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Chagot C, Blonski M, Machu JL, Bracard S, Lacour JC, Richard S. Idiopathic Intracranial Hypertension: Prognostic Factors and Multidisciplinary Management. J Obes 2017; 2017:5348928. [PMID: 28884026 PMCID: PMC5572623 DOI: 10.1155/2017/5348928] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/03/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) mostly affects young obese women and can lead to permanent visual impairment. However, prognostic factors and therapeutic strategy remain unclear. METHODS We retrospectively collected data from all patients diagnosed and managed for IIH in our university center from January 2001 to December 2016. RESULTS Seventy-nine patients were diagnosed with IIH. Bilateral transverse sinus stenosis (TSS) was found in 74% of the population. Visual outcome at 6 months was poor for 46% of patients, including all patients presenting weight gain of at least 5% since diagnosis (p < 0.001), whereas mean body mass index at diagnosis was not different between patients with poor versus good outcome (32.9 ± 7.7 versus 34.6 ± 9.4 kg·m-2). Other significant factors of poor prognosis were bilateral TSS (OR = 5.2; 95 CI: 1.24-24.9; p = 0.024). Thirteen patients with poor outcome after 6-month assessment underwent unilateral TSS stenting leading to visual improvement in 11 cases. CONCLUSION Weight gain, rather than initial weight, emerged as the leading factor of poor visual outcome in patients with IIH, followed by presence of bilateral TSS. Consequently, first-line treatment must include dietary measures to control weight. Unilateral stenting appears to be a safe second-line treatment option for patients with bilateral TSS.
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Affiliation(s)
- Claire Chagot
- Department of Neurology, Stroke Unit, University Hospital of Nancy, 54035 Nancy, France
| | - Marie Blonski
- Department of Neurology, Stroke Unit, University Hospital of Nancy, 54035 Nancy, France
| | - Jean-Loup Machu
- Centre d'Investigation Clinique Plurithématique (CIC-P 1433), INSERM U1116, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Serge Bracard
- Department of Neuroradiology, University Hospital of Nancy, 54035 Nancy, France
| | | | - Sébastien Richard
- Department of Neurology, Stroke Unit, University Hospital of Nancy, 54035 Nancy, France
- Centre d'Investigation Clinique Plurithématique (CIC-P 1433), INSERM U1116, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
- *Sébastien Richard:
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52
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Affiliation(s)
- Olga R. Thon
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - John W. Gittinger
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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53
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Dibas A, Yorio T. Glucocorticoid therapy and ocular hypertension. Eur J Pharmacol 2016; 787:57-71. [PMID: 27388141 PMCID: PMC5014726 DOI: 10.1016/j.ejphar.2016.06.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 12/31/2022]
Abstract
The projected number of people who will develop age-related macular degeneration in estimated at 2020 is 196 million and is expected to reach 288 million in 2040. Also, the number of people with Diabetic retinopathy will grow from 126.6 million in 2010 to 191.0 million by 2030. In addition, it is estimated that there are 2.3 million people suffering from uveitis worldwide. Because of the anti-inflammatory properties of glucocorticoids (GCs), they are often used topically and/or intravitreally to treat ocular inflammation conditions or edema associated with macular degeneration and diabetic retinopathy. Unfortunately, ocular GC therapy can lead to severe side effects. Serious and sometimes irreversible eye damage can occur as a result of the development of GC-induced ocular hypertension causing secondary open-angle glaucoma. According to the world health organization, glaucoma is the second leading cause of blindness in the world and it is estimated that 80 million will suffer from glaucoma by 2020. In the current review, mechanisms of GC-induced damage in ocular tissue, GC-resistance, and enhancing GC therapy will be discussed.
