Changes In Serum Cortisol Levels Research Articles

Adrenal Cortical Carcinoma Presenting as CSCR.

We describe a case of bilateral chronic central serous chorioretinopathy (CSCR) secondary to adrenal cortical carcinoma. Case report of a 70-year-old Hispanic man presenting with bilateral multifocal CSCR. Clinical findings of bilateral chronic CSCR along with 160 µm of subretinal fluid (SRF) and choroidal thickness greater than 400 µm without enhanced depth optical coherence tomography was noted in a patient presenting with distortion in vision in both eyes and weight gain of 15 pounds, weakness, and fatigue starting 8 months prior. Further endocrine testing showed an elevated 24-hour urinary free cortisol level of 137 µg with no change in serum cortisol levels following low-dose dexamethasone suppression test and undetectable serum adrenocorticotropic hormone (ACTH) levels consistent with ACTH-independent Cushing's syndrome. Imaging of the abdomen revealed heterogeneously enhancing masses, and biopsy of the adrenal tumor led to the diagnosis of adrenal cortical carcinoma. He died 3 weeks after starting hospice care, and only completed one round of chemotherapy. Adrenal tumors including adrenal cortical carcinoma may present as bilateral chronic central serous chorioretinopathy.

Changes in serum cortisol levels after 10 days of overfeeding and fasting.

Chronic caloric deprivation and obesity are complicated by hypercortisolemia. The effects of acute overfeeding and fasting on circulating free cortisol levels and conversion of cortisone to free cortisol are unknown. We hypothesized that serum-free cortisol and free cortisol-to-cortisone ratio would increase after both overfeeding and fasting. This is a prospective study of 22 healthy volunteers who completed a 10-day high-calorie protocol followed by a 10-day fast, separated by a 2-wk washout. Morning free and total cortisol and free cortisone levels (LC/MS) were measured at baseline and after 10 days of each intervention. Both high-calorie feeding and fasting increased total and free cortisol and the free cortisol-to-free cortisone ratio (P = 0.001 to P = 0.046). There were sex interactions, with significant effects in men (P < 0.001), but not in women (P = 0.898 and 1.000, respectively) in subset analyses examining the effects of fasting on free cortisol and the free-to-total cortisol ratio. Overfeeding and fasting both increase circulating free cortisol levels and appear to alter the balance between cortisol and its inactive metabolite, cortisone. Further study is warranted to determine whether elevated cortisol levels contribute to complications of starvation and obesity, such as bone fragility.NEW & NOTEWORTHY Overfeeding and fasting both increase circulating free cortisol levels and appear to alter the balance between cortisol and its inactive metabolite, cortisone. The effect of fasting on free cortisol levels is modified by sex. Further study is needed to determine the mechanisms driving the increases in cortisol.

Comparison of dorsal penile nerve block alone and in combination with lidocaine–prilocaine cream in neonates undergoing circumcision: a randomized controlled study

BackgroundSuboptimal neonatal circumcision analgesia causes a significant stress response. There is continued search for more effective analgesia for neonatal circumcision. We aimed to determine whether lidocaine–prilocaine cream (LPC) prior to...

Role of Lactium™ in Psychodermatology: The CERTAIN Trial# on Patients with Acne Vulgaris.

Stress plays an important role in the causation and aggravation of psychodermatological conditions such as acne vulgaris. Alpha casein hydrolysate (αs1-casein hydrolysate; Lactium) has been shown to decrease serum cortisol levels, reduce stress-related symptoms, and promote relaxation. “This study aimed to compare the efficacy and safety of Lactium™ plus standard care to those of standard of care alone in reducing stress levels and acne severity in patients with acne vulgaris.” The C.E.R.T.A.I.N trial (Name registered with Clinical Trials Registry-India-No. CTRI/2019/01/017172) is a randomized, controlled, multicenter, open-label, two-arm, investigator-initiated clinical trial. A total of 100 patients with moderate-to-severe acne vulgaris were enrolled and randomly assigned to one of the two groups: Lactium™ plus standard care or standard care alone. Stress levels were assessed using serum cortisol levels, Investigator's Global Assessment (IGA) acne severity scale scores, Perceived Stress Scale (PSS) scores, and the Hamilton Anxiety Rating Scale (HAM-A) scores. The Dermatology Life Quality Index (DLQI) was also used to assess the impact of the skin disease on patients' quality of life. At 12 weeks, stress levels were significantly lower in group A (Nixiyax plus standard of care) than that in group B(only standard care), as measured by the change in serum cortisol levels (4.75 ± 4.46 vs. −0.24 ± 5.22). Furthermore, the mean change in PSS scores (3.09 ± 2.04 vs. 0.90 ± 2.76) and HAM-A scores (5.11 ± 1.94 vs. 1.25 ± 3.13) was significant. Patients in both arms had a significant decrease in total, inflammatory, and noninflammatory acne lesions, as well as a significant improvement in DLQI and IGA scores. In patients with moderate-to-severe acne vulgaris, Lactium™ was found to be both safe and well-tolerated. Lactium™ plus standard care is more effective than standard care alone in reducing acne severity through stress reduction.

