Higher Serum Cortisol Levels Research Articles

ACTH-cortisol dissociation in patients with Kawasaki disease: a retrospective study.

ACTH-cortisol dissociation is recognized in patients with critical illnesses. Cytokines, including tumor necrosis factor-α and interleukin-6 induce hypercortisolemia by enhancing the ACTH-independent synthesis and secretion of cortisol and by reducing cortisol breakdown. Subsequently, hypercortisolemia suppresses ACTH secretion by negative feedback inhibition. ACTH-cortisol dissociation in patients with systemic inflammatory diseases has not been reported. Here, we examined whether ACTH-cortisol dissociation is recognized in patients with Kawasaki disease (KD) associated with hypercytokinemia, as well as the possible cytokine involvement in ACTH-cortisol dissociation, retrospectively. The levels of serum cortisol, plasma ACTH, and cytokine-induced proteins, i.e., plasma C-reactive protein (CRP), serum ferritin, and urinary β2-microglobulin (U-β2MG), in 232 patients with KD were measured at diagnosis. Quartile groups based on cytokine-induced protein levels were formed (Q1, Q2, Q3, and Q4). We found a low median plasma ACTH [median (range): 8.9 (<2.0-332.0) pg/mL] but a high median serum cortisol level [median (range): 25.8 (1.4-99.8) μg/dL] in the entire study population. The median serum cortisol levels were significantly higher in the CRP-Q4, ferritin-Q4, and U-β2MG-Q4 groups than in the CRP-Q1, ferritin-Q2, and U-β2MG-Q1 groups, respectively (p < 0.01; p < 0.01; p < 0.001). The median plasma ACTH levels were significantly lower in the CRP-Q4 and ferritin-Q4 groups than in the CRP-Q1 and ferritin-Q1 groups, respectively (p < 0.001; p < 0.001). ACTH-cortisol dissociation was identified in patients with KD. Our findings suggest that inflammatory cytokines are involved in ACTH-independent hypercortisolemia in patients with KD. ACTH-cortisol dissociation in other systemic inflammatory diseases needs further investigation.

Brain structural network alterations related to serum cortisol levels in drug-na\xefve, first-episode major depressive disorder patients: a source-based morphometric study

Higher cortisol levels due to a hyperactive hypothalamic–pituitary–adrenal axis have been reported in patients with major depressive disorder (MDD). Increased cortisol levels change both the brain morphology and function in MDD patients. The multivariate source-based morphometry (SBM) technique has been applied to investigate neuroanatomical changes in some neuropsychiatric diseases, but not MDD. We aimed to examine the alterations in gray matter (GM) networks and their relationship with serum cortisol levels in first-episode, drug-naïve MDD patients using SBM. Forty-two patients with MDD and 39 controls were recruited via interviews. Morning serum cortisol levels were measured, and high-resolution T1-weighted imaging followed by SBM analysis was performed in all participants. The patients had significantly higher serum cortisol levels than the controls. We found two GM sources, which were significantly different between patients with MDD and controls (prefrontal network, p < .01; insula-temporal network, p < .01). Serum cortisol levels showed a statistically significant negative correlation with the loading coefficients of the prefrontal network (r = − 0.354, p = 0.02). In conclusion, increased serum cortisol levels were associated with reductions in the prefrontal network in the early stage of MDD, and SBM may be a useful approach for analyzing structural MRI data.

MON-200 Clinical Characterizations of Aldosterone- and Cortisol-Producing Adrenal Tumors in Primary Aldosteronism

