Cortisol Excretion Research Articles

Change in urinary cortisol excretion mediates the effect of angry/hostile mood on 9 month diastolic blood pressure in HIV+ adults.

Cardiovascular disease is a growing concern in HIV disease management and nearly 1 out of 3 persons living with the virus is hypertensive. Biobehavioral factors such as anger, hostility, and HPA axis reactivity are emperically linked to blood pressure regulation. Whether HPA axis or mood disturbance increases risk for hypertension remains unclear in HIV disease. The aim of this study was to determine whether 9-month change in angry/hostile mood predicts alterations in systolic (SBP) or diastolic blood pressure (DBP), and whether this change is mediated by 24-h urinary cortisol (CORT)output. Sixty-one HIV positive adults, aged 41.1±8.6years, assigned to the control condition of a stress management intervention provided blood samples, 24-h urine specimens, blood pressurein-office, and self-reported mood at baseline and a 9-month follow-up. CORT was tested as a mediator in two separate models controlling for baseline BP, CD4 count, HIV-1 viral load, protease inhibitor use, body mass index, smoking status, and family history of cardiometabolic disease. Increase in angry/hostile mood was associated with greater SBP (β=0.33, CI 0.09, 0.56, p=0.01) and DBP (β=0.39, CI 0.16, 0.62, p<0.001) at follow-up. CORT partially mediated the effect of angry/hostile mood on DBP (β=0.28, CI 0.03, 0.54, p=0.03). Change in CORT was not related to SBP (β=0.12, CI -0.20, 0.44, p=0.46). The final mediation model accounted for 41.2% of the variance in 9-month DBP. Angry or hostile mood may contribute to increased risk for hypertension in persons treated for HIVvia disturbance of the HPA-axis.

The Effects of Relaxation Exercises and Park Walks During Workplace Lunch Breaks on Physiological Recovery

Considering the increasing demands of various occupational interventions, this study aimed at examining the impact of relaxation exercises and park walks during lunch breaks on physiological recovery (i.e., on changes in cortisol excretion and blood pressure). In a four-week randomized controlled trial, 153 knowledge workers in seven companies were allocated to one of three groups: relaxation, park walk, or control. Both intervention groups were required to undertake either a lunchtime relaxation exercise or a park walk on each working day for two consecutive weeks. Data were collected at baseline, during the two-week intervention period, and in the week after the intervention. Mixed-design analyses of variance (ANOVA) were conducted. No beneficial intervention effects were observed in cortisol awakening response (CARi) or cortisol decline during the day (CDD). Blood pressure decreased significantly in the afternoon at work in each group. This decrease was more pronounced in the park walk group ( d = .51–.58) than in the relaxation ( d = .18–.28) and control ( d = .31–.41) groups. Our study showed that changing knowledge workers’ lunch routines for a short period of time does not affect cortisol excretion, but may lower blood pressure at the end of the working day. This lowered blood pressure also seemed to occur among the controls, suggesting that measuring and keeping track of blood pressure may serve as an intervention. However, longer interventions are needed to achieve stronger and long lasting physiological recovery effects.

Type A Aortic Dissection, Apparent Mineralocorticoid Excess Syndrome, and Syndromic Aortic Root Dilatation

ABSTRACT Objective: To determine the cause of acute life-threatening aortic root dissection in a 36-year-old male with a long-standing history of apparent mineralocorticoid excess (AME) and hypertension since childhood. Methods: Cortisol metabolites were analyzed by urine tandem mass spectrometry. Screening for DNA variants was performed using the Marfan Syndrome and Related Aortopathies NextGen Sequencing Panel (Collagen Diagnostic Laboratory, University of Washington, Seattle). Cytogenetic microarray analysis (CombiMatrix, CA) was performed. Sequencing of the 11β-hydroxysteroid dehydrogenase type 2 gene (HSD11B2) in a region of homozygosity (ROH) identified on microarray analysis was targeted using Sanger sequencing (Prevention Genetics) on an ABI 3730x1 capillary sequencer. Results: There was reduced urinary excretion of all 11-carboxyl containing steroids and high excretion of free cortisol and its metabolites, consistent with a diagnosis of AME. Microarray analysis revealed 4 ROHs. One ROH contained ...

