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Madigan JA, Waters SF, Gartstein MA, Mattera JA, Connolly CP, Crespi EJ. Perinatal hair cortisol concentrations linked to psychological distress and unpredicted birth complications. Psychoneuroendocrinology 2024; 161:106921. [PMID: 38141367 DOI: 10.1016/j.psyneuen.2023.106921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 11/25/2023] [Accepted: 12/05/2023] [Indexed: 12/25/2023]
Abstract
Maternal well-being and stress during the perinatal period have been hypothesized to influence birth outcomes and the postnatal development of offspring. In the present study, we explored whether hair cortisol concentration (HCC) was related to symptoms of psychological distress during the perinatal period and with unpredicted birth complications (UBCs). Surveys measuring symptoms of perceived stress, state/trait anxiety, and depression were collected from 53 participants (mean age = 31.1, SD = 4.04; 83% Caucasian, 17% other races) during the third trimester and again at two and six months after birth, 24.5% of which reported UBCs. In a subset of participants, we measured HCC in hair samples collected during the third trimester (27-39 weeks) and six months after birth. Compared to participants reporting normal births, those reporting UBCs had significantly elevated composite stress, anxiety, and depression (SAD) scores two months after birth, but scores decreased by six months postpartum. During the third trimester, HCC was positively associated with reported SAD scores, and HCC was elevated in participants reporting birth complications. Logistic regression showed HCC, but not SAD scores, predicted UBCs (p = 0.023, pseudo R2= 19.7%). Repeated measures MANOVA showed HCC varied over the perinatal period depending on both SAD scores reported at two months postpartum and the experience of UBCs; but when SAD scores reported at six months postpartum were included in the model, the association between HCC and SAD scores and the influence of UBCs was diminished. Although generalizability is limited by our relatively small, homogeneous sample, findings support a positive association between reported psychological distress and HCC during pregnancy and at two months postpartum. We also report a novel finding that chronically elevated cortisol concentrations during pregnancy were related to the risk of UBCs and remain elevated through the early postpartum period, suggesting the importance of monitoring both psychological distress and HCC during the perinatal period.
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Affiliation(s)
- J A Madigan
- School of Biological Sciences, Washington State University, Pullman, WA 99164, USA; Center for Reproductive Biology, Washington State University, Pullman, WA 99164, USA
| | - Sara F Waters
- Department of Human Development, Washington State University, Vancouver, WA 99164, USA
| | - Maria A Gartstein
- Center for Reproductive Biology, Washington State University, Pullman, WA 99164, USA; Department of Psychology, Washington State University, Pullman, WA 99164, USA
| | - Jennifer A Mattera
- Center for Reproductive Biology, Washington State University, Pullman, WA 99164, USA; Department of Psychology, Washington State University, Pullman, WA 99164, USA
| | - Christopher P Connolly
- Department of Kinesiology and Educational Psychology, Washington State University, Pullman, WA 99164, USA
| | - Erica J Crespi
- School of Biological Sciences, Washington State University, Pullman, WA 99164, USA; Center for Reproductive Biology, Washington State University, Pullman, WA 99164, USA.
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Pavone G, Tartaglia N, De Fazio M, Monda V, Valenzano A, Cibelli G, Polito R, Torre MEL, Scattarella F, Mosca L, Scarinci A, Martines G, Pacilli M, Messina G, Monda M, Messina A, Ambrosi A. Lifestyle in Obese Individuals during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:healthcare10091807. [PMID: 36141419 PMCID: PMC9498623 DOI: 10.3390/healthcare10091807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Stay-at-home orders in response to the Coronavirus 2 (SARS-CoV-2) pandemic have forced abrupt changes to daily routines. The aim of this study is to describe the behavior of lifestyles of individuals with obesity on the waiting list for bariatric surgery in the Department of Medical and Surgical Sciences of University of Foggia during the COVID-19 pandemic. Materials and methods: From June 2020 to December 2020 an online survey format was administered to all the patients (n = 52) enrolled for bariatric surgery subjects with obesity, to obtain information about the COVID-19 pandemic’s impact on patients with obesity starting 9 March 2020 until 18 May 2020. Results: Our data showed that 58% of patients stated that the pandemic negatively affected their mood, 60% of patients confirmed that they changed their dietary behaviors during the stay-at-home period, as they consumed more unhealthy foods or spent less time cooking home cooked meals. In addition, 71% of patients stated that the closure of the gyms worsened their obesity condition and their mental well-being with an increase of a feeling of anxiety. Conclusions: Results showed that the COVID-19 pandemic has had a significant impact on health behaviors, including quality of life, mental health physical activity, weight maintenance, and consumption of sweets in obese patients.
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Affiliation(s)
- Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
| | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
- Correspondence: (N.T.); (R.P.); Tel./Fax: +39-0881-733808 (N.T.); Tel.:+39-881588095 (R.P.)
| | - Michele De Fazio
- Department of General Surgery and Liver Transplantation “M. Rubino”, University of Bari, 70124 Bari, Italy
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto, 71100 Foggia, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto, 71100 Foggia, Italy
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto, 71100 Foggia, Italy
- Correspondence: (N.T.); (R.P.); Tel./Fax: +39-0881-733808 (N.T.); Tel.:+39-881588095 (R.P.)
| | - Maria Ester La Torre
- Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto, 71100 Foggia, Italy
| | - Fabio Scattarella
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
| | - Laura Mosca
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Alessia Scarinci
- Department of Education Sciences, Psychology, Communication, University of Bari, 70121 Bari, Italy
| | - Gennaro Martines
- Department of General Surgery and Liver Transplantation “M. Rubino”, University of Bari, 70124 Bari, Italy
| | - Mario Pacilli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Viale Pinto, 71100 Foggia, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
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Polito R, Valenzano A, Monda V, Cibelli G, Monda M, Messina G, Villano I, Messina A. Heart Rate Variability and Sympathetic Activity Is Modulated by Very Low-Calorie Ketogenic Diet. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042253. [PMID: 35206443 PMCID: PMC8872337 DOI: 10.3390/ijerph19042253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
Obesity is characterized by an energy imbalance and by the accumulation of visceral adipose tissue. The energy balance is controlled by a complex set of balanced physiological systems that provide hunger and satiety signals to the brain and regulate the body’s ability to consume energy. The central nervous system controls the metabolic state, influencing the activity of other systems and receiving information from them. Heart rate variability (HRV) is the natural variability of the heart rate in response to several factors. HRV is related to the interaction between the SNS and the parasympathetic. In the light of this evidence, the aim of this study is to investigate the possible effects of the two different dietary regimens such as very low-calorie ketogenic diet (VLCKD) vs. low caloric diet (LCD), on the functions of the nervous system, with particular attention to the autonomous control of heart rate variability (HRV). A total of 26 obese subjects underwent diet therapy in order to reduce body weight; they were also randomly divided into two groups: the VLCKD group and the LCD group. Our results showed that in both groups, there is a reduction in heart rate as an indicator of sympathetic activity; we found a statistically significant variation only in the VLCKD group. Therefore, this study supports the notion that the sympathovagal balance can be modulated by a specific diet, but further studies are needed to clarify the molecular pathway undergoing this modulation.
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Affiliation(s)
- Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (R.P.); (A.V.); (G.C.); (G.M.)
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (R.P.); (A.V.); (G.C.); (G.M.)
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.M.); (M.M.); (I.V.)
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (R.P.); (A.V.); (G.C.); (G.M.)
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.M.); (M.M.); (I.V.)
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy; (R.P.); (A.V.); (G.C.); (G.M.)
| | - Ines Villano
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.M.); (M.M.); (I.V.)
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (V.M.); (M.M.); (I.V.)
- Correspondence: ; Tel.: +39-081-5665891
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Pathophysiology of Mild Hypercortisolism: From the Bench to the Bedside. Int J Mol Sci 2022; 23:ijms23020673. [PMID: 35054858 PMCID: PMC8775422 DOI: 10.3390/ijms23020673] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 02/07/2023] Open
Abstract
Mild hypercortisolism is defined as biochemical evidence of abnormal cortisol secretion without the classical detectable manifestations of overt Cushing’s syndrome and, above all, lacking catabolic characteristics such as central muscle weakness, adipose tissue redistribution, skin fragility and unusual infections. Mild hypercortisolism is frequently discovered in patients with adrenal incidentalomas, with a prevalence ranging between 5 and 50%. This high variability is mainly due to the different criteria used for defining this condition. This subtle cortisol excess has also been described in patients with incidentally discovered pituitary tumors with an estimated prevalence of 5%. To date, the mechanisms responsible for the pathogenesis of mild hypercortisolism of pituitary origin are still not well clarified. At variance, recent advances have been made in understanding the genetic background of bilateral and unilateral adrenal adenomas causing mild hypercortisolism. Some recent data suggest that the clinical effects of glucocorticoid (GC) exposure on peripheral tissues are determined not only by the amount of the adrenal GC production but also by the peripheral GC metabolism and by the GC sensitivity. Indeed, in subjects with normal cortisol secretion, the combined estimate of cortisol secretion, cortisone-to-cortisol peripheral activation by the 11 beta-hydroxysteroid dehydrogenase enzyme and GC receptor sensitizing variants have been suggested to be associated with the presence of hypertension, diabetes and bone fragility, which are three well-known consequences of hypercortisolism. This review focuses on the pathophysiologic mechanism underlying both the different sources of mild hypercortisolism and their clinical consequences (bone fragility, arterial hypertension, subclinical atherosclerosis, cardiovascular remodeling, dyslipidemia, glucose metabolism impairment, visceral adiposity, infections, muscle damage, mood disorders and coagulation).
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Abstract
Vasopressin (AVP) and copeptin are released in equimolar amounts from the same precursor. Due to its molecular stability and countless advantages as compared with AVP, copeptin perfectly mirrors AVP presence and has progressively emerged as a reliable marker of vasopressinergic activation in response to osmotic and hemodynamic stimuli in clinical practice. Moreover, evidence highlighting the prognostic potential of copeptin in several acute diseases, where the activation of the AVP system is primarily linked to stress, as well as in psychologically stressful conditions, has progressively emerged. Furthermore, organic stressors induce a rise in copeptin levels which, although non-specific, is unrelated to plasma osmolality but proportional to their magnitude: suggesting disease severity, copeptin proved to be a reliable prognostic biomarker in acute conditions, such as sepsis, early post-surgical period, cardiovascular, cerebrovascular or pulmonary diseases, and even in critical settings. Evidence on this topic will be briefly discussed in this article.
