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Fukuda M, Hamada K, Shimizu Y, Tanaka T. Adrenal Cushing syndrome in a patient with corticosteroid-treated asthma and worsening diabetes mellitus. BMJ Case Rep 2021; 14:14/8/e241080. [PMID: 34348911 PMCID: PMC8340277 DOI: 10.1136/bcr-2020-241080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 55-year-old woman with poor diabetic control and a long history of corticosteroid-treated asthma was admitted. Hypertension and dyslipidaemia developed 9 and 6 years ago, respectively, and both were poorly controlled. Three years ago, her asthma control improved, and oral/intravenous steroids were switched to inhalers. Around this time, she was diagnosed as diabetes mellitus and heavily treated with insulin and other drugs thereafter. Physical examination showed central obesity, moon face appearance, abdominal striae and purpura. Endocrinological examination revealed suppressed adrenocorticotropic hormone, but unsuppressed endogenous cortisol levels. Right adrenal mass with isotope uptake revealed by CT scan and 131I-adosterol scintigraphy was compatible with cortisol-producing adenoma, leading to the diagnosis of adrenal Cushing syndrome. A history of corticosteroid usage sometimes prevents us from the timely detection of endogenous cortisol excess. Our current case tells us a lesson of the importance of suspecting non-iatrogenic causes of Cushing syndrome even in patients heavily treated with corticosteroids.
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Affiliation(s)
- Mari Fukuda
- Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | - Keiko Hamada
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuki Shimizu
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomohiro Tanaka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Strontium gluconate potently promotes osteoblast development and restores bone formation in glucocorticoid-induced osteoporosis rats. Biochem Biophys Res Commun 2021; 554:33-40. [PMID: 33774277 DOI: 10.1016/j.bbrc.2021.02.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/20/2021] [Indexed: 11/23/2022]
Abstract
Glucocorticoid-induced osteoporosis (GIOP) has emerged as a challenge after long-term glucocorticoid administration during the clinical therapy of diverse diseases. Although some candidates for GIOP treatment have been explored, there is still a lack of reliable drugs for GIOP prevention. In this study, rat bone marrow stem cells (rBMSCs) were utilized to investigate the feasibility of applying strontium gluconate (GluSr), which displays mild activity, easy absorption and good biocompatibility, for GIOP prevention. Thirty-two SD rats were divided into 4 groups to explore the effects of GluSr on osteoporosis rescue in vivo. Our results suggested that GluSr markedly alleviated dexamethasone (DEX)-induced apoptosis of osteoblast precursor cells and rBMSCs and enhanced rBMSC osteogenesis differentiation in vitro. GluSr also effectively promoted osteoblast survival, inhibited osteoclast differentiation and restored bone formation in GIOP rat models. Microarray analysis of the femora from GIOP rats treated with GluSr revealed that the signalling pathways of the glucocorticoid receptor (GR), oestrogen receptor gene (ESR) and vitamin D receptor (VDR) were involved in bone restoration by GluSr. In summary, our study proved that GluSr enhanced osteoblast differentiation and suppressed osteoclast activity both in vitro and in vivo. GluSr might function as a novel strontium reagent for GIOP prevention.
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Efficacy of glucocorticoids, vitamin A and caffeine therapies for neonatal mortality in preterm infants: a network meta-analysis. Oncotarget 2017; 8:81167-81175. [PMID: 29113376 PMCID: PMC5655271 DOI: 10.18632/oncotarget.20882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/15/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction The paper aimed to evaluate the efficacy of different therapies in improving survival among preterm infants. Materials and Methods PubMed and Embase were searched from inception to 2017. We assessed studies for eligibility and extracted data. A Bayesian random-effects model was used to evaluate different therapies combined direct comparisons with indirect evidence. Consistency analysis was achieved using node-splitting plots. Surface under the cumulative ranking curve (SUCRA) was calculated to rank different therapies. Rankings of the competing therapies were also performed. Results A total of 42 randomized controlled trials (RCTs) were included for the network meta-analysis. Forest plots demonstrated that dexamethasone (OR = 10.13, 95% CrI: 5.11 to 17.89) and vitamin A (OR = 28.44, 95% CrI: 14.66 to 42.11) is superior to placebo in duration of oxygen supplementation while vitamin A (OR = −29.76, 95% CrI: −57.66 to −1.75) is inferior to placebo with regard to duration of hospitalization. Also, dexamethasone (OR = 0.42, 95% CrI: 0.24 to 0.68) showed lower incidence rate of BPD. SUCRA results showed the superiority of Budesonide based on primary efficacy outcomes. In addition, dexamethasone also showed high efficacy ranking in duration of ventilation, duration of oxygen supplementation, and occurrence of BPD. Hydrocortisone was effective in reducing neonatal mortality. No significant difference was found among these drugs. Conclusions No significant heterogeneity was found among these drugs. In general, budesonide might have the potential to be the optimal drug for its efficacy in reducing neonatal mortality and BPD, the two most essential outcome measures. Dexamethasone might be the suboptimal drug.
