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Jørgensen NT, Boesen VB, Borresen SW, Christoffersen T, Jørgensen NR, Plomgaard P, Christoffersen C, Watt T, Feldt-Rasmussen U, Klose M. Dual-release hydrocortisone improves body composition and the glucometabolic profile in patients with secondary adrenal insufficiency. Endocrine 2024; 84:1182-1192. [PMID: 38345683 PMCID: PMC11208214 DOI: 10.1007/s12020-024-03711-9] [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: 12/15/2023] [Accepted: 01/21/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Studies have suggested improved metabolic profiles in patients with adrenal insufficiency treated with dual-release hydrocortisone (DR-HC) compared with conventional hydrocortisone (C-HC). This study investigates the effect of DR-HC compared with C-HC treatment on five health variables: diurnal salivary cortisol/cortisone, body composition, bone health, glucose metabolism, lipids, and blood pressure. METHODS Prospective study of 27 participants (24 men) with secondary adrenal insufficiency with measurements during stable C-HC and 16 weeks after treatment switch to DR-HC. OUTCOMES Diurnal salivary-cortisol/cortisone, body composition assessed by Dual-Energy X-ray absorptiometry scan, bone status indices (serum type I N-terminal procollagen [PINP], collagen type I cross-linked C-telopeptide [CTX], osteocalcin, receptor activator kappa-B [RANK] ligand, osteoprotegerin, and sclerostin), lipids, haemoglobin A1c (HbA1c), and 24-hour blood pressure. RESULTS After the switch to DR-HC, the diurnal salivary-cortisol area under the curve (AUC) decreased non-significantly (mean difference: -55.9 nmol/L/day, P = 0.06). The salivary-cortisone-AUC was unchanged. Late-evening salivary-cortisol and cortisone were lower (-1.6 and -1.7 nmol/L, P = 0.002 and 0.004). Total and abdominal fat mass (-1.5 and -0.5 kg, P = 0.003 and 0.02), HbA1c (-1.2 mmol/mol, P = 0.02), and osteocalcin decreased (-7.0 µg/L, P = 0.03) whereas sclerostin increased (+41.1 pg/mL, P = 0.0001). The remaining bone status indices, lipids, and blood pressure were unchanged. CONCLUSION This study suggests that switching to DR-HC leads to lower late-evening cortisol/cortisone exposure and a more favourable metabolic profile and body composition. In contrast, decreased osteocalcin with increasing sclerostin might indicate a negative impact on bones. CLINICAL TRIAL REGISTRATION EudraCT201400203932.
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Affiliation(s)
- Nanna Thurmann Jørgensen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Victor Brun Boesen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stina Willemoes Borresen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thea Christoffersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Plomgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Torquil Watt
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Marianne Klose
- Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Karuppaiah G, Lee MH, Bhansali S, Manickam P. Electrochemical sensors for cortisol detection: Principles, designs, fabrication, and characterisation. Biosens Bioelectron 2023; 239:115600. [PMID: 37611448 DOI: 10.1016/j.bios.2023.115600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/09/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
Psychological stress is a major factor contributing to health discrepancies among individuals. Sustained exposure to stress triggers signalling pathways in the brain, which leading to the release of stress hormones in the body. Cortisol, a steroid hormone, is a significant biomarker for stress management due to its responsibility in the body's reply to stress. The release of cortisol in bloodstream prepares the body for a "fight or flight" response by increasing heart rate, blood pressure, metabolism, and suppressing the immune system. Detecting cortisol in biological samples is crucial for understanding its role in stress and personalized healthcare. Traditional techniques for cortisol detection have limitations, prompting researchers to explore alternative strategies. Electrochemical sensing has emerged as a reliable method for point-of-care (POC) cortisol detection. This review focuses on the progress made in electrochemical sensors for cortisol detection, covering their design, principle, and electroanalytical methodologies. The analytical performance of these sensors is also analysed and summarized. Despite significant advancements, the development of electrochemical cortisol sensors faces challenges such as biofouling, sample preparation, sensitivity, flexibility, stability, and recognition layer performance. Therefore, the need to develop more sensitive electrodes and materials is emphasized. Finally, we discussed the potential strategies for electrode design and provides examples of sensing approaches. Moreover, the encounters of translating research into real world applications are addressed.
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Affiliation(s)
- Gopi Karuppaiah
- Electrodics and Electrocatalysis Division, CSIR-Central Electrochemical Research Institute (CECRI), Karaikudi, 630 003, Tamil Nadu, India; School of Integrative Engineering, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea
| | - Min-Ho Lee
- School of Integrative Engineering, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea
| | - Shekhar Bhansali
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, 33174, USA.
| | - Pandiaraj Manickam
- Electrodics and Electrocatalysis Division, CSIR-Central Electrochemical Research Institute (CECRI), Karaikudi, 630 003, Tamil Nadu, India; Academy of Scientific and Innovative Research, Ghaziabad, 201 002, Uttar Pradesh, India.