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Affiliation(s)
- Adnan Dibas
- North Texas Eye Research Institute, UNT Health Science Center, Fort Worth, TX, USA.
| | - Thomas Yorio
- North Texas Eye Research Institute, UNT Health Science Center, Fort Worth, TX, USA
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Mollan SP, Ali F, Hassan-Smith G, Botfield H, Friedman DI, Sinclair AJ. Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management. J Neurol Neurosurg Psychiatry 2016; 87:982-92. [PMID: 26888960 PMCID: PMC5013119 DOI: 10.1136/jnnp-2015-311302] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/19/2016] [Indexed: 01/12/2023]
Abstract
Idiopathic intracranial hypertension (IIH) is a rare but important disease associated with significant morbidity. There is an expected rise in prevalence in line with the escalating global burden of obesity. Modern revisions in the terminology and diagnostic criteria for IIH help guide clinicians in investigations and researchers in standardising recruitment criteria for clinical trials. The pathophysiology of IIH is incompletely characterised; suggested underpinning mechanisms include the role of cerebrospinal fluid regulation as well as metabolic and endocrinological perspectives. Recent treatment trials are providing insights into the management but debate still surrounds key areas in treatment. This review will provide an up-to-date discussion on the potential pathogenic mechanisms and management of IIH.
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Affiliation(s)
- Susan P Mollan
- Birmingham Neuro-Ophthalmology Unit, Ophthalmology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Fizzah Ali
- Neurometabolism, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ghaniah Hassan-Smith
- Neurometabolism, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK Neurology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Hannah Botfield
- Neurometabolism, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Deborah I Friedman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alexandra J Sinclair
- Neurometabolism, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK Neurology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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55
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Bray B, Scholl JL, Tu W, Watt MJ, Renner KJ, Forster GL. Amphetamine withdrawal differentially affects hippocampal and peripheral corticosterone levels in response to stress. Brain Res 2016; 1644:278-87. [PMID: 27208490 DOI: 10.1016/j.brainres.2016.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/20/2016] [Accepted: 05/16/2016] [Indexed: 12/29/2022]
Abstract
Amphetamine withdrawal is associated with heightened anxiety-like behavior, which is directly driven by blunted stress-induced glucocorticoid receptor-dependent serotonin release in the ventral hippocampus. This suggests that glucocorticoid availability in the ventral hippocampus during stress may be reduced during amphetamine withdrawal. Therefore, we tested whether amphetamine withdrawal alters either peripheral or hippocampal corticosterone stress responses. Adult male rats received amphetamine (2.5mg/kg, ip) or saline for 14 days followed by 2 weeks of withdrawal. Contrary to our prediction, microdialysis samples from freely-moving rats revealed that restraint stress-induced corticosterone levels in the ventral hippocampus are enhanced by amphetamine withdrawal relative to controls. In separate groups of rats, plasma corticosterone levels increased immediately after 20min of restraint and decreased to below stress-naïve levels after 1h, indicating negative feedback regulation of corticosterone following stress. However, plasma corticosterone responses were similar in amphetamine-withdrawn and control rats. Neither amphetamine nor stress exposure significantly altered protein expression or enzyme activity of the steroidogenic enzymes 11β-hydroxysteroid dehydrogenase (11β-HSD1) or hexose-6-phosphate dehydrogenase (H6PD) in the ventral hippocampus. Our findings demonstrate for the first time that amphetamine withdrawal potentiates stress-induced corticosterone in the ventral hippocampus, which may contribute to increased behavioral stress sensitivity previously observed during amphetamine withdrawal. However, this is not mediated by either changes in plasma corticosterone or hippocampal steroidogenic enzymes. Establishing enhanced ventral hippocampal corticosterone as a direct cause of greater stress sensitivity may identify the glucocorticoid system as a novel target for treating behavioral symptoms of amphetamine withdrawal.
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Affiliation(s)
- Brenna Bray
- Division of Basic Biomedical Sciences, Center for Brain and Behavior Research, University of South Dakota, 414 East Clark St, Vermillion, SD, United States.
| | - Jamie L Scholl
- Division of Basic Biomedical Sciences, Center for Brain and Behavior Research, University of South Dakota, 414 East Clark St, Vermillion, SD, United States.
| | - Wenyu Tu
- Division of Basic Biomedical Sciences, Center for Brain and Behavior Research, University of South Dakota, 414 East Clark St, Vermillion, SD, United States.
| | - Michael J Watt
- Division of Basic Biomedical Sciences, Center for Brain and Behavior Research, University of South Dakota, 414 East Clark St, Vermillion, SD, United States.
| | - Kenneth J Renner
- Department of Biology, Center for Brain and Behavior Research, University of South Dakota, 414 East Clark St, Vermillion, SD, United States.
| | - Gina L Forster
- Division of Basic Biomedical Sciences, Center for Brain and Behavior Research, University of South Dakota, 414 East Clark St, Vermillion, SD, United States.