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Napeñas JJ, Kujan O, Arduino PG, Sukumar S, Galvin S, Baričević M, Costella J, Czerninski R, Peterson DE, Lockhart PB. World Workshop on Oral Medicine VI: Controversies regarding dental management of medically complex patients: assessment of current recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:207-26. [DOI: 10.1016/j.oooo.2015.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/28/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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Kovačević S, Nestorov J, Matić G, Elaković I. Dietary fructose-related adiposity and glucocorticoid receptor function in visceral adipose tissue of female rats. Eur J Nutr 2014; 53:1409-20. [PMID: 24420787 DOI: 10.1007/s00394-013-0644-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/17/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Excessive fructose intake coincides with the growing rate of obesity and metabolic syndrome, with women being more prone to these disorders than men. Findings that detrimental effects of fructose might be mediated by glucocorticoid regeneration in adipose tissue only indirectly implicated glucocorticoid receptor (GR) in the phenomenon. The aim of the present study was to elucidate whether fructose overconsumption induces derangements in GR expression and function that might be associated with fructose-induced adiposity in females. METHODS We examined effects of fructose-enriched diet on GR expression and function in visceral adipose tissue of female rats. Additionally, we analyzed the expression of genes involved in glucocorticoid prereceptor metabolism [11β-hydroxysteroid dehydrogenase type 1 (11βHSD1) and hexose-6-phosphate dehydrogenase], lipolysis (hormone-sensitive lipase) and lipogenesis (sterol regulatory element binding protein 1 and peroxisomal proliferator-activated receptor γ). RESULTS Fructose-fed rats had elevated energy intake that resulted in visceral adiposity, as indicated by increased visceral adipose tissue mass and its share in the whole-body weight. GR hormone binding capacity and affinity, as well as the expression of GR gene at both mRNA and protein levels were reduced in visceral adipose tissue of the rats on fructose diet. The glucocorticoid prereceptor metabolism was stimulated, as evidenced by elevated tissue corticosterone, while the key regulators of lipolysis and lipogenesis remained unaffected by fructose diet. CONCLUSIONS The results suggest that the 11βHSD1-mediated elevation of intracellular corticosterone may induce GR downregulation, which may be associated with failure of GR to stimulate lipolysis in fructose-fed female rats.
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Affiliation(s)
- Sanja Kovačević
- Department of Biochemistry, Institute for Biological Research "Siniša Stanković", University of Belgrade, 142 Despot Stefan Blvd, 11060, Belgrade, Serbia
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Rose AJ, Herzig S. Metabolic control through glucocorticoid hormones: an update. Mol Cell Endocrinol 2013; 380:65-78. [PMID: 23523966 DOI: 10.1016/j.mce.2013.03.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/21/2013] [Accepted: 03/08/2013] [Indexed: 01/28/2023]
Abstract
In the past decades, glucocorticoid (GC) hormones and their cognate, intracellular receptor, the glucocorticoid receptor (GR), have been well established as critical checkpoints in mammalian energy homeostasis. Whereas many aspects in healthy nutrient metabolism require physiological levels and/or action of GC, aberrant GC/GR signalling has been linked to severe metabolic dysfunction, including obesity, insulin resistance and type 2 diabetes. Consequently, studies of the molecular mechanisms within the GC signalling axis have become a major focus in biomedical research, up-to-date particularly focusing on systemic glucose and lipid handling. However, with the availability of novel high throughput technologies and more sophisticated metabolic phenotyping capabilities, as-yet non-appreciated, metabolic functions of GC have been recently discovered, including regulatory roles of the GC/GR axis in protein and bile acid homeostasis as well as metabolic inter-organ communication. Therefore, this review summarises recent advances in GC/GR biology, and summarises findings relevant for basic and translational metabolic research.
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Affiliation(s)
- Adam J Rose
- Joint Research Division, Molecular Metabolic Control, German Cancer Research Center (DKFZ) Heidelberg, Center for Molecular Biology (ZMBH), Heidelberg University, Network Aging Research, University Hospital Heidelberg, Germany
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Hanania NA. Safety of chronic obstructive pulmonary disease medications: a primary care perspective. Postgrad Med 2011; 123:72-9. [PMID: 21566417 DOI: 10.3810/pgm.2011.05.2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), which affects > 210 million individuals worldwide, places primary care practitioners at the forefront of diagnosing and managing COPD, and preventing adverse drug reactions (ADRs) associated with COPD medications. Therefore, it is essential that practitioners understand the safety profiles of these medications. They should also be aware of the host factors and any preexisting comorbidities in their patients that may impact the safety and efficacy of the prescribed therapy. Drug safety information obtained from randomized controlled trials, observational studies, and meta-analyses should be analyzed to assess the risk-benefit to a patient, since the majority of ADRs associated with COPD medications are predictable, and are avoidable with judicious use of these drugs. This article discusses the different medications available for COPD management and the factors affecting their safety based on current evidence.