Renal water conservation determines the increase in body weight after surgery: A randomized, controlled trial.

Background:The present study was undertaken to identify factors that correlate with the gain in body weight after surgery.Methods:Twenty-one patients (median age of 49 years) were randomized to receive either Ringer × s acetate or 6% dextran 70 as their first infusion fluid during cholecystectomy or hysterectomy. Each patient's body weight was measured before the surgery and on the first postoperative morning. Blood and urine samples were analyzed for signs of stress, inflammation, and kidney injury. The fluid retention index (FRI), which reflects how strongly the kidneys excrete or retain fluid, was also calculated.Results:The body weight increased by a median of 0.4 kg in the crystalloid fluid group and by 1.0 kg in the colloid fluid group (maximum 2.5 kg, P < 0.01). This difference was due to less urinary excretion after surgery in the colloid group (P < 0.03). The increase in body weight did not correlate with the infused fluid volume, the plasma concentrations of C-reactive protein or cortisol, or the urinary excretion of albumin, cortisol, or neutrophil gelatinase-associated lipocalin. However, the body weight increased with the postoperative FRI score (r = 0.64; P < 0.003) and with the surgery-induced change in FRI score (r = 0.72; P < 0.002).Conclusion:How strongly the kidneys excrete or retain fluid, which can be assessed by urine sampling, was the strongest indicator of the increase in body weight during the day of surgery. The amount of fluid alone did not correlate with the gain in body weight.

Knemometry is more sensitive to systemic effects of inhaled corticosteroids in children with asthma than 24-hour urine cortisol excretion

Pharmacodynamic assessment of the systemic effect of inhaled corticosteroids (ICSs) is often done by measuring 24-hour urine free cortisol (UFC) excretion. Knemometry assessing short-term lower-leg growth rate (LLGR) is a more rarely used alternative. The primary aim of this study was to compare the sensitivity of LLGR and 24-hour UFC excretion for evaluating systemic exposure to ICSs in prepubertal children with asthma. The secondary aim was to evaluate factors influencing the precision of LLGR calculated by the traditional 1 leg nonparametric method versus a new 2 leg parametric method. The study evaluated 60 children with mild asthma aged 5 to 12years participating in a randomized controlled trial of ICSs with longitudinal concomitant assessments of LLGR and 24-hour UFC excretion. The sensitivity of the safety assessments was analyzed by comparing LLGR and 24-hour UFC in the placebo run-in period with values in the ICS treatment period by using paired t tests. Factors with a potential influence on LLGR were analyzed by means of ANOVA and the Levene test of homogeneity. The mean LLGR was significantly reduced during the ICS versus placebo run-in periods: 0.18mm/wk (SD, 0.55mm/wk) versus 0.45mm/wk (SD, 0.39mm/wk), with a mean difference of 0.27mm/wk (95% CI, 0.05-0.48mm/wk; P=.02). In contrast, there was no difference in 24-hour UFC excretion: 6.91nmol/mmol (SD, 4.67nmol/mmol) versus 7.58nmol/mmol (SD, 6.17nmol/mmol), with a mean difference of 0.67nmol/mmol (95% CI, -1.13 to 2.48nmol/mmol; P=.46). We observed no significant difference in parametric determined LLGR caused by the child's age or sex, investigator, or season of measurement, whereas some differences were observed for the nonparametric LLGR. These findings suggest that knemometry is a more sensitive pharmacodynamic measure of systemic effects of ICSs than 24-hour UFC excretion and that a parametric determination of LLGR increases the sensitivity of the method. These findings should be considered by legislative authorities in the future.

Correlation of emotional labor and cortisol concentration in hair among female kindergarten teachers.

The purpose of this study was to explore whether two types of emotional labor, surface acting and deep acting, are related to hair cortisol concentration among kindergarten teachers. Surface acting and deep acting over the last month were measured with the Chinese version of the emotional labor scale in 43 kindergarten teachers. Hair samples with 1cm in length were cut from their posterior vertex region to represent cortisol excretion over one month. Cortisol concentrations were analyzed with high-performance liquid chromatography-tandem mass spectrometry. Positive association of emotion labor with hair cortisol concentration was significant for surface acting (r=0.34, p<0.05) and not significant for deep acting (r=0.14, p>0.05). More surface acting showed to be associated stronger with stress responses or higher HPA axis activity.