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Markey KA, Uldall M, Botfield H, Cato LD, Miah MAL, Hassan-Smith G, Jensen RH, Gonzalez AM, Sinclair AJ. Idiopathic intracranial hypertension, hormones, and 11β-hydroxysteroid dehydrogenases. J Pain Res 2016; 9:223-32. [PMID: 27186074 PMCID: PMC4847593 DOI: 10.2147/jpr.s80824] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) results in raised intracranial pressure (ICP) leading to papilledema, visual dysfunction, and headaches. Obese females of reproductive age are predominantly affected, but the underlying pathological mechanisms behind IIH remain unknown. This review provides an overview of pathogenic factors that could result in IIH with particular focus on hormones and the impact of obesity, including its role in neuroendocrine signaling and driving inflammation. Despite occurring almost exclusively in obese women, there have been a few studies evaluating the mechanisms by which hormones and adipokines exert their effects on ICP regulation in IIH. Research involving 11β-hydroxysteroid dehydrogenase type 1, a modulator of glucocorticoids, suggests a potential role in IIH. Improved understanding of the complex interplay between adipose signaling factors such as adipokines, steroid hormones, and ICP regulation may be key to the understanding and future management of IIH.
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Affiliation(s)
- Keira A Markey
- Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Maria Uldall
- Danish Headache Center, Clinic of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Hannah Botfield
- Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Liam D Cato
- Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Mohammed A L Miah
- Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Ghaniah Hassan-Smith
- Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Rigmor H Jensen
- Danish Headache Center, Clinic of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Ana M Gonzalez
- Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Alexandra J Sinclair
- Neurometabolism, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol 2016; 15:78-91. [PMID: 26700907 DOI: 10.1016/s1474-4422(15)00298-7] [Citation(s) in RCA: 271] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 09/07/2015] [Accepted: 10/13/2015] [Indexed: 01/10/2023]
Abstract
Idiopathic intracranial hypertension is a disorder characterised by raised intracranial pressure that predominantly affects young, obese women. Pathogenesis has not been fully elucidated, but several causal factors have been proposed. Symptoms can include headaches, visual loss, pulsatile tinnitus, and back and neck pain, but the clinical presentation is highly variable. Although few studies have been done to support evidence-based management, several recent advances have the potential to enhance understanding of the causes of the disease and to guide treatment decisions. Investigators of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) reported beneficial effects of acetazolamide in patients with mild visual loss. Studies have also established weight loss as an effective disease-modifying treatment, and further clinical trials to investigate new treatments are underway. The incidence of idiopathic intracranial hypertension is expected to increase as rates of obesity increase; efforts to reduce diagnostic delays and identify new, effective approaches to treatment will be key to meeting the needs of a growing number of patients.
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Affiliation(s)
- Keira A Markey
- Neurometabolism Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Susan P Mollan
- Neurometabolism Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Birmingham Neuro-Ophthalmology Unit, Ophthalmology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Rigmor H Jensen
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alexandra J Sinclair
- Neurometabolism Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
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SOSVOROVA L, MOHAPL M, HILL M, STARKA L, BICIKOVA M, VITKU J, KANCEVA R, BESTAK J, HAMPL R. Steroid Hormones and Homocysteine in the Outcome of Patients With Normal Pressure Hydrocephalus. Physiol Res 2015; 64:S227-36. [DOI: 10.33549/physiolres.933072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Normal pressure hydrocephalus (NPH) is one of a few treatable conditions of cognitive decline affecting predominately elderly people. Treatment, commonly based on the ventriculoperitoneal shunt insertion, leads to a partial or complete correction of patient's state, although its effect does not unfortunately always last. The aim of our study was to observe the changes of homocysteine and selected steroids and neurosteroids and follow-up the patients with respect to the duration of the NPH-related dementia improvement. The cerebrospinal fluid and plasma levels of cortisol, cortisone, dehydroepiandrosterone (DHEA), 7α-hydroxy-DHEA, 7β-hydroxy-DHEA, 7-oxo-DHEA, 16α-hydroxy-DHEA (all LC-MS/MS), DHEA-sulphate (DHEAS) (radioimmunoassay) and homocysteine (gas chromatography) were determined in NPH-diagnosed subjects before, during and 6, 12 and 24 months after shunt insertion. The cognitive functions ameliorated after shunt insertion and remain improved within 2 years. Changes in cerebrospinal fluid DHEAS, DHEA and its ratio, cortisone/cortisol and 16α-hydroxy-DHEA and plasma DHEAS, 7β-hydroxy-DHEA, cortisone/cortisol and homocysteine were found. Mentioned changes may contribute to the clarification of NPH pathogenesis. Altered neurosteroids levels are possible indicators to be utilized in the follow-up of NPH subjects. Moreover, plasma homocysteine may serve as an early indicator of NPH-related dementia.
