Higher Cortisol Levels Research Articles

The associations between paternal postpartum depressive symptoms and testosterone and cortisol levels in hair over the first two years postpartum.

After the birth of a child, also fathers may develop postpartum depression. Altered steroid hormone concentrations are discussed as a possible underlying mechanism, as these have been associated with depressive symptoms in previous studies outside the postpartum period. While higher paternal testosterone levels have been found to protect against paternal postpartum depressive symptoms (PPDS), an association between higher cortisol levels and PPDS has been seen in postpartum mothers, with no comparable studies available on fathers. This study aimed to investigate cross-sectional and longitudinal associations between testosterone and cortisol levels in hair and PPDS over a period of 2 years postpartum. Data from N = 226 fathers, who took part in the endocrine sub-study DREAMHAIR of the longitudinal prospective cohort study DREAM, were used. PPDS were assessed 8 weeks, 14 months, and 24 months after birth using the Edinburgh Postnatal Depression Scale. At the same time, fathers provided 2 cm scalp-near hair samples in which testosterone (HairT) and cortisol (HairF) levels were determined. Cross-sectional and longitudinal associations between HairT, HairF and paternal PPDS were investigated. Correlation analyses showed a negative cross-sectional association between HairF levels and paternal PPDS 14 months after birth. A random intercept cross-lagged panel model revealed prospective relationships between paternal PPDS 8 weeks postpartum and HairF 14 months postpartum, and additionally between 14 months and 2 years postpartum in an exploratory model with similarly good model fit. No further significant associations of HairF with paternal PPDS emerged, and none of the analyses with HairT became significant. The overall pattern of results was confirmed when controlling for the influence of batch and storage time on HairT and HairF levels. No consistent relationships between HairT or HairF and paternal PPDS emerged in this relatively healthy cohort. In HairF analyses with significant results, lower HairF was associated with more severe PPDS. Longitudinal results imply that altered cortisol secretion may rather follow than precede changes in paternal PPDS. Further research on hormonal changes in PPDS in fathers should consider possible covariates and examine fathers with higher depressive burden, which may help to identify fathers at risk and inform future preventive and interventive approaches.

The hidden cost of illicit trade: Evaluating the physiological health of smuggled European glass eels (Anguilla anguilla).

European eel is considered a "critically endangered" species due to its population decline (c.a. 98%) in all European waters, primarily because human activities. The eel life cycle is very complex as it includes long migrations, and although aquaculture can help in repopulation, at this time artificially raised eel larvae have little survival. Therefore, to reverse this situation, in 2007 the EU adopted the Eel Regulation, starting a series of plans to improve the conservation and the recovery of the eel population, which included a ban on importing and exporting eels in all EU countries. However, an illegal global market and food fraud developed, turning Europe into the source of the international illegal eel trade. This study reports the evaluation of the welfare consequences of the illegal transport of European glass eels using their epithelial mucus, one of the most promising tools for studying endangered fish species. We also aimed to determine the recovery time required in controlled conditions before their release to the Ebro River. The results showed that high metabolite and cortisol levels were observed in mucus. In addition, the defensive capacity against possible bacterial infections was also affected due to the transport conditions as bacterial co-culture with mucus analysis indicated. Regarding the recovery time, we analysed the same parameters as for the initial transport point resulting in a stabilisation of stress parameters and an increased defensive capacity from day 3 to the final release, but the best results were observed after 2months under optimal conditions. These findings suggest that transport stress is critical for the survival of glass eels, and the stress and defensive capacities analysis suggests the need for a recovery period prior to release. This approach represents a valuable contribution both for species subject to illegal trade and for the conservation of endangered species.

Selenium Enhances the Growth of Bovine Endometrial Stromal Cells by PI3K/AKT/GSK-3β and Wnt/β-Catenin Pathways.

