Elevated Serum Cortisol Levels Research Articles

Evaluation of Serum Cortisol Level, Hepatitis B and C Virus Infection and Elevated Aminotransferase Enzymes in a Group of Patients with Oral Lichen Planus

Objective: Oral Lichen planus (OLP) is a common oral disease that can be caused by a variety of circumstances, including the hepatitis B and C virus (HCV). Stress, as a psychological component, raises cortisol levels, which is linked to a cytokine imbalance that may predispose to the development of autoimmune disorders. An association between OLP and serum cortisol levels has been also widely established. In this study, we aimed to evaluate the relationship of serum cortisol levels, hepatitis B/C virus infections and alanine transaminase (ALT), aspartate transaminase (AST) in patients with oral lichen planus and to compare to healthy controls. Method: Forty adult patients with OLP and 40 age gender matched healthy controls were participated in the study. All patients were subjected to routine blood test and the estimation of serum cortisol levels, detection of anti-HCV antibody, hepatitis B surface antigen (HBsAg), alanine transaminase (ALT), aspartate transaminase (AST) by using the enzyme immunoassay. The data were statistically analyzed using Student-t, Mann-Whitney U, Chi-Square and Fischer’s Exact test. Results: Serum cortisol level of OLP patients was found to be 13.38±5.93, and that of the control group was 12.80±3.93. The OLP patients’ ALT-AST levels were 19.91±10.66, 20.81±9.85, and those of the control group were 19.91±10.66, 20.81±9.85, respectively. There was no statistical difference of serum cortisol levels, hepatitis B/C virus infections and ALT-AST levels in OLP patient compared to the healthy control group (p>.05). Conclusion: This study identified that there was no association between OLP and healthy controls regarding elevated serum cortisol levels, hepatitis B/C virus infection and aminotransferaze enzymes.

What Is Behind? Impact of Pelvic Pain on Perceived Stress and Inflammatory Markers in Women with Deep Endometriosis.

Introduction/Objectives: Endometriosis affects 10% of women worldwide. It is noteworthy that this condition is often accompanied by pelvic pain and stress. Endometriosis is a debilitating gynecological condition where tissue similar to the uterine lining grows outside the uterus, often causing significant pain and reproductive issues. We aimed to study the relationship between the intensity of pelvic pain, and stress and inflammatory markers in women with deep endometriosis. Methods: This cross-sectional study analyzed women diagnosed with deep endometriosis through imaging, surgery, and/or biopsy. We assessed pain using the Numerical Rating Scale (NRS). Stress was assessed with the Perceived Stress Scale (PSS-10) questionnaire and the serum cortisol levels. Additionally, we analyzed inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Results: Fifty-two women, with an average age of 37.8 ± 6.9 years, participated in this study. Forty-four percent of these participants demonstrated high levels of stress, as indicated by scores above 26 on the PSS-10. Those categorized with "high stress" on the PSS-10 questionnaire exhibited significantly higher pain levels compared to those with "low stress" (p < 0.05). Furthermore, patients experiencing more-severe pelvic pain (pain score > 7) had notably higher serum cortisol levels. Women with intense pelvic pain (scores above 7 on the NRS) had significantly elevated serum cortisol levels (Cohen's d = 0.72; p = 0.018). Conclusions: A positive association was found between stress levels and the intensity of pelvic pain in women with deep endometriosis, suggesting an interconnection between emotional aspects and biological responses.

Relationship of Endometriosis with Cortisol and Thyroid Function in Young Working Females

Objective: The study was focused to evaluate the role of endometriosis in development of hypothyroidism in working females subjected to chronic stress. Study Design: cross sectional study. Settings: This research was conducted at department of Gynecology &amp; Obstetrics, The University of Lahore Teaching Hospital, Lahore. Duration: The research was completed in from February 2023 to February 2024. Methods: Serum samples of fifty-five endometriosis patients and fifteen controls were analyzed for T3, T4, TSH, cortisol and estrogen levels by using ELISA kits. Results: The levels of TSH in patient’s serum is (1.02±0.168mIU/L) as related to control (3.08±1.090 mIU/L) were lower in females with endometriosis. Serum estrogen levels in endometriosis patients (67.07±5.54 pg/ml) were higher than normal controls (21.07±3.66pg/ml). Elevated levels of serum cortisol (27.25±3.27) than normal values (11.19±4.18) in endometriosis patients were observed. Thyroid problems may result from this imbalance. Furthermore, there is a change in the quantity of thyroid hormones (T3 and T4) in endometriotic cells. Production of T4 rose whereas that of T3 fell. Thus, our research shows that endometriosis increases the risk of thyroid malfunction and hormone imbalance in women. Conclusion: We came to the conclusion that thyroid hormone contributes to endometriosis because endometrial cells are sensitive to changes in TSH. The thyroid gland and its related hormone concentrations described a varied picture between healthy subjects and patients of endometriosis. Moreover, thyroid hormones and estrogen are found to play their significant roles in the disease.