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Kim GU, Kim N, Kim H. Association between self-reported medical diagnosis of depression and metabolic syndrome in a population-based study: A propensity score-matched analysis. Nurs Open 2021; 9:367-376. [PMID: 34582126 PMCID: PMC8685859 DOI: 10.1002/nop2.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/08/2021] [Accepted: 09/02/2021] [Indexed: 11/07/2022] Open
Abstract
The aim was to compare the metabolic syndrome in adults with and without depression in Korea using the 2013-2015 Korea National Health and Nutrition Examination Survey. A cross-sectional study was conducted involving secondary data analysis. National survey data on the self-reported medical diagnosis of depression and metabolic syndrome were collected between 2013 and 2015 and released for research purposes in 2017. We conducted a propensity score-matched study that included adults (n = 494) with and without depression at a 1:1 ratio, to reduce the impact of potential confounding factors between groups. Depression was not significantly associated with changes in metabolic syndrome. However, participants with depression had significantly higher triglycerides than those without depression (p = .008), highlighting the importance of periodically checking triglycerides in depressed patients. Nurses need to check the subcomponents of metabolic syndrome in depressed patients periodically, especially regarding the management of triglycerides.
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Affiliation(s)
- Go-Un Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Namhee Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Heejung Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
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The Role of Very Low Calorie Ketogenic Diet in Sympathetic Activation through Cortisol Secretion in Male Obese Population. J Clin Med 2021; 10:jcm10184230. [PMID: 34575351 PMCID: PMC8470486 DOI: 10.3390/jcm10184230] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 12/16/2022] Open
Abstract
Adipose tissue is considered an endocrine organ, and its excess compromises the immune response and metabolism of hormones and nutrients. Furthermore, the accumulation of visceral fat helps to increase the synthesis of cortisol. The hypothalamus-pituitary-adrenal (HPA) axis is a neuroendocrine system involved in maintaining homeostasis in humans under physiological conditions and stress, and cortisol is the main hormone of the HPA axis. It is known that a stress-induced diet and cortisol reactivity to acute stress factors may be related to dietary behavior. In obesity, to reduce visceral adipose tissue, caloric restriction is a valid strategy. In light of this fact, the aim of this study was to assess the effects of a commercial dietary ketosis program for weight loss on the sympathetic nervous system and HPA axis, through evaluation of salivary cortisol and GSR levels. Thirty obese subjects were recruited and assessed before and after 8 weeks of Very Low Calorie Ketogenic Diet (VLCKD) intervention to evaluate body composition and biochemical parameters. Salivary cortisol levels and GSR significantly decreased after dietary treatment; in addition, body composition and biochemical features were ameliorated. The VLCKD had a short-term positive effect on the SNS and HPA axes regulating salivary cortisol levels. Finally, the effects of the VLCKD on the SNS and HPA axis may lead to more individualized treatment strategies that integrate obesity and stress and support the usefulness of such therapeutic interventions in promoting the reduction of the individual disease burden.
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Voltan G, Boscaro M, Armanini D, Scaroni C, Ceccato F. A multidisciplinary approach to the management of adrenal incidentaloma. Expert Rev Endocrinol Metab 2021; 16:201-212. [PMID: 34240680 DOI: 10.1080/17446651.2021.1948327] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/23/2021] [Indexed: 01/15/2023]
Abstract
An adrenal incidentaloma (AI) is an adrenal neoplasm incidentally discovered during an imaging unrelated to suspected adrenal disease. The aim of the present review is to offer practical guidance on the multidisciplinary approach of AIs.Areas covered:The prevalence of AI is high in the aging population (up to 5-8%); however, hormonally active or malignant conditions are rare. After the discovery of an AI, it is suggested to assess in parallel if the mass is potentially malignant and functionally active. The answer to the former question is mainly based on medical history (extra-adrenal malignancies, new-onset of signs or symptoms) and imaging (conventional radiology and/or nuclear medicine). The answer to the latter question is a complete endocrine evaluation of both cortical (glucocorticoids, mineralocorticoids) and medullary (catecholamines) secretion.Expert opinion:A multidisciplinary discussion is suggested for patients with adrenal disease, after the exclusion of nonfunctioning benign cortical adenoma, in order to plan a close and tailored follow-up for the suspected malignant or functioning forms. Surgery is advised for patients with malignant disease (adrenocortical cancer) or with clinically relevant secreting neoplasm (primary aldosteronism, Cushing's syndrome, and pheochromocytoma).
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Affiliation(s)
- Giacomo Voltan
- Endocrinology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Marco Boscaro
- Endocrinology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Decio Armanini
- Endocrinology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Carla Scaroni
- Endocrinology, Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
| | - Filippo Ceccato
- Endocrinology, Department of Medicine DIMED, University of Padova, Padova, Italy
- Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
- Department of Neuroscience DNS, University of Padova, Padova, Italy
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Campana G, Loizzo S, Fortuna A, Rimondini R, Maroccia Z, Scillitani A, Falchetti A, Spampinato SM, Persani L, Chiodini I. Early post-natal life stress induces permanent adrenocorticotropin-dependent hypercortisolism in male mice. Endocrine 2021; 73:186-195. [PMID: 33630246 DOI: 10.1007/s12020-021-02659-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/10/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE It has been hypothesized that specific early-life stress (ES) procedures on CD-1 male mice produce diabetes-like alterations due to the failure of negative feedback of glucocorticoid hormone in the pituitary. The aim of this study is to investigate the possible mechanism that leads to this pathological model, framing it in a more specific clinical condition. METHODS Metabolic and hypothalamic-pituitary-adrenal-related hormones of stressed mice (SM) have been analyzed immediately after stress procedures (21 postnatal days, PND) and after 70 days of a peaceful (unstressed) period (90 PND). These data have been compared to parameters from age-matched controls (CTR), and mice treated during ES procedures with oligonucleotide antisense for pro-opiomelanocortin (AS-POMC). RESULTS At 21 PND, SM presented an increased secretion of hypothalamic CRH and pituitary POMC-derived peptides, as well as higher plasmatic levels of ACTH and corticosterone vs. CTR. At 90 PND, SM showed hyperglycemia, with suppression of hypothalamic CRH, while pituitary and plasmatic ACTH levels, as well as plasma corticosterone, were constantly higher than in CTR. These values are accompanied by a progressive acceleration in gaining total body weight, which became significant vs. CTR at 90 PND together with a higher pituitary weight. Treatment with AS-POMC prevented all hormonal and metabolic alterations observed in SM, both at 21 and 90 PND. CONCLUSIONS These findings show that these specific ES procedures affect the negative glucocorticoid feedback in the pituitary, but not in the hypothalamus, suggesting a novel model of ACTH-dependent hypercortisolism that can be prevented by silencing the POMC gene.
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Affiliation(s)
- Gabriele Campana
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Stefano Loizzo
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Andrea Fortuna
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Roberto Rimondini
- Department of Medical and Clinical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Zaira Maroccia
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Alfredo Scillitani
- Endocrinology and Diabetology, Ospedale "Casa Sollievo della sofferenza" IRCCS, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia, Italy
| | - Alberto Falchetti
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
| | - Santi Mario Spampinato
- Department of Pharmacy and Biotechnology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
- Division of Endocrine and Metabolic Diseases & Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - Iacopo Chiodini
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milan, Italy
- Division of Endocrine and Metabolic Diseases & Laboratory of Endocrine and Metabolic Research, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
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Hypothalamic-Pituitary Diseases and Erectile Dysfunction. J Clin Med 2021; 10:jcm10122551. [PMID: 34207687 PMCID: PMC8229897 DOI: 10.3390/jcm10122551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Abstract
Several hormones contribute to ensure penile erection, a neurovascular phenomenon in which nitric oxide plays a major role. Erectile dysfunction (ED), which is defined as the persistent inability to obtain or maintain penile erection sufficient for a satisfactory sexual performance, may be due to arteriogenic, neurogenic, iatrogenic, but also endocrinological causes. The hypothalamus–pituitary axis plays a central role in the endocrine system and represents a fundamental link between the brain and peripheral glands, including gonads. Therefore, the hormonal production of the hypothalamic–pituitary axis can control various aspects of sexual function and its dysregulation can compromise erectile function. In addition, excess and deficiency of pituitary hormones or metabolic alterations that are associated with some pituitary diseases (e.g., Cushing’s disease and acromegaly, hypopituitarism) can determine the development of ED with different mechanisms. Thus, the present review aimed to explore the relationship between hypothalamic and pituitary diseases based on the most recent clinical and experimental evidence.
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Parasiliti-Caprino M, Bioletto F, Frigerio T, D’Angelo V, Ceccato F, Ferraù F, Ferrigno R, Minnetti M, Scaroni C, Cannavò S, Pivonello R, Isidori A, Broglio F, Giordano R, Spinello M, Grottoli S, Arvat E. A New Clinical Model to Estimate the Pre-Test Probability of Cushing's Syndrome: The Cushing Score. Front Endocrinol (Lausanne) 2021; 12:747549. [PMID: 34675882 PMCID: PMC8524092 DOI: 10.3389/fendo.2021.747549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hypercortisolism accounts for relevant morbidity and mortality and is often a diagnostic challenge for clinicians. A prompt diagnosis is necessary to treat Cushing's syndrome as early as possible. OBJECTIVE The aim of this study was to develop and validate a clinical model for the estimation of pre-test probability of hypercortisolism in an at-risk population. DESIGN We conducted a retrospective multicenter case-control study, involving five Italian referral centers for Endocrinology (Turin, Messina, Naples, Padua and Rome). One hundred and fifty patients affected by Cushing's syndrome and 300 patients in which hypercortisolism was excluded were enrolled. All patients were evaluated, according to current guidelines, for the suspicion of hypercortisolism. RESULTS The Cushing score was built by multivariable logistic regression, considering all main features associated with a clinical suspicion of hypercortisolism as possible predictors. A stepwise backward selection algorithm was used (final model AUC=0.873), then an internal validation was performed through ten-fold cross-validation. Final estimation of the model performance showed an average AUC=0.841, thus reassuring about a small overfitting effect. The retrieved score was structured on a 17.5-point scale: low-risk class (score value: ≤5.5, probability of disease=0.8%); intermediate-low-risk class (score value: 6-8.5, probability of disease=2.7%); intermediate-high-risk class (score value: 9-11.5, probability of disease=18.5%) and finally, high-risk class (score value: ≥12, probability of disease=72.5%). CONCLUSIONS We developed and internally validated a simple tool to determine pre-test probability of hypercortisolism, the Cushing score, that showed a remarkable predictive power for the discrimination between subjects with and without a final diagnosis of Cushing's syndrome.