The bovine uterus is susceptible to bacterial infections after calving, particularly from Escherichia coli (E. coli), which often results in endometritis. Additionally, postpartum stress in cows can elevate cortisol levels in the body, inhibiting endometrial regeneration and reducing immune function, thereby further increasing the risk of infection. Selenium (Se) is a common feed additive in dairy farming, known for its anti-inflammatory and antioxidant effects. The aim of this study was to investigate the regulatory role of Se in the growth of bovine endometrial stromal cells (BESCs) under the conditions of LPS-induced inflammatory damage at high cortisol levels. BESCs were treated with 1, 2, 4 μM Se in combination with co-treatment of LPS and cortisol. The results indicated that LPS inhibited the cell viability and reduced the mRNA expression of CTGF, TGF-β1, and TGF-β3. Additionally, LPS increased apoptosis, hindered the cell cycle progression by blocking it in the G0/G1 phase, and suppressed the PI3K/AKT/GSK-3β and Wnt/β-catenin signaling pathways. Furthermore, increased concentrations of cortisol can exacerbate the impacts of LPS on cell proliferation and apoptosis. Conversely, the supplementation of Se promoted cell viability, increased the mRNA expression of TGF-β1 and TGF-β3, and enhanced cell cycle progression, while simultaneously repressing cell apoptosis as well as activating the PI3K/AKT/GSK-3β and Wnt/β-catenin signaling pathways. The above findings demonstrated that Se can promote cell proliferation, reduce cell apoptosis, and aid in the growth of BESCs damaged by LPS under high levels of cortisol. The potential mechanisms may be associated with the regulation of the PI3K/AKT/GSK-3β and Wnt/β-catenin signaling pathways.

Hormones synthesized by the adrenal reticulum protect bone density in premenopausal women with Cushing syndrome.

Differences in bone metabolism between patients with adrenal Cushing's syndrome (ACS) and Cushing's disease (CD) have been noted, but the impact of steroid hormones on bone metabolism remains underexplored. The purpose of this study is to explore the differences in bone metabolism between the two subtypes of Cushing's syndrome and the correlation between hormones synthesized by the adrenal reticulum and bone metabolism. This retrospective study included 75 premenopausal women, consisting of 33 patients with CD and 42 patients with ACS. The clinical characteristics, laboratory examination and bone metabolism differences between the two groups were analyzed. Then, 16 patients with ACS and 12 patients with CD underwent comparison of blood steroid hormone levels. Additionally, the relationship between bone mineral density (BMD) values and steroid hormone variables was analyzed. The serum and urinary cortisol and serum ACTH concentrations were significantly higher in patients with CD compared to those with ACS. Conversely, lumbar and femoral BMD were lower, and osteocalcin (OC) levels were elevated in the ACS group. Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulphate (DHEAS) had a significant positive correlation with Z-score in lumbar spine in both CD and ACS group. However, Z-score in femoral neck had a significant positive correlation with DHEA and DHEAS only in the ACS group. Bone loss is more pronounced in ACS than in CD, despite higher cortisol levels in CD patients. High levels of hormones synthesized by the adrenal reticulum might be protective for bone density in premenopausal women with hypercortisolism.

Effects of stress hormones on digestibility and performance in cattle: A review

Abstract Various stress factors affect the physiology of cattle. Environmental stressors include heat, cold, wind, humidity, nutrition, endocrine disruptors, and management. Several negative health effects are associated with the hormones produced under stress conditions. In cattle, cortisol has been associated with reduced rates of reproduction, lowered milk production, and suppression of the immune system causing greater disease susceptibility. For a better understanding of how stress hormones impact feed digestibility and animal performance, this review has been divided into four sections (feed digestibility, milk production, milk composition, and meat quality). In dairy cows, the transition period is challenging because of a shortage of energy and nutrients, inflammation, increased lipid peroxidation, as well as hormonal and metabolic changes. Stress hormones decrease milk yield, but cortisol affects arteriovenous pressure, which is essential for milk production (due to stressful conditions or other factors such as the use of steroid medicines). Higher cortisol levels have been observed in the hotter and more stressful months of the year. On the other hand, in early lactation, reduced feed intake can lead to acidosis, reduced milk fat, and lameness in cattle. Heat stress (HS) influences milk composition negatively, especially a decrease in milk protein. In fattening animals, HS reduces feed intake, animal growth, and production efficiency. These extreme events have short-term effects and can last a day or two. Practical solutions can be adopted to reduce HS by modifying the diet, increasing the amount of water for drinking, providing shade, and a good air exchange in the barn and installing sprinklers. It is possible to increase animal welfare and product quality based on the conclusions of this review.