Adrenocorticotropic hormone Secreting Olfactory Neuroblastoma producing Ectopic Cushing&amp;rsquo;s Syndrome

Olfactory neuroblastoma is a rare sinonasal tumour of neuroendocrine type arising from olfactory neuroepithelium. Cushing`s syndrome is a clinical entity occurring due to elevated serum cortisol levels which is commonly due to exogenous steroids. Ectopic ACTH giving rise to endogenous Cushing’s syndrome requires vigilant evaluation in recognition of ectopic site. This syndrome gives rise to multitude of metabolic derangements with high morbidity which warrants early evaluation and management.

Prednisolone-Induced Cushing's syndrome: A case report

Objective: Prednisolone, a frequently prescribed corticosteroid, is linked to diverse adverse effects, including Cushing's syndrome. Material and Methods: This report details a case of prednisolone-induced Cushing's syndrome in a 6-year-old girl diagnosed with Acute Disseminated Encephalomyelitis (ADEM). Prednisolone was administered to manage inflammation associated with ADEM. Subsequent to the tapering of prednisolone, the patient exhibited progressive weight gain, facial rounding, fatigue, and muscle weakness. Clinical examination revealed classic manifestations of Cushing's syndrome, including central obesity, moon facies, and proximal muscle weakness. Laboratory analysis confirmed elevated serum cortisol levels and suppressed adrenocorticotropic hormone (ACTH), confirming exogenous Cushing's syndrome induced by prednisolone. The patient's prednisolone dosage was gradually reduced under careful medical supervision. Regular follow-ups were conducted to monitor symptoms, weight fluctuations, and hormonal levels. With the decrease in prednisolone dosage, the patient's symptoms showed gradual improvement. Results and conclusion: Prednisolone-induced Cushing's syndrome arises as a recognized complication of corticosteroid therapy, primarily characterized by the suppression of the hypothalamic-pituitary-adrenal axis. Early awareness of this adverse effect is pivotal for prompt identification and management. This case emphasizes the significance of vigilant monitoring and judicious use of prednisolone to mitigate adverse effects like Cushing's syndrome. Swift recognition, dose adjustments, and a gradual tapering of corticosteroids play a crucial role in effectively managing this condition for optimal patient outcomes.

Study of insulin resistance, cortisol hormone and some biochemical parameters in Iraqi type 2 diabetic patients

The most prevalent type of diabetes disease is type 2. It resulted through cells' failure for recognizing and responding to insulin, which can increase the risk of this disease if improperly managed. This work seeks to assess few biochemical variables connected to glycemic index in people with type 2 diabetes (T2D). In this study, certain biochemical markers were taken from 37 patients with diabetes mellitus (DM). In the current study, lipid profile, kidney function, insulin, glycated hemoglobin (HbA1c), fasting blood sugar (FBS), uric acid, insulin resistance (HOMA-IR) and cortisol hormone were measured. The blood serum of the 37 patients were taken from diabetic center in Yarmouk hospital and 27 control sample were taken from healthy people in the University of Baghdad. The ages for healthy and unhealthy patients were (19 to 47 ) years old. The results showed that, diabetic participants had higher HbA1c, FBS, HOMA-IR, cortisol, urea, uric acid, lipid profile, and creatinine levels comparing to the control samples at P≤0.05. We concluded from this study, abnormally elevated levels of serum cortisol, FBS, HbA1c, and insulin. Increasing HOMA-IR indicated that IR is a risk factor for T2DM development. This work revealed a relationship between T2DM and kidney function parameters. It was found that patients with T2D having higher levels of creatinine and urea.

Effect of mineral-vitamin premix supplementation on behavioral, performance, hormonal, oxidative stress, and serum biochemical profiles on rutting male Camelus dromedarius in Egypt.