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Affiliation(s)
- Nicola A Hanania
- Pulmonary and Critical Care Medicine, Asthma Clinical Research Center, Baylor College of Medicine, Houston, TX 77030, USA.
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Farah CS, Lynch N, McCullough MJ. Oral fungal infections: an update for the general practitioner. Aust Dent J 2010; 55 Suppl 1:48-54. [PMID: 20553244 DOI: 10.1111/j.1834-7819.2010.01198.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Oral candidosis is the most common fungal infection encountered in general dental practice. It manifests in a variety of clinical presentations which may mimic more sinister diseases, and can occasionally be refractory to treatment requiring the attention of an oral medicine specialist. Management of oral candidosis should always include a thorough investigation of underlying predisposing conditions, as the disease often presents when the patient is systemically compromised. This update highlights the pathogenesis, clinical presentation, and management strategies of oral Candidal lesions commonly encountered in dental practice.
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Affiliation(s)
- C S Farah
- School of Dentistry, The University of Queensland, Brisbane.
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Rose AJ, Vegiopoulos A, Herzig S. Role of glucocorticoids and the glucocorticoid receptor in metabolism: insights from genetic manipulations. J Steroid Biochem Mol Biol 2010; 122:10-20. [PMID: 20170729 DOI: 10.1016/j.jsbmb.2010.02.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 12/14/2009] [Accepted: 02/10/2010] [Indexed: 12/21/2022]
Abstract
Since the discovery of the beneficial effects of adrenocortical extracts for treating adrenal insufficiency more than 80 years ago, glucocorticoids and their cognate, intracellular receptor, the glucocorticoid receptor have been characterized as critical checkpoints in the delicate hormonal control of energy homeostasis in mammals. Whereas physiological levels of glucocorticoids are required for proper metabolic control, aberrant glucocorticoid action has been linked to a variety of pandemic metabolic diseases, such as type II diabetes and obesity. Based on its importance for human health, studies of the molecular mechanisms of within the glucocorticoid signaling axis have become a major focus in biomedical research. In particular, the understanding of tissue-specific functions of the glucocorticoid receptor pathway has been proven to be of substantial value for the development of novel therapies in the treatment of chronic metabolic disorders. Therefore, this review focuses on the consequences of endogenous and experimental modulation of glucocorticoid receptor expression for metabolic homeostasis and dysregulation, particularly emphasizing tissue-specific contributions of the glucocorticoid pathway to the control of energy metabolism.
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Affiliation(s)
- Adam J Rose
- Molecular Metabolic Control, DKFZ-ZMBH Alliance, German Cancer Research Center, Heidelberg, Germany
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Leclere M, Lefebvre-Lavoie J, Beauchamp G, Lavoie JP. Efficacy of oral prednisolone and dexamethasone in horses with recurrent airway obstruction in the presence of continuous antigen exposure. Equine Vet J 2010; 42:316-21. [PMID: 20525049 DOI: 10.1111/j.2042-3306.2009.00022.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
REASONS FOR PERFORMING STUDY Orally administered prednisolone and dexamethasone are used commonly in the treatment of recurrent airway obstruction (RAO) in horses. However, the efficacy of prednisolone in improving pulmonary function during continuous antigen exposure has not been evaluated critically and there is little evidence supporting the efficacy of low-dose oral dexamethasone in the same conditions. HYPOTHESIS Oral prednisolone and dexamethasone improve pulmonary function in RAO under conditions of continuous antigen exposure, and dexamethasone is more effective than prednisolone at commonly used dosages. METHODS Using a randomised crossover design, prednisolone (2 mg/kg bwt) and dexamethasone (0.05 mg/kg bwt) were administered per os, s.i.d. for 7 days, to 7 horses during clinical exacerbation of the disease. Maximal difference in transpulmonary pressure (DeltaP(L)), lung resistance (R(L)) and elastance (E(L)) were measured before and after 3 and 7 days of treatment. RESULTS Prednisolone and dexamethasone improved pulmonary function significantly. However, the improvement was of greater magnitude after 3 and 7 days of treatment with dexamethasone compared to prednisolone. Also, after 7 days of treatment with dexamethasone, DeltaP(L) and R(L) were not different from values obtained when horses were on pasture, while all 3 pulmonary function parameters remained different from pasture values after prednisolone treatment. CONCLUSIONS Both corticosteroids improve pulmonary function, in spite of continuous antigen exposure. However, oral dexamethasone at 0.05 mg/kg bwt is more effective than prednisolone at 2 mg/kg bwt in the treatment of RAO. POTENTIAL RELEVANCE Prednisolone was shown, for the first time, to our knowledge, to improve the pulmonary function of horses with RAO in the presence of continuous antigen exposure. This study also demonstrates the efficacy of low-dose oral dexamethasone in reversing airway obstruction in these conditions.