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3
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Sarafoglou K, Merke DP, Reisch N, Claahsen-van der Grinten H, Falhammar H, Auchus RJ. Interpretation of Steroid Biomarkers in 21-Hydroxylase Deficiency and Their Use in Disease Management. J Clin Endocrinol Metab 2023; 108:2154-2175. [PMID: 36950738 PMCID: PMC10438890 DOI: 10.1210/clinem/dgad134] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
The most common form of congenital adrenal hyperplasia is 21-hydroxylase deficiency (21OHD), which in the classic (severe) form occurs in roughly 1:16 000 newborns worldwide. Lifelong treatment consists of replacing cortisol and aldosterone deficiencies, and supraphysiological dosing schedules are typically employed to simultaneously attenuate production of adrenal-derived androgens. Glucocorticoid titration in 21OHD is challenging as it must balance the consequences of androgen excess vs those from chronic high glucocorticoid exposure, which are further complicated by interindividual variability in cortisol kinetics and glucocorticoid sensitivity. Clinical assessment and biochemical parameters are both used to guide therapy, but the specific purpose and goals of each biomarker vary with age and clinical context. Here we review the approach to medication titration for children and adults with classic 21OHD, with an emphasis on how to interpret adrenal biomarker values in guiding this process. In parallel, we illustrate how an understanding of the pathophysiologic and pharmacologic principles can be used to avoid and to correct complications of this disease and consequences of its management using existing treatment options.
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Affiliation(s)
- Kyriakie Sarafoglou
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Minnesota Medical School, Minneapolis, MN 55454, USA
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA
| | - Deborah P Merke
- Department of Pediatrics, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Nicole Reisch
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, 80336 Munich, Germany
| | - Hedi Claahsen-van der Grinten
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, SE-17176, Stockholm, Sweden
| | - Richard J Auchus
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Helvacı BC, Başer H, Çakır B. Mini-review: pump therapy in endocrinology & metabolism beyond diabetes. Endocrine 2022; 76:245-252. [PMID: 35169961 DOI: 10.1007/s12020-022-03007-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/01/2022] [Indexed: 02/05/2023]
Abstract
The first pump developed by Dr. Kadish and his team in 1963 aimed to "continue subcutaneous insulin infusion". The number of patients using insulin pumps has increased since the 1980s. This historical perspective has labeled pump therapy in endocrinology and metabolism synonymous with insulin pumps. However, certain other hormonal disorders might also benefit from this kind of treatment. Pump therapy is currently the best approach to achieve physiological mimicry. Furthermore, it may help in overcoming pharmacokinetic issues or allergies. Until now, hormone replacement via pumps has been a salvage method for complex cases at the expense of increased costs. However, it is believed that applications of pump treatment will widen in the future owing to the rapidly evolving technology. In this mini review, data on pump use for patients with adrenal insufficiency, hypogonadism, hypoparathyroidism, congenital adrenal hyperplasia, and congenital hyperinsulinism have been briefly summarized. The study has aimed at covering all the relevant clinical studies and important case reports/series. METHODS: A systematic literature search has been conducted on PubMed database seeking articles published until May 2021 using a combination of the following Medical Subject Headings terms and keywords: pump "OR" continue infusion "AND" (adrenal insufficiency "OR" Addison "OR" hydrocortisone "OR" hypoparathyroidism "OR teriparatide" "OR" somatostatin "OR" hypogonadism "OR" hypoglycemia "OR" endocrinology "OR" hormone replacement). In addition, the reference publications in the identified articles have also been reviewed.