Examination Stress and Salivary Cortisol Levels in Kazakh and Indian Medical Students

Stress is an important component of modern life and has become a serious problem for the health of the population as a whole. Studying at a medical university is accompanied by significant psycho-emotional stress among students. Medical students experience acute stress during exams. One of the markers of stress is cortisol. Objectives: to evaluate the level of cortisol in Indian medical students and Kazakhstan medical students during the examination stress. Methods: The study involved 134 medical students aged from 18 to 23 years, of which 81 were men, 53 women, studying in the 1st, 2nd and 3rd years of the West Kazakhstan Medical University named after Marat Ospanov. Among them are 67 students from India (46 men and 21 women) and 67 students from Kazakhstan (35 men and 32 women). Groups for the study were formed by random sampling. Free cortisol concentrations in saliva were measured in a diagnostic laboratory using the standard kit "Cortisol Saliva ELISA" of the company "DBC". Results: No significant differences were found in the level of saliva cortisol under conditions outside exam stress (Cortisol 1) and saliva cortisol under exam stress conditions (Cortisol 2) between a group of Indian and Kazakhstan students without regard to year of study. The level of free saliva cortisol under conditions outside exam stress is significantly higher in the general group of women compared to the general group of men. Increased salivary cortisol levels under examination stress were observed in all groups and examined. Conclusion: Identification of a contingent of students with high levels of cortisol (i.e., more susceptible to stress) will allow us to develop and recommend a set of measures that will help reduce cortisol levels and neutralize its pathogenic effect on the functioning of the main systems of the body.

The role of testosterone and cortisol levels in nonsuicidal selfinjury in adolescents.

Nonsuicidal selfinjury (NSSI) is an important problem in adolescence, which is thought to serve several reinforcement functions (positive vs. negative, automatic vs. social). While the psychological mechanisms involved in NSSI are relatively well known, there is an important gap in the knowledge regarding the underlying biological mechanisms. This study examined the role of testosterone (T) and cortisol (C) in the frequency and reinforcement functions of NSSI. A total of 423 adolescents (age range = 13-17; 54.4% girls) from Basque Country (Spain) provided saliva samples to determine T and C levels and completed measures of NSSI 6 months later in 2017-2018. The results showed that T but not C was significantly associated with higher NSSI frequency and the four types of NSSI functions. In addition, C moderated the predictive association between T and NSSI for automatic negative reinforcement, such that this association was significant only when C was high. Participant sex did not moderate any association between hormones and NSSI. These preliminary results suggest that testosterone levels can affect NSSI behaviors in adolescence, thus helping to explain the increase in NSSI during this stage. Moreover, in situations in which NSSI serves to alleviate negative internal states, high levels of cortisol can be involved.

Study of the Effect of Massage Therapy on Serum Cortisol Concentration in a Patient with Chronic Stress

Stress is a condition that occurs when external or internal influences (stressors) are damaging or unusual in strength, which disrupt the homeostasis of the human organism. Cortisol is the glucocorticoid, which under the influence of stress factors increases its secretion more than 10 times. The aim of the study was to investigate the effect of massage therapy on serum cortisol concentration in patients with chronic stress. Material and methods: the study refers to a 3-month follow-up of a 32-year-old male patient with high serum cortisol levels. PSS – 10 (Perceived Stress scale) was used, serum cortisol was measured immunometrically with chemiluminescent labeling. Two courses of ten procedures were conducted with massage (classical or Chinese) therapy in the cervical-thoracic area. Results: Reduction of serum cortisol levels, reduction of pain symptoms, subjective and objective management of stressors. Conclusion: Massage therapy appears to be an effective method of managing stress and the pain symptoms associated with it.

Burnout components, perceived stress and hair cortisol in healthcare professionals during the second wave of COVID 19 pandemic

This study evaluates the impact of the COVID-19 pandemic on healthcare workers in Argentina, during the second wave in 2021. The aim is to assess stress and burnout, incorporating the assessment of hair cortisol levels as a biomarker of chronic stress. A total of 496 healthcare workers from three different hospitals were included in this study. Two of these hospitals depend on the Buenos Aires City Ministry of Health and the third hospital belongs to Buenos Aires University. Hair samples were obtained using scissors from the posterior vertex, as close to the scalp as possible. Each sample was weighed, and cortisol was extracted and then measured using an automated chemiluminescent method. Notably, 10% of the population exhibited hair cortisol levels above 128 pg/mg. Associations were found between high hair cortisol levels and age, workload, emotional exhaustion, and depersonalization. In addition, burnout, identified in 11% of participants, correlated with higher perceived stress and lower social support. Binary logistic regression revealed associations between burnout and perceived stress, and age. Finally, mediation analysis showed depersonalization as a mediating variable in the relationship between hair cortisol concentration and emotional exhaustion. In conclusion, this study highlights the complex relationships between stress, cortisol levels, and burnout. Prioritizing interventions and research is essential to support the well-being of frontline healthcare professionals, ensuring their resilience during challenging times.