Objective: Aldosterone- and cortisol-producing adrenal tumors (A/CPTs) are considered to be a subtype of primary aldosteronism (PA). The clinical characterizations of these tumors are still unclear, and they are often neglected by clinicians. The aim of this study was to summarize the clinical characterizations of these tumors to reduce the missed diagnosis. Methods: The clinical, imaging and pathological data of patients with PA admitted to our hospital from January 1, 2013 to December 31, 2016 was reviewed. All the PA patients with a combination of a positive aldosterone-to-renin ratio (ARR) and a positive captopril challenge test (CCT), in whom the dexamethasone inhibition test was performed as well, were included in our study. These patients were divided into two groups, A/CPTs group and simple PA group, according to the function of cortisol secretion. The data of the two groups were compared and analyzed with SPSS 23.0. P<0.05 was statistically significant. Results: There were 87 patients with PA included in our study, 32 of whom (36.8%) were diagnosed with A/CPTs. In these 32 A/CPTs patients, 31 patients (96.9%) were combined with subclinical Cushing syndrome. Compared to these in simple PA group (n=55), the patients in A/CPTs group (n=32) were elder (53.81±10.70 ys vs 48.42±10.17 ys, P=0.022), with larger diameter of adrenal tumors (1.50cm vs 1.15cm, P=0.001), higher fasting plasma glucose (5.33mmo/L vs 4.99mmol/L, P=0.047), higher serum cortisol levels and lower serum ACTH levels (all P<0.05). 24 patients in A/CPTs group and 23 patients in simple PA group underwent adrenalectomy. 6 patients (25.0%) in A/CPTs group and 3 patients (13.0%) in simple PA group received glucocorticoid replacement therapy after adrenalectomy. Conclusions:The prevalence of A/CPTs in PA is high. The patients with A/CPTs are mainly combined with subclinical Cushing syndrome, and prone to need glucocorticoid replacement therapy. Therefore, we recommend that all patients with PA should evaluate the function of cortisol secretion, and all patients with A/CPTs should be followed up closely after adrenalectomy to reduce the morbidity of adrenal insufficiency.

High Serum Cortisol levels are associated with fatigue and verbal fluency in Parkinson’s Disease: preliminary results (4137)

High Serum Cortisol levels are associated with fatigue and verbal fluency in Parkinson’s Disease: preliminary results (4137)

The Relation between Role of Serum Cortisol Level and Response to Various Respiratory Support Strategies among Preterm Infants

Introduction: Preterm infants are liable to various health problems including respiratory distress syndrome (RDS). There is variation in response to respiratory support. In preterm infants, cortisol hormone is secreted by the adrenocortical gland in response to stress. Objectives: To compare the serum cortisol levels in blood among preterm infants who needed different respiratory support strategies e.g. headbox, continuous positive airway pressure (CPAP), intubation surfactant extubation (INSURE) and mechanical ventilation (MV) and to correlate the cortisol levels to the severity of respiratory distress syndrome (RDS). Material and Methods: Observational prospective study that assessed the serum cortisol levels in preterm infants with RDS after initial respiratory support aged 28 - 34 gestational weeks that were admitted to the neonatal intensive care unit of Al Zahraa hospital of Al-Azhar University and Al-Estekama hospital between February 2019 and November 2019. Infants were classified into three groups, Group 1: 29 infants with severe RDS who needed a mechanical ventilator. Ten of them needed surfactant therapy. Group 2: 33 infants with moderate RDS who needed CPAP. Three of them needed surfactant therapy. Group 3: 28 infants with symptoms of mild RDS who needed headbox. None of them needed surfactant therapy. Blood samples were collected on the first day of life and were processed using the colorimetric ELISA method. Demographic and medical information was collected. Results: A total of 90 preterm infants were included. The serum cortisol reference was 4.3 - 22.4 mg/dl. Group 1 showed significantly higher serum cortisol levels compared to group 2 and group 3 (39.22 ± 9.91 mg/dl vs 28.96 ± 6.48 mg/dl vs 25.88 ± 5.42 mg/dl) respectively, (P-value = 0.001). Infants in group 2 who needed surfactant therapy had higher serum cortisol levels than those who did not need surfactant therapy (32.30 ± 5.92 mg/dl vs 28.33 ± 6.27 mg/dl). The serum cortisol levels were observed having a negative correlation with gestational age and birth weight. No significant differences were observed in terms of gender or type of delivery. Conclusion: Cortisol levels had a positive correlation with the severity of RDS who needed various respiratory support strategies.