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Affiliation(s)
| | - Hüsniye Başer
- Ankara City Hospital, Department of Endocrinology & Metabolism, Ankara, Turkey and Yıldırım Beyazıt University Faculty of Medicine Department of Endocrinology & Metabolism, Ankara, Turkey
| | - Bekir Çakır
- Ankara City Hospital, Department of Endocrinology & Metabolism, Ankara, Turkey and Yıldırım Beyazıt University Faculty of Medicine Department of Endocrinology & Metabolism, Ankara, Turkey
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Grant AD, Wilbrecht L, Kriegsfeld LJ. Adolescent Development of Biological Rhythms in Female Rats: Estradiol Dependence and Effects of Combined Contraceptives. Front Physiol 2021; 12:752363. [PMID: 35615288 PMCID: PMC9126190 DOI: 10.3389/fphys.2021.752363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/11/2021] [Indexed: 01/23/2023] Open
Abstract
Adolescence is a period of continuous development, including the maturation of endogenous rhythms across systems and timescales. Although, these dynamic changes are well-recognized, their continuous structure and hormonal dependence have not been systematically characterized. Given the well-established link between core body temperature (CBT) and reproductive hormones in adults, we hypothesized that high-resolution CBT can be applied to passively monitor pubertal development and disruption with high fidelity. To examine this possibility, we used signal processing to investigate the trajectory of CBT rhythms at the within-day (ultradian), daily (circadian), and ovulatory timescales, their dependence on estradiol (E2), and the effects of hormonal contraceptives. Puberty onset was marked by a rise in fecal estradiol (fE2), followed by an elevation in CBT and circadian power. This time period marked the commencement of 4-day rhythmicity in fE2, CBT, and ultradian power marking the onset of the estrous cycle. The rise in circadian amplitude was accelerated by E2 treatment, indicating a role for this hormone in rhythmic development. Contraceptive administration in later adolescence reduced CBT and circadian power and resulted in disruption to 4-day cycles that persisted after discontinuation. Our data reveal with precise temporal resolution how biological rhythms change across adolescence and demonstrate a role for E2 in the emergence and preservation of multiscale rhythmicity. These findings also demonstrate how hormones delivered exogenously in a non-rhythmic pattern can disrupt rhythmic development. These data lay the groundwork for a future in which temperature metrics provide an inexpensive, convenient method for monitoring pubertal maturation and support the development of hormone therapies that better mimic and support human chronobiology.
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Affiliation(s)
- Azure D. Grant
- The Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
| | - Linda Wilbrecht
- The Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Lance J. Kriegsfeld
- The Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, United States
- Graduate Group in Endocrinology, University of California, Berkeley, Berkeley, CA, United States
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6
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Kim DW, Zavala E, Kim JK. Wearable technology and systems modeling for personalized chronotherapy. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.coisb.2020.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Bhake RC, Kluckner V, Stassen H, Russell GM, Leendertz J, Stevens K, Linthorst ACE, Lightman SL. Continuous Free Cortisol Profiles-Circadian Rhythms in Healthy Men. J Clin Endocrinol Metab 2019; 104:5935-5947. [PMID: 31355884 DOI: 10.1210/jc.2019-00449] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/23/2019] [Indexed: 12/26/2022]
Abstract
CONTEXT The pituitary-adrenal axis had historically been considered a representative model for circadian rhythms. A recently developed portable collection device has provided the opportunity to evaluate free cortisol profiles using the microdialysis approach in individuals free to conduct their day-to-day activities in their own surroundings. METHODS Two separate experiments were conducted in healthy male volunteers. The total and subcutaneous (SC) free cortisol levels were measured at 10-minute intervals for a 24-hour period in one experiment, and the SC free cortisol levels were measured at 20-minute interval for 72 consecutive hours in free-living individuals in the second experiment. RESULTS The characteristic circadian rhythm was evident in both serum total and SC free cortisol, with the lowest levels achieved and maintained in the hours surrounding sleep onset and the peak levels occurring in every individual around waking. In all free-living individuals, the circadian rhythm was consistent across the 72-hour period, despite a wide range of activities. All the participants also showed increased cortisol after the consumption of lunch. The lowest levels during all 24-hour periods were observed during the hours after lights off, at the onset of sleep. CONCLUSIONS To the best of our knowledge, the present study is the first to report up to three consecutive 24-hour measurements of SC free cortisol in healthy individuals. We believe our study is a landmark study that paves the way for ambulatory monitoring of free cortisol profiles continuously for a period of 72 hours in free-living individuals performing their day-to-day activities whether healthy or with diseases involving the hypothalamic-pituitary-adrenal axis.