Poor semen quality is associated with impaired antioxidant response and acute phase proteins and is likely mediated by high cortisol levels in Brucella-seropositive dromedary camel bulls

Brucellosis in dromedary camel bulls leads to either temporary or permanent loss of fertility. Camel brucellosis is associated with both orchitis and epididymitis. However, the clinical signs of camel brucellosis are not clear as those in cattle. Therefore, this study aimed to diagnose camel brucellosis based on a serological screening using Rose Bengal plate test (RBPT) followed by competitive ELISA. To understand the impact of brucellosis on camel bull fertility, this study aimed to examine the semen characteristics, evaluate the testicular histopathology, examine hormonal profile, antioxidants and acute phase proteins (APP). A total of 150 mature bulls were used in this study. Blood samples were collected for serological, hormonal, and biochemical analysis. This study revealed that 6.6% and 7.3% of the examined bulls were Brucella-seropositive using RBPT and competitive ELISA, respectively. The Brucella-seropositive dromedary bulls showed poor semen quality, pathological changes orchitis, and lower testosterone. Moreover, our findings showed a higher cortisol level, and significant impairments in the measured APP and antioxidants in Brucella-seropositive bulls. In conclusion, the Brucella-seropositive dromedary bulls showed lower fertility due to poor semen quality and lower testosterone levels. Such lower fertility is likely mediated by high cortisol levels, and impaired APP and antioxidants’ defense response.

Analysis of associations of personality traits and stress with the level of serum cortisol in Sakha (Yakut) men

The purpose of this study is to test the hypothesis that personality traits and stressful situations experienced in childhood could be associated with the level of serum cortisol. The sample included 121 healthy adult men of Yakut (Sakha) ethnicity aged 18 to 27 years. To assess personality traits, the TCI temperament and character questionnaire by R. Cloninger was used. Serum cortisol levels were assessed by enzyme-linked immunosorbent assay (ELISA). It was found that such a temperament trait as “reward dependence” is associated with higher level of cortisol in the blood (p = 0.04). Experienced stressful situations are associated with the character trait “self-transcendence” (p = 0.049) but do not significantly affect cortisol levels. In individuals with high levels of stress, significant correlations were found between the “novelty seeking” (r = 0.33) and “self-directedness” (r = 0.36) with serum cortisol levels, which may reflect the prolonged effect of stress on increasing the sensitivity of the adrenal cortex. The results indicate a possible connection between one of the human temperament traits “reward dependence” and higher levels of cortisol in the blood. A high level of experienced stress situations reduces scores on the character trait “self-transcendence.”

Exam-related changes in salivary oxytocin and cortisol levels of preclinical medical students

ABSTRACT Objective: The relationship between exam conditions with the peripheral oxytocin and cortisol levels and psychological characteristics by gender were investigated. Participants and Methods: Thirty-six preclinical medical students gave saliva samples in exam-free and pre-and post-exam conditions and completed a comprehensive psychometric questionnaire. Results: Before the theoretical exam, cortisol levels were elevated in females but not in males, whereas, oxytocin levels were similar in both sexes under exam conditions. Genders were equalized in terms of most psychometric properties. Females did not feel prepared for the exam and experienced more anxiety before the exam than males. Females had higher cortisol levels before the exam than after the exam, but no change was observed in the cortisol levels of males by the exam conditions. Oxytocin levels did not differ significantly for any condition or group. Conclusion: Females may need to be supported in study planning and time management to increase exam preparedness and stress management to increase coping with stress. The study’s small sample size casts a shadow on the generalizability of the results. In future studies, the research process can be spread over a longer period and more people can be reached by not giving up strict selection rules.