Clinical effects of using a massage chair on stress measures in adults: A pilot randomized controlled trial

ObjectiveSince the clinical benefits of a massage chair have not been fully elucidated, we aimed to assess the effects of the long-term use of a massage chair on stress measures in adults. DesignRandomized controlled trial. SettingCommunity.InterventionsIn total, 80 adults aged 50–75 years were randomly assigned to the intervention group (n=41) and control group (n=39). The intervention group used the massage chair twice a day for 6 months. The control group was educated about lifestyle modification. Main outcome measuresThe primary outcome was the change in serum cortisol levels in the morning (8 a.m.) and afternoon (1 p.m.), and the secondary outcomes included changes in levels of dehydroepiandrosterone-sulfate (DHEA-S), serotonin, insulin-like growth factor, erythrocyte sedimentation rate, high sensitivity C-reactive protein, and natural killer cell activity, and results from a questionnaire on mood, cognition, and quality of life. ResultsThe use of the massage chair was associated with a decreasing trend in serum cortisol levels at 1 p.m. (-2.68 ug/dL, p = 0.059). Serum DHEA-S levels significantly decreased with the intervention (-9.66 ug/dL, p = 0.003). In addition, the perceived rate of depression and health status considerably improved following the intervention. ConclusionsChronic stress in adults could be effectively managed using a massage chair.

Association of serum cortisol level with severity of depression and improvement in newly diagnosed patients with major depressive disorder in Jimma medical center, Southwest Ethiopia.

BackgroundMajor Depressive Disorder (MDD) is the leading psychiatric disorder in low- and middle-income countries, and is to be the second leading cause of burden of disease by 2020. Cortisol plays a significant role in pathophysiology of MDD. Depression can alter serum cortisol level. However, the change in serum cortisol level and its association with depressive symptom severity and improvement among patients with MDD is not well studied.ObjectiveTo outline change in serum cortisol levels and its association with severity and improvement of depressive symptoms in newly diagnosed patients with MDD.MethodHospital based longitudinal study was conducted among 34 newly diagnosed patients who met DSM-V criteria of MDD. Venous blood sample was performed twice; pre- and post- 8 weeks of treatment. Serum cortisol concentration was measured using an extracted radioimmunoassay. The 17-item Hamilton Depression Scale (HAM-D) was used to rate depression at baseline and after 8 weeks of treatment. Paired t-test was done to look the mean difference of serum cortisol level and HAM-D, before and after treatment. Pearson correlation was done to look the association between serum cortisol levels, HAM-D scores and, sociodemographic and clinical factors. Statistical significance was set at p<0.05.ResultsThere is no significant difference in cortisol concentrations at baseline and end line (t (33) = 2.02, p = 0.052). However, there is significant difference in HAM-D total score (t (33) = 5.67, p<0.001). Baseline and end line serum cortisol levels were significantly correlated (r = .561, p = .001). Monthly family income is correlated with baseline HAM-D total score (r = -0.373, p = .030). There is no significant relationship between baseline serum cortisol level and HAM-D score. There is also no significant relationship between end line serum cortisol level and HAM-D score.ConclusionsThe symptoms of MDD were reduced following treatment but there is no significant difference in serum cortisol levels. Baseline and end line serum cortisol levels were significantly correlated. We recommend further research based on large sample.

