients

Assessment of adrenal function in pediatric cancer survivors.

Oncological therapy can temporarily or permanently disrupt adrenal gland function. The aim of our study was to assess the function of adrenal glands in cancer survivors and to find the best diagnostic tools for it. Sixty patients aged 1.2-14.9 years (mean 8.3 ±3.5) with diagnosed malignancies and 45 healthy children as controls were recruited to the study. Patients were assessed 0-8 years (mean 2.4 ±2.0 years) after the oncological therapy. In all patients fasting blood samples were collected to measure: glucose, sodium, potassium, cortisol, aldosterone, plasma renin activity (PRA), dehydroepiandrostenedione-sulphate (DHEA-S), adrenocorticotropic hormone (ACTH) and antibodies against the adrenal cortex (AAA). Moreover, 24-hour urinary free cortisol (UFC) was assessed. Test with synthetic ACTH was carried out with 250 µg in neuroblastoma and nephroblastoma patients and with 1 µg in other oncological patients. The levels of morning cortisol and sodium were significantly lower and blood glucose were higher in cancer survivors than in controls (p = 0.006, p = 0.043, p = 0.008). Basal laboratory tests confirmed adrenal insufficiency (AI) in 1 patient with neuroblastoma. Low-dose ACTH revealed AI in 3 patients with acute lymphoblastic leukemia. In the study group, UFC correlated with evening and midnight cortisol (p = 0.001, p = 0.006). In the control group UFC correlated with DHEA-S (r = 0.623, p = 0.0001). None of assessed parameters correlated with the time since the completion of oncological therapy. The study confirmed possibility of developing asymptomatic AI in cancer survivors even several years after therapy. Instead of morning cortisol, classical diagnostic low-dose ACTH test seems to be an optimal tool for adrenal function's assessment.

71 Adrenal Insufficiency among Children treated with Hormonal Therapy for Infantile Spasms

Abstract Primary Subject area Endocrinology and Metabolism Background Hormonal therapy is a standard treatment for children with infantile spasms. However, the high doses given and long treatment duration exposes patients to the potential risk of adrenal insufficiency (AI). There is, presently, limited data on occurrence of AI after hormonal therapy in this population. Objectives This study aims to quantify the incidence of AI among children with infantile spasms treated with high-dose corticosteroids and/or adrenocorticotropic hormone (ACTH). Design/Methods A retrospective chart review of patients less than 2 years old treated for infantile spasms was performed between January 2009 to March 2020 in one pediatric specialized hospital. Variables collected included sex, age, etiology, age at treatment initiation, type of hormonal treatment, dose and duration of treatment, concomitant medication and illness, other corticosteroid uses, hydrocortisone replacement therapy use, adrenal function testing, and signs of AI. Analysis included descriptive statistics, such as incidence and bivariate analysis. Results Thirty-one patients met the inclusion criteria and received a total of 33 separated courses of hormonal treatment. Adrenal function following each course of treatment was evaluated in all patients, either by tests or by the presence of adrenal crisis. Oral hydrocortisone replacement therapy was received by 32/33 (97%) children. AI occurred in 25/33 (76% [95% CI 58-89]) children. There was no predictive factor for adrenal insufficiency after hormonal treatment, and no drug regimen (duration or total received dose) was safe. Two patients (6%) presented to the emergency room with an acute adrenal crisis the day following the weaning off of hormonal treatment. They were the youngest children of the cohort, with an age of 1,6 and 2,7 months at the initiation of treatment. All other patients were aged 4 months and older. Conclusion This study suggests that adrenal suppression is frequent after standard hormonal therapy regimen for infantile spasms. This can lead to serious complications, such as adrenal crisis, if not supplemented. A routine laboratory assessment of adrenal function should be done after hormonal therapy for all patients. We suggest that hydrocortisone replacement therapy should be given at the end of hormonal therapy and until testing results for adrenal function are obtained, particularly for younger patients.

Biochemical transition during triphasic postpartum thyroiditis: confusion with central hypothyroidism.