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Affiliation(s)
- Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
- Oncological Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy
- *Correspondence: Mirko Parasiliti-Caprino, ; orcid.org/0000-0002-6930-7073
| | - Fabio Bioletto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
- Oncological Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Tommaso Frigerio
- Oncological Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Valentina D’Angelo
- Oncological Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine, DIMED, Hospital-University of Padova, Padova, Italy
| | - Francesco Ferraù
- Dipartimento di Patologia Umana DETEV “G. Barresi”, Università di Messina, UOC di Endocrinologia, AOU Policlinico G. Martino, Messina, Italy
| | - Rosario Ferrigno
- Sezione di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - Marianna Minnetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine, DIMED, Hospital-University of Padova, Padova, Italy
| | - Salvatore Cannavò
- Dipartimento di Patologia Umana DETEV “G. Barresi”, Università di Messina, UOC di Endocrinologia, AOU Policlinico G. Martino, Messina, Italy
| | - Rosario Pivonello
- Sezione di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - Andrea Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabio Broglio
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberta Giordano
- Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | | | - Silvia Grottoli
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Emanuela Arvat
- Oncological Endocrinology, Department of Medical Sciences, University of Turin, Turin, Italy
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12
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Ponzetto F, Settanni F, Parasiliti-Caprino M, Rumbolo F, Nonnato A, Ricciardo M, Amante E, Priolo G, Vitali S, Anfossi L, Arvat E, Ghigo E, Giordano R, Mengozzi G. Reference ranges of late-night salivary cortisol and cortisone measured by LC-MS/MS and accuracy for the diagnosis of Cushing's syndrome. J Endocrinol Invest 2020; 43:1797-1806. [PMID: 32772255 DOI: 10.1007/s40618-020-01388-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE International guidelines recommend salivary cortisol for the diagnosis of Cushing's syndrome. Despite mass spectrometry-based assays are considered the analytical gold-standard, there is still the need to define reference intervals and diagnostic accuracy of such methodology. METHODS 100 healthy volunteers and 50 consecutive patients were enrolled to compare LC-MS/MS and electrochemiluminescence assay for the determination of late-night salivary cortisol and cortisone. Moreover, we aimed to determine reference intervals of salivary steroids in a population of healthy individuals and diagnostic accuracy in patients with suspected hypercortisolism and in a population including also healthy individuals. RESULTS Method comparison highlighted a positive bias (51.8%) of immunoassay over LC-MS/MS. Reference intervals of salivary cortisol (0.17-0.97 µg/L), cortisone (0.84-4.85 µg/L) and ratio (0.08-0.30) were obtained. The most accurate thresholds of salivary cortisol for the diagnosis of hypercortisolism were 1.15 µg/L in the population with suspected hypercortisolism (AUC 1) and 1.30 µg/L in the population including also healthy individuals (AUC 1). Cut-off values of salivary cortisone (7.23 µg/L; Se 92.9%, Sp 97.2%, AUC 0.960 and Se 92.9%, Sp 99.1%, AUC 0.985 in suspected hypercortisolism and in overall population, respectively) and cortisol-to-cortisone ratio (0.20; Se 85.7%, Sp 80.6%, AUC 0.820 and Se 85.7%, Sp 85.5%, AUC 0.855 in suspected hypercortisolism and in overall population, respectively) were accurate and similar in both populations. CONCLUSION LC-MS/MS is the most accurate analytical platform for measuring salivary steroids. Obtained reference intervals are coherent with previously published data and diagnostic accuracy for diagnosis of overt hypercortisolism proved highly satisfactory.
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Affiliation(s)
- F Ponzetto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - F Settanni
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - M Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - F Rumbolo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - A Nonnato
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - M Ricciardo
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - E Amante
- Department of Chemistry, University of Turin, Turin, Italy
| | - G Priolo
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - S Vitali
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - L Anfossi
- Department of Chemistry, University of Turin, Turin, Italy
| | - E Arvat
- Oncologic Endocrinology, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - E Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - R Giordano
- Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | - G Mengozzi
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
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13
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Abdelhadi Z, Bladbjerg EM, Jensen DM, Schousboe A, Støving RK. Venous thromboembolism in anorexia nervosa: four cases from a specialized unit. Indication for thromboprophylaxis? Eat Weight Disord 2020; 25:1833-1837. [PMID: 31849001 DOI: 10.1007/s40519-019-00830-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of mortality and morbidity. VTE may occur asymptomatic or subclinical. Fluid retention during intensive re-nutrition or rapid weight changes are well-known phenomena in anorexia nervosa (AN) and may represent a significant risk factor for VTE. OBJECTIVE The incidence of VTE in patients with AN is unknown, and the conditions may be overlooked in a complex clinical picture. METHOD This study report four cases of VTE in women with severe AN (age range 19-41 years, BMI range 10.6-13.1) admitted to a specialized unit for medical stabilization. RESULTS DVT or PE was diagnosed in all four patients. The patients were admitted for intensive re-nutrition according to conventional conservative guidelines with slow increase in energy supply (start low and advance slow). Due to suspected VTE, thromboprophylaxis was given during hospitalization, three of whom were undergoing re-nutrition. CONCLUSION The four presented cases suggest that VTE during re-nutrition in AN may be an overlooked risk which may not be sufficiently addressed in the literature. General recommendations should not be issued on the basis of case reports; however, we want to raise awareness and call for studies to identify the VTE risk and appropriate thromboprophylaxis in AN patients.
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Affiliation(s)
- Zainab Abdelhadi
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
| | - Else Marie Bladbjerg
- Unit for Thrombosis Research, Department of Regional Health Research, The University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry, Hospital of South West Jutland, Esbjerg, Denmark
| | - Dorte Møller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Science, University of Southern Denmark, Odense, Denmark
| | - Amalie Schousboe
- Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark
| | - René Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark. .,Elite Research Center for Medical Endocrinology, Odense University Hospital, Odense, Denmark. .,Mental Health Services in the Region of Southern Denmark, Odense, Denmark. .,Clinical Institute, University of Southern Denmark, Odense, Denmark.
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14
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Kowal C, Peyre H, Amad A, Pelissolo A, Leboyer M, Schürhoff F, Pignon B. Psychotic, Mood, and Anxiety Disorders and Venous Thromboembolism: A Systematic Review and Meta-Analysis. Psychosom Med 2020; 82:838-849. [PMID: 32947580 DOI: 10.1097/psy.0000000000000863] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Several studies have shown that psychiatric disorders can be associated with venous thromboembolism (VTE) risk, that is, pulmonary embolism (PE) and/or deep vein thrombosis (DVT). In this study, we provide a systematic review and meta-analyses of the studies addressing this issue. METHODS All studies addressing the risk of VTE phenomena (whole VTE, PE, DVT, fatal VTE) in individuals with psychotic, mood, and anxiety disorders published between 1998 and 2019 were reviewed and included in the meta-analyses. Main characteristics of the studies and data concerning VTE risk were extracted. The methodological qualities of the studies were also analyzed. A random-effects meta-analysis model was used. A meta-analysis was conducted separately for each disorder, as well as separately for unadjusted and adjusted studies. Meta-analyses were repeated considering only good-quality studies. Heterogeneity was assessed. RESULTS Sixteen studies were reviewed and 15 included in the meta-analyses. Psychotic and bipolar disorders were significantly associated with VTE risk (VTE, DVT, PE, and fatal VTE for psychotic disorder: odds ratios [ORs] between 1.29 and 2.20; VTE, DVT, and PE for bipolar disorder: ORs between 1.22 and 2.14). Depression and anxiety disorders were associated with VTE risk only in adjusted analyses (DVT and PE for depression: ORs = 1.29; VTE and PE for anxiety disorders: ORs between 1.14 and 1.49). CONCLUSIONS The risk of VTE among individuals with psychiatric disorders may be explained by hypercoagulability and stasis, with both being related to, and independent of, treatment adverse effects. VTE risk should be taken into consideration in the treatment for people with psychiatric disorders.