The rutting period imposes a stressful condition on male camels, which results in elevated serum cortisol levels and alterations in their sexual behavior. Therefore, the current work was carried out to investigate the effect of mineral-vitamin premix supplementation on behavior, reproductive performance, hormones, serum oxidative stress profile, and other serum biochemical parameters of Camelus dromedarius during the breeding season. Fourteen mature, fertile male Camelus dromedarius were divided into two groups, a control group (n = 7) and a mineral-vitamin premix group (n = 7). The present study lasted for 95 days during the rutting period (1st February to 5th May). Each camel in the premix group received a daily diet of 50 g of mineral-vitamin premix throughout the whole rutting period, during which the frequencies and durations of the following behaviors: maintenance, posture, aggressiveness, and sexual activity were collected every 20 min. At the end of the study, blood samples were collected. Results revealed that the premix group showed higher (P < 0.05) maintenance (feeding and rumination), standing, and overall sexual desire-related behavior frequency, besides more times (P < 0.001) for rumination, standing, walking, and lying while showing lower (P < 0.001) frequencies of overall aggressive behaviors than the control group. The serum concentration of malondialdehyde, nitric oxide, cortisol, blood glucose, and urea evidenced a significant decrease in the premix group compared with the control one, while significantly elevated levels of reduced glutathione, testosterone, total antioxidant capacity, triiodothyronine, and thyroxin, total protein, albumin, globulin, calcium, phosphorus, potassium, and magnesium were recorded in the premix group in comparison with the control. It could be concluded that daily dietary supplementation of 50 g of mineral-vitamin premix to male camels during the breeding season is necessary to overcome the oxidative stress and serum cortisol concentration with a subsequent decrease in aggressive behavior and improvement to testosterone level in blood, body condition score and body weight gain.

THU033 High Prevalence Of Venous Thrombotic Events In Cushing’s Syndrome: Data From ERCUSYN

Abstract Disclosure: K. Isand: None. R.A. Feelders: None. T.C. Brue: None. M. Toth: None. T. Deutschbein: None. M. Reincke: None. M. Krsek: None. A. Santos: None. F. Demtroder: None. O. Chabre: None. C.J. Strasburger: None. J.A. Wass: None. S.M. Webb: None. A. Aulinas Maso: None. V. Volke: None. E. Valassi: None. For all ERCUSYN investigators Background: Patients with Cushing’s syndrome (CS) have increased risk of developing venous thromboembolic complications. The UK audit and meta-analysis of literature on Cushing’s disease (CD) over 50-years in Stoke-on-Trent by Clayton et al concluded that overall mortality in CD is double that of the general population. The risk of a thrombotic event (TE) (both arterial and venous) in patients with CS has been reported to be up to 10 times higher than that of the general population. When it comes to the cause of death, atherosclerotic diseases and venous thromboembolism (VTE) account for 43.4% of the deaths in patients with endogenous CS. Aim: To evaluate the prevalence of VTE in patients included in The European Registry on Cushing’s syndrome (ERCUSYN) and to study the details of each event to determine if there is any common line in patients who have been diagnosed with VTE. Methods: A retrospective observational cohort study; data extraction from the registry was taken on the 07.02.2022. Results: There were 95 VTE events among 2173 CS patients (prevalence of 4.4 %). Among the 57 centres included in the database (from 26 European countries), events were reported in 28 (from 16 countries). Patients were aged between 14-75 years, median age 47 years; 63(66%) were female. The 95 VTE events were observed in 70 (74%) pituitary-dependent, 12 (13%) adrenal-dependent, 10 (11%) ectopic and 3(3%) CS due to other causes. Comparing aetiologies, ectopic origin accounted for 10.5% of VTE patients and only 5% of those without VTE. Mean ± SD body mass index (BMI) reported in 68/95 patients was 28.8 ± 10.7 kg/m2, and more than three quarters (52; 76%) had a BMI above 25 kg/m2, being either overweight or obese; 21 (22%) patients were smoking. The most frequent comorbidity was hypertension (65 cases, 68%), followed by diabetes mellitus (40 cases, 42%) and osteoporosis (23, 24%); 7 (7%) had a cancer; 7 (7%) had active hypercortisolism (defined by elevated levels of midnight serum cortisol, urinary cortisol or cortisol day curve), 15 (16%) were in partial remission, 46 (48%) were cured and for 7 (7%) the status was unknown. Sixty-two (65%) had had 1 surgery, 22 (23%) had had two surgeries and 1 in the VTE group had 5 operations. Comparing groups, the VTE group had more surgeries than the no-VTE group. Mean operation rate per patient was 1.42 for the VTE group and 1.2 for no-VTE event group (p=0.0068). Seven (7%) patients died during the follow-up time (for different reasons). Conclusion: We report a high VTE rate in CS patients within ERCUSYN. Of note, to our knowledge this is the largest registry-based study to date looking at VTE in CS patients. Importantly, more than half of the VTE events were diagnosed in patients with normocortisolaemia. Presentation: Thursday, June 15, 2023

A psychological intervention based on cognitive‐behavioural therapy reduces psychopathological symptoms that indirectly influence the heart rate via cortisol in hypertensive patients: Preliminary results of a pilot study