The CT-derived fat-free muscle fraction is associated with inflammation and predicts outcome in patients with aortic stenosis undergoing TAVR

Abstract Background The ESC guidelines underscore the importance of objective risk stratification in making patient-centered decision for valve interventions. However, they primarily rely on surgical risk scores, not considering essential factors such as frailty. Computed tomography (CT) is a routine part of the pre-interventional workup in patients undergoing TAVR and allows for body composition analysis, including the assessment of fat-free muscle fraction (FFMF) as an indicator of muscle quality. Purpose This study aimed to assess the correlation between FFMF and both inflammation and endocrine disorders, and to investigate the predictive value of FFMF in patients with aortic stenosis undergoing TAVR. Methods The study included 789 patients undergoing TAVR between 2017 and 2019. Evaluations involved CT scans to assess body composition. Using densitometric thresholds, the skeletal muscle area at L3/L4 level was separated into fatty and lean muscle to calculate the FFMF. The cohort was divided into tertiles of high, medium, and low FFMF, Figure 1. Results The study population was 45.5% female with a mean age of 81.2±6.0 years. Overall, 261 (33.1%) patients had a high FFMF, 293 (37.1%) had a medium FFMF, and 235 (29.8%) had a low FFMF. Patients with a low FFMF were older (82.3±5.9 vs 81.6±5.6 vs 79.8±6.2 years, p<0.01) and had higher rates of atrial fibrillation (52 vs 43 vs 37%, p<0.01), compared to those with a medium and high FFMF. Regarding body composition, low FFMF patients had a higher percentage of body fat (28.7±11.2 vs 26.8±9.1 vs 24.2±9.6%, p=0.01) and a lower percentage of body muscle (30.9±5.3 vs 31.3±4.2 vs 32.7±4.4%, p=0.03). Moreover, a low FFMF was associated with inflammation, as indicated by increased levels of C-reactive protein (6.3 vs 4.2 vs 3.1 mg/l, p<0.01) and procalcitonin (0.06 vs 0.05 vs 0.05 µg/l, p=0.01). Endocrinological assessment revealed lower levels of estradiol (6.8 vs 14.7 vs 15.0 pg/ml, p=0.02) and testosterone (0.18 vs 0.48 vs 2.35 ng/ml, p<0.01) as well as higher levels of cortisol (8.9 vs 7.7 vs 7.6μg/dl, p=0.05) in low FFMF patients. Regarding clinical outcomes, low FFMF was associated with increased one-year mortality (23.4%) compared to medium (11.6%) or low FFMF (3.8%, p<0.01), Figure 2A. This difference persisted over five years (p<0.01), Figure 2B. ROC curve analysis showed that FFMF had the strongest association with one-year mortality (AUC 0.75, p<0.01) and was superior to the STS-PROM (AUC 0.65) and EuroSCORE II (AUC 0.64). Multivariate analysis revealed that low FFMF was independently associated with mortality following TAVR (OR: 3.19 [CI: 1.64 – 6.22], p<0.01). Conclusion The CT-derived FFMF is associated with inflammation and endocrinological disorder in patients undergoing TAVR. Importantly, a low FFMF is a strong and independent predictor of dismal outcomes. FFMF assessment can seamlessly integrate into routine pre-interventional CTs, offering a promising objective parameter for outcome prediction.

Temperature, dietary lipids, and Aeromonas hydrophila modulate self-protection mechanisms in pacu Piaractus mesopotamicus Holmberg 1887.

Water temperature has a direct influence on several physiological processes in fish. This study investigated the effects of the exposure of pacu (Piaractus mesopotamicus) to 10 days of reduced temperature in stress and innate immune and antioxidant systems, all of which are involved in energy mobilization. Two groups of fish, fed a control diet or a diet with a higher lipid level, were exposed for 10 days to 16°C and then inoculated with Aeromonas hydrophila bacterin. Samples were taken before and after 5 and 10 days of exposure. The results showed that the low temperature (16°C) was a stressor, increasing cortisol levels. Higher levels of cortisol were seen in fish with more body fat, especially at 16°C, compared to those fed control diet. The immune system was enhanced by low temperature that activated the hemolytic activity of the complement system (HAC50) and lysozyme after 10 days of exposure in fish with more body fat. Bacterin inoculation, regardless of temperature and body fat, impaired the respiratory activity of leukocytes, but the complement system activity remained at the levels seen before cold activation. Similarly, lysozyme remained at the levels seen before cold activation, showing later activation. Furthermore, soon after inoculation (at 3 and 6 h), bacterin induced oxidative stress that decreased at 24 h when the concentration of reduced glutathione (GSH) showed lower levels, suggesting that GSH was consumed to attenuate the oxidative stress. Pacu was resilient to the reduced temperature, displaying protective responses to the stressful condition using lipids to modulate these responses.