SummaryHypothyroidism occurring in the postpartum period can be due to pituitary or hypothalamic disease as in Sheehan’s syndrome and postpartum autoimmune hypophysitis or due to a primary thyroid disease as in postpartum thyroiditis. It is important that the correct diagnosis is ascertained because hypothalamic or pituitary disorders are often associated with other pituitary hormone deficiencies, especially life-threatening adrenal insufficiency or adrenal crisis. A combination of various symptoms and biochemical markers, especially serum thyroid-stimulating hormone levels dictate the initial diagnostic pathway. We present a case of a woman who presented with a 2-month history of tiredness and neck discomfort following delivery. A thyroid function test demonstrated results, which we initially interpreted as central hypothyroidism. Follow-up results indicated that this was in fact the transition period between the thyrotoxic phase and hypothyroid phases of postpartum thyroiditis. This case highlights the potential for diagnostic confusion between central hypothyroidism and postpartum thyroiditis.Learning pointsPostpartum thyroiditis affects one in twenty mothers within 12 months of delivery.The majority of patients have transient thyrotoxicosis only, some have transient hypothyroidism only, and the rest has a triphasic pattern (thyrotoxic, hypothyroid then a euthyroid phase).During the transition from the thyrotoxic phase to hypothyroid phase, when serum TSH is still suppressed, the biochemical results can resemble that of central hypothyroidism.If central hypothyroidism is suspected, then urgent diagnostic investigations should be carried out along with the assessment of adrenal function.There is a potential for diagnostic confusion between postpartum central hypothyroidism and postpartum thyroiditis; however, the obstetric history, clinical symptoms, and signs (headaches, breastfeeding, goitre, etc.) and serum adrenocorticotropic levels should help with the differential diagnosis.

The Prevalence of Adrenal Insufficiency in Kidney Transplant Recipients

Abstract Long term glucocorticoid therapy is a key component of immunosuppression for kidney transplant recipients (KTR), leading to a significant cumulative glucocorticoid exposure in this cohort. However, assessment of adrenal function and steroid education do not feature in clinical practice guidelines for KTR. This study aims to investigate the prevalence of adrenal insufficiency (AI) in KTR on maintenance prednisolone and develop a simple screening algorithm to identify patients at highest risk of AI. 67 KTR receiving prednisolone were recruited, with a median age of 52 yrs (IQR 39–64) and median time since transplantation of 79 months (IQR 46–146). Patients with known hypothalamic-pituitary-adrenal axis pathology, exposure to oral oestrogens or impaired graft function (creatinine >170 umol/l) were excluded. Participants underwent a short synacthen test [SST, Roche Elecsys II immunoassay, pass cortisol > 430 nmol/l, CV assay 1.8-2,1%)], assessment of lifetime glucocorticoid exposure and an assessment of metabolic health.72% (n=48) of participants failed the SST(30 min cortisol < 430nmol/l). Participants with AI had a higher daily prednisolone dose (4.9 vs 4.2mg/day, p=0.002), a greater cumulative glucocorticoid exposure (289 vs 111 mg/kg, p=0.03) and lower estimated glomerular filtration rate (63 vs 81 ml/min/1.73m2, p=0.03) than those with intact adrenal function. There was no difference in duration of glucocorticoids post transplantation, previous transplant history, pre-transplant glucocorticoid exposure, immunosuppression regime, exposure to other glucocorticoid preparations, BMI and cortisol binding globulin concentration between those who passed or failed a SST. Participants with AI had a lower baseline cortisol (143 vs 303 nmol/l, p<0.001), lower baseline serum ACTH (14 vs 20 pg/ml), a lower peak stimulated cortisol (325 vs 490 nmol/l, p< 0.001) and lower cortisol response (139 vs 189 nmol/l, p=0.013) to synacthen testing than those with normal adrenal function. A morning cortisol of <294 nmol/l predicted AI result with 100% sensitivity (95% CI 92–100%, p< 0.001) and 63% specificity, therefore AI could be excluded if morning cortisol >300nmol/l, reducing the need for stimulatory testing. Our results suggest KTR are at higher risk for AI than previously reported, highlighting a need for greater patient and physician awareness regarding AI. We suggest that KTR with a morning cortisol < 300nmol/l are at high risk of AI, and dynamic testing should be considered for these patients.