Unemployment as a chronic stressor: A systematic review of cortisol studies

Objective: Unemployment is a type of chronic stressor that impacts human health. The reasons for how the stress of unemployment affect health is still a matter of discussion. One of the pathways from chronic stress to ill health is mediated by cortisol, and so we set out to compile extant data on how its secretion is affected by unemployment.Design: A systematic literature search was conducted to establish the cortisol dysregulatory effects of this stressor.Main outcome measures: Only studies that specifically examined the effects of unemployment on cortisol excretion, and were written in English were included.Results: Ten reports were obtained and synthesised to determine the severity and complexity of the effect of unemployment on cortisol secretion. The resulting combined evidence is mixed in terms of degree or dynamic of relationship.Conclusions: The differences between the cumulate findings of the studies can be understood in the context of the lack of both standardised methodology and an absence of consensus on unemployment definition. We propose existing methodologies may be strengthened by acknowledging and accounting for the individual characteristics that may be relevant to the stress experience of unemployment.

Urinary free cortisol and androgens in the population—Hormone interactions and the relationship with body composition and bone status

ObjectiveAbnormal secretion of thyroid hormones, growth hormone, cortisol and androgens influences body composition. We hypothesised that higher cortisol excretion, in combination with higher androgen and IGF-I concentrations, had a synergistic, favourable effect on body mass and bone. Design, patients and methodsThis was a cross-sectional study on a population sample of 290 women and 93men. The mean age was 65.4±7.2yearsinwomen and 59.7±10.0yearsinmen. Body composition was assessed with bioimpedance, and skeletal health with calcaneal quantitative ultrasound and fracture rate. The influence of urinary free cortisol (UFC), serum DHEAs (women), testosterone (men), free T4andIGF-I on the outcome was studied with regression analyses adjusted for age and body mass index. ResultsIn women, higher concentrations of UFC, DHEAs, IGF-I and lower free T4, were associated with higher fat-free mass. Only a higher UFC concentration was associated with favourable calcaneal measurements. In men, higher testosterone was associated with higher fat-free mass and lower fat mass. Higher IGF-I concentration, but not UFC, was independently associated with higher fat-free mass in men. Interaction analyses did not reveal any additive effects of hormones on body composition or bone in either sex. In both men and women, only age was associated with osteoporotic fractures. ConclusionSerum concentrations of androgens together with IGF-I were positively associated with body composition in both sexes. Urinary cortisol was positively associated with fat-free mass and bone status in women only. Increasing age, but not hormones, was the major determinant of osteoporotic fractures in this population sample.

Intensified training periods: when much is to too much?

[b]Introduction.[/b] This study has been undertaken in order to examine the usefulness of selected biomarkers as commonly used for monitoring of biological responses to an intensified training period.[b]Material and methods.[/b] The subject was monitored day-by-day throughout an a 2-wk training period, which preceded a pre competition 10-day taper period. Morning blood biochemical indices, perceived sleep quality (SQ), hand-grip strength (H-GS), visuo-attentional motor level (VAM) were assayed and provided to the coach no later than 3 hours after blood sampling and just before the morning training session. Overnight collected urine samples were stored frozen until determination of urinary creatinine, urea and free cortisol.[b]Results. [/b]During the first half of the training period plasma creatine kinase tended to increase, whereas T tended to decrease. In the morning of the 10th day of the period the testosterone rapidly decreased under the lower physiological limit, that was associated with strongly elevated urinary excretion cortisol and urea, deteriorated SQ, H-GS, VAM and reported malaise. Judoka had to stop training. After 2 days of rest period all these psycho-physiological indices returned to the baseline values, judoka felt better and declared his willingness to resume the training.[b]Conclusions.[/b] The results showed usefulness of comprehensive biometric monitoring across an intensified training period. Excessive training with inadequate rest periods resulted in unpredictable, acute psycho-physical indispositions along with changes in the physiological markers similar to those noted during chronic fatigue. Considering very short length of the duration of that syndrome, it does meet criteria of overtraining/overreaching.