Gamma Knife radiosurgery: effect on corticotropin-secreting pituitary adenoma

Introduction: Cushing's disease (CD) is a complex endocrine disorder characterized by an increased risk of recurrence and persistence of hypercortisolism after initial transsphenoidal adenomectomy, a situation requiring alternative therapeutic measures.&#x0D; Case presentation: A 21-year-old female patient was admitted for weight gain with centripetal fat distribution, transient headache, hair thinning and psycho-emotional lability. Clinical examination revealed round facies, acne, purple-red striae, hirsutism with a Ferriman-Gallwey score of 20. The hormonal profile revealed high serum cortisol (of 283.1 ng/mL, normal:70-225 ng/mL) and high ACTH (Adrenocorticotropic Hormone) levels (of 260.6 pg/mL, normal: 7.2-63.3 pg/mL). The pituitary MRI (Magnetic Resonance Imaging) examination found a 4.3/4.4/6.2mm left paramedian microadenoma. The persistence of hypercortisolism after adenomectomy required GKRS (Gamma Knife radiosurgery). Four months after radiosurgery, complete remission of the disease was achieved and it was maintained at the last evaluation. At present, the patient is 20 weeks pregnant.&#x0D; Conclusions: Gamma Knife radiosurgery offers a high control rate of pituitary adenomas and a reasonable rate of remission of residual hypercortisolism after neurosurgical treatment. After surgery or GKRS, periodic monitoring is necessary for patients with CD due to the risk of pituitary insufficiency or relapse.

Editors' note: Circulating cortisol and cognitive and structural brain measures: The Framingham Heart Study

Using cross-sectional data from the Framingham Heart Study including nondemented middle-aged adults, Echouffo-Tcheugui et al. identified an association between higher serum cortisol levels and lower brain volume and poorer performance on a variety of cognitive assessments. Although the serum cortisol measurement was acquired at a single point in time, and may not be reflective of chronic elevations in cortisol as Barbosa et al. assert, the data are strongly suggestive of a correlation. The investigators also agree that hair cortisol might be a better indicator of long-term cortisol levels; however, these data were not available in this observational cohort. Drs. Jimenez-Pavon and Carbonell-Baeza comment on the role that physical activity (PA) and cardiorespiratory fitness (CRF) may have on structural brain integrity and cognitive performance. Some of these associations from the Framingham Heart Study have been previously published in Neurology ® in 2016. Although analysis of these physiologic variables may be worthy of further investigation, Echouffo-Tcheugi et al. argue that PA and CRF may alter cortisol levels (and thereby, neural structure and function), but that such a mediation could lead to an overadjustment. Based on the results of this analysis, the investigators emphasize that cortisol levels may be the bridge the between PA/CRF and brain volume and cognitive performance. Using cross-sectional data from the Framingham Heart Study including nondemented middle-aged adults, Echouffo-Tcheugui et al. identified an association between higher serum cortisol levels and lower brain volume and poorer performance on a variety of cognitive assessments. Although the serum cortisol measurement was acquired at a single point in time, and may not be reflective of chronic elevations in cortisol as Barbosa et al. assert, the data are strongly suggestive of a correlation. The investigators also agree that hair cortisol might be a better indicator of long-term cortisol levels; however, these data were not available in this observational cohort. Drs. Jimenez-Pavon and Carbonell-Baeza comment on the role that physical activity (PA) and cardiorespiratory fitness (CRF) may have on structural brain integrity and cognitive performance. Some of these associations from the Framingham Heart Study have been previously published in Neurology ® in 2016. Although analysis of these physiologic variables may be worthy of further investigation, Echouffo-Tcheugi et al. argue that PA and CRF may alter cortisol levels (and thereby, neural structure and function), but that such a mediation could lead to an overadjustment. Based on the results of this analysis, the investigators emphasize that cortisol levels may be the bridge the between PA/CRF and brain volume and cognitive performance.

Relation between Baseline Total Serum Cortisol Level and Outcome in Pediatric Intensive Care Unit

Elevated cortisol level is an component of the stress response. However, some patients have low cortisol levels; a condition termed: critical illness-related corticosteroid insufficiency (CIRCI). Basal cortisol levels during PICU admission may be related to outcome. This prospective cohort study aimed to assess basal total serum cortisol levels and their relation to outcome in PICU. The study included 81 children over 6 months. Total serum cortisol was assessed using an early morning sample. The severity of illness was assessed using the PRISM-III score. Outcome measures included mechanical ventilation duration, use of inotropic support, length of stay, mortality. Comparison between patients’ subgroups according to total serum cortisol levels revealed significantly higher PRISM-III score in patients with total serum cortisol levels. In addition, those patients had a significantly higher mortality rate when compared with patients with low and normal total serum cortisol levels. Multivariate logistic regression analysis recognized high total serum cortisol level and PRISM-III score as significant predictors of mortality. We concluded that PRISM-III score and elevated total serum cortisol levels are significant predictors of mortality in the PICU. Although CIRCI is prevalent in this population, it wasn’t associated with an increased mortality rate.

