Assessment Of Adrenocortical Function Research Articles

Non-invasive assessment of adrenocortical function as a measure of stress in the endangered golden langur.

The golden langur (Trachypithecus geei) is an endangered primate endemic to northern India and Bhutan. The main stressors to the species are habitat degradation and fragmentation. Non-invasive fecal glucocorticoid metabolite (fGCM) analysis is a powerful tool for assessing stress associated with environmental disturbances in wildlife. However, interspecific differences in glucocorticoid metabolism require careful selection of the antibody used in their quantification. The goals of this study were to: 1) validate an enzyme immunoassay (EIA) to determine fecal GC metabolite (fGCM) concentrations in the golden langur and 2) compare fGCM concentrations between golden langurs living under different environmental conditions. We compared five enzyme immunoassays for determining stress related physiological responses in golden langurs by performing an adrenocorticotropic stimulation test in both sexes. Our validations identified an 11-oxoaetiocholanolone EIA detecting 11, 17 dioxoandrostanes as the most suitable assay for monitoring adrenocortical activity in the species. FGCM concentrations from semi-captive temple langurs were significantly higher than respective stress steroid concentrations in free-ranging or pet/zoo langurs. This study presents a validated practical method for non-invasive monitoring of adrenocortical function in this rare and declining species.

Progress in understanding of adrenal insufficiency in septic patients

Background Sepsis is one of the critical complications following serious injuries or major surgeries. It is a leading cause of death. The mortality of septic shock exceeds 40%. Accumulating studies have demonstrated that the severity of adrenal cortex dysfunction has a vital impact on the phenotype and prognosis of sepsis, while glucocorticoid(GC) may be an effective intervention. However, the mechanisms underlying adrenocortical dysfunction remain unclear. Objective To review strategies for assessment of adrenocortical function, and timely supplement of GC, aiming to appropriately compensate the impaired adrenal function, finally, to improve prognosis and to reduce mortality of sepsis. Content At the early stage of sepsis, hypothalamus-pituitary-adrenal axis(H-P-A) is activated, and is followed by release of GC and mobilization of inflammation cascades, especially mitogen-activated protein kinase(MAPK) and nuclear regulatory factor-κB pathways. GC counteracts the inflammation cascades. At the late stage of sepsis or during sepsis shock, damages of adrenocortical cells and vascular epithelia cells occur in adrenal gland, resulting in adrenocortical dysfunction, including low levels of GC and low affinity of GC receptors. The measurement of serum GC and adrenocorticotrophic hormone are combined to assess adrenocortical function: adrenal insufficiency(AI) or relative adrenal insufficiency(RAI). Low doses of GC help to reverse septic shock, improve adrenal function, and maintain normal hemodynamics in septic patients. Trend Further investigation in understanding the mechanisms underlying AI and RAI are highly demanded to optimize therapeutic application of GC in sepsis. Key words: Sepsis; Septic shock; Adrenal insufficiency; Relative adrenal insufficiency

Is Perioperative Systemic Inflammation the Result of Insufficient Cortisol Production in Patients with Colorectal Cancer?

Patients with colorectal cancer who have a raised systemic inflammatory response before surgery have been shown to have poorer long-term and short-term outcomes. The presence of an ongoing systemic inflammatory response in these patients may be due to impaired cortisol production. The aim of the present study was to examine the relationship between the perioperative systemic inflammatory response and endogenous cortisol production. A prospective study was performed to incorporate the assessment of adrenocortical function using synthetic adrenocorticotrophic hormone, a short Synacthen test, as part of the preoperative assessment of patients undergoing resection for colorectal cancer. A total of 80 patients underwent short Synacthen testing. There were no significant associations between the baseline, 30 min, or change (both relative and absolute) in cortisol and age (all p > 0.10), sex (all p > 0.10), site (all p > 0.10), TNM stage (all p > 0.10), modified Glasgow prognostic score (all p > 0.10), NLR (all p > 0.10), white cell count (all p > 0.10) or postoperative C-reactive protein concentrations (all p > 0.10). Impaired cortisol production was uncommon in patients with potentially curable colorectal cancer. The presence of a perioperative systemic inflammatory response was not significantly associated with impaired cortisol production.

Is systemic inflammation the result of insufficient cortisol production in patients with colorectal cancer?