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Affiliation(s)
- L. SOSVOROVA
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czech Republic
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59
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Sosvorova L, Hill M, Mohapl M, Vitku J, Hampl R. Steroid hormones in prediction of normal pressure hydrocephalus. J Steroid Biochem Mol Biol 2015; 152:124-32. [PMID: 25976421 DOI: 10.1016/j.jsbmb.2015.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/13/2015] [Accepted: 05/07/2015] [Indexed: 12/20/2022]
Abstract
Normal pressure hydrocephalus (NPH) is a treatable neurological disorder affecting elderly people with the prevalence increasing with age. NPH is caused by abnormal cerebrospinal fluid (CSF) reabsorption and manifested as a balance impairment, urinary incontinence and dementia development. These symptoms are potentially reversible if recognized early. Diagnosis of NPH is difficult and can be easily mistaken for other neurodegenerative disorders, which makes NPH one of the major misdiagnosed diseases worldwide. The aim of the study was to find out the appropriate combination of indicators, based on CSF steroids, which would contribute to a clearer NPH diagnosis. The levels of CSF cortisol, cortisone, dehydroepiandrosterone (DHEA), 7α-OH-DHEA, 7β-OH-DHEA, 7-oxo-DHEA, 16α-OH-DHEA and aldosterone (all LC-MS/MS) were determined in our patients (n=30; NPH, 65-80 years) and controls (n=10; 65-80 years). The model of orthogonal projections to latent structures (OPLS) was constructed to predict NPH. Cortisone, 7α-OH-DHEA, 7β-OH-DHEA, 7-oxo-DHEA, aldosterone, 7α-OH-DHEA /DHEA, 7-oxo-DHEA/7α-OH-DHEA, 7β-OH-DHEA/7-oxo-DHEA and 16α-OH-DHEA/DHEA in the CSF were identified as the key predictors and the model discriminated patients from controls with 100% sensitivity and 100% specificity. The suggested model would contribute to early and accurate NPH diagnosis, enabling promptly treatment of the disease.
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Affiliation(s)
- Lucie Sosvorova
- Institute of Endocrinology, Department of Steroids and Proteofactors, Narodni 8, 116 94 Prague, Czech Republic.