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Affiliation(s)
- R C Bhake
- University Hospitals Leicester National Health Service Trust, Leicester, United Kingdom
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
| | - V Kluckner
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - H Stassen
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - G M Russell
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
| | - J Leendertz
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
| | - K Stevens
- Department of Medical Statistics, Faculty of Health: Medicine, Dentistry, and Human Sciences, University of Plymouth, Plymouth, United Kingdom
| | - A C E Linthorst
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - S L Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
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8
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Choudhury S, Lightman S, Meeran K. Improving glucocorticoid replacement profiles in adrenal insufficiency. Clin Endocrinol (Oxf) 2019; 91:367-371. [PMID: 31017681 DOI: 10.1111/cen.13999] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022]
Abstract
There is an increased mortality associated with adrenal insufficiency despite glucocorticoid replacement therapy with a standardized mortality ratio greater than two. The cause of the increased mortality is yet to be definitively elucidated, but may be due to excess steroid exposure, or replacement regimens that are uncoupled from the normal physiological cortisol profile. Cortisol secretion follows an ultradian pattern which is not possible to reproduce using oral replacement. With the advent of new pumps, it is now possible to mimic the pulsatility of the adrenal glands. While the cognitive and emotional benefits of reproducing the ultradian rhythm are known, the presence of long-term benefits is not yet clear. There is a dearth of evidence and high-quality studies to underline our current understanding of the pathophysiology of adrenal insufficiency and replacement therapy. There is a particular lack of research comparing objective outcomes between patients receiving hydrocortisone replacement (either standard therapy or new sustained release preparations), prednisolone replacement and ultradian pumps. Direct comparative studies are now warranted to understand the optimal approach.
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Affiliation(s)
- Sirazum Choudhury
- Department of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Stafford Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, Department of Translational Health Science, University of Bristol, Bristol, UK
| | - Karim Meeran
- Department of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
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Zavala E, Wedgwood KCA, Voliotis M, Tabak J, Spiga F, Lightman SL, Tsaneva-Atanasova K. Mathematical Modelling of Endocrine Systems. Trends Endocrinol Metab 2019; 30:244-257. [PMID: 30799185 PMCID: PMC6425086 DOI: 10.1016/j.tem.2019.01.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 12/12/2022]
Abstract
Hormone rhythms are ubiquitous and essential to sustain normal physiological functions. Combined mathematical modelling and experimental approaches have shown that these rhythms result from regulatory processes occurring at multiple levels of organisation and require continuous dynamic equilibration, particularly in response to stimuli. We review how such an interdisciplinary approach has been successfully applied to unravel complex regulatory mechanisms in the metabolic, stress, and reproductive axes. We discuss how this strategy is likely to be instrumental for making progress in emerging areas such as chronobiology and network physiology. Ultimately, we envisage that the insight provided by mathematical models could lead to novel experimental tools able to continuously adapt parameters to gradual physiological changes and the design of clinical interventions to restore normal endocrine function.
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Affiliation(s)
- Eder Zavala
- Living Systems Institute, University of Exeter, Exeter EX4 4QD, UK; EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter EX4 4QD, UK; Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter EX4 4QD, UK; College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK.
| | - Kyle C A Wedgwood
- Living Systems Institute, University of Exeter, Exeter EX4 4QD, UK; EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter EX4 4QD, UK; Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter EX4 4QD, UK; College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK
| | - Margaritis Voliotis
- Living Systems Institute, University of Exeter, Exeter EX4 4QD, UK; EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter EX4 4QD, UK; Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter EX4 4QD, UK; College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK
| | - Joël Tabak
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter EX4 4PS, UK
| | - Francesca Spiga
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol BS1 3NY, UK
| | - Stafford L Lightman
- EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter EX4 4QD, UK; Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol BS1 3NY, UK
| | - Krasimira Tsaneva-Atanasova
- Living Systems Institute, University of Exeter, Exeter EX4 4QD, UK; EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter EX4 4QD, UK; Centre for Biomedical Modelling and Analysis, University of Exeter, Exeter EX4 4QD, UK; College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK
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Gardner M, Lightman S, Kuh D, Comijs H, Deeg D, Gallacher J, Geoffroy MC, Kivimaki M, Kumari M, Power C, Hardy R, Richards M, Ben-Shlomo Y. Dysregulation of the hypothalamic pituitary adrenal (HPA) axis and cognitive capability at older ages: individual participant meta-analysis of five cohorts. Sci Rep 2019; 9:4555. [PMID: 30872618 PMCID: PMC6418174 DOI: 10.1038/s41598-019-40566-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 02/19/2019] [Indexed: 01/04/2023] Open
Abstract
Evidence on the association between functioning of the hypothalamic pituitary adrenal (HPA) axis and cognitive capability at older ages is mixed. We undertook a systematic review (until October 2016) and individual participant data (IPD) meta-analysis to test if dysregulation of the HPA axis is associated with worse cognitive capability. Five cohort studies were included in the IPD meta-analysis of diurnal cortisol patterns with crystallised and fluid cognitive ability. Higher night time cortisol was associated with worse fluid ability (standardised coefficient per SD increase −0.063, 95% CI −0.124, −0.002, P = 0.04; I2 = 79.9%; age and gender adjusted). A larger diurnal drop was associated with better fluid ability (standardised coefficient per SD increase 0.037, 95% CI 0.008, 0.065, P = 0.01; I2 = 49.2%; age and gender adjusted). A bigger cortisol awakening response (CAR) was weakly associated with better fluid (P = 0.09; I2 = 0.0%; age and gender adjusted) and crystallised (P = 0.10; I2 = 0.0%; age and gender adjusted) ability. There is weak evidence that a greater diurnal decline of the HPA axis and a larger CAR are associated with improvements in cognition at older ages. As associations are cross-sectional, we cannot rule out reverse causation.