AbstractObjectiveThis study aimed at assessing the effectiveness of cognitive‐behavioural therapy (CBT) integrated with psychoeducation in a group of hypertensive patients with clinically significant psychopathological symptoms.MethodsOne hundred hypertensive patients completed the Symptom Checklist‐90‐Revised. Of them, 17 scored above the clinical range (cut‐off = 0.75) on the Global Severity Index and were included in the study. Psychological distress was assessed again after the intervention (T1) and 6 months after the end of treatment (T2). In addition, the cortisol dosage and the heart rate (HR) measurement were collected at both T0 and T2. Then, mediation analyses were carried out to calculate whether psychopathological distress might predict HR through elevated serum cortisol levels, at both T0 and T2.ResultsThe psychological intervention (CBT integrated with psychoeducation) reduced most of the psychopathological symptoms (anxiety, depression, somatisations, obsessions and compulsions, hostility, interpersonal sensitivity and paranoid ideation) but not cortisol dosage and HR measurement. However, psychological distress indirectly predicted HR via cortisol at T0 but not at T2.ConclusionThese results suggest and encourage the replicability of data in larger sample sizes and the comparison with a control group. Nevertheless, these results highlight a need for a multidimensional assessment of disorders affecting the mental and physical spheres of patients to support their overall well‐being.

The Association of the Hypothalamic-Pituitary-Adrenal Axis with Appetite Regulation in Children with Fetal Alcohol Spectrum Disorders (FASDs)

Prenatal alcohol exposure causes growth impairment and a wide range of developmental, physical, and cognitive disorders in children, collectively referred to as fetal alcohol spectrum disorders (FASDs). In the course of FASDs, abnormalities can also affect eating behavior and nutritional status, but these problems have received little attention. Therefore, the aim of our study was to determine the levels of hormones involved in the action of the hypothalamic-pituitary-adrenal axis: proopiomelanocortin (POMC), cortisol, and adrenocorticotropic hormone (ACTH), in the serum of patients with FASDs. To our knowledge, none of these hormones studied have yet been evaluated in FASDs to date. We investigated 62 FASD patients and 23 healthy controls by applying an enzyme-linked immunosorbent method (ELISA). Fasting POMC levels were significantly lower in patients with FASDs (10.97 vs. 18,57 ng/mL, p = 0.039) compared to controls. However, there were no differences in cortisol concentrations. Additionally, the sex and subgroup status (fetal alcohol syndrome (FAS), neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE), and FASD risk) did not affect hormone levels. POMC was positively correlated with some clinical parameters such as age, BMI percentile, carbohydrate biomarkers, and ACTH. A positive correlation was observed between ACTH and cortisol levels, as well as ACTH and cholesterol levels. Data analysis showed no HPA axis abnormalities in the form of elevated serum cortisol and ACTH levels. Differences in POMC concentration may indicate the involvement and/or impairment of central nervous system structures in hormonal alterations in FASD individuals, caused by prenatal alcohol exposure. Hormonal dysregulation in FASDs can contribute to reduced growth and development, as well as many other disturbed processes, including neurological/neurodevelopmental dysfunctions. Further insightful studies involving a larger group of patients are needed to determine the potential impact of the measured hormones.

A STUDY ON THE CORRELATION BETWEEN SERUM CORTISOL LEVELS AND SEVERITY OF ACUTE ISCHEMIC STROKE.

INTRODUCTION: There are many clinical variables like symptom severity and advanced age which are identied as potential predictors of outcome in patients with acute stroke. But there is an immense need to detect a biomarker for predicting the outcome of acute stroke. The stress response that occurs after the event of acute stroke causes the activation of the hypothalamic–pituitary–adrenal (HPA) axis. Certain studies have found that increased serum cortisol level in patients with acute stroke is related to larger infarct volume, greater stroke severity and poor outcome, including death AIM AND OBJECTIVE: To assess the relationship of single serum cortisol levels to the severity of acute ischemic stroke. MATERIALS AND METHODS: About 50 new cases of acute ischemic stroke patients, within 72 hours of the acute neurological event, who were admitted to the Chalmeda Anand Rao institute of medical sciences, Karimnagar, Telangana were included in the study. The study was conducted for 6 months.CT Brain was taken during admission to conrm acute ischemic stroke. NIHSS (National Institute of Health Stroke Scale) scores for all the patients were assessed for severity at the time of admission. Serum cortisol levels were measured the next day early morning. After 15 days, the functional outcome of the patients was assessed using the Modied Rankin Scale. The correlation between serum cortisol levels and stroke scales is assessed byChi–Square Test. All statistical analyses are performed using SPSS (software package used for statistical analysis) package. RESULTS: Of the 50 cases, the serum cortisol level of 23 cases was within normal limits(&lt;/=690nmol/L) of which 65.2% had NIHSS scores of less than or equal to 6 and 34.8% of the cases had NIHSS scores more than 6. As the NIHSS score of less than or equal to 6 is considered to be a minor stroke, it is obvious from the above ndings that most of the cases with normal cortisol levels had no major stroke. The remaining 27 cases had elevated serum cortisol levels.100% of the cases with serum cortisol levels of more than 690nmol/L had NIHSS scores above 6. With a p-value of &lt;0.001, this is found to be statistically signicant. As the NIHSS score above 6 is considered to be moderate to severe stroke, it is obvious from the above observation that nearly all cases with elevated cortisol levels had moderate to severe stroke. Of the 50 cases, serum cortisol levels of 23 cases were within normal limits(,/=690nmol/L)of which 78.3% had MRS scores less than or equal to 3 and 21.7% had MRS scores more than 3. Since the MRS score is a measure of functional outcome and any score less than or equal to 3 is considered to have a favourable outcome, it is clear from the above ndings that most of the cases with normal serum cortisol had a favourable outcome with minimal neurological impairment. And in the remaining 27 cases which had serum cortisol levels of more than 690 nmol/L, 3.7% had an MRS score of less than or equal to 3 and 96.3% had an MRS score of more than 3. With a p-value of &lt;0.001, this is statistically signicant. Since an MRS score of more than 3 is associated with a bad outcome, most of the cases with elevated serum cortisol had a poor outcome with severe neurological impairment. CONCLUSION: Among the patients with acute ischemic stroke, high serum cortisol levels at the time of admission correlate with, Clinical severity which is assessed by the National Institute of Health Stroke Scale and Poor prognosis and functional outcome after 15 days which is assessed by the Modied Rankin Scale