| | - Martin Hill
- Institute of Endocrinology, Department of Steroids and Proteofactors, Narodni 8, 116 94 Prague, Czech Republic
| | - Milan Mohapl
- University Military Hospital Prague, Department of Neurosurgery, U Vojenske nemocnice 1200, 169 02 Prague, Czech Republic
| | - Jana Vitku
- Institute of Endocrinology, Department of Steroids and Proteofactors, Narodni 8, 116 94 Prague, Czech Republic
| | - Richard Hampl
- Institute of Endocrinology, Department of Steroids and Proteofactors, Narodni 8, 116 94 Prague, Czech Republic
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Sosvorova L, Vitku J, Chlupacova T, Mohapl M, Hampl R. Determination of seven selected neuro- and immunomodulatory steroids in human cerebrospinal fluid and plasma using LC-MS/MS. Steroids 2015; 98:1-8. [PMID: 25676787 DOI: 10.1016/j.steroids.2015.01.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/31/2014] [Accepted: 01/23/2015] [Indexed: 01/17/2023]
Abstract
Dehydroepiandrosterone (DHEA) and its 7-oxo- and 7-hydroxy-metabolites occurring in the brain are considered neurosteroids. Metabolism of the latter is catalysed by 11β-hydroxysteroid dehydrogenase (11β-HSD) which also interconverts cortisol and cortisone. The concurrent metabolic reaction to DHEA 7-hydroxylation is the formation of 16α-hydroxy-DHEA. The LC-MS/MS method using triple stage quadrupole-mass spectrometer was developed for simultaneous quantification of free DHEA, 7α-hydroxy-DHEA, 7β-hydroxy-DHEA, 7-oxo-DHEA, 16α-hydroxy-DHEA, cortisol and cortisone in human plasma and cerebrospinal fluid (CSF). The method employs 500 μL of human plasma and 3000 μL of CSF extracted with diethyl ether and derivatized with 2-hydrazinopyridine. It has been validated in terms of sensitivity, precision and recovery. In plasma, the following values were obtained: limit of detection: 2-50p g/mL; limit of quantification: 5-140 pg/mL; within-day precision 0.58-14.58%; between-day precision: 1.24-13.89% and recovery: 85-113.2%). For CSF, the values of limit of detection: 2-28 pg/mL; limit of quantification: 6-94 pg/mL; within-day precision; 0.63-5.48%; between-day precision: 0.88-14.59% and recovery: 85.1-109.4% were acquired. Medians and concentration ranges of detected steroids in plasma and CSF are given in subjects with excluded normal pressure hydrocephalus (n=37; 65-80 years). The method enables simultaneous quantification of steroids important for the estimation of 11β-HSD activity in human plasma and CSF. It will be helpful in better understanding various degenerative diseases development and progression.
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Affiliation(s)
- Lucie Sosvorova
- Institute of Endocrinology, Department of Steroids and Proteofactors, Narodni 8, 11694 Prague, Czech Republic
| | - Jana Vitku
- Institute of Endocrinology, Department of Steroids and Proteofactors, Narodni 8, 11694 Prague, Czech Republic
| | - Tereza Chlupacova
- Institute of Endocrinology, Department of Steroids and Proteofactors, Narodni 8, 11694 Prague, Czech Republic
| | - Milan Mohapl
- Military University Hospital Prague, Department of Neurosurgery, U Vojenske nemocnice 1200, 16902 Prague, Czech Republic
| | - Richard Hampl
- Institute of Endocrinology, Department of Steroids and Proteofactors, Narodni 8, 11694 Prague, Czech Republic.
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61
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Morgan WH, Balaratnasingam C, Lind CRP, Colley S, Kang MH, House PH, Yu DY. Cerebrospinal fluid pressure and the eye. Br J Ophthalmol 2015; 100:71-7. [DOI: 10.1136/bjophthalmol-2015-306705] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/22/2015] [Indexed: 11/04/2022]
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An integrated mechanism of pediatric pseudotumor cerebri syndrome: evidence of bioenergetic and hormonal regulation of cerebrospinal fluid dynamics. Pediatr Res 2015; 77:282-9. [PMID: 25420176 PMCID: PMC4641240 DOI: 10.1038/pr.2014.188] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/20/2014] [Indexed: 12/15/2022]
Abstract
Pseudotumor cerebri syndrome (PTCS) is defined by the presence of elevated intracranial pressure (ICP) in the setting of normal brain parenchyma and cerebrospinal fluid (CSF). Headache, vision changes, and papilledema are common presenting features. Up to 10% of appropriately treated patients may experience permanent visual loss. The mechanism(s) underlying PTCS is unknown. PTCS occurs in association with a variety of conditions, including kidney disease, obesity, and adrenal insufficiency, suggesting endocrine and/or metabolic derangements may occur. Recent studies suggest that fluid and electrolyte balance in renal epithelia is regulated by a complex interaction of metabolic and hormonal factors; these cells share many of the same features as the choroid plexus cells in the central nervous system (CNS) responsible for regulation of CSF dynamics. Thus, we posit that similar factors may influence CSF dynamics in both types of fluid-sensitive tissues. Specifically, we hypothesize that, in patients with PTCS, mitochondrial metabolites (glutamate, succinate) and steroid hormones (cortisol, aldosterone) regulate CSF production and/or absorption. In this integrated mechanism review, we consider the clinical and molecular evidence for each metabolite and hormone in turn. We illustrate how related intracellular signaling cascades may converge in the choroid plexus, drawing on evidence from functionally similar tissues.