Effect of Various Grades of Exercise on Serum Cortisol

Increasing incidence and prevalence of chronic diseases are mostly due to improving socio-economic statusand changes in modern lifestyles, including diets which are high in salt, sugar, and undesirable fats anddecrease in physical activity levels in Indian population. The present study evaluates the effect of variousgrades of exercise on serum cortisol in healthy young Indian adults. The objective of the study was toevaluate the pre and post exercise changes in serum cortisol levels. A total 56 healthy First year MBBSstudent’s age between 18-27 yrs of either sex were taken at G.S.V.M. Medical College Kanpur. The subjectswere treated with moderate and heavy exercise. Pre-exercise determination of serum total cortisol of all thesubjects was done. Post-exercise determination of serum total cortisol of all the subjects after duration ofone week and 12 weeks of exercise was done. After completion of 12 weeks of exercise a comparison wasmade between pre and post exercise values of total serum cortisol. Statistical Analysis was done by pairedstudent ‘t’ test and 95% level of confidence was taken significant (p&lt;0.05).Results indicated that Serumcortisol varies with different grades of exercise and there was slight increase in serum cortisol concentrationafter moderate exercise but it was of not very much significance. There are some divergent findings alsoand most literature has cited that an approximate 60% exercise intensity threshold is necessary to elicit asignificant increase in blood cortisol.Thus, according to our study, there is correlation of the serum cortisollevels according to the different grades of exercise.

An Herbal Drug, Gongjin-dan, Ameliorates Acute Fatigue Caused by Short-Term Sleep-Deprivation: A Randomized, Double-Blinded, Placebo-Controlled, Crossover Clinical Trial.

Introduction: Gongjin-dan (GJD) is an herbal drug commonly used in Korea and China to combat fatigue, but there are only few clinical studies on its effectiveness and experimental studies on its mechanism of action, and no randomized controlled trial of GJD on the efficacy and mechanism of action has been reported. Here, we performed an exploratory study to evaluate both questions regarding GJD use in humans.Methods: A randomized, double-blinded, placebo-controlled, crossover clinical trial was conducted in the Republic of Korea. Healthy male participants were recruited and randomly allocated to groups receiving GJD-placebo or placebo-GJD in sequence. Fatigue was artificially induced by sleep deprivation for 2 nights. The primary outcome was a change in serum cortisol level; levels of biomarkers for stress hormones as well as oxidative stress and immunologic factors were also assessed, and questionnaires on fatigue and sleep quality were conducted.Results: Twelve and 11 participants were assigned to the GJD-placebo and placebo-GJD groups, respectively. Of all 23 participants, depending on crossover design, we analyzed a total of 20 participants for GJD, and 21 for placebo. An increase in serum cortisol appeared to be attenuated by GJD administration (p = 0.25), but the effect was not statistically significant; a similar pattern was observed in salivary cortisol levels (p = 0.14). Overall, GJD showed a tendency to reduce fatigue according to the Brief Fatigue Inventory (BFI, p = 0.07) and the Fatigue Severity Scale (FSS, p = 0.13) questionnaires. BFI and FSS scores in the first stage (before the crossover), however, were significantly improved (BFI, p = 0.02; FSS, p = 0.05) after GJD treatment (relative to placebo). GJD also seemed to improve sleep quality as assessed by the Leeds Sleep Evaluation Questionnaire (p = 0.06), with a significant improvement specifically in the condition “Getting To Sleep” (p = 0.02). Five participants experienced minor adverse events, but no adverse events were specific to the GJD administration period.Conclusions: This trial produced the first clinical evidence that GJD might have anti-fatigue properties, especially under sleep deprivation; however, the investigation of cortisol-mediated mechanisms requires further larger-scale studies in the future.Trial registration: World Health Organization International Clinical Trials Registry Platform KCT0001681 (http://apps.who.int/trialsearch/Trial2.aspx?TrialID=KCT0001681).

A prospective study of risk factors associated with persistent pleural effusion after total cavopulmonary connection with special reference to serum cortisol level.