Relationship among Serum Hydrocortisone and Impairment in Left Ventricle Diastolic Function with Subjects of Diabetes Mellitus

Background: Diabetes mellitus (DM) is considered main dangerous feature for the expansion of cardiac metabolic and coronary disorders. Chronic Heart failure along conserved ejection fraction (EF %) were distinguished by the dysfunction of left ventricle diastolic phase (LVDD). Aim: Aim of subjects with elevated serum cortisol or hydrocortisone level establish with Cushing’s syndrome has to be related with the progression of the LVDD. Methodology: We select 42 patients Diagnosed with (DM) and 40 subjects with no DM. Which was underwent echocardiography assessment at multiple hospitals of Lahore within two years of duration. The functions of left ventricle were estimate and the percentage of before time diastolic rate from inflow to trans-mitral before time diastolic rate be considered while guide for diastolic purpose. Concentration of serum cortisol in Plasma, glucose levels, serum fasting cholesterol and triglyceride levels, along by means of anti glycemic medications plus additional scientific distinctiveness was estimated, as well as along its relationship among E/A was resolute by means of only one variable and multiple variable analysis. Results: Multiple variable linear regression study illustrate that log of E/A were confidently associated by age factor (P=0.018), blood pressure systolic phase (P=0.003) and hydrocortisone (P=0.037), in subjects of diabetes mellitus. Multiple variable analysis illustrate that hydrocortisone were completely associated by means of age (P=0.016) and glycated hemoglobin (P=0.011). Therefore no relationship found among E/A and serum hydrocortisone levels in control subjects. Conclusion: Raised levels of hydrocortisone concentration might elevate the possibility of rising in subjects of diabetes mellitus. Keywords: Diabetes mellitus, left ventricle diastolic function, serum hydrocortis

Effect of coconut water and milk on heat stress-induced gastrointestinal tract dysmotility in rats: Role of oxidative stress and inflammatory response.

The potential effects of coconut water (CCW) and milk (CCM) on gastrointestinal motility {intestinal transit (IT), intestinal fluid accumulation (IFA) and colonic motility}, tissue oxidative, and inflammatory responses in heat-stressed rats were investigated. There were four (4) temperature exposure groups; (i) Control at 30°C, (CON), (ii) heat-stressed (HS) group exposed to the ambiance of 40°C, (iii) heat-stressed pre-treated with coconut water (HS+ CCW), and (iv) coconut milk (HS+CCM). Skin temperatures (ST) and rectal temperatures (RT) were taken daily, before and after 2hr heat exposure. GE, IT, and IFA were assessed using standard methods while colonic motility was assessed by colonic bead expulsion (CBE) time after the 14-day exposure. Serum cortisol and lipid peroxidation, antioxidant enzyme activities, inflammatory cytokines in intestinal samples were assessed. Stomach and intestinal morphology were equally examined on histomorphometry. Increased GE, IT, IFA, and colonic motility were observed in HS. CCW and CCM reversed the increases in GE, IT, IFA, and colonic motility in the heat-stressed rats (p<.05). Elevated serum cortisol level and intestinal MDA were significantly reduced in the CCW and CCM treated. Tissue GPx, T-AOC, and T-SOD were all enhanced in HS+CCW and HS+CCM. While tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were suppressed in the HS group, interleukin-4 (IL-4) and interleukin-10 (IL-10) were enhanced with CCW and CCM. Altered intestinal morphology in the HS was also significantly mitigated by CCW and CCM. We showed that coconut water and milk could ameliorate intestinal dysmotility associated with heat stress via oxidative stress reduction and suppression of inflammatory responses. PRACTICAL APPLICATIONS: Heat stress impacts negatively on intestinal health and integrity in both humans and animals via oxidative stress and inflammation. Conversely, coconut has demonstrated anti-oxidative and anti-inflammatory properties in health and medicinal applications. From the findings of this study, coconut water and milk display beneficial potentials against the untoward heat stress effect on gastrointestinal health.

