Depression of plasma cortisol and the steroid ocular pressure response

[Cortisol levels in plasma and aqueous humour of patients with steroid induced and other glaucomas]

The paper describes the role of endogenous glucocorticoids in the pathogenesis of open-angle glaucoma. As to steroid-induced glaucoma (SG), however, indicators of systemic and local cortisol metabolism are yet underinvestigated. Aim - to determine and compare systemic (plasma) and local (aqueous humour) cortisol concentrations in patients with SG and other types of glaucoma (OTG).

MATERIAL AND METHODS

A prospective analysis was conducted in 64 patients who underwent plasma and aqueous humor sampling. All the patients were divided into 4 groups: group 1 - 11 patients with steroid induced ocular hypertension (SOH) and SG; group 2 - 31 patients with OTG; group 3 - 10 patients on steroid therapy (ST) without a so called 'steroid response'; group 4 - the controls (12 patients with cataract).

RESULTS

The mean cortisol levels in plasma and aqueous humour were the following: 177.5±29.4 ng/ml and 53.1±12.2 ng/ml in patients with SOH and SG; 277.7±33.6 ng/ml and 44.6±4.4 ng/ml in patients with OTG; 125.2±28.1 ng/ml in patients on ST; 147.2±19.1 ng/ml and 29.8±3.2 ng/ml in the controls. The highest plasma and aqueous humour cortisol levels were found in groups 2 and 1, respectively.

CONCLUSION

Plasma and aqueous humour levels of cortisol appeared to be higher in glaucoma patients than in the controls. Taking into account the fact that plasma cortisol levels are higher in steroid responders, it is recommended that all patients on ST undergo cortisol testing.

Bernard Schwartz, MD, PhD, Founding Chair of Ophthalmology, Tufts University School of Medicine, and Founding Editor of Survey of Ophthalmology

Bernard Schwartz, MD, PhD (1927-2007) was first and foremost a scholar. He was a teacher, serving as Professor of ophthalmology for many years at Tufts University; an administrator, chairing the department of ophthalmology for over 20 years; a clinician, practicing primarily in the field of glaucoma; a scientist with a broad interest in ophthalmic research; an historian, especially of medical history; and an editor, primarily of Survey of Ophthalmology. Throughout all of his activities, the central theme was always scholarship.

A Sick Eye in a Sick Body? Systemic Findings in Patients with Primary Open-angle Glaucoma

Despite intense research, the pathogenesis of primary open-angle glaucoma (POAG) is still not completely understood. There is ample evidence for a pathophysiological role of elevated intraocular pressure; however, several systemic factors may influence onset and progression of the disease. Systemic peculiarities found in POAG include alterations of the cardiovascular system, autonomic nervous system, immune system, as well as endocrinological, psychological, and sleep disturbances. An association between POAG and other neurodegenerative diseases, such as Alzheimer disease and Parkinson disease, has also been described. Furthermore, the diagnosis of glaucoma can affect the patient's quality of life. By highlighting the systemic alterations found in POAG, this review attempts to bring glaucoma into a broader medical context.

Department of Ophthalmology at the New York University Medical Center, 1960-2001. A personal journey

This autobiographical narrative describes many of the activities of the Department of Ophthalmology at New York University Medical Center that took place under the stewardship of Goodwin M. Breinin, who was chairman from 1958 to 2000. The author recalls his 40 years of collaborative research during this period, exploring the visual system with many faculty members at New York University and participating in departmentally sponsored studies elsewhere.

Hormonal regulation of intraocular pressure

A detailed review of the hormonal effects on intraocular pressure is presented. There is evidence that corticotropin, vasopressin, thyroxin, insulin, glucocorticoids and mineralocorticoids may play a role in the physiologic regulation of intraocular pressure. Growth hormone, melanocyte stimulating hormone, progesterone, estrogen, chorionic gonadotropin and relaxin may influence intraocular pressure when administered in pharmacologic doses. Whether the key to understanding primary open-angle glaucoma lies in recognizing abnormal endocrine mechanisms, especially involving glucocorticoids, remains unclear at the present time.

Plasma cortisol suppression response in the South African black population with glaucoma

Plasma cortisol suppression was measured in 25 Black glaucomatous patients and in 19 Black patients of similar age and sex, but without glaucoma, who acted as controls. Initial serum cortisol levels were found to be slightly higher in the glaucomatous group. The response to systemically-administered cortisone was statistically more marked in the glaucomatous patients compared with the control group.