The Fontan operation is usually followed by significant pleural effusion. We aimed to study the factors associated with persistent pleural effusion with special reference to serum cortisol levels. Thirty-eight patients undergoing the Fontan operation between September 2015 and November 2016 were prospectively studied. Parameters studied included age, weight, symptoms, atrio- ventricular valve regurgitation/stenosis/atresia, ventricular function, pulmonary artery pressures, oxygen saturation, aorto-pulmonary, and veno-venous collaterals, type of Fontan, duration of cardiopulmonary bypass, need for inotropes, duration of mechanical ventilation, conduit size, presence or absence of fenestration, and serum cortisol levels. The latter were measured before and after the Fontan operation and the co-relation between pleural effusion and change in serum cortisol levels was studied. Mean age at operation was 13.1 ± 5.6years (median 13years). Mean duration and amount of pleural drainage was 15.76 ± 13.2days (median 11.5days) and 9.15 ± 4.6mL/kg/day (median 9mL/kg/day) respectively. Statistically significant risk factors for prolonged pleural effusion were higher pulmonary artery (PA) pressures (r = 0.328, p = 0.003, odds ratio 1.30), higher inotropic score (r = 0.4, p = 0.01), lower rise in serum cortisol (p = 0.03),elevated superior caval venous pressure (CVP) at 6h (r = 0.44, p = 0.005) and 12h (r = 0.4, p = 0.01) and higher duration of mechanical ventilation (r = 0.45, p = 0.005). PA pressures > 15mmHg, higher inotropic score, higher CVP and lower rise in serum cortisol levels following the Fontan operation were associated with persistent pleural effusion.

Prognostic Value of Cortisol in Patients with Acute Ischemic Stroke

Background: Activation of the hypothalamo-pituitary-adrenal axis has been shown in acute ischemic stroke. Some recent studies suggest that serum cortisol level may have prognostic value in patients with ischemic stroke. The aim of this study was to evaluate the prognostic value of cortisol in patients with acute ischemic stroke. Methods: In this prospective observational study, 51 patients with acute ischemic stroke were evaluated. Cardioembolic and lacunar strokes were excluded. In the first 24 hours of admission, serum cortisol level, national institutes of health stroke scale (NIHSS), diabetes and hypertension were assessed to determine their value to predict mortality within 90 days. The results were analyzed using descriptive statistics, t-test, chi-square test and logistic regression. Results: In this study, 26 patients (51%) were female and the rest were male. Serum cortisol level was normal in 37 patients (72.5%). 14 patients died (27.5%) during the follow-up period. The mean serum cortisol level of dead patients were 33.48 ± 15.14 μg/dL and for alive patients was 35.10 ± 19.74. This difference was not statistically significant. After statistical analysis using logistic regression, no significant correlation between serum cortisol level and mortality was seen. Conclusions: Although ischemic stroke is associated with change in serum cortisol level but this change has no prognostic value.

Preliminary evaluation on the effectiveness of varying doses of supplemental tryptophan as a calmative in horses

Tryptophan (Trp), the amino acid precursor to serotonin, is a common ingredient in many commercial equine calming supplements. However, there is little scientific research to support the efficacy of tryptophan at modifying horse behavior. The objective of this study was to examine how various doses of supplemental tryptophan impact reactive behavior and physiological stress measurements in the horse. Eleven horses (9 geldings, 2 mares) were assigned a series of four treatments in a randomized crossover design. Supplemental tryptophan was provided orally at rates of 0 (CON), 20 (LOW), 40 (MED), and 60 (HIGH) mg/kg bodyweight for three days. Horses received behavior tests to measure startle response on Days 1 and 3 of treatment. Heart rate measurements and the speed at which horses fled from startling stimuli were recorded. Serum glucose, lactate, and cortisol levels were compared before and after startle tests. Additionally, a subset of samples was analyzed for tryptophan content and the ratio of tryptophan to other large neutral amino acids. Significant sedative effects were seen at LOW Day 1 on heart rate during the startle test (P=0.05) and on change in serum lactate levels (P=0.03). At MED Day 1, sedative effects were seen on change in serum cortisol levels (P=0.01). Excitatory effects were seen at MED Day 3 on the time for heart rate to return to baseline after the startle test (P=0.03). No significant effects were seen at the HIGH dose. Amino acid analysis verified treatment effect on Day 1. Across treatments, levels were similar on Days 1 and 3 (P=0.9) while there were no significant increases in amino acids on Day 3 (P=0.98). Overall, tryptophan supplementation had both sedative and excitatory effects on physiological stress measurements but did not change reactive behavior of horses in this study.