High cortisol levels are associated with oxidative stress and mortality in maintenance hemodialysis patients

BackgroundChronic stimulation of the mineralocorticoid receptor has been suggested as one of the potential causes of cardiovascular events and death in patients with end-stage renal disease. This observational cohort study was performed to demonstrate that serum cortisol might be a predictive marker for patient mortality and to evaluate its association with oxidized low-density lipoprotein (oxLDL) in hemodialysis (HD) patients.MethodsPatients receiving HD three times a week were screened for enrollment at two institutions. Baseline cortisol levels were measured before each HD session, and the patients were divided into two groups according to the median value of serum cortisol before analysis. The baseline characteristics and laboratory values of the high and low cortisol groups were compared. Serum cortisol, adrenocorticotropic hormone, renin, aldosterone, and oxLDL were measured in 52 patients to evaluate the effect of oxidative stress on serum cortisol levels.ResultsA total of 133 HD patients were enrolled in this cohort study. Compared to the patients with low serum cortisol levels, the patients with high serum cortisol levels (baseline cortisol ≥ 10 μg/dL) showed higher rates of cardiovascular disease (59.7% vs. 39.4%, P=0.019) and left ventricular systolic dysfunction (LVSD) (25.9% vs. 8.0%, P=0.016). The patients in the high cortisol group demonstrated higher all-cause mortality than those in the low cortisol group. The serum cortisol level was an independent risk factor for patient mortality (hazard ratio 1.234, 95% confidence interval 1.022-1.49, P=0.029). Among the 52 patients with oxLDL measurements, oxLDL was an independent risk factor for elevated serum cortisol levels (Exp(B) 1.114, P=0.013) and LVSD (Exp(B) 12.308, P=0.045). However, plasma aldosterone levels did not affect serum cortisol levels.ConclusionsSerum cortisol is a useful predictive marker for all-cause death among patients receiving HD. OxLDL is an independent marker for elevated serum cortisol among HD patients.

Clinical and biological correlates of morning serum cortisol in children and adolescents with overweight and obesity.

A fraction of children with obesity have increased serum cortisol levels. In this study, we describe the clinical characteristics of obese children and adolescents with elevated morning serum cortisol levels and the relationship between the cortisol levels and components of the metabolic syndrome. Retrospective medical record review study of children aged 4 to 18 years with overweight or obesity seen for obesity management in the Pediatric Obesity Clinic of the UZ Brussel between 2013 and 2015. A total of 234 children (99 boys and 135 girls) with overweight (BMI z-score > 1.3) without underlying endocrine or genetic conditions were included. Mean (SD) age was 10.1 (2.8) years, BMI SD-score 2.5 (0.6), and body fat percentage 37% (7.9). Serum fasting cortisol levels were elevated (>180 μg/L) in 49 children, normal (62-180 μg/L) in 168, and decreased (<62 μg/L) in 12. Serum fasting cortisol was not significantly correlated with gender, age, or degree of adiposity. But correlated significantly with fasting glucose (Rs = 0.193; p < 0.005), triglycerides (Rs = 0. 143; p < 0.05), fibrinogen (Rs = 0.144; p < 0.05) and leptin levels (Rs = 0.145; p < 0.05). After adjustment for serum insulin and leptin, the correlation between serum cortisol and fasting glucose remained significant. Elevated morning serum cortisol levels were found in 20% of overweight or obese children and adolescents, irrespective of the degree of adiposity, and were associated with higher fasting glucose, irrespective of underlying insulin resistance. The long-term cardiometabolic consequences of hypercortisolemia in childhood obesity needs further study.