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Affiliation(s)
- Célia Kowal
- From the AP-HP, GH Henri Mondor (Kowal), Service de pharmacie, Créteil; AP-HP, Hôpital universitaire Robert Debré (Peyre), Service de pédopsychiatrie, Paris; AP-HP, DMU IMPACT, GH Henri Mondor (Pelissolo, Leboyer, Schürhoff, Pignon), Service de Psychiatrie; Inserm, U955, team 15 (Pelissolo, Leboyer, Schürhoff, Pignon); Fondation FondaMental (Pelissolo, Leboyer, Schürhoff, Pignon); UPEC, Université Paris-Est Créteil Faculté de médecine (Pelissolo, Leboyer, Schürhoff, Pignon), Créteil; Univ. Lille, CNRS UMR 9193-PsyCHIC-SCALab, and CHU Lille (Amad), Pôle de Psychiatrie, Unité CURE; Fédération régionale de recherche en santé mentale (F2RSM) Hauts-de-France (Amad), Lille, France; and Institute of Psychiatry, Psychology and Neuroscience (Amad), College London, London, United Kingdom
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15
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Andersen MS, Jensen RC, Schmedes AV, Brandslund I, Kyhl HB, Jensen TK, Glintborg D. Third trimester cortisol status is associated with offspring sex and polycystic ovary syndrome status: Odense Child Cohort. Fertil Steril 2019; 112:764-772. [DOI: 10.1016/j.fertnstert.2019.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/06/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022]
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16
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Ceccato F, Marcelli G, Martino M, Concettoni C, Brugia M, Trementino L, Michetti G, Arnaldi G. The diagnostic accuracy of increased late night salivary cortisol for Cushing's syndrome: a real-life prospective study. J Endocrinol Invest 2019; 42:327-335. [PMID: 29987756 DOI: 10.1007/s40618-018-0921-1] [Citation(s) in RCA: 22] [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: 06/03/2018] [Accepted: 06/26/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIM A prompt diagnosis of Cushing's Syndrome (CS) in high-risk populations is mandatory: 1-mg dexamethasone suppression test (1-mg DST), late night salivary cortisol (LNSC), and urinary-free cortisol (UFC) are recommended, despite thresholds calculated in retrospective studies. Our aim was to study the diagnostic accuracy of LNSC measured with chemiluminescence assay in a prospective study, confirming discrepancies with mass spectrometry (MS). MATERIALS AND METHODS We enrolled 117 controls and 164 suspected CS (CS = 47, non-CS = 117). In case of increased LNSC, high clinical suspicion of CS or adrenal incidentaloma, patients were hospitalized to exclude/confirm CS. RESULTS LNSC levels were higher in patients with suspected CS, CS, and non-CS than controls. Considering 16 nmol/L as threshold for CS, overall LNSC revealed SE 97% and SP 84% in the whole group of subjects considered, achieving positive/negative likelihood ratio of 5.56/0.045, respectively. 35 out of 81 subjects with increased LNSC were non-CS (15 diabetic and 20 obese): considering only those patients with increased likelihood to have a CS (the non-CS patients) SP decreased to 70%, and further reduced to 60% if we discharged subjects with adrenal incidentaloma. MS analyses reduced partially the number of false-positive LNSC. CONCLUSIONS LNSC measured in automated chemiluminescence is reliable in clinical practice: it present a high diagnostic accuracy to exclude hypercortisolism in patients with normal cortisol levels. MS could be used to reduce the number of false-positive results; nevertheless, some non-CS subjects with functional hypercortisolism could have a mild impairment of cortisol rhythm.
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Affiliation(s)
- F Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, 35128, Padua, PD, Italy.
| | - G Marcelli
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - M Martino
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - C Concettoni
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - M Brugia
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - L Trementino
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - G Michetti
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
| | - G Arnaldi
- Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Umberto I Hospital, Polytechnic University of Marche, Via Tronto 10B, 60020, Torrette, AN, Italy
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17
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Voinescu BI. Common Sleep, Psychiatric, and Somatic Problems According to Work Schedule: an Internet Survey in an Eastern European Country. Int J Behav Med 2019; 25:456-464. [PMID: 29557074 DOI: 10.1007/s12529-018-9719-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE A wide range of health problems was investigated, aiming to identify the presence and severity of a set of self-reported and common sleep, psychiatric, and somatic health problems among working professionals in four different shift schedules (morning, evening, rotating, and day) in several cities in Romania. METHODS A heterogeneous sample of 488 workers of different professions completed online a battery of tests, namely the Basic Nordic Sleep Questionnaire, the Parasomnia Questionnaire, the Epworth Sleepiness Scale, and the Patient Health Questionnaire, designed to identity symptoms of insomnia, sleepiness, snoring, parasomnia, as well as of depression, anxiety, eating, somatoform, and alcohol use disorders, respectively. The timing and the duration of the sleep, along with the presence of high blood pressure and type 2 diabetes mellitus were also inquired. The prevalence of the different health problems in relation to the type of shift schedule was evaluated with the Pearson Chi-square test. ANOVA was used to calculate the significance of the difference between the means, while associations with different health problems were estimated by binary logistic regression. RESULTS The most common mental health problems were depression (26%), insomnia (20%), alcohol misuse (18%), and anxiety (17%). No significant differences based on the type of shift in terms of health problems were found, except for high blood pressure and symptoms of panic disorder that were more frequently reported by the workers in early morning shifts. Together with the workers in rotating shifts, they also reported increased sleepiness, poorer sleep quality, and shorter sleep duration. In contrast, the workers in evening shifts reported less severe health problems and longer sleep duration. CONCLUSIONS Working in early morning shifts was found to be associated with poorer health outcomes, while working in rotating and early morning shifts with more severe sleep-related problems.
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Affiliation(s)
- Bogdan I Voinescu
- Department of Clinical Psychology and Psychotherapy, Laboratory for the Research of Sleep Disorders and Circadian Psychobiology, International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Str. Republicii 37, 400013, Cluj-Napoca, Romania. .,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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18
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Secondary Arterial Hypertension: From Routine Clinical Practice to Evidence in Patients with Adrenal Tumor. High Blood Press Cardiovasc Prev 2018; 25:345-354. [DOI: 10.1007/s40292-018-0288-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/31/2018] [Indexed: 12/24/2022] Open
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19
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Sedghamiz H, Morris M, Craddock TJA, Whitley D, Broderick G. High-fidelity discrete modeling of the HPA axis: a study of regulatory plasticity in biology. BMC SYSTEMS BIOLOGY 2018; 12:76. [PMID: 30016990 PMCID: PMC6050677 DOI: 10.1186/s12918-018-0599-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/26/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenal (HPA) axis is a central regulator of stress response and its dysfunction has been associated with a broad range of complex illnesses including Gulf War Illness (GWI) and Chronic Fatigue Syndrome (CFS). Though classical mathematical approaches have been used to model HPA function in isolation, its broad regulatory interactions with immune and central nervous function are such that the biological fidelity of simulations is undermined by the limited availability of reliable parameter estimates. METHOD Here we introduce and apply a generalized discrete formalism to recover multiple stable regulatory programs of the HPA axis using little more than connectivity between physiological components. This simple discrete model captures cyclic attractors such as the circadian rhythm by applying generic constraints to a minimal parameter set; this is distinct from Ordinary Differential Equation (ODE) models, which require broad and precise parameter sets. Parameter tuning is accomplished by decomposition of the overall regulatory network into isolated sub-networks that support cyclic attractors. Network behavior is simulated using a novel asynchronous updating scheme that enforces priority with memory within and between physiological compartments. RESULTS Consistent with much more complex conventional models of the HPA axis, this parsimonious framework supports two cyclic attractors, governed by higher and lower levels of cortisol respectively. Importantly, results suggest that stress may remodel the stability landscape of this system, favoring migration from one stable circadian cycle to the other. Access to each regime is dependent on HPA axis tone, captured here by the tunable parameters of the multi-valued logic. Likewise, an idealized glucocorticoid receptor blocker alters the regulatory topology such that maintenance of persistently low cortisol levels is rendered unstable, favoring a return to normal circadian oscillation in both cortisol and glucocorticoid receptor expression. CONCLUSION These results emphasize the significance of regulatory connectivity alone and how regulatory plasticity may be explored using simple discrete logic and minimal data compared to conventional methods.
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Affiliation(s)
- Hooman Sedghamiz
- Center for Clinical Systems Biology, Rochester General Hospital, 1425 Portland Ave, Rochester, 14621 US
| | - Matthew Morris
- Center for Clinical Systems Biology, Rochester General Hospital, 1425 Portland Ave, Rochester, 14621 US
| | - Travis J. A. Craddock
- Institute for Neuro Immune Medicine, Nova Southeastern University, 8501 SW 124th Avenue, Davie, 33183 US
- Departments of Psychology and Neuroscience, Computer Science, and Clinical Immunology, Nova Southeastern University, 8501 SW 124th Avenue, Davie, 33183 US
| | - Darrell Whitley
- School of Computer Science, Colorado State University, University Ave, Fort Collins, 80521 US
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, 1425 Portland Ave, Rochester, 14621 US
- Biomedical Engineering Department, Rochester Institute of Technology, One Lomb Memorial Drive, Rochester, 14623 US
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Abstract
PURPOSE OF REVIEW Stress has long been suspected to be interrelated to (abdominal) obesity. However, interindividual differences in this complex relationship exist. We suggest that the extent of glucocorticoid action partly explains these interindividual differences. We provide latest insights with respect to multiple types of stressors. RECENT FINDINGS Increased long-term cortisol levels, as measured in scalp hair, are strongly related to abdominal obesity and to specific mental disorders. However, not all obese patients have elevated cortisol levels. Possibly, the interindividual variation in glucocorticoid sensitivity, which is partly genetically determined, may lead to higher vulnerability to mental or physical stressors. Other evidence for the important role for increased glucocorticoid action is provided by recent studies investigating associations between body composition and local and systemic corticosteroids. Stress may play a major role in the development and maintenance of obesity in individuals who have an increased glucocorticoid exposure or sensitivity. These insights may lead to more effective and individualized obesity treatment strategies.
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Affiliation(s)
- Eline S van der Valk
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Room D-428, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mesut Savas
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Room D-428, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisabeth F C van Rossum
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Room D-428, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Internal Medicine, division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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21
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Gant CM, Minovic I, Binnenmars H, de Vries L, Kema I, van Beek A, Navis G, Bakker S, Laverman GD. Lower Renal Function Is Associated With Derangement of 11- β Hydroxysteroid Dehydrogenase in Type 2 Diabetes. J Endocr Soc 2018; 2:609-620. [PMID: 29942925 PMCID: PMC6007243 DOI: 10.1210/js.2018-00088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/17/2018] [Indexed: 02/08/2023] Open
Abstract
Context Derangement of 11-β hydroxysteroid dehydrogenase type 1 and type 2 (11β-HSD1 and 11β-HSD2), which regulate intracellular cortisol production, has been suggested in both type 2 diabetes (T2D) and chronic kidney disease (CKD). However, activity of 11β-HSD enzymes in patients with T2D and CKD has never been assessed. Objectives To compare 11β-HSD activities between patients with T2D and healthy controls, and assess whether in T2D, renal function is associated with 11β-HSD activities. Design Cross-sectional analysis in the Diabetes and Lifestyle Cohort Twente (DIALECT-1). Setting Referral center for T2D. Patients Patient with T2D [n = 373, age 64 ± 9 years, 58% men, 26% of patients estimated glomerular filtration rate (eGFR) <60 mL/min·1.73 m2] and healthy controls (n = 275, age 53 ± 11 years, 48% men). Mean Outcome Measure We measured cortisol, cortisone, and metabolites [tetrahydrocortisol (THF), allo-THF (aTHF), and tetrahydrocortisone (THE)] in 24-hour urine samples. Whole body 11β-HSD and 11β-HSD2 activities were calculated as the urinary (THF + aTHF)/THE and cortisol/cortisone ratios, respectively. Results Patients with T2D had a higher (THF + aTHF)/THE ratio [1.02 (0.84 to 1.27) vs 0.94 (0.79 to 1.0), P < 0.001] and cortisol/cortisone ratio [0.70 (0.58 to 0.83) vs 0.63 (0.54 to 0.74), P < 0.001] than healthy controls. In T2D, lower eGFR was associated with a higher (THF + aTHF)/THE ratio (β = −0.35, P < 0.001), and a higher cortisol/cortisone ratio (β = −0.16, P = 0.001). Conclusions In this real-life secondary care setting of patients with T2D, 11β-HSD enzymes activities were shifted to higher intracellular cortisol production in T2D, which was further aggravated in patients with CKD. Prospective analyses are warranted to investigate causality of these associations.