7464 Delayed Diagnosis of Cushing’s Disease after Five Year History of Hirsutism

Abstract Disclosure: E. McBride: None. A.N. Davis: None. G. Elshimy: None. J. Vender: None. Introduction: Women may experience hirsutism for years before seeing a physician or before undergoing diagnostic testing. This case demonstrates that delayed workup of hirsutism can lead to delayed diagnosis and treatment of aggressive Cushing’s disease. Case: A 40-year-old African American female presented for initial evaluation with a 5-year history of hirsutism, which had never been evaluated, and a high cortisol level in the setting of type 2 diabetes mellitus and hypertension. She had a 60lb weight gain over 5 years, progressive hirsutism, easy bruising, and purple striae. Labs were significant for cortisol 23.86mcg/dL, ACTH 67pg/mL, HbA1c 8.9%, DHEAS 347mcg/dL, 17-OH progesterone 102ng/dL. A 1mg dexamethasone suppression test resulted in a non-suppressed cortisol of 12.64mcg/dL. She had an elevated 24 hour urine free cortisol level of 78mcg and an elevated midnight salivary cortisol with values of 474ng/dL and 396ng/dL. An 8mg dexamethasone suppression test resulted in a cortisol of 5.55mcg/dL. MRI brain pituitary protocol revealed a 6x4mm microadenoma of the pituitary gland. This is consistent with an ACTH producing pituitary adenoma (Cushing’s disease). The microadenoma was surgically removed by transsphenoidal approach. The pathology of the tumor revealed an elevated Ki-67 of 5%. Patient required hydrocortisone replacement for a couple of months that was later discontinued. Moreover, she is no longer on any medications for her diabetes, and her hypertension significantly improved postoperatively. Discussion: Hirsutism and androgen excess in women are most commonly caused by polycystic ovarian syndrome (PCOS). However, non-PCOS diagnoses, such as Cushing’s disease, should be considered as they are commonly missed due to lack of a pragmatic screening approach. Pituitary microadenomas are often benign, but 30-40% of cases are invasive and considered aggressive. Aggressiveness can be evaluated by using the tumor marker Ki67, which is a nuclear marker that reflects cell proliferation. While controversial, one proposed cutoff for aggressive pituitary adenomas is Ki67 ≥3%. The pathology of the tumor in this patient was aggressive with Ki67 of 5% This case demonstrates the importance of identifying hirsutism early in order to exclude the more dangerous causes of hirsutism such as Cushing’s disease. By early diagnosis and surgery, we may limit the progression of associated comorbidities such as diabetes mellitus and limit the growth of a potentially aggressive adenoma. Presentation: 6/1/2024