Circadian misalignment leads to changes in cortisol rhythms, blood biochemical variables and serum miRNA profiles

The circadian clock plays a critical role in synchronizing the inner molecular, metabolic and physiological processes to environmental cues that cycle with a period of 24 h. Non-24 h and shift schedules are commonly used in maritime operations, and both of which can disturb circadian rhythms. In this study, we first conducted an experiment in which the volunteers followed a 3-d rotary schedule with consecutive shift in sleep time (rotatory schedule), and analyzed the changes in salivary cortisol rhythms and blood variables. Next we conducted another experiment in which the volunteers followed an 8 h-on and 4-h off schedule (non-24-h schedule) to compare the changes in blood/serum variables. The rotatory schedule led to elevated levels of serum cortisol during the early stage, and the phase became delayed during the early and late stages. Interestingly, both of the schedules caused comprehensive changes in blood/serum biochemical variables and increased phosphate levels. Furthermore, transcriptomic analysis of the plasma miRNAs from the volunteers following the rotatory schedule identified a subset of serum miRNAs targeting genes involved in circadian rhythms, sleep homeostasis, phosphate transport and multiple important physiological processes. Overexpression of miRNAs targeting the phosphate transport associated genes, SLC20A1 and SLC20A2, showed altered expression due to rotary schedule resulted in attenuated cellular levels of phosphate, which might account for the changed levels in serum phosphate. These findings would further our understanding of the deleterious effects of shift schedules and help to optimize and enhance the performances and welfare of personnel working on similar schedules.

Epinephrine to the Rescue: Identifying the Offending Side in Bilateral (B/L) Macronodular Adrenal Hyperplasia (BMAH) With Cushing Syndrome (CS) and Hyperaldosteronism

Management of ACTH-independent CS in the setting of B/L adrenal masses can be challenging. We present a patient with concomitant cortisol and aldosterone hypersecretion and B/L adrenal masses who was treated with unilateral adrenalectomy (UA) based on simultaneous B/L adrenal vein sampling (AVS) results normalized to plasma epinephrine levels, to correct for flow and dilution. A 60-year-old lady presented for evaluation of incidentally discovered B/L adrenal masses. CT abdomen with contrast revealed B/L lobulated adrenal glands measuring 3.4 x 5.5 x 4.1 cm on the right and 3.8 x 4.2 x 2 cm on the left (pre contrast density of 37 and 44 Hounsfield Units respectively). She had a recent diagnosis of HTN and prediabetes. She reported fatigue, easy bruising, and muscle weakness. Family history was notable for a sister with CS and B/L adrenal masses who was successfully treated with UA. On physical examination her BP was 160/94 mm Hg and she did not have an obvious cushingoid appearance. Laboratory testing included an elevated AM serum cortisol level of 16.6 mcg/dL following 1 mg of dexamethasone given at 11 pm the previous night. ACTH was <1.0 pg/mL consistent with ACTH-independent CS. She had a serum aldosterone level of 26.6 ng/dL(4.0 - 31.0 ng/dL),simultaneous plasma renin activity of 0.5 ng/ml/hr (0.5–4 ng/ml/hr) and serum potassium level of 4.4 mmol/l. She underwent B/L simultaneous AVS. Given concomitant hyperaldosteronism, plasma epinephrine levels were measured to determine successful catheter placement and to correct for flow and dilution between the adrenal veins. Right adrenal vein to peripheral vein cortisol ratio was 9.27 (> 6.5) consistent with cortisol hypersecretion. The right to left cortisol ratio was 2.3 (>/= 2.3), consistent with right sided predominance. Right to left ratio of the epinephrine corrected cortisol level was 2.7. She underwent right adrenalectomy, and pathology showed macronodular adrenal hyperplasia. Postoperatively, she had resolution of HTN and normalization of 24 hour urine free cortisol. UA is increasingly becoming recognized as a successful treatment for BMAH due to lower risk of adrenal crisis when compared to B/L adrenalectomy. In a recent publication, remission from CS was seen in 94.4 % of patients with BMAH following UA, with recurrence in 19% of patients. The mean time to recurrence was 5 years. We utilized cutoff values that were previously reported for cortisol lateralization in interpreting AVS. Our patient attained remission of CS 9 months post UA. Epinephrine levels were not significantly different between the adrenal veins, possibly due to simultaneous AVS, so we were also able to calculate epinephrine corrected cortisol ratios. Simultaneous B/L AVS with epinephrine to localize autonomous hypercortisolism in the setting of concomitant hyperaldosteronism can be beneficial in guiding surgical management of patients.

Primary Aldosteronism as the Initial Presentation of Adrenocortical Multiple Hormone Producing Tumor