Traditional Actions: SIREP Influence Cortisol, IFN- and IL-10 In Elderly with Sleep Disorders

Introduction: Sirep, is one of the traditional intervention of people in East Java Indonesia, especially Tengger tribe using spells to meet the needs of human sleep. Elderly in Indonesia is someone who has more than 60 years of age. Elderly in general often experience sleep disturbances fulfillment, But the effects of nursing Sirep as an immunomodulator to the levels of cortisol, IFN-Rα and IL-10 is still unknown in nursing perspective. Method: The population of this study were 70 elderly with the number of respondents were 43 elderly. They were divided into two groups for 23 elderly with 6-month sirep intervention (mean age, 69.6 ± 5.2 years) as an experiment group and 20 elderly as control group (65.8 ± 5.4 years). The need of sleep is implemented to Evaluate the sample of immune modulation, cortisol levels, IFN-Rα and IL10. The molecular biology of the samples was determined using ELISA analysis. The statistical analysis of the data used Determine ANOVA and t-test. Results: After the 6 -month intervention, there re is significant changes in serum cortisol levels (p = 0.0001) and a different test with a control intervention was also significant (p = 0.00 1 3). Significant changes in serumlevels of IFN-Rα is (p = 0.0003) and a different test with a control intervention is also significant (p = 0.016 4), while the change in the levels of IL-10 in serum is significant (p = 0.0003) and test different intervention with no significant control (p = 0.1143). Discussion: This study supports the hypothesis that sirep can improve immune modulator in elderly. However, immune modulator showed a slight improvement in the nursing intervention of sirep group, suggesting that a longer or more frequent sessions of intervention might have an effect.

The Effects of Traditional East Java Indonesia Sirep on Cortisol Level, IFN- and IL-10 in Folk Home Elderly Disturbed Sleep Needs

Background: Sirep, is one of the traditional intervention of people in East Java Indonesia, especially Tengger tribe using spells to meet the needs of human sleep. In context Indonesia, Elderly is human being aged 60 years and older who experience sleep disturbances fulfillment. Furthermore, sirep as immunomodulator effect on levels of cortisol, IFN-gRα and IL-10 is still unknown in nursing perspective.Method: The population of this study were 70 elderly with the number ofrespondents were 43 elderly. They were divided into two groups that are (1) 23 elderly with 6-month sirep intervention (mean age, 69.6 ± 5.2 years) as an experiment group, and (2) 20 elderly as control group (65.8 ± 5.4 years). The need of sleep is implemented to Evaluate the sample of immune modulation, cortisol levels, IFN-gRα and IL-10. The molecular biology of the samples was determined using ELISA analysis. The statistical analysis of the data used Determine ANOVA and t-test.Results: After the 6 -month intervention, there re is significant changes in serum cortisol levels (p = 0.0001) and a different test with a control intervention was also significant (p = 0.00 1 3). Significant changes in serumlevels of IFN-gRα is (p = 0.0003) and a different test with a control intervention is also significant (p = 0.016 4), while the change in the levels of IL-10 in serum is significant (p = 0.0003) and test different intervention with no significant control (p = 0.1143).Conclusion: This study supports the hypothesis that sirepcan improve immune modulator in elderly. However, immune modulator showed a slight improvement in the nursing intervention of sirep group, suggesting that a longer or more frequent sessions of intervention might have an effect..

Evaluation of the anti-fatigue effects of a traditional herbal drug, Gongjin-dan, under insufficient sleep conditions: study protocol for a randomised controlled trial.

BackgroundMany herbal medicines are traditionally used as anti-fatigue agents in east Asian countries; however, there is a dearth of clinical evidence supporting the anti-fatigue effects of such medicines and their mechanisms. This study is a feasibility trial to assess the clinical efficacy of Gongjin-dan (GJD) and verify its mechanisms by exploring fatigue outcomes, including endocrine and immunological biomarkers in humans.Methods/DesignTo investigate the anti-fatigue effects of GJD and the mechanism underlying these effects, a randomised, double-blind, placebo-controlled crossover clinical trial was designed. Participants (24 healthy male volunteers) will be hospitalised for 4 days (3 nights), during which acute fatigue and stress conditions will be induced by sleep deprivation, and GJD or a placebo will be administered (twice daily). The primary outcome will be changes in serum cortisol levels, measured in the morning, as an objective biomarker of sleep deprivation-induced fatigue and stress. The secondary outcomes will include: the Fatigue Severity Scale; the Brief Fatigue Inventory, and the Leeds Sleep Evaluation Questionnaire scores; levels of salivary cortisol, epinephrine, norepinephrine, oxidative stress-related biomarkers, homocysteine, and immunological factors; and heart rate variability. After a washout period of more than 4 weeks, a second treatment phase will commence in which participants who were previously administered the placebo will receive the drug and vice versa, following the same treatment regime as in the first phase.DiscussionThis study protocol provides a unique opportunity to enhance our understanding of fatigue and the effects of GJD on fatigue in terms of endocrine and immunological mechanisms by validating the study design and determining feasibility. Findings from this trial will help researchers to design a pilot or definitive clinical trial of traditional herbal medicine for chronic fatigue.Trial registrationKorean National Clinical Trial Registry CRIS; KCT0001681, registered on 29 October 2015.