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63
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Crowley RK, Hughes B, Gray J, McCarthy T, Hughes S, Shackleton CHL, Crabtree N, Nightingale P, Stewart PM, Tomlinson JW. Longitudinal changes in glucocorticoid metabolism are associated with later development of adverse metabolic phenotype. Eur J Endocrinol 2014; 171:433-42. [PMID: 24986533 DOI: 10.1530/eje-14-0256] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Dysregulation of enzymes that control local tissue steroid metabolism has been implicated in the pathogenesis of obesity and insulin resistance; however, longitudinal changes in glucocorticoid metabolism have not been investigated. This study was performed to evaluate the role of glucocorticoid metabolism in the development of insulin resistance and obesity and to identify biomarkers for future development of metabolic disease. DESIGN This was a prospective longitudinal observation study conducted over 5 years. METHODS A 24-h collection was used to serially analyze urinary glucocorticoid and mineralocorticoid metabolites in 57 obese and overweight patients with no prior diagnosis of diabetes mellitus, recruited from the community. RESULTS Baseline higher 5α-reductase (5αR) activity, but not 11β-hydroxysteroid dehydrogenase type 1 activity, was predictive of increased fasting insulin at final visit (11.4 compared with 7.4 mU/l in subjects with lower 5αR activity, P<0.05), area under the curve insulin response to oral glucose tolerance test (176.7 compared with 89.1 mU/l.h, P<0.01), and homeostasis model assessment (HOMA2-IR; 1.3 compared with 0.8, P<0.01). Higher total glucocorticoid production was associated with abnormal glucose tolerance and increased BMI. During this study, systolic blood pressure increased (equivalent to ∼1 mmHg/year), as did plasma sodium levels; this evidence of increased mineralocorticoid activity was associated with increased aldosterone metabolites and decreased 11β-hydroxysteroid dehydrogenase type 2 activity. CONCLUSIONS Increased 5αR activity and glucocorticoid secretion rate over time are linked with the development of metabolic disease, and may represent targets for therapeutic intervention, which merits further study.
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Affiliation(s)
- Rachel K Crowley
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Beverly Hughes
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Joanna Gray
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Theresa McCarthy
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Susan Hughes
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Cedric H L Shackleton
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Nicola Crabtree
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Peter Nightingale
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Paul M Stewart
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
| | - Jeremy W Tomlinson
- School of Clinical and Experimental MedicineInstitute of Biomedical Research, Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University of Birmingham, Birmingham B15 2TT, UKNIHR/Wellcome Trust Clinical Research FacilityQueen Elizabeth Hospital, Birmingham, UK
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Salpietro V, Polizzi A, Di Rosa G, Romeo AC, Dipasquale V, Morabito P, Chirico V, Arrigo T, Ruggieri M. Adrenal disorders and the paediatric brain: pathophysiological considerations and clinical implications. Int J Endocrinol 2014; 2014:282489. [PMID: 25276129 PMCID: PMC4167812 DOI: 10.1155/2014/282489] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/12/2014] [Indexed: 01/27/2023] Open
Abstract
Various neurological and psychiatric manifestations have been recorded in children with adrenal disorders. Based on literature review and on personal case-studies and case-series we focused on the pathophysiological and clinical implications of glucocorticoid-related, mineralcorticoid-related, and catecholamine-related paediatric nervous system involvement. Childhood Cushing syndrome can be associated with long-lasting cognitive deficits and abnormal behaviour, even after resolution of the hypercortisolism. Exposure to excessive replacement of exogenous glucocorticoids in the paediatric age group (e.g., during treatments for adrenal insufficiency) has been reported with neurological and magnetic resonance imaging (MRI) abnormalities (e.g., delayed myelination and brain atrophy) due to potential corticosteroid-related myelin damage in the developing brain and the possible impairment of limbic system ontogenesis. Idiopathic intracranial hypertension (IIH), a disorder of unclear pathophysiology characterised by increased cerebrospinal fluid (CSF) pressure, has been described in children with hypercortisolism, adrenal insufficiency, and hyperaldosteronism, reflecting the potential underlying involvement of the adrenal-brain axis in the regulation of CSF pressure homeostasis. Arterial hypertension caused by paediatric adenomas or tumours of the adrenal cortex or medulla has been associated with various hypertension-related neurological manifestations. The development and maturation of the central nervous system (CNS) through childhood is tightly regulated by intrinsic, paracrine, endocrine, and external modulators, and perturbations in any of these factors, including those related to adrenal hormone imbalance, could result in consequences that affect the structure and function of the paediatric brain. Animal experiments and clinical studies demonstrated that the developing (i.e., paediatric) CNS seems to be particularly vulnerable to alterations induced by adrenal disorders and/or supraphysiological doses of corticosteroids. Physicians should be aware of potential neurological manifestations in children with adrenal dysfunction to achieve better prevention and timely diagnosis and treatment of these disorders. Further studies are needed to explore the potential neurological, cognitive, and psychiatric long-term consequences of high doses of prolonged corticosteroid administration in childhood.