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Affiliation(s)
- Christina Maria Gant
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente Hospital, PP Almelo and Hengelo, Netherlands.,Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Isidor Minovic
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Heleen Binnenmars
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Laura de Vries
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Ido Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - André van Beek
- Department of Endocrinology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Gerjan Navis
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Stephan Bakker
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Gozewijn Dirk Laverman
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente Hospital, PP Almelo and Hengelo, Netherlands
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Dajani R, Hadfield K, van Uum S, Greff M, Panter-Brick C. Hair cortisol concentrations in war-affected adolescents: A prospective intervention trial. Psychoneuroendocrinology 2018; 89:138-146. [PMID: 29358120 DOI: 10.1016/j.psyneuen.2017.12.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/06/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
Temporal examinations of the biological signature of stress or trauma in war-affected populations are seldom undertaken. Moreover, few studies have examined whether stress biomarkers track biological sensitivity to brief interventions targeting the improvement of psychosocial wellbeing. Our study is the first to prospectively examine, in war-affected adolescents, the associations between hair cortisol concentrations (HCC) and self-reports of stress, insecurity, posttraumatic reactions, and lifetime trauma. We conducted a randomized controlled trial to test the impact of an 8-week intervention based on profound stress attunement. We collected data for a gender-balanced sample of 733 Syrian refugee (n = 411) and Jordanian non-refugee (n = 322) adolescents (12-18 years), at three time-points. We used growth mixture models to classify cortisol trajectories, and growth models to evaluate intervention impact on stress physiology. We observed three trajectories of HCC: hypersecretion, medium secretion, and hyposecretion (9.6%, 87.5% and 2.9% of the cohort, respectively). For every one percent increase in levels of insecurity, adolescents were 0.02 times more likely to have a trajectory of hypersecretion (95% CI: 1.00, 1.03, p = 0.01). For each additional symptom of posttraumatic stress reported, they were 0.07 times less likely to show hyposecretion (95% CI: 0.89, 0.98, p = 0.01). Indeed, stronger posttraumatic stress reactions were associated with a pattern of within-individual cortisol dysregulation and medium secretion. Overall, HCC decreased by a third in response to the intervention (95% CI: -0.19, -0.03, p = 0.01). While the intervention decreased HCC for youth with hypersecretion and medium secretion, it increased HCC for youth with hyposecretion (95% CI: 0.22, 1.16, p = 0.004), relative to controls. This suggests a beneficial regularization of cortisol levels, corroborating self-reports of improved psychosocial wellbeing. We did not find evidence to suggest that gender, resilience, or posttraumatic stress disorder influenced the strength or direction of responses to the intervention. This robust impact evaluation exemplifies the utility of biomarkers for tracking physiological changes in response to interventions over time. It enhances the understanding of trajectories of endocrine response in adverse environments and patterns of stress responsivity to ecological improvement.
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Affiliation(s)
- Rana Dajani
- Department of Biology and Biotechnology, Hashemite University, Zarqa 13115 Jordan; Radcliffe Institute for Advanced Study, Harvard University, 10 Garden Street, Cambridge, MA 02138, USA.
| | - Kristin Hadfield
- Department of Biological and Experimental Psychology, Fogg Building, Queen Mary University of London, London, E1 4NS, UK.
| | - Stan van Uum
- Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada; Division of Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 268 Grosvenor St., London, Ontario, N6G 4L1, Canada.
| | - Michael Greff
- Robarts Research Institute, Western University, 1151 Richmond St. N., London, Ontario, N6A 5B7, Canada; Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, 800 Commissioners Rd. E., London, Ontario, N6C 2R6, Canada.
| | - Catherine Panter-Brick
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06511, USA; Jackson Institute for Global Affairs, Yale University, 55 Hillhouse Avenue, New Haven, CT 06511, USA.
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Karakash SD, Tschankoshvili N, Weedon J, Schwartz RM, Kirschbaum C, Minkoff H. Hypocortisolism and preterm birth. J Neonatal Perinatal Med 2017; 9:333-339. [PMID: 28009336 DOI: 10.3233/npm-161640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to determine whether hypocortisolism is associated with preterm birth, using hair cortisol as a marker of long term hypothalamic-pituitary-adrenal axis activity. STUDY DESIGN In a prospective, matched, case-control study, 29 women who had a preterm birth at 24-36w5d gestation were compared to 29 women who delivered at term, matched for maternal age, gestational age, and ethnicity. Cases' samples were collected within 72 h of preterm birth and controls at the same gestational age as the corresponding case. Participants completed validated questionnaires regarding general stress and childhood trauma. The Wilcoxon signed-rank test was used to compare the distribution of mean hair cortisol scores between cases and controls. Conditional logistic regression was used to predict case vs. control by hair cortisol score, controlling for relevant covariates. RESULTS Baseline characteristics of cases and controls did not differ. Hair cortisol levels were significantly lower among cases in the adjusted analysis. Hair cortisol level was a predictor of case versus control. Each 10-pg.mg-1 increase in hair cortisol level was associated with an estimated 33% decreased odds of being a case. The only significant difference in the validated questionnaires was an increased measure of emotional neglect in the preterm group. CONCLUSION Our study suggests that women who deliver prematurely may have lower hair cortisol levels than women who deliver at term. Normal hypothalamic-pituitary-adrenal axis activation is a physiologic, adaptive response to stress. One hypothesis to explain our results are that women who are stressed, but unable to mount an adequate stress response could be at particular risk for preterm birth.
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Affiliation(s)
- S D Karakash
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
| | - N Tschankoshvili
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Orange Park, FL, USA
| | - J Weedon
- Research Division, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - R M Schwartz
- Department of Population Health, North Shore-LIJ School of Medicine, Great Neck, NY, USA
| | - C Kirschbaum
- Department of Psychology, Technical University of Dresden, Dresden, Germany
| | - H Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Abstract
PURPOSE OF REVIEW This review focuses on the pathophysiological and clinical aspects of diabetes mellitus occurring in patients with Cushing disease (CD). RECENT FINDINGS Insulin resistance and impairment in insulin secretion are both involved in the pathogenesis of glucocorticoid-induced diabetes. Correction of glucocorticoid excess does not always resolve abnormalities of glucose homeostasis, and correction of hyperglycaemia is specifically required. In fact, insulin resistance may persist even after correction of glucocorticoid excess and diabetes needs to be treated for long term. On the other hand, emerging drugs used in the treatment of CD, such as the novel somatostatin analog pasireotide, may have direct effects on glucose homeostasis regardless of control of cortisol excess. Diabetes mellitus is a frequent and early complication of CD with important diagnostic, prognostic and therapeutic implications. Specifically, diagnosis of CD in patients with diabetes may be difficult due to potential misinterpretation of markers of cortisol hypersecretion. Moreover, diabetes mellitus is often difficult to be controlled in CD requiring a careful and dedicated therapeutic approach. Finally, the coexistence of diabetes may influence the therapeutic decision making in CD, since drugs used in this setting may variably influence glucose homeostasis regardless of control of hypercortisolism.
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Affiliation(s)
- G Mazziotti
- Endocrinology Unit, ASST Carlo Poma, Mantova, Italy
| | - A M Formenti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - S Frara
- Vita-Salute University San Raffaele Milan, Milan, Italy
| | - F Maffezzoni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - M Doga
- Vita-Salute University San Raffaele Milan, Milan, Italy
| | - A Giustina
- Vita-Salute University San Raffaele Milan, Milan, Italy.
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Jiang H, He NY, Sun YH, Jian FF, Bian LG, Shen JK, Yan FH, Pan SJ, Sun QF. Altered spontaneous brain activity in Cushing's disease: a resting-state functional MRI study. Clin Endocrinol (Oxf) 2017; 86:367-376. [PMID: 27859451 DOI: 10.1111/cen.13277] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/21/2016] [Accepted: 11/04/2016] [Indexed: 01/23/2023]
Abstract
CONTEXT AND OBJECTIVE Cushing's disease (CD) provides a unique and naturalist model for studying the influence of hypercortisolism on the human brain and the reversibility of these effects after resolution of the condition. This cross-sectional study used resting-state fMRI (rs-fMRI) to investigate the altered spontaneous brain activity in CD patients and the trends for potential reversibility after the resolution of the hypercortisolism. We also aim to determine the relationship of these changes with clinical characteristics and cortisol levels. SUBJECTS AND METHODS Active CD patients (n = 18), remitted CD patients (n = 14) and healthy control subjects (n = 22) were included in this study. Amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) values were calculated to represent spontaneous brain activity. RESULTS Our study resulted in three major findings: (i) active CD patients showed significantly altered spontaneous brain activity in the posterior cingulate cortex (PCC)/precuneus (PCu), occipital lobe (OC)/cerebellum, thalamus, right postcentral gyrus (PoCG) and left prefrontal cortex (PFC); (ii) trends for partial restoration of altered spontaneous brain activity after the resolution hypercortisolism were found in several brain regions; and (iii) active CD patients showed a significant correlation between cortisol levels and ALFF/ReHo values in the PCC/PCu, a small cluster in the OC and the right IPL. CONCLUSIONS This study provides a new approach to investigating brain function abnormalities in patients with CD and enhances our understanding of the effect of hypercortisolism on the human brain. Furthermore, our explorative potential reversibility study of patients with CD may facilitate the development of future longitudinal studies.
