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Park SS, Kim YH, Kang H, Ahn CH, Byun DJ, Choi MH, Kim JH. Serum and hair steroid profiles in patients with nonfunctioning pituitary adenoma undergoing surgery: A prospective observational study. J Steroid Biochem Mol Biol 2023; 230:106276. [PMID: 36858289 DOI: 10.1016/j.jsbmb.2023.106276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/02/2023]
Abstract
Patients who undergo transsphenoidal surgery (TSS) experience perioperative hormonal changes, but there are few studies on the perioperative changes of serum and hair steroid profiles. This study investigated the perioperative changes in steroid metabolic signatures in patients with nonfunctioning pituitary adenoma (NFPA) who underwent transsphenoidal surgery (TSS). A total of 55 participants who underwent TSS for NFPA at a single center between July 2017 and October 2018 were enrolled. Fifteen serum steroids and their metabolic ratios were profiled using gas chromatography-mass spectrometry (GC-MS) before and 1 day, 1 week, and 3 months after TSS. Five steroids from hair samples collected 1 day and 3 months after TSS were also quantitatively compared. Serum cortisol and its A-ring reductive metabolites, as well as 6β-hydroxycortisol, increased dramatically 1 day after TSS and then gradually decreased. Seven serum steroids, including adrenal androgens and mineralocorticoids, and hair cortisone levels were significantly lower in patients with preoperative adrenocorticotropic hormone (ACTH) deficiency (N = 7) than in those without ACTH deficiency (N = 48). Serum levels of dehydroepiandrosterone (DHEA) levels 1 week after TSS predicted ACTH deficiency 3 months after TSS, with 100 % sensitivity and 86 % specificity. A significant positive correlation between the preoperative serum and hair DHEA levels (r = 0.356, P = 0.008) was observed. These findings suggest that the levels of DHEA in both the serum and hair could be an early marker of ACTH deficiency after TSS. In addition, hair cortisone may be a useful preoperative indicator of chronic ACTH deficiency.
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Affiliation(s)
- Seung Shin Park
- Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Republic of Korea
| | - Yong Hwy Kim
- Pituitary Center, Seoul National University Hospital, Republic of Korea; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Chang Ho Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Dong Jun Byun
- Center for Advanced Biomolecular Recognition, Korea Institute of Science and Technology, Republic of Korea
| | - Man Ho Choi
- Center for Advanced Biomolecular Recognition, Korea Institute of Science and Technology, Republic of Korea.
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Republic of Korea,; Pituitary Center, Seoul National University Hospital, Republic of Korea.
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Gonzalez D, Maidana P, Ibar C, Jamardo J, Jacobsen D, Fritzler A, Fortuna F, Fernandez G, Lamas-Majek E, Mallea-Gil S, Ballarino C, Onetto C, Lopez M, Mesch V, Fabre B. Hair cortisol in polycystic ovary syndrome. Sci Rep 2022; 12:10309. [PMID: 35725989 PMCID: PMC9209522 DOI: 10.1038/s41598-022-14061-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of the study was to evaluate adrenal axis hyperactivation measuring hair cortisol levels, and its influence on the relationship among metabolic parameters, inflammation markers and androgens in adult women with PCOS. 44 women (18–34 years) with PCOS diagnosis and a control group of 49 healthy women (19–35 years) were included. In both gropus body mass index (BMI) was calculated and waist circumference (WC) was measured. Hair cortisol, total serum testosterone (TT), serum cortisol, 25 OH vitamin D (25OHD), insulin, high sensitivity C-reactive protein (hsCRP), triglycerides (TG), HDL cholesterol (HDL), glucose and leptin were measured. Bioavailable testosterone (bioT) was calculated. Hair cortisol concentration was higher and significantly different in PCOS patients compared to the control group (130 vs 63 pg/mg of hair, p < 0.001). Subsequently, patients with PCOS were divided into two groups according to hair cortisol levels: group 1 with normal hair cortisol concentration and group 2 with levels above the upper limit of the reference values (128 pg/mg of hair). In group 2, TT significantly correlated with 25OHD, hsCRP, TG/HDL index, BMI, WC, insulin and HOMA (p < 0.05); bioT correlated with hsCRP and leptin (p < 0.05). Finally, 25OHD was inversely correlated with leptin and with TG/HDL index (p < 0.05). High hair cortisol concentration in patients with PCOS confirmed hyperactivation of the HPA axis. The associations observed were only found in patients with PCOS with high hair cortisol levels (> 128 pg/mg of hair), showing a possible effect of HPA axis in these associations.