e14092 Background: Patients with colorectal cancer who have a raised systemic inflammatory response have been shown to have poorer outcomes, independent of their tumour stage. In particular, the combination of C-reactive protein (CRP) and albumin, the modified Glasgow Prognostic Score (mGPS) has been shown to have consistent and superior prognostic value. However, the basis of a systemic inflammatory response in these patients is not clear. One hypothesis is that the presence of a systemic inflammatory response in patients with colorectal cancer may be due to impaired cortisol production, a potent anti-inflammatory agent. Therefore, the aim of the present study was to examine the relationship between preoperative systemic inflammatory response and endogenous cortisol production. Methods: A prospective study was performed to incorporate the assessment of adrenocortical function using synthetic ACTH, a short Synacthen test, as part of the preoperative assessment of patients undergoing potentially curative resection for colorectal cancer. Preoperative systemic inflammatory response was assessed using mGPS. Results: A total of 80 patients underwent short Synacthen testing. The majority of patients were under 75 years old (79%), were male (59%), had colon cancer (75%) and had TNM stage I/II disease (54%). Approximately 50% received adjuvant treatment. Using standard criteria (peak cortisol <450 nmol/L = inadequate) impaired cortisol response was seen in 3 (4%) patients. There were no significant associations between the baseline, 30 minute, or change in cortisol (both relative and absolute) and age (p=0.814, p=0.443, p=0.730, p=0.929), sex (p=0.714, p=0.440, p=0.324, p=0.953), site (p=0.519, p=0.255, p=0.145, p=0.222), TNM stage (p=0.115, p=0.591, p=0.492, p=0.289), mGPS (p=0.280, p=0.202, p=0.800, p=0.818), or white cell count (p=0.787, p=0.316, p=0.462, p=0.567). Conclusions: The results of the present study show that impaired cortisol production, as evidenced by the short Synacthen test, was uncommon in patients with potentially curable colorectal cancer. Moreover, they indicate that the presence of a systemic inflammatory response is not associated with impaired cortisol production.

Assessment of adrenocortical function in the critically ill

The assessment of adrenocortical function in the critically ill continues to be a source of controversy. In this review we discuss the physiology of glucocorticoids, and the changes seen in critical illness. The reasons for the differences in establishing diagnostic criteria for adrenal insufficiency in the critically ill are also examined.

Assessment of adrenocortical function in the critically ill

To review current concepts in the diagnosis of adrenocortical disease in the critically ill patient.A review of articles reported on adrenocortical insufficiency in the acutely ill patient.The contribution of adrenal insufficiency to the morbidity of critically ill patients is currently under renewed scrutiny. The debate continues about the role of steroids in sepsis and essentially the question remains unanswered. Central to this debate is the issue of whether adrenal insufficiency is common in the critically ill patient. What is incontrovertible is that adrenocortical function is essential for host survival during critical illness, but what constitutes adrenocortical insufficiency in critically ill patients is not clear. Absolute adrenocortical insufficiency (diagnosed by very low plasma cortisol concentrations) is uncommon in the intensive care population. The diagnosis of relative adrenocortical insufficiency (elevated basal plasma cortisol with a subnormal increase in plasma concentrations following an ACTH stimulus) continues to generate debate. The controversy surrounding the role of steroids in sepsis and the confusion over the criteria for diagnosing adrenal insufficiency in the critically ill are reviewed.We suggest that the following caveats be borne in mind when diagnosing adrenal insufficiency in the critically ill patient. Firstly, the gold standard for the diagnosis has not been established. Secondly, caution must be exercised when interpreting a single plasma cortisol value. In the event of a single result indicating adrenal hypofunction, we suggest repeating the measurements after a 6 to 12 hour interval. The clinician must also be aware of variations in cortisol concentrations induced by the assay. Thirdly, the clinician must be aware of the potential limitations of the conventional high dose corticotrophin test. We also suggest that plasma free cortisol is more relevant than total plasma cortisol in the assessment of adrenal function in critical illness and that the low dose corticotrophin test is more sensitive than the conventional high dose test. These areas should be the subject of further investigations.

Assessment of adrenocortical function and autoantibodies in a baby born to a mother with autoimmune polyglandular syndrome Type 2

We describe the case of a baby born to a mother with Addison's disease in the context of Autoimmune Polyendocrine Syndrome Type 2. Adrenal cortex autoantibodies and steroid 21-hydroxylase autoantibodies were detectable in the sera of both mother and baby, suggesting the transplacental passage of these autoantibodies. Adrenal autoantibodies were present in the baby's serum at delivery, at 3, 6 and till 34 months of age but no signs of clinical or subclinical adrenal insufficiency were found in the baby during the observation period. These data suggest that the presence of adrenal autoantibodies in serum alone is not a sufficient cause for the development of autoimmune adrenalitis.

45. Assessment of adrenocortical function during prolonged stress activation in critical illness

45. Assessment of adrenocortical function during prolonged stress activation in critical illness

Urinary free cortisol versus 17-hydroxycorticosteroids: a comparative study of their diagnostic value in Cushing's syndrome.

We evaluated the usefulness of the basal urinary 24-h excretion rates of free cortisol versus 17-hydroxycorticosteroids in the diagnosis of Cushing's syndrome. On an outpatient basis, both urinary free cortisol and 17-hydroxycorticosteroids levels were determined in 48 patients with Cushing's syndrome, as well as in 95 obese and 94 healthy control persons of normal weight. Determination of the urinary free cortisol content allowed a clear-cut distinction between the patients with hypercortisolism and the controls, resulting in a sensitivity of 100% and specificity of 98% for the diagnosis of Cushing's syndrome. The diagnostic accuracy of urinary free cortisol was distinctly superior to that of 17-hydroxycorticosteroids, which showed a wide overlap of values between the groups, with a sensitivity of 73% and a specificity of 94%. In conclusion, the measurement of basal urinary free cortisol provided an excellent diagnostic sensitivity and specificity in the assessment of adrenocortical function. This simple and accurate test thus seems to be particularly useful in the outpatient evaluation of patients with suspected Cushing's syndrome.