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Affiliation(s)
- Michael Gardner
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Stafford Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, Bristol, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Hannie Comijs
- Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Dorly Deeg
- Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Meena Kumari
- Department of Epidemiology and Public Health, University College London, London, UK.,ISER, University of Essex, Essex, UK
| | - Chris Power
- Population, Policy and Practice, UCL, Great Ormond Street, Institute of Child Health, University College London, London, UK
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | | | - Yoav Ben-Shlomo
- Department of Population Health Sciences, University of Bristol, Canynge Hall, Bristol, UK
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11
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Grant AD, Wilsterman K, Smarr BL, Kriegsfeld LJ. Evidence for a Coupled Oscillator Model of Endocrine Ultradian Rhythms. J Biol Rhythms 2018; 33:475-496. [PMID: 30132387 DOI: 10.1177/0748730418791423] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Whereas long-period temporal structures in endocrine dynamics have been well studied, endocrine rhythms on the scale of hours are relatively unexplored. The study of these ultradian rhythms (URs) has remained nascent, in part, because a theoretical framework unifying ultradian patterns across systems has not been established. The present overview proposes a conceptual coupled oscillator network model of URs in which oscillating hormonal outputs, or nodes, are connected by edges representing the strength of node-node coupling. We propose that variable-strength coupling exists both within and across classic hormonal axes. Because coupled oscillators synchronize, such a model implies that changes across hormonal systems could be inferred by surveying accessible nodes in the network. This implication would at once simplify the study of URs and open new avenues of exploration into conditions affecting coupling. In support of this proposed framework, we review mammalian evidence for (1) URs of the gut-brain axis and the hypothalamo-pituitary-thyroid, -adrenal, and -gonadal axes, (2) UR coupling within and across these axes; and (3) the relation of these URs to body temperature. URs across these systems exhibit behavior broadly consistent with a coupled oscillator network, maintaining both consistent URs and coupling within and across axes. This model may aid the exploration of mammalian physiology at high temporal resolution and improve the understanding of endocrine system dynamics within individuals.
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Affiliation(s)
- Azure D Grant
- The Helen Wills Neuroscience Institute, University of California, Berkeley, California
| | - Kathryn Wilsterman
- Department of Integrative Biology, University of California, Berkeley, California
| | - Benjamin L Smarr
- Department of Psychology, University of California, Berkeley, California
| | - Lance J Kriegsfeld
- The Helen Wills Neuroscience Institute, University of California, Berkeley, California.,Department of Psychology, University of California, Berkeley, California
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12
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Ultradian rhythmicity of plasma cortisol is necessary for normal emotional and cognitive responses in man. Proc Natl Acad Sci U S A 2018; 115:E4091-E4100. [PMID: 29632168 DOI: 10.1073/pnas.1714239115] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Glucocorticoids (GCs) are secreted in an ultradian, pulsatile pattern that emerges from delays in the feedforward-feedback interaction between the anterior pituitary and adrenal glands. Dynamic oscillations of GCs are critical for normal cognitive and metabolic function in the rat and have been shown to modulate the pattern of GC-sensitive gene expression, modify synaptic activity, and maintain stress responsiveness. In man, current cortisol replacement therapy does not reproduce physiological hormone pulses and is associated with psychopathological symptoms, especially apathy and attenuated motivation in engaging with daily activities. In this work, we tested the hypothesis that the pattern of GC dynamics in the brain is of crucial importance for regulating cognitive and behavioral processes. We provide evidence that exactly the same dose of cortisol administered in different patterns alters the neural processing underlying the response to emotional stimulation, the accuracy in recognition and attentional bias toward/away from emotional faces, the quality of sleep, and the working memory performance of healthy male volunteers. These data indicate that the pattern of the GC rhythm differentially impacts human cognition and behavior under physiological, nonstressful conditions and has major implications for the improvement of cortisol replacement therapy.