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Affiliation(s)
- M Leclere
- Clinical Sciences Department, Faculté de Médecine Vétérinaire, Université de Montréal. 3200 Sicotte Saint-Hyacinthe, J2S 7C6, Quebec, Canada
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Gonzalez-Moles MA, Scully C. HPA-suppressive effects of aqueous clobetasol propionate in the treatment of patients with oral lichen planus. J Eur Acad Dermatol Venereol 2010; 24:1055-9. [PMID: 20158585 DOI: 10.1111/j.1468-3083.2010.03591.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Oral topical corticosteroids have potential to produce inhibition of the hypothalamus-pituitary-adrenal (HPA) axis. OBJECTIVE To assess whether clobetasol propionate (CP) in aqueous solution causes HPA inhibition. PATIENTS AND METHODS Sixty-two patients with oral lichen planus or oral lichenoid lesions presenting with severe lesions were treated with topical oral 0.05% CP plus 100,000 IU/cm(3) nystatin in aqueous solution. Initial treatment of three 5-min mouthwashes (10 mL) daily was reduced, when the response was deemed complete or excellent, to a maintenance treatment of one 5-min mouthwash on alternate days for 6 months; treatment was then withdrawn and patients were followed up for 1 year. HPA function was assessed by plasma cortisol measurement and adrenocorticotropin (ACTH) stimulation at the end of the initial and maintenance treatment regimens. RESULTS The HPA axis was more frequently inhibited during initial (53/62; 85.5%) vs. maintenance (2/49; 4%) regimens of aqueous CP. LIMITATIONS In patients with morning plasma cortisol levels between 3 and 18 microg/dL, a normal result for the ACTH stimulation test only moderately reduces the possibility that a patient has secondary adrenal insufficiency. This can be considered a minor limitation in our study, as only three patients required additional assessment with the ACTH stimulation test. CONCLUSIONS Hypothalamus-pituitary-adrenal inhibition is substantial during initial treatment with aqueous CP three times daily.
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Affiliation(s)
- M A Gonzalez-Moles
- Oral Medicine Department, School of Dentistry, Granada University, Granada, Spain.
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Fischer DJ, Epstein JB, Klasser G. Multiple sclerosis: an update for oral health care providers. ACTA ACUST UNITED AC 2009; 108:318-27. [PMID: 19716502 DOI: 10.1016/j.tripleo.2009.05.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 05/24/2009] [Accepted: 05/28/2009] [Indexed: 11/20/2022]
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system. The disease mostly affects young adults and is increasing in prevalence and incidence. Multiple sclerosis is characterized by periods of activity and remission which, after numerous relapses, cause permanent neurologic deficits. Diagnosis of MS is based on patient history and clinical examination supplemented by the findings of radiologic and laboratory tests. Numerous motor and sensory disturbances occur in MS and may present in the orofacial region. This medical management update highlights issues that are important to the oral health care provider, including orofacial manifestations of MS and dental considerations for patients with MS.
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Affiliation(s)
- Dena J Fischer
- Department of Oral Medicine and Diagnostic Sciences, UIC College of Dentistry, University of Illinois at Chicago, Chicago, Illinois 60612-7213, USA.
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Vegiopoulos A, Herzig S. Glucocorticoids, metabolism and metabolic diseases. Mol Cell Endocrinol 2007; 275:43-61. [PMID: 17624658 DOI: 10.1016/j.mce.2007.05.015] [Citation(s) in RCA: 332] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Revised: 05/14/2007] [Accepted: 05/17/2007] [Indexed: 12/14/2022]
Abstract
Since the discovery of the beneficial effects of adrenocortical extracts for treating adrenal insufficiency more than 80 years ago, glucocorticoids (GC) and their cognate, intracellular receptor, the glucocorticoid receptor (GR) have been characterized as critical components of the delicate hormonal control system that determines energy homeostasis in mammals. Whereas physiological levels of GCs are required for proper metabolic control, excessive GC action has been tied to a variety of pandemic metabolic diseases, such as type II diabetes and obesity. Highlighted by its importance for human health, the investigation of molecular mechanisms of GC/GR action has become a major focus in biomedical research. In particular, the understanding of tissue-specific functions of the GC-GR pathway has been proven to be of substantial value for the identification of novel therapeutic options in the treatment of severe metabolic disorders. Therefore, this review focuses on the role of the GC-GR axis for metabolic homeostasis and dysregulation, emphasizing tissue-specific functions of GCs in the control of energy metabolism.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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