High Serum Cortisol Levels as a Potential Indicator for Changes in Well-Regulated Daily Life among Junior High School Students.

Problematic smartphone use among adolescents has become a social concern and is associated with poor sleep quality. The relationship between life habits, such as smartphone use and sleep duration, and levels of immunological and neuroendocrine biomarkers, including the stress hormone cortisol, in adolescents seems to be important to objectively comprehend their health and well-being in school life. However, such a relationship has not been well documented. We therefore studied rural junior high school students in Japan to elucidate the relationship between serum cortisol (SC) levels and their life habits. A total of 155 students in the seventh grade in 2016 were recruited as subjects. Of them, 140 students with eligible responses and blood samples (12-13 years; 80 boys, 60 girls) were finally included in the study (response rate 90.3%). A questionnaire survey concerning wake-up time, sleep duration, and the length of time using a smartphone per day was conducted. Blood samples were collected from peripheral veins of participants under fasting conditions between 8:30 and 11:00 a.m. The Spearman rank correlation coefficients were as follows: between SC and wake-up time, 0.199 (p = 0.018); between SC and sleep duration, 0.185 (p = 0.029); and between SC and time spent on smartphones, 0.172 (p = 0.042). The multiple regression analysis showed that high SC levels were significantly associated with late wake-up time and with short sleep duration. We therefore propose that measuring SC levels is useful for early detection of the change in the well-regulated daily life among junior high school students.

Serum cortisol level as a useful predictor of surgical disease in patients with acute abdominal pain

Introduction. The immediate aim should be to identify potentially resuscitative acute abdominal pain that requires prompt investigation or early surgical interven-tion. We aimed to evaluate whether serum cortisol levels differentiate surgical and non-surgical disease in patients with acute abdominal pain.&nbsp;Materials and methods. In this prospec-tive cross-sectional study, the primary end-point was defined as differences in serum cortisol levels between surgically and non-surgically treated patients with non-traumatic acute abdominal pain. The secondary end-point was to compare the cortisol levels with defined complete blood count (CBC) parameters in those groups. Results. One hundred eleven patients with acute abdominal pain were included in the study. Three most frequent diagnoses were nonspecific abdominal pain, acute appendicitis and dyspeptic complaints. Thirty patients were hospitalized and 22 of them were operated. The median cortisol level was 23.13 µg/dl in surgically treated patients and 13.94 µg/dl in non-surgically treated patients (p&lt;0.001). The area under the ROC curve using cortisol to detect surgical disease was 0.750 (95% CI, 0.659-0.827) and the accuracy of cortisol to de-tect surgical disease was not inferior to de-fined CBC parameters. A cortisol value of 17.98 µg/dl had a sensitivity of 67.4% and a specificity of 77.3% for surgical disease. Conclusion. Operated patients had higher serum cortisol levels. High serum cortisol levels may indicate surgical disease at the early stage on admission in ED patients with acute abdominal pain and may be used as a marker in the prediction of acute surgical abdomen.

The Possible Effects of High Vessel Traffic on the Physiological Parameters of the Critically Endangered Yangtze Finless Porpoise (Neophocaena asiaeorientalis ssp. asiaeorientalis).