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Affiliation(s)
- Vincenzo Salpietro
- Department of Pediatric Neurology, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
- Unit of Genetics and Paediatric Immunology, Department of Pediatrics, University of Messina, Italy
| | - Agata Polizzi
- National Center for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
- Institute of Neurological Sciences, National Research Council, Catania, Italy
| | - Gabriella Di Rosa
- Infantile Neuropsychiatry Unit, Department of Pediatrics, University of Messina, Italy
| | - Anna Claudia Romeo
- Unit of Genetics and Paediatric Immunology, Department of Pediatrics, University of Messina, Italy
| | - Valeria Dipasquale
- Unit of Genetics and Paediatric Immunology, Department of Pediatrics, University of Messina, Italy
| | - Paolo Morabito
- Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Italy
| | - Valeria Chirico
- Unit of Genetics and Paediatric Immunology, Department of Pediatrics, University of Messina, Italy
| | - Teresa Arrigo
- Unit of Genetics and Paediatric Immunology, Department of Pediatrics, University of Messina, Italy
| | - Martino Ruggieri
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Italy
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Cortisol biosynthesis in the human ocular surface innate immune response. PLoS One 2014; 9:e94913. [PMID: 24736562 PMCID: PMC3988113 DOI: 10.1371/journal.pone.0094913] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/20/2014] [Indexed: 12/14/2022] Open
Abstract
Innate immune responses have a critical role in regulating sight-threatening ocular surface (OcS) inflammation. While glucocorticoids (GCs) are frequently used to limit tissue damage, the role of intracrine GC (cortisol) bioavailability via 11-beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1) in OcS defense, remains unresolved. We found that primary human corneal epithelial cells (PHCEC), fibroblasts (PHKF) and allogeneic macrophages (M1, GM-CSF; M2, M-CSF) were capable of generating cortisol (M1>PHKF>M2>PHCEC) but in corneal cells, this was independent of Toll-like receptor (TLR) activation. While PolyI∶C induced maximal cytokine and chemokine production from both PHCEC (IFNγ, CCL2, CCL3, and (CCL4), IL6, CXCL10, CCL5, TNFα) and PHKF (CCL2, IL-6, CXCL10, CCL5), only PHKF cytokines were inhibited by GCs. Both Poly I∶C and LPS challenged-corneal cells induced M1 chemotaxis (greatest LPS-PHKF (250%), but down-regulated M1 11β-HSD1 activity (30 and 40% respectively). These data were supported by clinical studies demonstrating reduced human tear film cortisol∶cortisone ratios (a biomarker of local 11β-HSD1 activity) in pseudomonas keratitis (1∶2.9) versus healthy controls (1∶1.3; p<0.05). This contrasted with putative TLR3-mediated OcS disease (Stevens-Johnson Syndrome, Mucous membrane pemphigoid) where an increase in cortisol∶cortisone ratio was observed (113.8∶1; p<0.05). In summary, cortisol biosynthesis in human corneal cells is independent of TLR activation and is likely to afford immunoprotection under physiological conditions. Contribution to ocular mucosal innate responses is dependent on the aetiology of immunological challenge.