Assessment of adrenal function after ACTH treatment in children with infantile spasms: a retrospective analysis of local practices and trends (4835)

Assessment of adrenal function after ACTH treatment in children with infantile spasms: a retrospective analysis of local practices and trends (4835)

Assessment of Adrenal Function in COVID-19

Assessment of Adrenal Function in COVID-19

Assessment of adrenal function at birth using adrenal glucocorticoid precursor to product ratios to predict short-term neonatal outcomes.

Most neonatal outcomes in neonates are related to normal adrenal gland function. Assessment of adrenal function in a sick preterm neonate remains a challenge, thus we hypothesized that adrenal steroid precursors to their product ratios have a direct relationship with neonatal outcomes. We studied demographics of pregnancy and neonatal outcomes in 99 mother-infant pairs (24-41 weeks) and assayed 7 glucocorticoid precursors in the cortisol biosynthesis/degradation pathway. We correlated antenatal factors and short-term neonatal outcomes with these precursors and their ratios to assess maturity of individual enzymes. We found no correlation between cortisol levels with antenatal factors and outcomes. Antenatal steroid use impacted several cortisol precursors. 17-OH pregnenolone-to-cortisol ratio at birth was the best predictor of short-term neonatal outcomes, such as hypotension, RDS, IVH and PDA. A cord blood 17-OH pregnenolone:cortisol ratio of <0.21 predicts which neonate will have a normal outcome with a high sensitivity and specificity. Maternal factors and antenatal steroids impact neonatal adrenal function and leads to maturation of adrenal function. 17-OH pregnenolone:cortisol ratio and not cortisol is the best predictor of adrenal function. Adrenal function can be assessed by evaluating the profile of adrenal steroids.

Assessment of Adrenal Function in Cirrhotic Patients with Spontaneous Bacterial Peritonitis

Background: One of the subjects that has become a big issue in recent years is adrenal Insuffi-ciency in cirrhotic patients, it is evidenced that there is an argument association between cir-rhotic patients with spontaneous bacterial peritonitis and adrenocortical dysfunction. Aim: to assess adrenal function in chronic liver disease patients with spontaneous bacterial peritonitis to measure hepato-adrenal syndrome problem in our patients. Subjects and Methods: cross sectional analytic study was carried out including 160 persons divided into 4 groups, 40 pa-tients for each. Group1(healthy or control group), Group2 (Patients with compensated liver disease), Group 3 (patients with cirrhotic liver disease and sterile ascites and Group 4( patients with cirrhotic liver disease and spontaneous bacterial peritonitis), Then serum cortisol level was assessed for each group at 8a.m , 8p.m and post synacthen test then the comparison was held to assess adrenal function among them. Results: Our study revealed statistically signifi-cant differences between the comparative groups with pre and post synacthen test where adrenal insufficiency was clear. P-value was (0.001), mean value of total neutrophilic count (p=<0.001), relation between adrenal insufficiency and Child-Pugh score (p= <0.001). Conclu-sion: Spontaneous bacterial peritonitis plays a very major role in adrenal insufficiency.

Assessment of adrenal function and recovery of HPA axis in children with chronic asthma assessed by LDSST

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Assessment of neonatal adrenal size using high resolution 2D ultrasound and its correlation with birth demographics and clinical outcomes

Objective: Assessment of adrenal function in a sick neonate remains a challenge in spite of major advances in neonatal care. We used 2D ultrasound of adrenal glands to assess maturity of adrenal glands in extremely preterm infants and sick term and near term infants. Study design: We collected demographics details of 99 mother–infants pairs (24–41 weeks) and obtained 2D ultrasound scans of adrenal glands in first week of life to measure adrenal volume, fetal zone size, and adrenal to kidney ratios. Relationship between adrenal measurements, antenatal factors, and postnatal outcomes were studied. Results: We reported normative adrenal gland volume data during gestation from 80 appropriate for gestational age (AGA) infants. In a binary analysis, adrenal size was significantly related to gender, race, intrauterine growth restriction (IUGR), maternal chorioamnionitis, and maternal hypertension. Linear regression analysis showed that fetal zone is significantly related to not only gestational age but also chorioamnionitis and later development of intraventricular hemorrhage (IVH). Adrenal volume likewise is also related to gestational age, preeclampsia, and IVH. Conclusions: Antenatal maternal factors and uterine environment affects adrenal growth and development thus postnatal high resolution 2D US scan of adrenal glands can provide useful information to predict outcomes. This information can complement hormone and adrenocorticotrophic hormone (ACTH) stimulation assays.