Background: Poyang is the largest freshwater lake in China, where the acoustic environment and space for the critically endangered Yangtze finless porpoises (YFPs) has been altered by heavy vessel traffic and dredging activities. The density of vessel and the rate of dredging increases annually, especially in the area with the highest density of YFPs. The heavy vessel traffic can cause an increase in the physical activities and direct physical injuries to the YFPs. Furthermore, noise is a potent stressor to all cetaceans irrespective of age and can compromise all their physiological functions. The objective of this study was to examine the possible effects of heavy vessel traffic and dredging on the biochemistry, hematology, adrenal, thyroid, and reproductive hormones of two different YFP populations. One population was living in Poyang Lake and the second living in the Tian-E-Zhou Oxbow which is a semi-natural resserve.Results: The results showed statistically significantly higher levels of serum cortisol, fT3, fT4, and lowered testosterone in both adult and juvenile YFPs living in Poyang Lake vs. adult YFPs living in the Tian-E-Zhou Oxbow. The serum biochemical parameters (Aspartate Amino Transferase, Alkaline Phosphatase, High Density Lipoprotein cholesterol ratio, Globulin, Uric acid, Glucose, K+, and Amylase) and the hematology parameters (Red Blood Cells, Hematocrit, Mean Corpuscular Volume, White Blood Cells, and Eosinophils) were statistically significantly higher in the adult Poyang Lake YFPs vs. adult Tian-E-Zhou Oxbow YFPs. On the other hand, adult males of the Tian-E-Zhou Oxbow also showed significantly higher levels of the serum biochemical parameters (Total Cholesterol, Light Density Lipoprotein cholesterol, Direct Bilirubin, Albumin, Lactate Dehydrogenase, CO2, and Na+) and the blood parameters (Mean Corpuscular Hemoglobin and Mean Corpuscular Hemoglobin Concentration). In Poyang Lake YFPs, various parameters showed significantly positive (fT4, amylase, neutrophil, Ca+2) or negative (total protein, lymphocyte) correlations with cortisol levels.Conclusions: The hyperactivity of adrenal glands in response to heavy vessel traffic and dredging resulted in significantly elevated cortisol levels in Poyang Lake YFPs. The higher cortisol level could possibly have affected various hormonal, hematological, and biochemical parameters, and ultimately the YFPs physiology.

Hormonal aggressiveness according to the expression of cellular markers in corticotroph adenomas.

The molecular mechanisms underlying tumor growth in Cushing's disease (CD) still remain a challenge. Moreover, clinical manifestations of CD may vary depending on hormonal activity; however, factors involved in the hormonal aggressiveness of adrenocorticotropic hormone (ACTH)-secreting pituitary tumors have not been fully clarified. We investigated the association between the expression of cellular markers regarding pituitary tumor progression and initial or postoperative hormone levels in patients with CD. Tumor tissues from 28 corticotroph adenomas (female 26, male 2, mean age 39.21 ± 10.39 years) were subject to immunohistochemical study using the following antibodies: pituitary tumor-transforming gene 1 (PTTG1), cyclin D1, p16, p27, brahma related-gene 1 (Brg1), and Ki-67. We then analyzed the relationship between each cellular marker expression and hormone levels, including 24 h urinary free cortisol (UFC), plasma ACTH, and serum cortisol. PTTG1 and Ki-67 were expressed in 100% and 50% of patients, respectively. However, the levels did not reflect initial hormonal activity. The cyclin D1-negative group showed higher serum cortisol levels compared to the cyclin D1-positive group (p = 0.01). The 24 h UFC levels were significantly higher in the p27-negative group than in the p27-positive group (p = 0.04), whereas the Brg1-positive group revealed higher serum cortisol levels than in the Brg1-negative group (p = 0.02). Although PTTG1 and Ki-67 play an essential role in developing ACTH-secreting tumors, cyclin D1, p27, and Brg1 may be better biomarkers to determine hormonal aggressiveness of the tumor. Further research is needed to understand the influence of cellular markers on hormonal activity in CD.

Measurement of midnight ACTH levels is useful for the evaluation of midnight cortisol levels

ObjectiveElevated midnight cortisol levels induced by non-suppressed ACTH levels may lead to false-positive results for hypercortisolism in patients with adrenal incidentaloma. We investigated whether plasma ACTH-associated high midnight serum cortisol levels are correlated with other endocrinological findings with respect to hypothalamic-pituitaryadrenal function or hypercortisolism status. MethodsTwo-hundred-forty-six patients with adrenocortical adenoma were evaluated via measurements of midnight ACTH and cortisol levels, a 1-mg dexamethasone suppression test (DST), and a cosyntropin-releasing hormone (CRH) stimulation test. Patients were divided into four groups according to their midnight plasma ACTH levels. ResultsThe groups with higher midnight ACTH levels had significantly higher basal ACTH levels. A positive relationship was observed between midnight serum cortisol and serum cortisol in the 1-mg DST for all groups; stronger associations were observed in the group with lower midnight ACTH. In the CRH test, peak, delta, and sigma ACTH had significant inverse relationships with midnight cortisol levels in the lowest and second lowest midnight ACTH groups. Patients with midnight cortisol levels >3.5 μg/dL were further divided into two groups according to whether their midnight plasma ACTH levels were below or above 10.0 pg/mL. There were significantly fewer patients with hypercortisolism in the higher ACTH group; midnight serum cortisol levels were associated with hypercortisolism only in the lower ACTH group. ConclusionWe demonstrated that midnight ACTH-associated cortisol values were not correlated with other endocrinological findings or hypercortisolism state. Measurement of midnight ACTH levels is important, and careful evaluation is needed for patients with higher midnight ACTH levels.