Introduction: Primary aldosteronism (PA) accounts for ∼10% of cases of hypertension in adults, however it’s a rare disease in children. We present a rare pediatric case with PA as the initial presentation of adrenocortical multiple hormone producing tumor. Case: A 7-year-old Japanese girl, who had right-sided hypoplastic leg and foot syndactyly, presented to our hospital due to abnormal ECG of ST depression at V6 on school health check-up. She showed normal growth, no signs of virilization nor Cushingoid appearance. She had elevated blood pressure (164/98 mmHg), low potassium (2.6–3.0 mEq/L) and low cardiac ejection fraction (30–40%). Her plasma aldosterone concentration (PAC) was 441 pg/mL and aldosterone/renin ratio (ARR) was 1470. Contrast-enhanced CT and MRI showed a right adrenal mass (34×22×30 mm) with high lipid content, which led to the diagnosis of primary aldosteronism by the right adrenal adenoma. Adrenal venous sampling failed to identify localization of aldosterone production. Since the possibility of bilateral production of aldosterone remained, the girl was treated with multiple anti-hypertensive medicine including spironolactone and potassium supplementation. Although the serum potassium levels were maintained within normal range, exercise-induced PVCs occurred 6 months after first visit. Abdominal US showed no changes in size of the tumor. Ten months later, she showed gradual weight gain without growth deceleration. Twelve months later, abdominal US revealed apparent enlargement of the right adrenal mass, and MRI scan showed a 156% increase in size of the right adrenal mass (32×50×53 mm). She showed further weight gain with moon face, hirsutism and acne. Hormonal analysis revealed elevated serum and urine cortisol levels (30–40μg/dL and 269–337 μg/m2/day, respectively), and suppressed ACTH levels with no diurnal variation. Serum testosterone levels elevated to 1.00 ng/mL and serum DHEA-S to 273 μg/dL. Retrospective analysis of serum testosterone at the first visit was already mildly elevated to 0.47 ng/mL. Although no distant metastases were detected before surgery, direct liver invasion was found at right adrenal tumor rejection. Clinical Lessons: Primary aldosterone producing adenoma is extremely rare in childhood. In our case, initially the adrenal tumor produced aldosterone predominantly, and it revealed to produce glucocorticoid and androgen later on. Androgen producing adrenal tumor in children tends to have malignant nature. Although initial presentation was compatible with the primary aldosteronism, intense follow-up with detailed monitoring of various hormone levels and images, and early surgical intervention should be considered.

Host-Parasite Interaction in Sarcoptes scabiei Infestation in Porcine Model with a Preliminary Note on Its Genetic Lineage from India.

Simple SummaryScabies or mange caused by Sarcoptess cabiei is the latest addition of WHO’s list oftropical neglected diseases. It causes severe itching to the host. It has a wide host range including humans, farm animals, companion animals, and wild animals. It is anemerging/re-emerging disease with high prevalence in underdeveloped and developing countries. The disease has zoonotic importance and is of significant public health concern as cross-transmission or species jumping is very common. To date, fifteen Sarcoptes varieties have been reported as per host origin. Differential diagnosis at variety level is very crucial for epidemiological study and scratching future eradication program of the disease. As morphotaxonomy fails to differentiate varieties, use of molecular markers is crucial. Moreover, it is very important to understand the host-parasite interaction at the systemic level for a better understanding on the pathogenicity of the disease. Here, we report the genetic characterization of S. scabiei from India and host-parasite interaction in a porcine model.The burrowing mite Sarcoptes scabiei causes scabies in humans or mange in animals. It infests a wide range of mammalian species including livestock, companion animals, wild animals, and humans. Differential diagnosis of Sarcoptes varieties is key for epidemiological studies and for formulation of an eradication program. Host-parasite interaction at the systemic level is very important to understand the pathogenicity of the mite. This communication deals with the preliminary report on the genetic characterization of S. scabiei from India. Moreover, the effect of S. scabiei infestation on host physiology with special emphasis on serum biochemical parameters, lipid profile, oxidant/antioxidant balance, stress parameters, and immune responses were evaluated in a porcine model. Cytochrome C oxidase 1 and voltage-sensitive sodium channel based phylogenetic study could distinguish human and animals isolates but could not distinguish host or geographical specific isolates belonging to animal origin. An absence of host-specific cluster among animal isolates argues against the hypothesis of delineating S. scabiei as per host origin. Elevated levels of markers of liver function such as albumin, AST, ALT, ALP, and LDH in infested animals indicated impaired liver function in infested animals. S. scabiei infestation induced atherogenic dyslipidemia indicated by elevated levels of total cholesterol, low-density lipoprotein cholesterol and triglycerides, and a decreased level of high-density lipoprotein cholesterol. Oxidative stress in infested animals was indicated by a high level of nitric oxide and serum MDA as oxidative stress markers and low antioxidant capacity. S. scabiei triggered stress response and elevated levels of serum cortisol and heat shock proteins were recorded in infested animals. S. scabiei infestation increased the serum concentration of immunoglobulins and was associated with up-regulation of IL-2, IFN-γ, IL-1β, and IL-4 indicating both Th1 and Th2 response. The results of the study will be helpful for a better understanding of host-parasite interaction at the systemic level in crusted scabies in pigs.

Elevated serum cortisol level and its cut off value in major depressive disorder in an urban metropolitan area: A case control study

Elevated serum cortisol level and its cut off value in major depressive disorder in an urban metropolitan area: A case control study