Spontaneous Adrenal Hemorrhage in Pregnancy

INTRODUCTION: Abdominal pain during pregnancy has a broad differential diagnosis which includes spontaneous adrenal hemorrhage (SAH). A high index of suspicion is necessary to diagnose SAH as most patients present with nonspecific symptoms including pain, fever and hypotension. Rarely, patients can develop retroperitoneal bleeding and present with hemodynamic instability. METHODS: We present two cases of symptomatic SAH in the third trimester. Patient 1 was a 35 year old nullipara who presented at 36 weeks of gestation with left flank pain. Patient 2 was a 27 year old multipara at 38 weeks who presented with left upper quadrant pain. Initial suspicion was for renal pathology in both cases and diagnosis of SAH was ultimately made by CT scan. Both were managed with pain control, serial hemoglobin assessments and abdominal exams and resulted in uncomplicated vaginal deliveries. Interval CT scan in patient 2 demonstrated a complete resolution of pathology. RESULTS: If unrecognized, adrenal hemorrhage can lead to adrenal crisis, shock and theoretically death for both mother and fetus. While the initial imaging study in pregnancy is ultrasound, MRI or CT scan is needed for confirmation. Recommended laboratory evaluations include serial hemoglobin measurements as well as assessment of adrenal function. Scant literature is available on optimal mode of delivery but in a stable patient, vaginal delivery can be safely undertaken. CONCLUSION: SAH, although rare, is an important consideration when evaluating abdominal and flank pain in pregnancy. Management options vary from conservative management to surgical intervention depending on the stability of the patient.

Assessment of Adrenal Function and Health-Related Quality of Life in Advanced Gastric Cancer Patients Who Received First-Line Chemotherapy

Objective: We performed this prospective study to identify both the incidence of adrenal insufficiency (AI) and health-related quality of life (HRQOL) in advanced gastric cancer (AGC) patients who were treated with the S-1 plus cisplatin (SP) regimen as a first-line palliative chemotherapy. Methods: We assessed adverse events (AEs) observed in 52 patients who received the SP regimen for AGC between January 2009 and June 2010 using the Common Toxicity Criteria Adverse Events (CTCAE) version 3.0. Adrenal function was assessed at baseline and 12 weeks after chemotherapy using the low-dose adrenocorticotropic hormone stimulation test. HRQOL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC-QLQ C30). Results: The incidence of AI was 30.8% (n = 16) and of AE observed 55% (n = 29) among 52 patients after 12 weeks of chemotherapy. Of 29 patients with AE, 34.4% (n = 10) were diagnosed with AI, and of 23 patients without AE, 26.1% (n = 6) were diagnosed with AI. Conclusion: The incidence of secondary AI in AGC patients was not rare and was not correlated with the presence of nonspecific AEs. Although patients diagnosed with AI did not show any related symptoms, they are at risk of potentially life-threatening consequences. Thus, the evaluation of AI could be suggested for patients who received chemotherapy.

Assessment of adrenal function in patients with acute hepatitis using serum free and total cortisol