Serum Cortisol and the Risk of Osteoporosis in Nigerians on Medroxyprogesterone Acetate

Depo-Provera®; Depot-Medroxyprogesterone Acetate (DMPA) is one of the most used contraceptives and it is currently used by more than 30 million women in most of developed and developing countries. The study was designed to investigate the relationship between serum cortisol and the risk of osteoporosis in Nigerians using Depo-Provera®. We investigated 50 women using Depo-Provera® and 50 age-matched control, not on DPMA. Serum cortisol, progesterone, estrogen, estradiol, serum calcium, cathepsin K and urinary excretion rate of calcium were determined in subjects and controls. Serum cortisol and cathepsin K were significantly higher in women using DPMA Vs controls (P<0.01), we also found a significantly lower estradiol, serum calcium and an increased urinary excretion rate of calcium in subjects using DPMA as compared to controls (P<0.05). We found a positive correlation between serum cortisol and serum calcium (r=0.553) (P<0.01), serum cortisol and cathepsin K (r=0.568, P<0.05). Our study shows that hypercortisolaemia may be responsible for calcium loss, further investigation is needed to determine if cortisol induced calcium loss is responsible for bone demineralization associated with the use of DPMA.

Low Impact of Urinary Cortisol in the Assessment of Hydrocortisone Replacement Therapy.

Hydrocortisone replacement therapy is a cornerstone in the treatment of adrenal insufficiency (AI). While urinary cortisol has been used as a diagnostic tool for AI, it remains unclear whether it is a useful parameter to monitor hydrocortisone replacement therapy. Aim of this study was to evaluate possible differences in cortisol metabolism between adrenal insufficient patients and healthy subjects and to assess the value of urinary cortisol in AI management. In a case-control study, urinary cortisol excretion was determined in 14 patients with primary and secondary AI receiving hydrocortisone infusions from midnight to 8:00 AM. Results were correlated with serum cortisol levels and compared to urinary values obtained from 53 healthy volunteers. Urinary cortisol excretion in healthy subjects was 14.0±7.8 μg/8 h (range: 0.24-35.4), levels did not differ between 3 groups aged 20-34 years, 35-49 years, and ≥50 years. Patients with AI receiving hydrocortisone infusions demonstrated significantly higher rates of urinary cortisol excretion (51.6±37.8 μg/8 h; range 17.1-120.0, p<0.001); the values correlated with serum cortisol levels (r(2)=0.98). Of interest, patients with secondary AI showed significantly higher serum cortisol levels after hydrocortisone infusion than those with primary AI, conceivably due to residual adrenal function. In conclusion, we showed that: (i) there is a wide inter-individual variability in urinary cortisol excretion rates; (ii) cortisol metabolism in adrenal insufficient patients differs when compared to controls; (iii) there is a strong correlation between urinary and serum cortisol levels; and (iv) urinary cortisol levels despite their variability may help to discriminate between secondary and primary adrenal insufficiency.

Multifactorial monitoring of training load in elite rugby sevens players: cortisol/cortisone ratio as a valid tool of training load monitoring.

The effectiveness of selected physiological and perceptual measures for monitoring training load and fatigue was studied in 16 male elite rugby sevens players during a 6-week intense training block (IT) and 2-week tapering (TAP). Daily training load (TL) and strain (TS) as well as weekly total score of fatigue (TSF) were quantified respectively by the session-rating of perceived exertion (RPE) method and an 8-item questionnaire. Also, testing was performed and 24 h urinary cortisol (C), cortisone (Cn), adrenaline (A) and noradrenalin (NA) excretion was measured before (T0) and after the IT (T1) and after the TAP (T2). The TL, TS and TSF increased during the IT and decreased during the TAP, in conjunction with a significant drop and improvement, respectively, of performance standards during the two periods. At T1, C and Cn levels increased while A and NA levels decreased, resulting in a higher C/Cn ratio and lower A/NA ratio, respectively. At T2, both C/Cn and A/NA returned to baseline values. The changes in C/Cn ratio, after the 6-week IT, were more closely related to mean TL, TS and TSF (r=0.75-0.76 vs. r=0.48-0.58, p<0.01) and to changes in the majority of performance measures than to A/NA ratio. Only the changes in C/Cn ratio after the 2-week TAP were related to mean TL, TS and TSF (r=0.61-0.68, p<0.01). The changes in hormone levels, training strain and performance standards reflected the physical and mental stressors of training, with complete recovery, as indicated by physiological homeostasis, achieved after an appropriate tapering period.