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El-Farhan N, Rees DA, Evans C. Measuring cortisol in serum, urine and saliva - are our assays good enough? Ann Clin Biochem 2017; 54:308-322. [PMID: 28068807 DOI: 10.1177/0004563216687335] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cortisol is a steroid hormone produced in response to stress. It is essential for maintaining health and wellbeing and leads to significant morbidity when deficient or present in excess. It is lipophilic and is transported bound to cortisol-binding globulin (CBG) and albumin; a small fraction (∼10%) of total serum cortisol is unbound and biologically active. Serum cortisol assays measure total cortisol and their results can be misleading in patients with altered serum protein concentrations. Automated immunoassays are used to measure cortisol but lack specificity and show significant inter-assay differences. Liquid chromatography - tandem mass spectrometry (LC-MS/MS) offers improved specificity and sensitivity; however, cortisol cut-offs used in the short Synacthen and Dexamethasone suppression tests are yet to be validated for these assays. Urine free cortisol is used to screen for Cushing's syndrome. Unbound cortisol is excreted unchanged in the urine and 24-h urine free cortisol correlates well with mean serum-free cortisol in conditions of cortisol excess. Urine free cortisol is measured predominantly by immunoassay or LC-MS/MS. Salivary cortisol also reflects changes in unbound serum cortisol and offers a reliable alternative to measuring free cortisol in serum. LC-MS/MS is the method of choice for measuring salivary cortisol; however, its use is limited by the lack of a single, validated reference range and poorly standardized assays. This review examines the methods available for measuring cortisol in serum, urine and saliva, explores cortisol in disease and considers the difficulties of measuring cortisol in acutely unwell patients and in neonates.
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Affiliation(s)
- Nadia El-Farhan
- 1 Biochemistry Department, Royal Gwent Hospital, Newport, UK
| | - D Aled Rees
- 2 Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Carol Evans
- 3 Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
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Bielefeld P, Schouten M, Lucassen PJ, Fitzsimons CP. Transcription factor oscillations in neural stem cells: Implications for accurate control of gene expression. NEUROGENESIS 2017; 4:e1262934. [PMID: 28321433 PMCID: PMC5345753 DOI: 10.1080/23262133.2016.1262934] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 01/14/2023]
Abstract
Naturally occurring oscillations in glucocorticoids induce a cyclic activation of the glucocorticoid receptor (GR), a well-characterized ligand-activated transcription factor. These cycles of GR activation/deactivation result in rapid GR exchange at genomic response elements and GR recycling through the chaperone machinery, ultimately generating pulses of GR-mediated transcriptional activity of target genes. In a recent article we have discussed the implications of circadian and high-frequency (ultradian) glucocorticoid oscillations for the dynamic control of gene expression in hippocampal neural stem/progenitor cells (NSPCs) (Fitzsimons et al., Front. Neuroendocrinol., 2016). Interestingly, this oscillatory transcriptional activity is common to other transcription factors, many of which regulate key biological functions in NSPCs, such as NF-kB, p53, Wnt and Notch. Here, we discuss the oscillatory behavior of these transcription factors, their role in a biologically accurate target regulation and the potential importance for a dynamic control of transcription activity and gene expression in NSPCs.
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Affiliation(s)
- Pascal Bielefeld
- Neuroscience Program, Swammerdam Institute for Life Sciences, Faculty of Sciences, University of Amsterdam
| | - Marijn Schouten
- Neuroscience Program, Swammerdam Institute for Life Sciences, Faculty of Sciences, University of Amsterdam
| | - Paul J Lucassen
- Neuroscience Program, Swammerdam Institute for Life Sciences, Faculty of Sciences, University of Amsterdam
| | - Carlos P Fitzsimons
- Neuroscience Program, Swammerdam Institute for Life Sciences, Faculty of Sciences, University of Amsterdam
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Simunkova K, Jovanovic N, Rostrup E, Methlie P, Øksnes M, Nilsen RM, Hennø H, Tilseth M, Godang K, Kovac A, Løvås K, Husebye ES. Effect of a pre-exercise hydrocortisone dose on short-term physical performance in female patients with primary adrenal failure. Eur J Endocrinol 2016; 174:97-105. [PMID: 26494876 DOI: 10.1530/eje-15-0630] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/21/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Many patients with primary adrenal insufficiency (Addison's disease) take extra doses of glucocorticoids during stressful events, but a benefit has not been demonstrated in controlled trials. Here, we investigated the effects of a pre-exercise hydrocortisone dose on cardiorespiratory, hormonal and metabolic parameters in response to short-term strenuous physical activity. DESIGN This was a randomized placebo-controlled, two-week cross-over clinical trial. PARTICIPANTS Ten women with Addison's disease and 10 age-matched healthy females participated in the study. MEASUREMENTS All women in the study underwent maximal incremental exercise testing. A stress dose of 10 mg hydrocortisone or placebo was given 1 h prior to exercise on two occasions. Blood samples were drawn before, and 0, 15 and 30 min post exercise. Oxygen uptake, maximal aerobic capacity, endocrine and metabolic responses to physical activity, as well as health status by questionnaires were evaluated. RESULTS Maximal aerobic capacity and duration of exercise were significantly lower in patients than in healthy subjects and did not improve with the treatment. After an extra hydrocortisone dose serum cortisol was significantly higher than in the healthy subjects (P<0.001). Post-exercise glucose and adrenaline levels were significantly lower and free fatty acids insignificantly higher in patients irrespective of stress dose. Stress dosing did not alter other metabolic or hormonal parameters or quality of life after the exercise. CONCLUSIONS The patients did not benefit from an extra dose of hydrocortisone in short strenuous exercise. Stress dosing may not be justified in this setting. Whether stress dosing is beneficial in other types of physical activity will have to be examined further.