8411 Ectopic ACTH-dependent Cyclical Cushing’s Syndrome- the Art of Hide-and-seek

Abstract Disclosure: H. Mon: None. A. Kapoor: None. S. Qureshi: None. M. Martineau: None. K. Meeran: None. Case report: A 72-years-old lady was admitted with hypokalaemia, hyperglycaemia with metabolic alkalosis with background hypertension, type2 diabetes, osteoporosis and right-sided breast cancer treated with chemotherapy and radiotherapy 3years ago. She was previously seen in Endocrinology Clinic for similar episode and deemed not having Cushing’s or Conn’s syndrome on workup. During this admission, although there was no obvious Cushingoid appearance, there was refractory hypokalaemia. On further exploration, there were previous admissions with similar episodes in UK and in her home country, within the same year, a few months apart. Therefore, endocrinology workup was conducted for suspected cyclical Cushing’s syndrome. It demonstrated raised 24-hour urinary free cortisol of 5643 nmol/24hour (reference range 0-164 nmol/24hours), unsuppressed low dose dexamethasone suppression test with cortisol level of 800 nmol/L and increased ACTH level of 429 ng/L. MRI (pituitary) showed no pituitary lesion with probable empty sella and CSF filled. However, CT (thorax) showed enlarging lesion (previously from 1cm to 1.6cm) in the left lower lobe, concerning lung metastasis or primary lung malignancy. PET scan showed left lower lobe nodule having low-grade activity with likelihood of indolent malignancy and appearances of physiologic adrenal hyperplasia. Management: Given persistently high cortisol levels during admission with ongoing hyperglycaemia and refractory hypokalaemia, metyrapone was started and titrated accordingly. Her clinical condition including potassium and cortisol levels effectively responded to metyrapone. Gallium scan was booked for detail localization with ongoing lung MDT (multidisciplinary team meeting) and neuroendocrine tumour MDT.However, after starting metyrapone, she had type 1 respiratory failure, not responding to initial antibiotics. After excluding other possible respiratory aetiologies, empirical treatment for Pneumocystosis pneumonia (PCP) was initiated, after which blood test for Beta-D-glucan was found out to be significantly raised, supporting the presumptive diagnosis. Conclusion: Our case highlighted the following interesting points 1. diagnostic challenges, due to the fluctuating nature of cyclical Cushing’s syndrome, presenting with recurrent hypokalaemia. 2. the interesting nature of likely ACTH-dependent cyclical Cushing’s syndrome, progressing into florid Cushing’s syndrome, with efficacy to metyrapone 3. rare and compelling combination of 3 conditions of Cyclical Cushing’s syndrome, being ectopic ACTH-dependent and complicated by Pneumocystosis pneumonia (PCP). Presentation: 6/1/2024

8193 Mauriac Syndrome Uncovered, The Insulin Access Impact in Type 1 Diabetes Mellitus

Abstract Disclosure: D.H. Sacoto: None. R. Belokovskaya: None. K. Gebran: None. K. Madani: None. A. De Rosairo: None. D. Patel: None. A.A. Franco-Akel: None. Introduction: Mauriac syndrome is a rare complication of poorly controlled type 1 diabetes mellitus (T1DM). It is reversible with appropriate glycemic control; however, factors affecting healthcare access to insulin are leading to its re-emergence. We present a case of Mauriac syndrome as a complication of uncontrolled T1DM due to insulin access. Case: A 22-year-old Hispanic female with a history of T1DM presented to the emergency department with a two-day history of abdominal pain. She was diagnosed with diabetic ketoacidosis (DKA) (blood glucose: 802 mg/dL; pH 7.14; bicarbonate: 7 mmol/L; anion gap: 34; positive serum ketones). Incidental transaminitis was noted. R factor showed a cholestatic pattern of 0.6 (AST: 136 U/L, ALT: 49 U/L, alkaline phosphatase:286 U/L). US liver revealed an enlarged liver (craniocaudal: 16.5 cm) without biliary obstruction. Her phenotype consisted of short stature (4.8 feet) with a moon face and a protuberant abdomen. Her records revealed a normal karyotype 46 XX, with a bone age of 4 years, pubertal delay, low insulin-like growth factor-1 levels (58 ng/mL), and long-standing hyperlipidemia. Over the years, she experienced multiple DKA episodes in the context of uncontrolled T1DM (hemoglobin A1c:11-13 %). The main problem identified included difficulty with insulin access, specifically related to insurance coverage as well as managing her disease. Glycemic control has significantly improved with continuous glucose monitoring and updated insurance status. Discussion: Mauriac syndrome is characterized by hepatomegaly, transaminitis, delayed pubertal maturation, growth failure, and cushingoid features. Hyperglycemia leads to intrahepatic glycogen deposition and the lack of insulin to lipolysis and ketosis, leading to high cortisol levels and growth delay. Factors leading to uncontrolled T1DM include lack of insulin access. The high cost is considered a major barrier, with an average price per millimeter of insulin tripled from 231 to 736 US dollars. Even patients with insurance tend to have high co-pays and deductibles, with a 61% chance of delay or denial due to pre-approval requirements. Lower socioeconomic status, lack of access to devices such as insulin pumps, migratory status, social support, and ethnic background are other factors related to glycemic control. Our patient belongs to a family of immigrants with low socioeconomic status, which might have contributed to the development of Mauriac syndrome. Since clinical and laboratory abnormalities are reversible with appropriate glycemic control, advocating for policies that facilitate better insulin access is paramount. Presentation: 6/2/2024