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Affiliation(s)
- D Gonzalez
- Departamento de Bioquímica Clínica-Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 956 (1113), Junín, Buenos Aires, Argentina
| | - P Maidana
- Departamento de Bioquímica Clínica-Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 956 (1113), Junín, Buenos Aires, Argentina
| | - C Ibar
- Departamento de Bioquímica Clínica-Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 956 (1113), Junín, Buenos Aires, Argentina
| | - J Jamardo
- Departamento de Bioquímica Clínica-Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 956 (1113), Junín, Buenos Aires, Argentina
| | - D Jacobsen
- Departamento de Bioquímica Clínica-Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 956 (1113), Junín, Buenos Aires, Argentina
| | - A Fritzler
- Departamento de Bioquímica Clínica-Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 956 (1113), Junín, Buenos Aires, Argentina
| | - F Fortuna
- Departamento de Bioquímica Clínica-Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 956 (1113), Junín, Buenos Aires, Argentina
| | - G Fernandez
- División Ginecología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, 2351 (1120), Córdoba, Buenos Aires, Argentina
| | - E Lamas-Majek
- División Ginecología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, 2351 (1120), Córdoba, Buenos Aires, Argentina
| | - S Mallea-Gil
- Servicio de Endocrinología, Hospital Militar Central, Luis María Campos, 726 (1426), Buenos Aires, Argentina
| | - C Ballarino
- Servicio de Endocrinología, Hospital Militar Central, Luis María Campos, 726 (1426), Buenos Aires, Argentina
| | - C Onetto
- División Ginecología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, 2351 (1120), Córdoba, Buenos Aires, Argentina
| | - M Lopez
- División Ginecología, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, 2351 (1120), Córdoba, Buenos Aires, Argentina
| | - Viviana Mesch
- Departamento de Bioquímica Clínica-Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 956 (1113), Junín, Buenos Aires, Argentina.
| | - B Fabre
- Departamento de Bioquímica Clínica-Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, 956 (1113), Junín, Buenos Aires, Argentina
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Lopez M, Ruiz MO, Rovnaghi CR, Tam GKY, Hiscox J, Gotlib IH, Barr DA, Carrion VG, Anand KJS. The social ecology of childhood and early life adversity. Pediatr Res 2021; 89:353-367. [PMID: 33462396 PMCID: PMC7897233 DOI: 10.1038/s41390-020-01264-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/14/2020] [Accepted: 10/12/2020] [Indexed: 01/30/2023]
Abstract
An increasing prevalence of early childhood adversity has reached epidemic proportions, creating a public health crisis. Rather than focusing only on adverse childhood experiences (ACEs) as the main lens for understanding early childhood experiences, detailed assessments of a child's social ecology are required to assess "early life adversity." These should also include the role of positive experiences, social relationships, and resilience-promoting factors. Comprehensive assessments of a child's physical and social ecology not only require parent/caregiver surveys and clinical observations, but also include measurements of the child's physiology using biomarkers. We identify cortisol as a stress biomarker and posit that hair cortisol concentrations represent a summative and chronological record of children's exposure to adverse experiences and other contextual stressors. Future research should use a social-ecological approach to investigate the robust interactions among adverse conditions, protective factors, genetic and epigenetic influences, environmental exposures, and social policy, within the context of a child's developmental stages. These contribute to their physical health, psychiatric conditions, cognitive/executive, social, and psychological functions, lifestyle choices, and socioeconomic outcomes. Such studies must inform preventive measures, therapeutic interventions, advocacy efforts, social policy changes, and public awareness campaigns to address early life adversities and their enduring effects on human potential. IMPACT: Current research does not support the practice of using ACEs as the main lens for understanding early childhood experiences. The social ecology of early childhood provides a contextual framework for evaluating the long-term health consequences of early life adversity. Comprehensive assessments reinforced with physiological measures and/or selected biomarkers, such as hair cortisol concentrations to assess early life stress, may provide critical insights into the relationships between early adversity, stress axis regulation, and subsequent health outcomes.
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Affiliation(s)
- Marcela Lopez
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine
| | - Monica O. Ruiz
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Cynthia R. Rovnaghi
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine
| | - Grace K-Y. Tam
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine
| | - Jitka Hiscox
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine,Department of Civil Engineering, Stanford School of Engineering, Stanford, CA
| | - Ian H. Gotlib
- Department of Psychology, Stanford University School of Humanities & Sciences, Stanford, CA
| | - Donald A. Barr
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA,Stanford University Graduate School of Education, Stanford, CA
| | - Victor G. Carrion
- Department of Psychiatry (Child and Adolescent Psychiatry), Clinical & Translational Neurosciences Incubator, Stanford University School of Medicine, Stanford, CA
| | - Kanwaljeet J. S. Anand
- Pain/Stress Neurobiology Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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Abstract
Asthma is the most common chronic inflammatory disease of children, and inhaled corticosteroids (ICSs) are the most effective and commonly used treatment of persistent asthma. ICSs currently approved for and commonly used by children with asthma include beclomethasone dipropionate, budesonide, fluticasone propionate, mometasone furoate, ciclesonide, and triamcinolone acetonide. This article reviews 4 areas critical to understanding potential adverse endocrine outcomes of ICSs and placing them in proper perspective: (1) influence of drug/delivery device properties on systemic steroid burden; (2) adrenal insufficiency during ICS treatment; (3) growth effects of ICS and asthma itself; and (4) bone mineral accretion during ICS therapy.
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Affiliation(s)
- David B Allen
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H4/448 CSC - Pediatrics, 600 Highland Avenue, Madison, WI 53792-4108, USA.