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Affiliation(s)
- Hong Jiang
- Department of Neurosurgery, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Na-Ying He
- Department of Radiology, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Hao Sun
- Department of Neurosurgery, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang-Fang Jian
- Department of Endocrinology, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu-Guan Bian
- Department of Neurosurgery, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Kang Shen
- Department of Neurosurgery, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fu-Hua Yan
- Department of Radiology, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Si-Jian Pan
- Department of Neurosurgery, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing-Fang Sun
- Department of Neurosurgery, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Rui-Jin Lu-Wan Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Pleil KE, Helms CM, Sobus JR, Daunais JB, Grant KA, Kash TL. Effects of chronic alcohol consumption on neuronal function in the non-human primate BNST. Addict Biol 2016. [PMID: 26223349 DOI: 10.1111/adb.12289] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Alterations in hypothalamic-pituitary-adrenal axis function contribute to many of the adverse behavioral effects of chronic voluntary alcohol drinking, including alcohol dependence and mood disorders; limbic brain structures such as the bed nucleus of the stria terminalis (BNST) may be key sites for these effects. Here, we measured circulating levels of several steroid hormones and performed whole-cell electrophysiological recordings from acutely prepared BNST slices of male rhesus monkeys allowed to self-administer alcohol for 12 months or a control solution. Initial comparisons revealed that BNST neurons in alcohol-drinking monkeys had decreased membrane resistance, increased frequency of spontaneous inhibitory postsynaptic currents (sIPSCs) with no change in spontaneous excitatory postsynaptic currents (sEPSCs). We then used a combined variable cluster analysis and linear mixed model statistical approach to determine whether specific factors including stress and sex hormones, age and measures of alcohol consumption and intoxication are related to these BNST measures. Modeling results showed that specific measures of alcohol consumption and stress-related hormone levels predicted differences in membrane conductance in BNST neurons. Distinct groups of adrenal stress hormones were negatively associated with the frequency of sIPSCs and sEPSCs, and alcohol drinking measures and basal neuronal membrane properties were additional positive predictors of inhibitory, but not excitatory, PSCs. The amplitude of sEPSCs was highly positively correlated with age, independent of other variables. Together, these results suggest that chronic voluntary alcohol consumption strongly influences limbic function in non-human primates, potentially via interactions with or modulation by other physiological variables, including stress steroid hormones and age.
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Affiliation(s)
- Kristen E. Pleil
- Bowles Center for Alcohol Studies & Department of Pharmacology, School of Medicine; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Christa M. Helms
- Division of Neuroscience, Oregon National Primate Research Center; Oregon Health & Science University; Beaverton OR USA
| | - Jon R. Sobus
- Human Exposure and Atmospheric Sciences Division, National Exposure Research Laboratory, Office of Research and Development; U.S. Environmental Protection Agency; Research Triangle Park NC USA
| | - James B. Daunais
- Department of Physiology & Pharmacology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Kathleen A. Grant
- Division of Neuroscience, Oregon National Primate Research Center; Oregon Health & Science University; Beaverton OR USA
| | - Thomas L. Kash
- Bowles Center for Alcohol Studies & Department of Pharmacology, School of Medicine; University of North Carolina at Chapel Hill; Chapel Hill NC USA
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Bozic J, Galic T, Supe-Domic D, Ivkovic N, Ticinovic Kurir T, Valic Z, Lesko J, Dogas Z. Morning cortisol levels and glucose metabolism parameters in moderate and severe obstructive sleep apnea patients. Endocrine 2016; 53:730-9. [PMID: 27000083 DOI: 10.1007/s12020-016-0925-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/11/2016] [Indexed: 12/26/2022]
Abstract
Obstructive sleep apnea (OSA) has been associated with dysregulation of the hypothalamic-pituitary-adrenal axis and alterations in glucose metabolism with increased risk for type 2 diabetes. The aim of the current study was to compare morning plasma cortisol levels and glucose metabolism parameters between moderate (apnea-hypopnea index (AHI): 15-30 events/h) and severe OSA patients (AHI >30 events/h), with respective controls. A total of 56 male OSA patients, 24 moderate (AHI = 21.1 ± 5.3) and 32 severe (AHI = 49.7 ± 18.1), underwent a full-night polysomnography, oral glucose tolerance test (OGTT), and measurement of morning plasma cortisol levels. These groups were compared to 20 matched subjects in a control group. Morning plasma cortisol levels were statistically lower in severe OSA group than in moderate OSA and control groups (303.7 ± 93.5 vs. 423.9 ± 145.1 vs. 417.5 ± 99.8 pmol/L, P < 0.001). Significant negative correlations were found between morning plasma cortisol levels and AHI (r = -0.444, P = 0.002), as well as oxygen desaturation index (r = -0.381, P = 0.011). Fasting plasma glucose (5.0 ± 0.5 vs. 5.4 ± 0.7 vs. 4.9 ± 0.6 mmol/L, P = 0.009) was higher in the severe OSA group compared to moderate OSA and controls. Homeostasis model assessment insulin resistance (HOMA-IR) was higher in the severe OSA group compared to moderate OSA and controls (4.6 ± 3.7 vs. 2.7 ± 2.0 and 2.2 ± 1.8, respectively, P = 0.006). In conclusion, our study showed that morning plasma cortisol levels measured at 8 a.m. were significantly lower in severe OSA patients than those in moderate OSA group and controls. Morning plasma cortisol levels showed a negative correlation with AHI and oxygen desaturation index. Additionally, this study confirmed the evidence of glucose metabolism impairment in moderate and severe OSA patients, with more pronounced effect in the severe OSA patients group.
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Affiliation(s)
- Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Tea Galic
- Study of Dental Medicine, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Daniela Supe-Domic
- Department of Medical Laboratory Diagnostics, University Hospital Split, Spinciceva 1, Split, Croatia
| | - Natalija Ivkovic
- Split Sleep Medicine Center, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Zoran Valic
- Department of Physiology, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Josip Lesko
- Departments of Anatomy and Neuroscience, University of Mostar School of Medicine, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Zoran Dogas
- Split Sleep Medicine Center, University of Split School of Medicine, Soltanska 2, Split, Croatia.
- Department of Neuroscience, University of Split School of Medicine, Soltanska 2, Split, 21000, Croatia.
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Crespo I, Santos A, Gómez-Ansón B, López-Mourelo O, Pires P, Vives-Gilabert Y, Webb SM, Resmini E. Brain metabolite abnormalities in ventromedial prefrontal cortex are related to duration of hypercortisolism and anxiety in patients with Cushing's syndrome. Endocrine 2016; 53:848-56. [PMID: 27103571 DOI: 10.1007/s12020-016-0963-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
Chronic exposure to excessive glucocorticoid (GC) concentration in Cushing's syndrome (CS) can affect the brain structurally and functionally; ventromedial prefrontal cortex (vmPFC) is rich in GC receptors and therefore particularly vulnerable to excessive GC concentration. Proton magnetic resonance spectroscopy ((1)H-MRS) is a sensitive, non-invasive imaging technique that provides information on brain metabolites in vivo. Our aim was to investigate metabolite concentrations in vmPFC of CS patients and their relationship with clinical outcome. Twenty-two right-handed CS patients (7 active/15 in remission, 19 females, 41.6 ± 12.3 years) and 22 right-handed healthy controls (14 females, 41.7 ± 11 years) underwent brain MRI and (1)H-MRS exams at 3 Tesla. Concentrations of glutamate (Glu), glutamate + glutamine (Glx), creatine (Cr), N-Acetyl-aspartate (NAA), N-Acetyl-aspartate + N-acetylaspartylglutamate (total NAA), choline-containing compounds (Cho) and myoinositol (MI) were determined. Moreover, anxiety and depressive symptoms were evaluated with the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory-II (BDI-II) test, respectively. CS patients had lower concentrations of glutamate and total NAA in the vmPFC than healthy controls (8.6 ± 1.2 vs. 9.3 ± 0.7 mmol/L, and 6.4 ± 0.8 vs. 6.8 ± 0.4 mmol/L, respectively; p < 0.05). Duration of hypercortisolism was negatively correlated with total NAA (r = -0.488, p < 0.05). Moreover, the concentration of total NAA was negatively correlated with anxiety state (r = -0.359, p < 0.05). Brain metabolites are abnormal in the vmPFC of patients with CS. Decreased total NAA and glutamate concentrations indicate neuronal dysfunction that appear to be related with duration of hypercortisolism and anxiety.
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Affiliation(s)
- Iris Crespo
- Endocrinology/Medicine Departments, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), C/Sant Antoni Maria Claret n.167, 08025, Barcelona, Spain
| | - Alicia Santos
- Endocrinology/Medicine Departments, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), C/Sant Antoni Maria Claret n.167, 08025, Barcelona, Spain
| | - Beatriz Gómez-Ansón
- Neuroradiology Unit, Hospital de Sant Pau, and IIB-Sant Pau, UAB, Barcelona, Spain
| | | | - Patricia Pires
- INNDACYT, Avda. Europa, 20, Planta Baja Puerta, D 08907, Hospitalet de Llobregat, Spain
| | | | - Susan M Webb
- Endocrinology/Medicine Departments, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), C/Sant Antoni Maria Claret n.167, 08025, Barcelona, Spain
| | - Eugenia Resmini
- Endocrinology/Medicine Departments, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), C/Sant Antoni Maria Claret n.167, 08025, Barcelona, Spain.