Development and optimization of psychological stress model in mice using 2 level full factorial design

IntroductionPsychological stress has long been a silent killer, impairing normal physiological functions and leading to a variety of diseased conditions. However, the existing animal models for studying psychological stress have been marred by their inherent limitations warranting further research in their development and optimization. MethodsIn this study 25 full factorial design was utilized for the development and optimization of psychological stress model in mice by applying different stressors viz., slanted cage(X1), restraint(X2), no bedding(X3), dirty bedding(X4) and isolation(X5) at two time duration levels of 30 and 60min. The development of behavioral changes like depression, anxiety and anhedonia was taken as criteria for development of stress. These responses were analyzed using Design Expert 7.1.6. (Stat-Ease, Inc., USA). The maximum effective responses obtained were taken as a criterion for optimization. The optimized model was applied to measure the change in serum cortisol level to confirm the stress development. ResultsThe statistical data showed that a quadratic model was fitted to the data obtained. All the factors were found to have a significant role in the development of stress among which restraint, slanted cage and dirty bedding were found to be more causal (p<0.05). Serum cortisol level was increased significantly in the stressed mice of optimized model (p<0.05). DiscussionUtilizing the magnitude of responses from the quadratic equations, it can be concluded that slanted cage, restraint and dirty bedding stressors should be applied for longer duration than other stressors for psychological stress development in mice. The study could lay a strong platform for the use of quality by design approach in the development of robust, efficient and resourceful animal models.

Efficacy of inpatient treatment for atopic dermatitis evaluated by changes in serum cortisol levels

When dealing with patients with severe atopic dermatitis (AD), inpatient treatment is useful for alleviating skin symptoms in short periods of time. We previously found that many severe AD patients had low serum cortisol levels at admission. The present study was undertaken to evaluate the efficacy of inpatient treatment in 29 adults with AD through comparisons of serum cortisol, plasma adrenocorticotropic hormone (ACTH), serum thymus and activation-regulated chemokine (TARC), and serum lactate dehydrogenase (LDH) levels at admission with those at the time of discharge. Serum cortisol and plasma ACTH levels were significantly higher at discharge. On the other hand, serum TARC and serum LDH were significantly lower at discharge. We examined whether the suppression of hypothalamic-pituitary-adrenocortical function that was seen at admission was attributable to disturbed circadian rhythms due to sleep disorders by analyzing hypothalamic-pituitary-adrenocortical function in relation to the presence/absence of sleep disorders, serum cortisol levels and daily urinary free cortisol. Of the 17 patients with low serum cortisol levels upon admission, 15 (88.2%) had sleep disorders upon admission. However, the daily urinary free cortisol increased significantly from 8.0±5.5μg/day (at admission) to 18.5±17.2μg/day (at discharge). These results suggested that the suppression of endocrine function seen at admission was not attributable to disturbed circadian rhythms due to sleep disorders but represented true suppression of the endocrine system. These results indicated that inpatient care was useful for treating patients with severe AD, enabling efficient improvement of the skin condition and recovery from suppressed endocrine function.