Effects of herbal medicine on ovulation in premature ovarian insufficiency patients during in vitro fertilization

Introduction: Premature ovarian insufficiency (POI) is a condition in which menopause occurs before the age of 40 and is known to be a relatively common disease that occurs in 1% of all women. The only way for patients diagnosed with POI to become pregnant is through oocyte donation, in which fertilized ovums are transplanted by receiving oocytes from donors.4 Can POI patients increase their chances of normal ovulation? POI patients were more likely to observe and collect follicles larger than the average 15 mm diameter when herbal medicine was administered. Methods: This study is a retrospective cohort study conducted on POI patients undergoing in vitro fertilization (IVF) who visited our hospital from 2020 to 2022. We would like to report the response rate to gonadotropin-releasing hormone (GnRH) during IVF in the hyperovulation induction low response group after herbal medicine treatment. Statistical analysis was performed using IBM’s SPSS Statistics to verify significance with a P-value<0.05. Results: In recovering ovarian POI patient's ovarian function, herbal medicine treatment increased the response rate to GnRH (the number of oocytes collected) during IVF, follicle-stimulating hormone (FSH) and cortisol levels decreased, and estradiol (E2) and luteinizing hormone (LH) levels increased. Conclusions: It was confirmed that herbal medicine treatment can increase the probability of normal ovulation in patients with idiopathic POI with high cortisol levels. Until now, it has been known that ovarian function cannot be recovered once irreversibly decreased, but by increasing the probability of ovulation through herbal medicine treatment, it is significant that it may be possible to suppress ovarian aging or preserve fertility.

Determining the Levels of Cortisol, Testosterone, Lactic Acid and Anaerobic Performance in Athletes Using Various Forms of Coffee.

Coffee is considered one of the most preferred and consumed beverage types in the world, and caffeine is known to increase physical performance due to its ergogenic properties. The aim of this study is to examine the effects of coffee consumption in different forms on cortisol, testosterone, lactic acid and anaerobic performance levels. A total of 15 licensed male football players participated in the research voluntarily. The research was implemented in a single-blind, counterbalanced, randomized and crossover study design. Participants were given caffeinated coffee (CK), decaffeinated coffee (placebo) (DK), powdered caffeine (in a gelatin capsule) (PC) and powdered placebo (maltodextrin in a capsule) (PM) on different days, and the Wingate test protocol was performed after the warm-up protocol. Blood samples were collected post-test. Cortisol, testosterone and lactic acid levels in the serum samples taken were determined by the ELISA method. As a result, it was revealed that caffeinated coffee given to participants who exercise increased anaerobic power. However, it was observed that lactic acid levels were higher in placebo and decaffeinated coffee. The highest level of cortisol was found in caffeinated coffee and powdered caffeine compared to the placebo. Testosterone values were observed to be highest in caffeinated coffee and decaffeinated coffee compared to a placebo. The study suggests that the type of caffeine is a factor that affects absorption rate, which impacts performance and hormone levels.

Dynamic interplay of cortisol and BDNF in males under acute and chronic psychosocial stress – A randomized controlled study

The neurotrophic protein brain-derived neurotrophic factor (BDNF) plays a pivotal role in brain function and is affected by acute and chronic stress. We here investigate the patterns of BDNF and cortisol stress reactivity and recovery under the standardized stress protocol of the TSST and the effect of perceived chronic stress on the basal BDNF levels in healthy young men. Twenty-nine lean young men underwent the Trier Social Stress Test (TSST) and a resting condition. Serum BDNF and cortisol were measured before and repeatedly after both conditions. The perception of chronic stress was assessed by the Trier Inventory for Chronic Stress (TICS). After the TSST, there was a significant increase over time for BDNF and cortisol. Stronger increase in cortisol in response to stress was linked to an accelerated BDNF decline after stress. Basal resting levels of BDNF was significantly predicted by chronic stress perception. The increased BDNF level following psychosocial stress suggest a stress-induced neuroprotective mechanism. The presumed interplay between BDNF and the HPA-axis indicates an antagonistic relationship of cortisol on BDNF recovery post-stress. Chronically elevated high cortisol levels, as present in chronic stress, could thereby contribute to reduced neurogenesis, and an increased risk of neurodegenerative conditions in persons suffering from chronic stress.