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Spanakis EK, Wang X, Sánchez BN, Diez Roux AV, Needham BL, Wand GS, Seeman T, Golden SH. Lack of significant association between type 2 diabetes mellitus with longitudinal change in diurnal salivary cortisol: the multiethnic study of atherosclerosis. Endocrine 2016; 53:227-39. [PMID: 26895003 PMCID: PMC4902713 DOI: 10.1007/s12020-016-0887-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/02/2016] [Indexed: 02/02/2023]
Abstract
Cross-sectional association has been shown between type 2 diabetes and hypothalamic-pituitary-adrenal (HPA) axis dysregulation; however, the temporality of this association is unknown. Our aim was to determine if type 2 diabetes is associated with longitudinal change in daily cortisol curve features. We hypothesized that the presence of type 2 diabetes may lead to a more blunted and abnormal HPA axis profile over time, suggestive of increased HPA axis dysregulation. This was a longitudinal cohort study, including 580 community-dwelling individuals (mean age 63.7 ± 9.1 years; 52.8 % women) with (n = 90) and without (n = 490) type 2 diabetes who attended two MultiEthnic Study of Atherosclerosis Stress ancillary study exams separated by 6 years. Outcome measures that were collected were wake-up and bedtime cortisol, cortisol awakening response (CAR), total area under the curve (AUC), and early, late, and overall decline slopes. In univariate analyses, wake-up and AUC increased over 6 years more in persons with as compared to those without type 2 diabetes (11 vs. 7 % increase for wake-up and 17 vs. 11 % for AUC). The early decline slope became flatter over time with a greater flattening observed in diabetic compared to non-diabetic individuals (23 vs. 9 % flatter); however, the change was only statistically significant for wake-up cortisol (p-value: 0.03). Over time, while CAR was reduced more, late decline and overall decline became flatter, and bedtime cortisol increased less in those with as compared to those without type 2 diabetes, none of these changes were statistically significant in adjusted models. We did not identify any statistically significant change in cortisol curve features over 6 years by type 2 diabetes status.
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Affiliation(s)
- Elias K Spanakis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA
| | - Xu Wang
- Department of Epidemiology, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Brisa N Sánchez
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Ana V Diez Roux
- Department of Epidemiology, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Belinda L Needham
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Gary S Wand
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA
| | - Teresa Seeman
- Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sherita Hill Golden
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Tirabassi G, Chelli FM, Ciommi M, Lenzi A, Balercia G. Influence of the hypothalamic-pituitary-adrenal axis dysregulation on the metabolic profile of patients affected by diabetes mellitus-associated late onset hypogonadism. Nutr Metab Cardiovasc Dis 2016; 26:53-59. [PMID: 26643209 DOI: 10.1016/j.numecd.2015.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 09/16/2015] [Accepted: 10/11/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Functional hypercortisolism (FH) is generated by clinical states able to chronically activate the hypothalamic-pituitary-adrenal (HPA) axis [e.g. diabetes mellitus (DM)]. No study has evaluated FH influence in worsening the metabolic profile of male patients affected by DM-associated hypogonadism. In this retrospective work, we assess the possible association between HPA axis-dysregulation and cardiovascular risk factors in men simultaneously affected by DM and late-onset hypogonadism (LOH). METHODS AND RESULTS Fourteen DM and LOH subjects affected by FH (Hypercort-DM-LOH) and fourteen DM and LOH subjects who were not suffering from FH (Normocort-DM-LOH) were retrospectively considered. Clinical, hormonal and metabolic parameters were retrieved. All metabolic parameters, except for systolic blood pressure, were significantly worse in Hypercort-DM-LOH than in Normocort-DM-LOH. After adjustment for body mass index, waist and total testosterone, Hypercort-DM-LOH subjects showed significantly worse metabolic parameters than Normocort-DM-LOH ones. In Normocort-DM-LOH, no significant correlation between general/hormonal parameters and metabolic variables was present. In Hypercort-DM-LOH, positive and significant correlations of cortisol area under the curve (AUC) after corticotropin releasing hormone with glycemia, triglycerides and blood pressure were evident; on the other hand, negative and significant correlation was present between cortisol AUC and high density lipoprotein (HDL) cholesterol. The associations of AUC cortisol with glycemia, HDL cholesterol and diastolic blood pressure (DBP) were further confirmed at quantile regression after adjustment for therapy. CONCLUSIONS FH may determine a worsening of the metabolic profile in DM-associated hypogonadism.
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Affiliation(s)
- G Tirabassi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - F M Chelli
- Department of Economics and Social Sciences, Polytechnic University of Marche, Ancona, Italy
| | - M Ciommi
- Department of Economics and Social Sciences, Polytechnic University of Marche, Ancona, Italy
| | - A Lenzi
- Andrology, Pathophysiology of Reproduction and Endocrine Diagnosis Unit, Policlinic Umberto I, University of Rome "La Sapienza", Rome, Italy
| | - G Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy.
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Iizuka N, Chen Q, Tominaga Y, Ikura Y, Iwai Y. Cytomegalovirus-Associated Gastroduodenal Ulcers in a Patient With Functional Hypercortisolism: A Case Report. Medicine (Baltimore) 2015; 94:e1940. [PMID: 26559263 PMCID: PMC4912257 DOI: 10.1097/md.0000000000001940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cytomegalovirus (CMV)-associated gastroduodenal ulcers (GDU) are a rare digestive disease, which principally affect immunocompromised patients. We recently experienced CMV-associated GDU occurring in a seemingly immunocompetent patient. The rarity of such a condition was inimical to a correct clinical diagnosis.A 77-year-old woman with Alzheimer's disease was admitted to our hospital because of vomiting and anorexia. Her general condition was extremely poor due to severe dehydration. Any invasive procedures including gastroduodenal endoscopy could not be performed. Laboratory test results showed electrolyte imbalance, hyperglycemia, and hypercortisolemia. The plasma adrenocorticotropic hormone level was rather low. On her 11th day in hospital, she suddenly fell into shock status. Despite intensive care, the patient could not be rescued. An autopsy was performed and revealed that she had suffered from CMV-associated GDU and died of candidemia that invaded through the ulcer. Her adrenal glands showed neither neoplasm nor hyperplasia, suggesting that her hypercortisolism was a purely functional disorder. We concluded that the severe opportunistic infections were developed in association with functional hypercortisolism.This case suggests that functional hypercortisolism, even though transient, can cause a patient to be immunocompromised.
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Affiliation(s)
- Noriaki Iizuka
- From the Department of Diabetology and Endocrinology, Takatsuki General Hospital, Takatsuki, Japan (NI, QC, YT); and Department of Pathology, Takatsuki General Hospital, Takatsuki, Japan (Y Ikura, Y Iwai)
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Li R, Jia Y, Pan S, Li X, Song H, Zhao R. Glucocorticoid Receptor Mediates the Effect of High-Fat Diet on Mitochondrial Oxidative Phosphorylation in Mouse Liver. DNA Cell Biol 2015; 35:51-8. [PMID: 26479079 DOI: 10.1089/dna.2015.2932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Obesity is associated with hepatic mitochondrial dysfunction. The relationship between glucocorticoids (GCs) and obesity has also been demonstrated in several researches. Recent research showed that GCs can affect the mitochondrial function. However, the role of glucocorticoid receptor (GR) in obesity-induced mitochondrial dysfunction remains unclear. C57BL/6 male mice fed with a high-fat diet (HFD) for 7 weeks were used as a model. The mice were shown to be overweight, together with lower serum and hepatic corticosterone levels. The hepatic expressions of mitochondrial DNA (mtDNA)-encoded genes were lower in the HFD mice, same as the mtDNA copy number, ATP content, and COX enzyme activity. Both the translocation of GR (NR3C1) into mitochondria and the binding of GR to the mtDNA were lower in the liver of HFD mice. The PGC1α mRNA expression, protein content, and translocation into mitochondria were also found to be reduced, with the lower GR binding to the promoter region of PGC1α in the liver of HFD mice. GR, as a transcription factor, may take an important role in the regulation of mitochondrial oxidative phosphorylation in the HFD mice by interacting with PGC1α and controlling mtDNA expression.
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Affiliation(s)
- Runsheng Li
- 1 Key Laboratory of Animal Physiology and Biochemistry, Nanjing Agricultural University , Nanjing, People's Republic of China
| | - Yimin Jia
- 1 Key Laboratory of Animal Physiology and Biochemistry, Nanjing Agricultural University , Nanjing, People's Republic of China
| | - Shifeng Pan
- 1 Key Laboratory of Animal Physiology and Biochemistry, Nanjing Agricultural University , Nanjing, People's Republic of China .,2 College of Veterinary Medicine, Yangzhou University , Yangzhou, People's Republic of China
| | - Xian Li
- 1 Key Laboratory of Animal Physiology and Biochemistry, Nanjing Agricultural University , Nanjing, People's Republic of China
| | - Haogang Song
- 1 Key Laboratory of Animal Physiology and Biochemistry, Nanjing Agricultural University , Nanjing, People's Republic of China
| | - Ruqian Zhao
- 1 Key Laboratory of Animal Physiology and Biochemistry, Nanjing Agricultural University , Nanjing, People's Republic of China
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Remer T. High salt intake: detrimental not only for blood pressure, but also for bone health? Endocrine 2015; 49:580-2. [PMID: 25957669 DOI: 10.1007/s12020-015-0626-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/04/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Remer
- Department of Nutritional Epidemiology, Institute of Nutrition and Food Science (IEL), University of Bonn, DONALD Study Centre, Dortmund, Germany,
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Ceccato F, Bernkopf E, Scaroni C. Sleep apnea syndrome in endocrine clinics. J Endocrinol Invest 2015; 38:827-34. [PMID: 26122486 DOI: 10.1007/s40618-015-0338-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/10/2015] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is a chronic condition with a high prevalence (up to 7 % of the general population) characterized by frequent episodes of upper airway collapse while sleeping. Left untreated, OSAS can cause severe complications, including systemic hypertension, cardiovascular disease, stroke, and abnormal glucose metabolism. This review aims to summarize the close links between OSAS, endocrinology, and metabolism. In patients with metabolic syndrome, OSAS is an independent risk factor for the onset of type 2 diabetes and a worsening glycemic control. The accumulation of adipose tissue in the neck and limited chest wall dynamics, hypoxia, and local micro-inflammation link visceral obesity closely with OSAS. There is now an abundance of convincing data indicating that promoting lifestyle changes, improving sleep hygiene, and adjusting diet can ameliorate both metabolic syndrome and OSAS, especially in obese patients. The incidence of OSAS in acromegaly is high, though GH treatments seem to be unrelated to the onset of apnea in GH-deficient individuals. Prospective studies have suggested an association between hypertension and OSAS because intermittent nocturnal hypoxia prompts an increase in sympathetic tone, endothelial dysfunction, and vascular inflammation: aldosterone excess may have a pathophysiological role, and some authors have reported that treating OSAS leads to a modest, but significant, reduction in blood pressure.