Changes in serum cortisol levels during community-acquired pneumonia: The influence of dexamethasone

In community-acquired pneumonia (CAP), the cortisol level on admission can be a useful biomarker for prognosis. Serial cortisol measurements during the clinical course of disease and their association with disease outcome have never been reported. Furthermore, the time to recovery of the hypothalamic-pituitary-adrenal axis after a short course of dexamethasone during infection is unclear. We analyzed data from 270 hospitalized patients with CAP. Total serum cortisol was measured on presentation, day 1, 2, 4, and on control visit (day 30). Intensive care unit (ICU) admission and mortality were assessed. Additionally, to study the influence of dexamethasone on the kinetics of the cortisol response, we analyzed serial cortisol values of 43 patients treated with a four-day regimen of dexamethasone 5 mg. During hospital stay, 26/270 patients (9.6%) were admitted to the ICU and 15/270 patients (5.6%) died. Compared to patients with an uneventful recovery, cortisol on presentation was significantly higher in patients with an adverse outcome (360 μg/L, IQR 209-597 vs. 238 μg/L, IQR 151-374) (p:0.01), and also remained significantly higher throughout the course of disease. Dexamethasone treatment resulted in nearly complete suppression of the endogenous cortisol production after the first dose, but cortisol production was fully recovered on control visit. In conclusion, we showed that an adverse outcome of CAP was associated with persisting higher total serum cortisol throughout the course of disease. Delta-cortisol could be another meaningful biomarker in CAP. Next, our data indicate that a four-day dexamethasone regimen during CAP does not lead to prolonged secondary adrenal insufficiency.

Cushing's Disease in Children: Report of Three Cases

Cushing's disease is rare in children and adolescents. We report the clinical presentations of three children with Cushing's disease. All three exhibited the typical symptoms and signs of weight gain and growth retardation. Tw o also demonstrated personality changes, hypertension and hypokalemia, the last of these being rarely reported in patients with Cushing's disease. Lack of diurnal changes in serum cortisol levels was the most common biochemical finding. Serum cortisol levels were suppressed by low-dose dexamethasone in one patient, which is not typical for patients with Cushing's disease. Imaging studies are essential for localizing the tumor. Transsphenoidal surgery remains the treatment of choice, and pituitary irradiation should be considered for those patients whose tumors cannot be totally removed. Careful follow-up of these patients with awareness of the possibilities of relapse and the complications of hypopituitarism is indicated.

The Effects of Rosuvastatin on the Serum Cortisol, Serum Lipid, and Serum Mevalonic Acid Levels in the Healthy Indian Male Population

In this open-label, balanced, randomized, placebo-controlled, parallel study, healthy male volunteers were randomly divided into two groups. Each group received either a single oral dose of rosuvastatin 20 mg or placebo. Estimations were done at predose on day 1 of dosing (baseline) and 24 h postdose after days 7 and 14. Serum cortisol and serum lipid levels were estimated using enzyme-linked immunosorbent assay kits and serum mevalonic acid (MVA) levels were measured using validated liquid chromatography-tandem mass spectrometry method. Rosuvastatin produced a statistically significant (P < 0.05) decrease in total cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, and triglycerides. However, the increase in high-density lipoprotein cholesterol and decrease in cortisol and MVA were not statistically significant when compared to the placebo-treated group. The study showed that rosuvastatin at a dose of 20 mg/day for a period of 14 days was very potent as cholesterol-lowering agent, without any significant change in serum cortisol level in the healthy Indian male population.

Immunoreactivities and Levels of Mineralocorticoid and Glucocorticoid Receptors in the Hippocampal CA1 Region and Dentate Gyrus of Adult and Aged Dogs

Corticosteroids are important factors in the maintenance of homeostasis in the brain. They are regulated via the interaction with two corticosteroid receptor systems-the mineralocorticoid (MR) and glucocorticoid receptor (GR). In the present study, we observed age-related changes in serum cortisol levels, and immunoreactivities and protein levels of MR and GR in the hippocampal CA1 region and dentate gyrus. The serum cortisol levels were significantly high (about twofold) in the aged group compared to that in the adult group. In the adult dog (2-3 years old), MR and GR immunoreactivity was detected in neurons in the pyramidal layer of the CA1 region, and in the granular and multiform layers of the dentate gyrus. In the aged dog (10-12 years old), MR immunoreactivity in the CA1 region was significantly decreased, especially, in the dentate multiform layer. In contrast, GR immunoreactivity in the aged dog was slightly decreased in the CA1 region and dentate gyrus. In the Western blot analysis, MR protein level in the aged dog was significantly lower compared to that of the adult dog; GR protein level in the aged dog was not significantly decreased. This result indicates that the reduction of MR immunoreactivity and protein level in the hippocampus of the aged dog may be associated with neural dysfunction in the aged hippocampus.