Association of nocturnal serum cortisol level with diabetic microvascular complications in overweight/obese type 2 diabetic patients

Objective To explore the association of nocturnal serum cortisol levels with diabetic microvascular complications in overweight or obese patients with type 2 diabetes mellitus. Methods Serum cortisol levels of 316 overweight or obese type 2 diabetic patients were tested at midnight by the method of chemiluminescence. Diabetic microvascular complications were compared among various groups according to nocturnal serum cortisol levels. All the patients with nocturnal serum cortisol level >50 nmol/L were asked to undergo overnight low-dose dexamethasone suppression test to rule out the possibility of subclincal Cushing′s syndrome. The incidences of diabetic nephropathy (DN), diabetic retinopathy (DR), and diabetic peripheral neuropathy (DPN) were examined in all the patients. Results (1)The incidence of DN was gradually increased from 13.3% to 27.7% and 44.2% in patients with low, medium, and high cortisol level groups, showing a statistical difference among 3 groups(P<0.05). The incidences of DR in medium and high cortisol level groups were higher than that in low cortisol level group (40.6% and 47.7% vs 22.7%, both P<0.01). The incidence of DPN in high cortisol level group was higher as compared with low cortisol level group (60.5% vs 38.7%, P<0.01). (2)Nocturnal serum cortisol level in patients with diabetic microvascular complications was higher than that in patients without complications [ (136.87±105.78 vs 97.55±93.48) nmol/L, P<0.01]. Nocturnal serum cortisol level in patients with multiple diabetic microvascular complications was higher than that in patients with single diabetic microvascular complication [ (151.66±114.54 vs 117.69±90.26) nmol/L, P<0.05]. (3)Single factor logistic regression analysis showed that higher nocturnal serum cortisol level was a risk factor for diabetic microvascular complications in addition to female, age, longer diabetic duration, higher fasting plasma glucose (FPG). Multivariate logistic regression analysis showed that higher nocturnal serum cortisol level was still a risk factor for diabetic microvascular complications after adjusted by diabetic duration, FPG, HbA1C, and the use of insulin (P=0.013). Conclusion Nocturnal serum cortisol level seems to be a risk factor for diabetic microvascular complications in overweight or obese patients with type 2 diabetes mellitus. (Chin J Endocrinol Metab, 2018, 34: 834-838) Key words: Overweight; Obese; Diabetes mellitus, type 2; Cortisol; Diabetic microvascular complications

Serum Cortisol as a Predictor of Major Adverse Pulmonary Event in Emergency Department Acutely Dyspneic Patients.

Cortisol is a steroid hormone released from the adrenal glands in response to stressful conditions. Elevated cortisol levels have been described in stress, but it is unclear whether these are associated with adverse outcomes. In this study, we assess whether cortisol levels drawn in patients presenting with dyspnea to the ED were a predictor of major adverse pulmonary event (MAPE). In 87 patients presenting with dyspnea to the ED, cortisol levels were determined. Patients were then assessed to determine the following MAPE: endotracheal intubation (ETI) in the ED, admission to the intensive care unit (ICU), and in-hospital all-cause mortality. Forty-four patients (50.6%) were female and 33 (37.9%) were diagnosed with heart failure. Cortisol levels in patients with and without MAPE were 34.3μg/dL and 23.8μg/dL, respectively (p<0.001). Also, cortisol levels were found higher in patients intubated in the ED than nonintubated patients (54.2μg/dL vs 25.7μg/dL, p<0.001), higher in patients admitted to the ICU (38.7μg/dL vs 24 μg/dL, p<0.001), and higher in patients who died in hospital (50μg/dL vs 24.3μg/dL, p<0.001). The area under the ROC curve using cortisol to detect any component of MAPE—ETI or ICU admission or in-hospital all-cause mortality—was 0.76 (95% CI, 0.65-0.84). A cortisol value of 31.4μg/dL had sensitivity of 70.8% and specificity of 79.4% for predicting MAPE. Patients in the MAPE group had higher serum cortisol levels than those without any MAPE. Cortisol may be used as a marker to predict MAPE in nontraumatic acutely dyspneic adult patients on ED admission.