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Affiliation(s)
- F Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, 35128, Padua, Italy,
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Wang K, Wu Y, Yang Y, Chen J, Zhang D, Hu Y, Liu Z, Xu J, Shen Q, Zhang N, Mao X, Liu C. The associations of bedtime, nocturnal, and daytime sleep duration with bone mineral density in pre- and post-menopausal women. Endocrine 2015; 49:538-48. [PMID: 25449993 DOI: 10.1007/s12020-014-0493-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 11/24/2014] [Indexed: 01/03/2023]
Abstract
To explore the association of sleep patterns with bone mineral density (BMD) in pre- and post-menopausal women, we used a questionnaire to evaluate the sleep patterns and performed calcaneal quantitative ultrasound to estimate BMD, in 6,510 women aged 40 years or older, from June to November 2011 in Nanjing City. We found a 1.7-fold risk of osteoporosis in post-menopausalwomen with bedtime of ≥0:00 am (OR = 1.69, 95 % CI 1.39-2.13), compared to those whose bedtime of <0:00 am. post-menopausalwomen with excessive total sleep (>10 h vs. 8-9 h, OR = 1.54, 95 % CI 1.05-2.02) were shown to have a higher risk of osteoporosis, however, this high risk was not detected in those with excessive nocturnal sleep (>10 h vs. 8-9 h, OR = 0.85, 95 % CI 0.62-1.30). By contrast, post-menopausalwomen with inadequate nocturnal sleep (≤7 h vs. 8-9 h, OR = 1.68, 95 % CI 1.32-2.75), excessive daytime sleep (≥180 min vs. 0 min, OR = 1.52, 95 % CI 1.08-2.13), and noontime nap (>60 min vs. 0 min: OR = 1.37, 95 % CI 1.06-1.76) were demonstrated to have higher risk of bone loss. Nevertheless, these associations were not found in premenopausal women. We conclude that delayed bedtime, nocturnal sleep deprivation, excessive daytime sleep, and noontime nap, but not reduced total sleep duration, could promote bone loss in post-menopausalwomen, which might be related to circadian rhythm disturbances. However, they have limited influences to BMD in women who were still in menstruating. Mechanism responsible for the phenomena warrants further investigation.
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Affiliation(s)
- Kun Wang
- Department of Endocrinology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Chinese Medicine, 100, Hongshan Road, Nanjing, 210028, China
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Korte SM, Prins J, Krajnc AM, Hendriksen H, Oosting RS, Westphal KG, Korte-Bouws GA, Olivier B. The many different faces of major depression: It is time for personalized medicine. Eur J Pharmacol 2015; 753:88-104. [DOI: 10.1016/j.ejphar.2014.11.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/16/2014] [Accepted: 11/26/2014] [Indexed: 01/11/2023]
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Sabbadin C, Donà G, Bordin L, Iacobone M, Camozzi V, Mian C, Armanini D. Transient hypercortisolism and symptomatic hyperthyroidism associated to primary hyperparathyroidism in an elderly patient: case report and literature review. BMC Endocr Disord 2015; 15:4. [PMID: 25631825 PMCID: PMC4417273 DOI: 10.1186/1472-6823-15-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/15/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is often found on routine blood tests, at a relatively asymptomatic stage. However many studies suggest different systemic effects related to PHPT, which could be enhanced by an abnormal cortisol release due to chronic stress of hyperparathyroidism. Being PHPT frequently found in the 6(th) to 7(th) decade of life, a careful and multifaceted approach should be taken. CASE PRESENTATION We report the case of an elderly patient with symptomatic PHPT and incidental pulmonary embolism. He was treated with hydration, zoledronic acid, cinacalcet and high-dose unfractionated heparin. Parathyroid surgery was successfully performed, but patient's conditions suddenly worsened because of a transient thyrotoxicosis, probably induced by a previous exposure to iodine load and/or thyroid surgical manipulation. A short-term treatment with beta-blockers was introduced for symptomatic relief. The patient also presented a transient hypercortisolism with elevated ACTH, likely due to stress related not only to aging and hospitalization but also to PHPT, resolved only four months after parathyroid surgery. CONCLUSION Chronic hyperparathyroidism has been linked with increased all-cause mortality. A functional chronic hypercortisolism could be established, enhancing PHPT related disorders. Only parathyroid surgery has been demonstrated to cure PHPT and complications related, showing similar outcome between older and younger patients. However, the management of post-operative period should be more careful in fragile patients. In particular, the early diagnosis and treatment of a transient post-operative thyrotoxicosis could improve recovery. Due to the increase in prevalence and the evidence of many related complications even in asymptomatic PHPT, expert opinion-based guidelines for surgical treatment of PHPT should be developed especially for elderly patients.
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Affiliation(s)
- Chiara Sabbadin
- Department of Medicine-Endocrinology, University of Padua, Via Ospedale 105, 35128, Padua, Italy.
| | - Gabriella Donà
- Department of Molecular Medicine-Biological Chemistry, University of Padua, Padua, Italy.
| | - Luciana Bordin
- Department of Molecular Medicine-Biological Chemistry, University of Padua, Padua, Italy.
| | - Maurizio Iacobone
- Minimally Invasive Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
| | - Valentina Camozzi
- Department of Medicine-Endocrinology, University of Padua, Via Ospedale 105, 35128, Padua, Italy.
| | - Caterina Mian
- Department of Medicine-Endocrinology, University of Padua, Via Ospedale 105, 35128, Padua, Italy.
| | - Decio Armanini
- Department of Medicine-Endocrinology, University of Padua, Via Ospedale 105, 35128, Padua, Italy.
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Cortés-Puch I, Hicks CW, Sun J, Solomon SB, Eichacker PQ, Sweeney DA, Nieman LK, Whitley EM, Behrend EN, Natanson C, Danner RL. Hypothalamic-pituitary-adrenal axis in lethal canine Staphylococcus aureus pneumonia. Am J Physiol Endocrinol Metab 2014; 307:E994-E1008. [PMID: 25294215 PMCID: PMC4254987 DOI: 10.1152/ajpendo.00345.2014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The clinical significance and even existence of critical illness-related corticosteroid insufficiency is controversial. Here, hypothalamic-pituitary-adrenal (HPA) function was characterized in severe canine Staphylococcus aureus pneumonia. Animals received antibiotics and titrated life-supportive measures. Treatment with dexamethasone, a glucocorticoid, but not desoxycorticosterone, a mineralocorticoid, improves outcome in this model. Total and free cortisol, adrenocorticotropic hormone (ACTH). and aldosterone levels, as well as responses to exogenous ACTH were measured serially. At 10 h after the onset of infection, the acute HPA axis stress response, as measured by cortisol levels, exceeded that seen with high-dose ACTH stimulation but was not predictive of outcome. In contrast to cortisol, aldosterone was largely autonomous from HPA axis control, elevated longer, and more closely associated with survival in early septic shock. Importantly, dexamethasone suppressed cortisol and ACTH levels and restored ACTH responsiveness in survivors. Differing strikingly, nonsurvivors, sepsis-induced hypercortisolemia, and high ACTH levels as well as ACTH hyporesponsiveness were not influenced by dexamethasone. During septic shock, only serial measurements and provocative testing over a well-defined timeline were able to demonstrate a strong relationship between HPA axis function and prognosis. HPA axis unresponsiveness and high aldosterone levels identify a septic shock subpopulation with poor outcomes that may have the greatest potential to benefit from new therapies.
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Affiliation(s)
- Irene Cortés-Puch
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland;
| | - Caitlin W Hicks
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland; Department of General Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; National Institutes of Health Research Scholars Program, Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Junfeng Sun
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Steven B Solomon
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Peter Q Eichacker
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Daniel A Sweeney
- Medical Intensivist Program, Washington Hospital, Fremont, California
| | - Lynnette K Nieman
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Bethesda, Maryland
| | - Elizabeth M Whitley
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa; and
| | - Ellen N Behrend
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Charles Natanson
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Robert L Danner
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
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Sansone A, Romanelli F, Gianfrilli D, Lenzi A. Endocrine evaluation of erectile dysfunction. Endocrine 2014; 46:423-30. [PMID: 24705931 DOI: 10.1007/s12020-014-0254-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
Erectile dysfunction is highly prevalent, affecting up to half of men in their 50-70s, and has been variably associated to a variety of causes including unhealthy lifestyles, such as smoking or overweight, or comorbidities such as hypertension, diabetes mellitus, and neurological disorders. General interest toward ED has exploded since the introduction of phosphodiesterase type 5 inhibitors-oral drugs that are widely accepted as the first line treatment in patients suffering from this conditions. In the last decade, the time lapse between first symptoms of sexual disorders and seeking of medical advice has greatly reduced. Unfortunately, none of the PDE5i has been proven curative, but rather acts as a symptomatic treatment. The availability of very active and safe drugs, however, diminished the space for diagnosis and search of etiological treatments. This is particularly true for the several endocrinopathies associated with ED. A number of epidemiological data support an inverse relationship between sexual health and testosterone levels, and it is well accepted that testosterone deficiency is a good marker of sexual and physical frailty. However, several other hormones, including LH, prolactin, TSH, and FT4 are involved in sexual functioning and should be investigated in a proper work-out of ED. Existing guidelines provide information almost entirely focusing on late-onset hypogonadism and therapeutic strategies; this mini-review aims to provide a wider spectrum of the diagnostic endocrine work-out of ED patients unrevealing the complexity of conditions, overt or subclinical, which can affect ED.
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Affiliation(s)
- Andrea Sansone
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy,
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