Pharmacokinetics and Systemic Activity of a New Patent of an Inhaled Corticosteroid/Long-Acting β2-Agonist Combination for Use in Asthma Therapy: Fluticasone Furoate/Vilanterol Trifenatate.

The present paper reviews pharmacokinetics and systemic activity of a new patent of fluticasone fumarate/vilanterol trifenatate and summarises the efficacy data in children, adolescents and adults with asthma. Bioavailability of oral deposition of fluticasone furoate is approximately 1%, of oral and pulmonary deposition 15%. Fluticasone furoate 400, 600 and 800 µg have been associated with reductions in 24h urine cortisol excretion in adults, whereas several studies on fluticasone furoate/ vilanterol trifenatate 100/25 µg and 200/25 µg once daily found no suppressive effects. Bronchodilation was detected in adults with asthma from 5 minutes after vilanterol trifenatate was inhaled and up to 24 hours after. Five large clinical trials which were sponsored by the manufacturer GlaxoSmithKline provided evidence that dry powder fluticasone furoate/vilanterol trifenatate 100/25 µg and 200/25 µg once daily are efficacious in asthma in patients ≥ 12 years of age. It remains to be proven, however, that once daily dosing may improve asthma control as compared to twice daily dosing. Efficacy and the systemic activity potential for hypothalamic-pituitary-adrenal and growth suppression of fluticasone furoate have not been established in children. The potential for systemic activity of fluticasone furoate in children may be assessed by knemometry.

Sleep Hypoxemia and Urinary Free Cortisol in Patients with Obstructive Sleep Apnea

Objective: This study evaluated the influence of obstructive sleep apnea (OSA) on hypothalamic–pituitary–adrenal (HPA) axis aiming to identify the polysomnographic data associated with cortisol abnormalities. Methods: Forty-one men referred for suspected OSA underwent polysomnography and were classified according to the apneahypopnea index (AHI) into control group (n=16) and OSA group (n=25). The assessment of the HPA axis function included low-dose (0.25 mg) dexamethasone suppression test, the circadian rhythm of salivary cortisol secretion and the measurement of urinary free cortisol (UFC) excretion in a 24-hour urine collection. Results: No differences were found between groups for age (p=0.112), body mass index (BMI) (p=0.617), waist circumference (WC) (p=0.358). UFC was higher in the OSA group compared with the control group (p=0.013). There was no correlation between the UFC and BMI. There was a negative correlation between UFC and minimum oxygen saturation (p=0.006) and positive correlations between UFC and rapid-eye-movement (REM) oxygen desaturation index (p=0.004), AHI (p=0.024) and arousal index (p=0.010). In a multivariable linear regression analysis, including, arousal index and minimum O2 saturation or REM ODI as independent variables and UFC as the dependent variable, only minimum O2 saturation or REM ODI were associated with high UFC levels. Conclusion: Our results demonstrated that OSA is associated with increased UFC. The severity of hypoxemia is the major factor of this neuroendocrine dysregulation.

A patient with Cushing disease lateralizing a pituitary adenoma by inferior petrosal sinus sampling using desmopressin: a case report.

A 14-year-old girl was referred for evaluation of the etiology of Cushing syndrome. During the previous 2 years, she had experienced weight gain, secondary amenorrhea, growth retardation, and back pain. Random serum cortisol level, 24-hour urinary free cortisol excretion, and overnight and low-dose dexamethasone suppression tests suggested Cushing syndrome. Midnight adrenocorticotropic hormone (ACTH) level and high-dose dexamethasone suppression test confirmed Cushing disease. Pituitary magnetic resonance imaging was suspicious for microadenoma. To eliminate ectopic ACTH syndrome, and lateralize the pituitary tumor, inferior petrosal sinus sampling (IPSS) was performed by desmopressin use to stimulate ACTH. Finally, the patient was diagnosed with Cushing disease due to ACTH-secreting pituitary microadenoma, lateralized to the left side; subsequently underwent transsphenoidal surgery. Here we report a case of a 14-year-old girl diagnosed with Cushing disease with a pituitary tumor lateralized by IPSS using desmopressin, which is very rare in pediatric Cushing disease.