The correlation between longitudinal changes in hypothalamic-pituitary-adrenal (HPA)-axis activity and changes in neurocognitive function in mixed-state bipolar II disorder.

IntroductionIn this study, we aim to determine 1) the differences in cortisol in patients with bipolar II disorder (BD-II) and control subjects and 2) the correlation between cortisol levels and cognitive function in patients with BD-II during a 24-week follow-up period.MethodsWe recruited a total of 32 BD-II patients and 30 healthy control subjects. The BD-II patients were assessed for clinical severity and serum cortisol level at baseline and at weeks 8, 16, and 24. The Brief Assessment of Cognition in Affective Disorders (BACA) was adopted to evaluate cognitive function at baseline and endpoint (week 24). Meanwhile, we assessed the controls for serum cortisol level and BACA at baseline.ResultsWe observed that the BD-II group had a higher serum cortisol level and lower BACA composite scores compared with the healthy controls at baseline. A significant correlation was found between changes in Verbal Fluency, a subset of BACA, and changes in serum cortisol level after the 24-week follow-up, controlling for age, gender, years of education, and clinical severity (P<0.001).ConclusionWe propose that serum cortisol may be involved in the psychopathological mechanisms of cognitive decline in BD-II.

Effects of transportation stress on quality and sensory profiles of Nile tilapia fillets

This study evaluated pre-slaughter stress and its influence on the stress indicators, quality characteristics and sensory characteristics of Nile tilapia fillets. To this end, two experiments were conducted: (1) two transportation times (60 and 240 min), with a density of 200 kg m−3, were compared to control treatment fish (in which the fish were removed from the net cage and immediately euthanized); and (2) two transportation densities (100 and 400 kg m−3), transported for 180 min, compared with control treatment fish. In experiment 1, the transportation time of 60 min resulted in higher levels of serum cortisol and plasma glucose compared to the transportation time of 240 min and the control. Fish fillets transported for 240 min had higher water-holding capacity, less water loss by pressure and higher levels of juiciness compared to fish transported for 60 min. Color, pH and water loss during cooking were not affected by transportation time. In experiment 2, transportation densities of 100 and 400 kg m−3 did not significantly affect the stress indicators nor the instrumental quality parameters of the fillets, but fish transported at 400 kg m−3 showed better visual acceptance by panellists.

Mechanism of Chronic Stress-induced Reduced Atherosclerotic Medial Area and Increased Plaque Instability in Rabbit Models of Chronic Stress.

Background:Chronic stress contributes to increased risks of atherosclerotic diseases including heart disease, stroke, and transient ischemic attack. However, its underline mechanisms are poorly understood. This study aimed to elucidate the mechanism via which chronic stress exerts its effect on atherosclerosis (AS).Methods:Fifty male New Zealand white rabbits were used. Aortic balloon-injury model was applied. Both social stress and physical stress methods were adopted to establish chronic stress models. The lumen stenotic degree, intimal and medial areas, maximum fibrous cap thickness, and plaque contents were measured with histological sections. Proteomic methods were applied to detect protein changes in abdominal aortas to identify the specialized mediators. Real-time reverse transcription-polymerase chain reaction was used for further verification and investigation.Results:The stress rabbits exhibited lower body weight, worse fur state, more inactivity behavior, and higher serum cortisol level. Chronic stress was significantly associated with the decreased medial area and increased plaque instability, which was manifested by thinner fibrous caps, larger lipid cores, more macrophages, and new vessels but fewer smooth muscle cells and elastic fibers. After chronic stress, the apoptosis-related genes UBE2K, BAX, FAS, Caspase 3, Caspase 9, and P53 were upregulated, and BCL-2/BAX was down-regulated; the angiogenesis-related genes ANG and VEGF-A were also highly expressed in atherosclerotic arteries.Conclusions:Rabbit models of chronic stress were successfully established by applying both social stress and physical stress for 8 weeks. Chronic stress can reduce AS tunica media and accelerate plaque instability by promoting apoptosis and neovascularization.