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Affiliation(s)
- Katerina Simunkova
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Nevena Jovanovic
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Espen Rostrup
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Paal Methlie
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Marianne Øksnes
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Roy Miodini Nilsen
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Hanne Hennø
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Mira Tilseth
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Kristin Godang
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Ana Kovac
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Kristian Løvås
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
| | - Eystein S Husebye
- Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway
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Lightman S. Rhythms Within Rhythms: The Importance of Oscillations for Glucocorticoid Hormones. RESEARCH AND PERSPECTIVES IN ENDOCRINE INTERACTIONS 2016. [DOI: 10.1007/978-3-319-27069-2_10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Walker JJ, Spiga F, Gupta R, Zhao Z, Lightman SL, Terry JR. Rapid intra-adrenal feedback regulation of glucocorticoid synthesis. J R Soc Interface 2015; 12:20140875. [PMID: 25392395 PMCID: PMC4277077 DOI: 10.1098/rsif.2014.0875] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The hypothalamic–pituitary–adrenal axis is a vital neuroendocrine system that regulates the secretion of glucocorticoid hormones from the adrenal glands. This system is characterized by a dynamic ultradian hormonal oscillation, and in addition is highly responsive to stressful stimuli. We have recently shown that a primary mechanism generating this ultradian rhythm is a systems-level interaction where adrenocorticotrophin hormone (ACTH) released from the pituitary stimulates the secretion of adrenal glucocorticoids, which in turn feedback at the level of the pituitary to rapidly inhibit ACTH secretion. In this study, we combine experimental physiology and mathematical modelling to investigate intra-adrenal mechanisms regulating glucocorticoid synthesis. Our modelling results suggest that glucocorticoids can inhibit their own synthesis through a very rapid (within minutes), presumably non-genomic, intra-adrenal pathway. We present further evidence for the existence of a short time delay in this intra-adrenal inhibition, and also that at the initiation of each ACTH stimulus, this local feedback mechanism is rapidly antagonized, presumably via activation of the specific ACTH receptor (MC2R) signalling pathway. This mechanism of intra-adrenal inhibition enables the gland to rapidly release glucocorticoids while at the same time preventing uncontrolled release of glucocorticoids in response to large surges in ACTH associated with stress.
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Affiliation(s)
- J J Walker
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Whitson St., Bristol BS1 3NY, UK
| | - F Spiga
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Whitson St., Bristol BS1 3NY, UK
| | - R Gupta
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK
| | - Z Zhao
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Whitson St., Bristol BS1 3NY, UK
| | - S L Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Whitson St., Bristol BS1 3NY, UK
| | - J R Terry
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, UK Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Whitson St., Bristol BS1 3NY, UK
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Mallappa A, Sinaii N, Kumar P, Whitaker MJ, Daley LA, Digweed D, Eckland DJA, Van Ryzin C, Nieman LK, Arlt W, Ross RJ, Merke DP. A phase 2 study of Chronocort, a modified-release formulation of hydrocortisone, in the treatment of adults with classic congenital adrenal hyperplasia. J Clin Endocrinol Metab 2015; 100:1137-45. [PMID: 25494662 PMCID: PMC5393506 DOI: 10.1210/jc.2014-3809] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Treatment of congenital adrenal hyperplasia (CAH) is suboptimal. Inadequate suppression of androgens and glucocorticoid excess are common and current glucocorticoid formulations cannot replace the cortisol circadian rhythm. OBJECTIVES The primary objective was to characterize the pharmacokinetic profile of Chronocort, a modified-release hydrocortisone formulation, in adults with CAH. Secondary objectives included examining disease control following 6 months of Chronocort with dose titration. DESIGN, SETTING, AND PATIENTS Sixteen adults (eight females) with classic CAH participated in an open-label, nonrandomized, Phase 2 study at the National Institutes of Health Clinical Center. Twenty-four-hour blood sampling was performed on conventional glucocorticoids and following 6 months of Chronocort. Chronocort was initiated at 10 mg (0700 h) and 20 mg (2300 h). Dose titration was performed based on androstenedione and 17-hydroxyprogresterone (17-OHP) levels and clinical symptomatology. MAIN OUTCOME MEASURES The primary outcome was cortisol pharmacokinetics of Chronocort and secondary outcomes included biomarkers of CAH control (androstenedione and 17-OHP). RESULTS In patients with CAH, Chronocort cortisol profiles were similar to physiologic cortisol secretion. Compared with conventional therapy, 6 months of Chronocort resulted in a decrease in hydrocortisone dose equivalent (28 ± 11.8 vs 25.9 ± 7.1 mg/d), with lower 24-hour (P = .004), morning (0700-1500 h; P = .002), and afternoon (1500-2300 h; P = .011) androstenedione area under the curve (AUC) and lower 24-hour (P = .023) and morning (0700-1500 h; P = .02) 17-OHP AUC. CONCLUSIONS Twice-daily Chronocort approximates physiologic cortisol secretion, and was well tolerated and effective in controlling androgen excess in adults with CAH. This novel hydrocortisone formulation represents a new treatment approach for patients with CAH.