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Baan EJ, van den Akker ELT, Engelkes M, de Rijke YB, de Jongste JC, Sturkenboom MCJM, Verhamme KM, Janssens HM. Hair cortisol and inhaled corticosteroid use in asthmatic children. Pediatr Pulmonol 2020; 55:316-321. [PMID: 31651095 PMCID: PMC7003950 DOI: 10.1002/ppul.24551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/26/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adrenal suppression is a side effect of long-term use of inhaled corticosteroids (ICS). Hair cortisol concentration (HCC) measurement is a noninvasive tool for measuring adrenal function that may be useful for asthmatic patients who are on long-term ICS treatment. The aim of this study was to compare HCC between children with and without asthma and to explore the association between HCC and ICS dose in asthmatic children. METHODS A cross-sectional observational study in subjects with or without asthma (n = 72 and 226, respectively, age 6-21 years). Hair samples were obtained from the posterior vertex for each subject and data on medication use were collected using questionnaires. HCC was analyzed by liquid chromatography-mass spectrometry in the most proximal 3 cm of hair. RESULTS Median HCC was significantly lower in subjects with asthma than in subjects without asthma: 1.83 pg/mg and 2.39 pg/mg, respectively (P value after adjustment for age, sex, and body mass index: .036). Median HCC was 1.98 pg/mg in asthmatics using no ICS, 1.84 pg/mg in those using a low dose, 1.75 pg/mg in those on a medium dose, and 1.46 in those using a high ICS dose (P = .54). CONCLUSION We observed a significantly lower HCC in asthmatics than in healthy controls and a nonsignificant trend of lower HCC with increasing ICS dose. Whether HCC measurement may be used to detect individuals at risk for hypocortisolism and may be useful to monitor adrenal function in asthmatic children using ICS needs to be further investigated.
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Affiliation(s)
- Esmé J Baan
- Department of Medical Informatics, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Erica L T van den Akker
- Department of Pediatrics, Division of Endocrinology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Marjolein Engelkes
- Department of Medical Informatics, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | | | - Katia M Verhamme
- Department of Medical Informatics, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Hettie M Janssens
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
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Abstract
We present the development of the first procedure for hair cortisol measurement through an automated method. Hair samples were obtained from 286 individuals. After cortisol extraction, samples were measured in a Siemens Immulite 2000 (Gwynedd, UK) automated chemoluminiscent immunoassay analyzer. Normal reference values were obtained from hair cortisol levels measured in 213 healthy individuals with low levels of stress. Hair cortisol concentration median was 55 pg/mg hair (2.5–97.5 percentile (40–128)) in healthy individuals with low levels of stress and 250 pg/mg hair (range 182–520) in stressed individuals. No significant differences were observed in hair cortisol levels between subjects with and without dye (40 (40–107) and 40 (40–155) pg/mg hair, respectively; p = 0.128). The novel procedure presented here shows an adequate analytical performance.
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Wu H, Zhou K, Xu P, Xue J, Xu X, Liu L. Associations of perceived stress with the present and subsequent cortisol levels in fingernails among medical students: a prospective pilot study. Psychol Res Behav Manag 2018; 11:439-445. [PMID: 30349410 PMCID: PMC6183660 DOI: 10.2147/prbm.s181541] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Cortisol in fingernails could retrospectively reflect cumulative stress over a long period. However, the association between fingernail cortisol and perceived stress needs to be validated. This exploratory study aimed to investigate the associations of perceived stress with the present and subsequent cortisol levels in fingernails of the subjective stress measurement among medical students. Methods Students were recruited from a medical university in Shenyang, China. The final sample consisted of 51 students (16 men, 35 women). On the Day 30 of our data and fingernail collection procedure, the 10-item Perceived Stress Scale was used to measure perceived stress. Fingernail samples were collected twice, on Days 15 (denoted as FD15) and 45 (denoted as FD45) of the procedure, and participants were asked to grow fingernails for 15 days in each collection. Cortisol was determined by an enzyme immunoassay method using the ELISA kit. Multiple linear regression was performed to examine the association between perceived stress and cortisol level. The Bonferroni correction was made for multiple comparisons. Results The level of cortisol was 5.65 pg/mg (SD =1.88) for FD15 and 5.41 pg/mg (SD =1.63) for FD45. Perceived stress was not associated with the cortisol level of FD15 (β=−0.014, P=0.924), but it was significantly and positively associated with the cortisol level of FD45 (β=0.436, P=0.003), which remained significant after Bonferroni correction. The associations between fingernail cortisol and demographic variables (gender, age, BMI, and physical activity) were not significant. Conclusion This study was the first to investigate fingernail cortisol in China. Perceived stress was positively associated with the subsequent cortisol levels in fingernails, but not the present. The findings suggested that fingernail cortisol could indicate stress exposure in the past. Furthermore, a simple and easy self-reported measure could reflect cumulative stress as measured by fingernail cortisol.
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Affiliation(s)
- Hui Wu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China,
| | - Kexin Zhou
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China,
| | - Peiyao Xu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China,
| | - Jiayu Xue
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China,
| | - Xin Xu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Li Liu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China,
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