Generating diversity in human glucocorticoid signaling through a racially diverse polymorphism in the beta isoform of the glucocorticoid receptor

Alternative splicing of the human glucocorticoid receptor gene generates two isoforms, hGRα and hGRβ. hGRβ functions as a dominant-negative regulator of hGRα activity and but also has inherent transcriptional activity, collectively altering glucocorticoid sensitivity. Single-nucleotide polymorphisms in the 3′ UTR of hGRβ have been associated with altered receptor protein expression, glucocorticoid sensitivity, and disease risk. Characterization of the hGRβ G3134T polymorphism has been limited to a relatively small, homogenous population. The objective of this study was to determine the prevalence of hGRβ G3134T in a diverse population and assess the association of hGRβ G3134T in this population with physiological outcomes. In a prospective cohort study, 3730 genetically diverse participants were genotyped for hGRβ G3134T and four common GR polymorphisms. A subset of these participants was evaluated for clinical and biochemical measurements. Immortalized human osteosarcoma cells (U-2 OS), stably transfected with wild-type or G3134T hGRβ, were evaluated for receptor expression, stability, and genome-wide gene expression. Glucocorticoid-mediated gene expression profiles were investigated in primary macrophages isolated from participants. In a racially diverse population, the minor allele frequency was 74% (50.7% heterozygous carriers and 23.3% homozygous minor allele), with a higher prevalence in Caucasian non-Hispanic participants. After adjusting for confounding variable, carriers of hGRβ G3134T were more likely to self-report allergies, have higher serum cortisol levels, and reduced cortisol suppression in response to low-dose dexamethasone. The presence of hGRβ G3134T in U-2 OS cells increased hGR mRNA stability and protein expression. Microarray analysis revealed that the presence of the hGRβ G3134T polymorphism uniquely altered gene expression profiles in U-2 OS cells and primary macrophages. hGRβ G3134T is significantly present in the study population and associated with race, self-reported disease, and serum levels of glucocorticoids. Underlying these health differences may be changes in gene expression driven by altered receptor stability.

Association of Stress Biomarkers With 30-Day Unplanned Readmission and Death.

The theory that posthospitalization stress might increase the risk of postdischarge complications has never been investigated. To assess whether serum levels of stress biomarkers at discharge are associated with readmission and death after an acute-care hospitalization. We prospectively included 346 patients aged ≥50 years admitted to the department of general internal medicine at a large community hospital between April 8, 2013 and September 23, 2013. We measured the serum levels of several biomarkers at discharge: midregional pro-adrenomedullin, copeptin, cortisol, and prolactin. All patients were followed for up to 90 days after discharge (none was lost to follow-up). The main outcome was first unplanned readmission or death within 30 days after hospital discharge. We assessed the additional value of biomarkers to 2 validated readmission prediction scores: the LACE index (Length of stay, Admission Acuity, Charlson Comorbidity Index, and number of Emergency department visits within preceding 6 months) and the HOSPITAL score (Hemoglobin level at discharge, discharge from Oncology service, Sodium level at discharge, any Procedure performed during index hospitalization, Index admission Type, number of Admissions within preceding 12 months, and Length of stay). Forty patients (11.6%) had a 30-day unplanned readmission or death. High serum copeptin and cortisol levels were associated with an increase in the odds of unplanned readmission or death (odds ratios [95% confidence interval] 2.69 [1.29-5.64] and 3.43 [1.36, 8.65], respectively). We found no significant association with midregional pro-adrenomedullin or prolactin. Furthermore, these stress biomarkers increased the performance of two readmission prediction scores (LACE index and HOSPITAL score). High serum levels of copeptin and cortisol at discharge were independently associated with 30-day unplanned readmission or death, supporting a possible negative effect of hospitalization stress during the postdischarge period. Stress biomarkers improved the performance of prediction models and therefore could help better identify high-risk patients.