BackgroundAdrenal dysfunction is frequently reported in severe acute hepatitis using serum total cortisol. AimsBecause 90% of serum cortisol is bound to proteins that are altered during stress, we investigated the effect of decreased cortisol-binding proteins on serum total and free cortisol in severe acute hepatitis. Methods43 severe and 31 non-severe acute hepatitis and 29 healthy controls were enrolled consecutively and studied prospectively. Baseline (T0) and cosyntropin-stimulated (T60) serum total and free cortisol concentrations were measured. ResultsT0 and T60 serum total cortisol did not differ significantly between severe, non-severe hepatitis and healthy controls. Conversely, serum free cortisol (T0p=0.012; T60p<0.001) concentrations increased from healthy controls to severe hepatitis, accompanied by a decrease in corticosteroid-binding globulin and albumin (all p<0.001). In acute hepatitis (n=74), patients with “low” corticosteroid-binding globulin (<28mg/L) had higher T0 serum free cortisol than others (103.1 [61.2–157] vs. 56.6 [43.6–81.9]nmol/L, p=0.0024). Analysis of covariance showed that at equal concentration of total cortisol, the free cortisol concentration was significantly higher in severe than in non-severe hepatitis (p<0.001) or healthy controls (p<0.001). ConclusionsIn severe hepatitis, the decrease in cortisol-binding proteins impairs correct diagnosis of adrenal dysfunction. This could be corrected by measuring or estimating free cortisol.

PS-315 Neonatal Adrenal Suppression After Maternal Corticosteroid Use? A Single-centre Case-study

Background The use of supra-physiological exogenous corticosteroids in pregnancy can lead to neonatal adrenal suppression causing life-threatening disease. However, evidence on the occurrence of neonatal adrenal suppression after maternal steroid use, is lacking. Objective Examining the occurrence of adrenal suppression in newborns after maternal steroid use during pregnancy. Methods Single-centre case series including all newborns (n = 18) between October 1st, 2006 and February 1st, 2014 of mothers using prednisolone, more than 10 mg/ day. Newborns were routinely assessed by physical examination, blood glucose concentrations, serum cortisol, adrenocorticotropic hormone concentration and urinary steroid profiles within 48 h after birth. Hypoglycemia was defined as blood glucose below 2,6 mmol/L (46 mg/dl). Abnormal serum cortisol was defined as twice below 100 nmol/L. An abnormal urinary steroid profile was defined as absence of fetal metabolites. Results Six newborns suffered from hypoglycemia, responding well to oral feedings or intravenous glucose administration. All had additional risk factors for hypoglycemia; none had abnormal serum cortisol concentrations or urinary steroid profiles. In two newborns abnormalities in urinary steroid profiles were suggestive for adrenal suppression, although both had adequate serum cortisol concentrations. In both cases, the infants were born prematurely and placenta bed pathology was suspected. After four weeks, urinary steroid profiles of both neonates showed fetal metabolites. Conclusion No clinically relevant adrenal suppression was found in eighteen newborns of mothers using corticosteroids during pregnancy. Assessment of adrenal function should be preserved for newborns with clinical suspicion of adrenal dysfunction or with risk factors as prematurity or placenta bed pathology.

Assessment of adrenal function in liver diseases

Background:In recent times, there are reports of adrenal dysfunction in whole spectrum of liver disease. Adrenal insufficiency (AI) has been shown to correlate with progression of liver disease. Hence this study was conducted to assess adrenal function in subjects with acute liver disease (ALD), chronic liver disease (CLD) and post liver transplantation (LT).Material and Methods:This study included 25 healthy controls, 25 patients of ALD, 20 subjects of CLD with Child-Pugh stage A (CLD-1) and 30 with Child-Pugh stage B or C (CLD-2), and 10 subjects with LT. All subjects were assessed clinically, biochemically and for adrenal functions.Results:AI was present in 9 (34.6%) patients with ALD, 20 (40%) patients with CLD and 4 (40%) in subjects with LT. AI was more common in CLD-2 (18 patients – 60%) than CLD-1 (2 patients – 10%). All patients with chronic liver disease had significantly lower basal cortisol (8.8±4.8, P=0.01), stimulated cortisol (18.2±6.3, P <0.00001) and incremental cortisol (9.4±4.6, P <0.00001) as compared to controls. There was increase in percentage of subjects with adrenal dysfunction with progression of liver disease as assessed by Child-Pugh staging. AI was predicted by lower levels of serum protein, serum albumin, total cholesterol and HDL cholesterol and higher levels of serum bilirubin and INR. Adrenal functions showed recovery following liver transplantation.Conclusions:AI forms important part of spectrum of acute and chronic liver disease. Deterioration of synthetic functions of liver disease predicts presence of AI, and these patients should be evaluated for adrenal dysfunction periodically.