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Batra R, Sinclair A. Idiopathic intracranial hypertension; research progress and emerging themes. J Neurol 2013; 261:451-60. [PMID: 24085346 DOI: 10.1007/s00415-013-7019-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/19/2013] [Accepted: 06/20/2013] [Indexed: 12/29/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a condition characterised by increased intracranial pressure of unknown cause predominantly seen in obese women of childbearing age and associated with a history of recent weight gain. The aetiology is poorly understood and there are no evidence-based guidelines on the management of the disease. We aim to provide a review of the recent literature outlining the latest advances in this field over the past few years. Areas of emerging interest related to the pathophysiology of IIH will be discussed, such as the role of obesity, adipose tissue and 11β-hydroxysteroid dehydrogenase type 1. We consider the latest research on the role of venous sinus stenosis in IIH and ex vivo advances into cerebrospinal fluid drainage via the arachnoid granulation tissue. The latest techniques for optic nerve head evaluation and the role of optical coherence tomography will be summarised. Finally, we will discuss recent advances in the management of IIH, including weight loss, and medical and surgical treatment strategies.
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Affiliation(s)
- Ruchika Batra
- Birmingham Neuro-ophthalmology Unit, University Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK,
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Gathercole LL, Lavery GG, Morgan SA, Cooper MS, Sinclair AJ, Tomlinson JW, Stewart PM. 11β-Hydroxysteroid dehydrogenase 1: translational and therapeutic aspects. Endocr Rev 2013; 34:525-55. [PMID: 23612224 DOI: 10.1210/er.2012-1050] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1) interconverts the inactive glucocorticoid cortisone and its active form cortisol. It is widely expressed and, although bidirectional, in vivo it functions predominantly as an oxoreductase, generating active glucocorticoid. This allows glucocorticoid receptor activation to be regulated at a prereceptor level in a tissue-specific manner. In this review, we will discuss the enzymology and molecular biology of 11β-HSD1 and the molecular basis of cortisone reductase deficiencies. We will also address how altered 11β-HSD1 activity has been implicated in a number of disease states, and we will explore its role in the physiology and pathologies of different tissues. Finally, we will address the current status of selective 11β-HSD1 inhibitors that are in development and being tested in phase II trials for patients with the metabolic syndrome. Although the data are preliminary, therapeutic inhibition of 11β-HSD1 is also an exciting prospect for the treatment of a variety of other disorders such as osteoporosis, glaucoma, intracranial hypertension, and cognitive decline.
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Affiliation(s)
- Laura L Gathercole
- School of Clinical and Experimental Medicine, University of Birmingham, Queen Elizabeth Hospital, Edgbaston B15 2TH, United Kingdom
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Peng KP, Fuh JL, Wang SJ. High-pressure headaches: idiopathic intracranial hypertension and its mimics. Nat Rev Neurol 2012; 8:700-10. [DOI: 10.1038/nrneurol.2012.223] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sinclair AJ, Kuruvath S, Sen D, Nightingale PG, Burdon MA, Flint G. Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review. Cephalalgia 2011; 31:1627-33. [PMID: 21968519 DOI: 10.1177/0333102411423305] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The role of cerebrospinal fluid (CSF) diversion in treating idiopathic intracranial hypertension (IIH) is disputed. METHOD We conducted a 10-year, retrospective case note review to evaluate the effects of CSF diversion in IIH. Symptoms, signs and details of shunt type, complications and revisions were documented at baseline, 6, 12 and 24 months post-operatively. RESULTS Fifty-three IIH patients were shunted [predominantly lumboperitoneal (92%)]. The most common symptom pre-surgery was headache (96%). Post-operatively, significantly fewer patients experienced declining vision and visual acuity improved at 6 (p = 0.001) and 12 months (p = 0.016). Headache continued in 68% at 6 months, 77% at 12 months and 79% at 2 years post-operatively. Additionally, post-operative low-pressure headache occurred in 28%. Shunt revision occurred in 51% of patients, with 30% requiring multiple revisions. CONCLUSION We conclude that CSF diversion reduces visual decline and improves visual acuity. Unfortunately, headache remained in the majority of patients and low-pressure headache frequently complicated surgery. Over half of the patients required shunt revision with the majority of these requiring multiple revisions. We suggest that CSF shunting should be conducted as a last resort in those with otherwise untreatable, rapidly declining vision. Alternative treatments, such as weight reduction, may be more effective with less associated morbidity.
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