Allelic variation of the COMT gene in a despotic primate society: A haplotype is related to cortisol excretion in Macaca fuscata

Sequence variations in genes of the monoamine neurotransmitter system and their common function in human and non-human primate species are an ongoing issue of investigation. However, the COMT gene, coding for the catechol-O-methyltransferase, has not yet attracted much scientific attention regarding its functional role in non-human primates. Considering that a polymorphism of the human COMT gene affects the enzyme activity and cortisol level in response to a social stressor, this study investigated the impact of COMT on endocrine stress and behavioural parameters in Japanese macaques (Macaca fuscata). The species exemplifies a despotic hierarchy in which males' social rank positions require an adaptation of behaviour strategies. During the mating period steroid secretion and the frequency of aggressive encounters between males increase. We addressed i) whether this species exhibits potential functional COMT variants, ii) whether these variants are associated with faecal cortisol excretion of males, iii) how they are distributed among different social rank positions and iv) whether they are associated with behavioural strategies during times of mate competition. By genotyping 26 males we identified three COMT haplotypes (HT), including a putative splice mutant (HT3). This variant was associated with increased cortisol excretion. Given the observed inverse correlation between cortisol and physical aggression, we assume that different COMT haplotypes may predispose individuals to pursue more or less aggressive strategies. How these gene-stress effects might favour a specific social role is discussed. Our study of non-invasive genotyping in combination with behavioural and endocrine parameters represents an important step towards the understanding of gene-stress effects in a hierarchically organised primate society.

Efficacy and safety of fluticasone furoate/vilanterol or tiotropium in subjects with COPD at cardiovascular risk.

BackgroundFluticasone furoate/vilanterol (FF/VI) is a novel, once-daily, inhaled corticosteroid/long-acting β2-agonist combination approved for the treatment of COPD and asthma. We compared the safety and efficacy of FF/VI and tiotropium (TIO) in subjects with moderate-to-severe COPD with greater risk for comorbid cardiovascular disease (CVD).MethodsThis randomized, blinded, double-dummy, parallel-group study compared a once-daily morning dose of FF/VI 100/25 mcg delivered via ELLIPTA™ with TIO 18 mcg via HandiHaler® for 12 weeks in subjects with diagnosed COPD, forced expiratory volume in 1 second (FEV1) 30%–70% predicted, and CVD or CVD risk. The primary endpoint was change from baseline in 24-hour weighted mean FEV1 on Day 84. Other efficacy endpoints included time to onset of bronchodilation, trough FEV1, other spirometry measures, rescue medication use, symptoms, quality of life (St George’s Respiratory Questionnaire-COPD [SGRQ-C]), and health status (COPD Assessment Tests [CAT]) measures. Safety endpoints included cardiovascular monitoring, cortisol excretion, COPD exacerbations, and adverse events, including prespecified drug effects.ResultsBoth FF/VI and TIO improved the 24-hour weighted mean FEV1 from baseline after 12 weeks with no significant difference between treatments. Other endpoints favored FF/VI for time to onset of bronchodilation, rescue medication use, dyspnea, SGRQ-C and CAT scores, or favored TIO for change from baseline in forced vital capacity and inspiratory capacity. Pneumonia occurred more frequently in the FF/VI group, and two TIO-treated subjects died following cardiovascular events. Other safety measures were similar between groups, and cardiovascular monitoring did not reveal increased CVD risk.ConclusionBoth FF/VI and TIO were efficacious in improving lung function in subjects with COPD and comorbid CVD or CVD risk factors, with minor differences in efficacy and safety profiles.