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Affiliation(s)
- Ashwini Mallappa
- National Institutes of Health Clinical Center (A.M., N.S., L.A.D., P.K., C.V.R., D.P.M.), Bethesda, Maryland, USA 20892; Diurnal Ltd (M.J.W., D.D., D.J.A.E., W.A., R.J.R.), Cardiff, United Kingdom CF14 4UJ; The Eunice Kennedy Shriver National Institute of Child Health and Human Development (L.K.N., D.P.M.), Bethesda, Maryland, USA 20892; Centre for Endocrinology, Diabetes, and Metabolism, School of Clinical and Experimental Medicine (W.A.), University of Birmingham, Birmingham, United Kingdom B15 2TT; and University of Sheffield (R.J.R), Sheffield, United Kingdom S10 2RX
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Russell GM, Lightman SL. Can side effects of steroid treatments be minimized by the temporal aspects of delivery method? Expert Opin Drug Saf 2014; 13:1501-13. [DOI: 10.1517/14740338.2014.965141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Russell GM, Durant C, Ataya A, Papastathi C, Bhake R, Woltersdorf W, Lightman S. Subcutaneous pulsatile glucocorticoid replacement therapy. Clin Endocrinol (Oxf) 2014; 81:289-93. [PMID: 24735400 PMCID: PMC4231230 DOI: 10.1111/cen.12470] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 04/05/2014] [Accepted: 04/11/2014] [Indexed: 11/29/2022]
Abstract
The glucocorticoid hormone cortisol is released in pulses resulting in a complex and dynamic ultradian rhythm of plasma cortisol that underlies the classical circadian rhythm. These oscillating levels are also seen at the level of tissues such as the brain and trigger pulses of gene activation and downstream signalling. Different patterns of glucocorticoid presentation (constant vs pulsatile) result not only in different patterns of gene regulation but also in different neuroendocrine and behavioural responses. Current 'optimal' glucocorticoid replacement therapy results in smooth hormone blood levels and does not replicate physiological pulsatile cortisol secretion. Validation of a novel portable pulsatile continuous subcutaneous delivery system in healthy volunteers under dexamethasone and metyrapone suppression. Pulsatile subcutaneous hydrocortisone more closely replicates physiological circadian and ultradian rhythmicity.
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Affiliation(s)
- Georgina M Russell
- Henry Wellcome Laboratories for Integrative Neurosciences and Endocrinology, Dorothy Hodgkin Building, University of BristolBristol, UK
| | - Claire Durant
- Henry Wellcome Laboratories for Integrative Neurosciences and Endocrinology, Dorothy Hodgkin Building, University of BristolBristol, UK
| | - Alia Ataya
- School of experimental psychology, University of BristolBristol, UK
| | - Chrysoula Papastathi
- Henry Wellcome Laboratories for Integrative Neurosciences and Endocrinology, Dorothy Hodgkin Building, University of BristolBristol, UK
| | - Ragini Bhake
- Henry Wellcome Laboratories for Integrative Neurosciences and Endocrinology, Dorothy Hodgkin Building, University of BristolBristol, UK
| | | | - Stafford Lightman
- Henry Wellcome Laboratories for Integrative Neurosciences and Endocrinology, Dorothy Hodgkin Building, University of BristolBristol, UK
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