New approaches in human adrenocortical pathology: Assessment of adrenocortical function in surgical specimen of human adrenal glands

In adrenocortical pathology, it is important to localize the sites of steroid biosynthesis in order to obtain a better understanding of steroid metabolism. Previous morphological techniques, including light- and electron-microscopical examination, histochemistry, and immunohisto-chemistry of steroids, as well as biochemical studies, could not satisfactorily demonstrate which types of cortical cells produce which steroid hormones. Recent purification and characterization of specific steroidogenic enzymes, such as cytochrome P-450, that are involved in adrenal steroid biosynthesis have made it possible to generate specific antibodies and DNA probes against the enzymes that catalyze specific reaction(s) in the complicated biochemical cascade of steroidogenesis. By employing these antibodies and DNA probes, it has became possible to detect the expression of specific steroidogenic enzymes in surgically resected human adrenal cortex and its disorders. This can indicate the site(s) of specific steroid hormone(s) catalyzed by the expressed enzymes.

Plasma Cortisol Levels in Umbilical Cord Plasma and Its Change During the First Two Hours Following Delivery

Although assessment of adrenocortical function at birth has been made by several investigators, the results obtained do not agree well with one another. Also, knowledge of the cortisol level during the postnatal period was scanty. The purpose of the present study is : 1) to assess cortisol levels in normal newborns at birth and to compare them with levels in distressed newborns ; 2) to investigate changes of plasma cortisol levels in normal babies during the first 2 hours following delivery.Cortisol was measured in maternal and cord plasma, as well as in normal newborn plasma by a competitive protein-binding radioassay. An assessment of the reproducibility and precision of the method is presented. In maternal plasma, the average cortisol concentration (32. 4 μg/dl) was 2. 4 times greater than in umbilical arterial plasma (13. 3 μg/dl). The correlation coefficients do not suggest a significant relationship between the maternal and umbilical venous cortisol concentrations which means poor placental transfer of cortisol.To determine whether distressed infants showed evidence of adrenal cortical hyperfunction as compared to normal babies, serum cortisol levels were measured in infants delivered by vacuum extraction or forceps. No difference was found in circulation cortisol levels between these groups. However, Gemzell observed a higher 17-hydroxycorticosteroids concentration in the infants delivered by low forceps than in normal infants. These results suggest that the ability of the neonatal adrenal cortex to respond in the face of perinatal stress is variable according to individuals.Cortisol concentrations from normal infants at 1/2, 1, 2, 6, 12, 24 hours after birth were measured. In spite of individual variations and the limited number of observations, it is apparent that the cortisol concentration fell after birth. The levels of cortisone obtained at 1 hour of age were about half the levels at birth and were maintained during the first day of life.

Adrenocortical function and anxiety

1. The nature of the adrenocortical-anxiety relationship is reexamined and affirmed to be a specific relationship rather than a nonspecific one. 2. The suggestion is offered that a shift from glucocorticoid to mineralocorticoid secretion results in a concomitant shift from euphoric to dysphoric mood. 3. Recent advances in assessment of adrenocortical function are reviewed, particularly hormone production rate measurement and nonprotein-bound cortisol determination (functionally active hormone). 4. Recent work on the psychological correlates of adrenocortical function are also reviewed and particular emphasis attached to predictive studies based on elucidation of components of the diagnostic evaluative interview as well as to the social setting of the experimental situation.

Assessment of adrenocortical function.

OF the steroid hormones secreted by the human adrenal cortex into the adrenal venous effluent, only cortisol and aldosterone are essential to life processes. These steroids account for most of the ...

Assessment of adrenocortical function.

The authors discuss the clinical features of chronic adrenocortical disorders (except those due to aldosterone alterations) and indicate the laboratory tests that should be carried out to assess adrenocortical function. They also present an outline of these laboratory procedures, including the results, relative value and special significance of the tests.

The diagnosis of adrenocortical disorders by laboratory methods.

IN the twenty-two years since the isolation of the first adrenal steroid, 29 compounds have been identified. Since the discovery and isolation of aldosterone, the identification of steroids other than hydrocortisone in blood and the demonstration of aberrent steroids synthesized by adrenal glands with specific enzymatic defects, the unitarian concept of adrenal-hormone elaboration has become untenable. As a consequence, the assessment of adrenocortical function by any single laboratory test is not possible, and some selection of specific tests is necessary. The physician with a diagnostic problem involving the adrenal cortex now finds himself confronted with an embarrassing variety of laboratory . . .

Assessment of adrenocortical function in cases of pituitary tumour.

Assessment of adrenocortical function in cases of pituitary tumour.