Increased Steroid Excretion in Children with Extremely Low Birth Weight at a Median Age of 9.8 years

Background: Events during foetal or early extrauterine life may affect bodily structure and/or functions and even pave the way for adult diseases. Aims: To find whether extremely low birth weight (ELBW) infants differ from healthy controls regarding the excretion of steroid metabolites. Methods: The study compared 17 female and 10 male ELBW infants, all prepubertal, aged 8-11 years, birth weight <1,000 g, with 27 age- and sex-matched controls. All were healthy at the time of the study. Height, weight and BMI did not differ between the groups. Results were adjusted according to body surface area. 36 urinary steroid metabolites were quantified by gas chromatography-mass spectrometry. Results: In the ELBW girls 33/36 steroid metabolites were higher (19 significantly) than in the controls. All 36 steroid metabolites were higher in the ELBW boys (9 significantly) than in the controls. Sums of mineralocorticoid precursors, metabolites descriptive for cortisol and parameters of adrenal androgen production were significantly higher in ELBW infants (both sexes). Only the sum of the metabolites known to be illustrative for adrenal 11β-hydroxysteroid dehydrogenase activity was not different. Conclusion: Prepubertal ELBW children have an augmented urinary excretion of adrenal androgens, cortisol and mineralocorticoid precursors. These findings corroborate and help to explain the link between early-life adversity and subsequent adrenocortical function.

Renal injury during hip fracture surgery: an exploratory study.

The present observational study was undertaken to identify potential markers of poor outcome, such as renal failure and mortality, after hip fracture surgery. Forty-three patients, with a mean age of 78 years, were studied having undergone acute hip fracture surgery. Analysis included the urinary excretion of cortisol, albumin and sodium. The degree of fluid retention was evaluated based on the urinary excretion of metabolic end products. Fluid retention and the excretion of albumin and neutrophil gelatinase-associated lipocalin (NGAL) were measured repeatedly in a sub-group of 15 patients who also underwent haemodynamic monitoring. The perioperative change in serum creatinine and a 30-day mortality served as outcome measures. Although serum creatinine increased by > 25% in 21% of the patients, only a high preoperative creatinine concentration correlated with a 30-day mortality. The subgroup analysis revealed that fluid retention was pronounced and remained essentially unchanged up to the first postoperative day. A rise in serum creatinine was always preceded by increased urinary excretion of NGAL that, in turn, was associated with preoperative fluid retention. The only perioperative event that correlated with a higher 30-day mortality was perioperative aggravation of albuminuria (67% vs 0%, P < 0.01), which became more common with advanced age and a low cardiac index. Two different mechanisms seem to affect the kidneys during hip fracture surgery. The first elevates the serum creatinine concentration while the second increases the albuminuria. Only the second mechanism had a bearing on mortality.

Born from pre-eclamptic pregnancies predisposes infants to altered cortisol metabolism in the first postnatal year.

Pre-eclampsia leads to disturbed fetal organ development, including metabolic syndrome, attributed to altered pituitary-adrenal feedback loop. We measured cortisol metabolites in infants born from pre-eclamptic and normotensive women and hypothesised that glucocorticoid exposure would be exaggerated in the former. Twenty-four hour urine was collected from infants at months 3 and 12. Cortisol metabolites and apparent enzyme activities were analysed by gas chromatography-mass spectrometry. From 3 to 12 months, excretion of THS, THF and pregnandiol had risen in both groups; THF also rose in the pre-eclamptic group. No difference was observed with respect to timing of the visit or to hypertensive status for THE or total F metabolites (P>0.05). All apparent enzymes activities, except 17α-hydroxylase, were lower in infants at 12 compared to 3 months in the normotensive group. In the pre-eclamptic group, only 11β-HSD activities were lower at 12 months.17α-hydroxylase and 11β-HSD activities of tetrahydro metabolites were higher in the pre-eclamptic group at 3 months (P<0.05). 11β-hydroxylase activity increased in the pre-eclamptic group at 12 months. Cortisol excretion, determined by increased 11β-hydroxylase, compensates for high 11β-HSD-dependent cortisol degradation at 3 months and at 12 months counterbalances the reduced cortisol substrate availability in infants born from pre-eclamptic mothers.