1
|
Yovich JL, Regan SLP, Zaidi S, Keane KN. The Concept of Growth Hormone Deficiency Affecting Clinical Prognosis in IVF. Front Endocrinol (Lausanne) 2019; 10:650. [PMID: 31636602 PMCID: PMC6788257 DOI: 10.3389/fendo.2019.00650] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/06/2019] [Indexed: 01/11/2023] Open
Abstract
The current understanding of human growth hormone (hGH; here GH) action is that the molecule is a 191-amino acid, single-chain polypeptide that is synthesized, stored and secreted by the somatotroph cells within the lateral wings of the anterior pituitary gland. It can be classified as a protein (comprising more than 50 amino acids) but true proteins have tertiary and quaternary chains creating a more complex structure, hence GH is usually classified as a polypeptide. GH is normally secreted at night during sleep and promotes skeletal, visceral and general body growth through the action of somatomedins or IGFs, notably IGF-1. In some tissues, GH action is directed via specific receptors GHRs; these are most abundant in liver, adipose and muscle tissues but have also been shown in granulosa cells, testicular tissues and on the oocyte, as well as in glandular cells of the luteal phase endometrium and decidua; such findings being recent and minimally researched to now. Following engagement with its receptor, the transduction process activates multiple signaling proteins. These all lead to extensive metabolic and mitogenic (growth promoting) responses. Clinically, GH is known to have an important role in pubertal development and is a key hormone for the vigor associated with adolescence and early adult life stages but has a faded presence and role for later adulthood, beyond age 30 years, and is minimally detected in advanced age, beyond 40 years. In association with the rapidly increasing trend for delaying reproduction beyond age 35 years, GH is being widely researched now as a potential adjuvant for infertility treatment in this group who, studies consistently show, have a poorer prognosis than younger females when relying on autologous oocytes. The idea that the age-related reduction in fertility prognosis is a feature of growth hormone deficiency is supported by our studies showing an elevated binding protein IGFBP-3/IGF-1 ratio and this can be reduced to a normal range (matching younger, good prognosis women) by the administration of GH as an adjuvant.
Collapse
Affiliation(s)
- John L. Yovich
- PIVET Medical Centre, Perth, WA, Australia
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA, Australia
| | - Sheena L. P. Regan
- PIVET Medical Centre, Perth, WA, Australia
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA, Australia
| | | | - Kevin N. Keane
- PIVET Medical Centre, Perth, WA, Australia
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA, Australia
| |
Collapse
|
2
|
Pedersen M, Asprusten TT, Godang K, Leegaard TM, Osnes LT, Skovlund E, Tjade T, Øie MG, Wyller VBB. Lifestyle factors during acute Epstein-Barr virus infection in adolescents predict physical activity six months later. Acta Paediatr 2019; 108:1521-1526. [PMID: 30685875 DOI: 10.1111/apa.14728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/27/2018] [Accepted: 01/22/2019] [Indexed: 01/14/2023]
Abstract
AIM Acute Epstein-Barr virus (EBV) infection is a trigger of prolonged fatigue. This study investigated baseline predictors of physical activity six months after an acute EBV infection. METHODS A total of 200 adolescents (12-20 years old) with acute EBV infection were assessed for 149 possible baseline predictors and followed prospectively. In this exploratory study, we performed linear regression analysis to assess possible associations between baseline predictors and steps per day at six months. RESULTS In the final multiple linear regression model, physical activity six months after acute EBV infection was significantly and independently predicted by baseline physical activity (steps per day), substance use (alcohol and illicit drugs) and human growth hormone (adjusted R2 = 0.20). CONCLUSION Baseline physical activity, substance use and plasma growth hormone are independent predictors of physical activity six months after an acute EBV infection in adolescents, whereas markers of the infection and associated immune response do not seem to be associated with physical activity six months later.
Collapse
Affiliation(s)
- Maria Pedersen
- Department of Pediatrics; Vestre Viken Hospital Trust; Drammen Norway
| | | | - Kristin Godang
- Section of Specialized Endocrinology; Department of Endocrinology; Oslo University Hospital; Oslo Norway
| | - Truls Michael Leegaard
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Microbiology and Infectional Control; Akershus University Hospital; Lørenskog Norway
| | - Liv Toril Osnes
- Department of Immunology; Oslo University Hospital; Oslo Norway
| | - Eva Skovlund
- Norwegian Institute of Public Health; Oslo Norway
| | | | - Merete Glenne Øie
- Department of Psychology; University of Oslo; Oslo Norway
- Research Division; Innlandet Hospital Trust; Lillehammer Norway
| | - Vegard Bruun Bratholm Wyller
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Pediatrics; Akershus University Hospital; Lørenskog Norway
| |
Collapse
|
3
|
Tölli A, Borg J, Bellander BM, Johansson F, Höybye C. Pituitary function within the first year after traumatic brain injury or subarachnoid haemorrhage. J Endocrinol Invest 2017; 40:193-205. [PMID: 27671168 PMCID: PMC5269462 DOI: 10.1007/s40618-016-0546-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/01/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Reports on long-term variations in pituitary function after traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH) diverge. The aim of the current study was to evaluate the prevalence and changes in pituitary function during the first year after moderate and severe TBI and SAH and to explore the relation between pituitary function and injury variables. METHODS Adults with moderate and severe TBI or SAH were evaluated at 10 days, 3, 6 and 12 months post-injury/illness. Demographic, clinical, radiological, laboratory, including hormonal data were collected. RESULTS A total of 91 adults, 56 (15 women/41 men) with TBI and 35 (27 women/8 men) with SAH were included. Perturbations in pituitary function were frequent early after the event but declined during the first year of follow-up. The most frequent deficiency was hypogonadotrope hypogonadism which was seen in approximately 25 % of the patients. Most of the variations were transient and without clinical significance. At 12 months, two patients were on replacement with hydrocortisone, four men on testosterone and one man on replacement with growth hormone. No relations were seen between hormonal levels and injury variables. CONCLUSIONS Perturbations in pituitary function continue to occur during the first year after TBI and SAH, but only a few patients need replacement therapy. Our study could not identify a marker of increased risk of pituitary dysfunction that could guide routine screening. However, data demonstrate the need for systematic follow-up of pituitary function after moderate or severe TBI or SAH.
Collapse
Affiliation(s)
- A Tölli
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden.
| | - J Borg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88, Stockholm, Sweden
| | - B-M Bellander
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden
| | - F Johansson
- Medical Library, Danderyd University Hospital, Stockholm, Sweden
| | - C Höybye
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
4
|
Yadav D, Akhtar A, Schweiger M, Tsilianidis L. A Case of Primary and Secondary Adrenal Insufficiency in Children. Clin Pediatr (Phila) 2016; 55:304-7. [PMID: 26092585 DOI: 10.1177/0009922815591895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Divya Yadav
- Cleveland Clinic Children's, Cleveland, OH, USA
| | | | | | | |
Collapse
|
5
|
Acute adrenal insufficiency in cervical spinal cord injury. World Neurosurg 2011; 77:561-3. [PMID: 22120347 DOI: 10.1016/j.wneu.2011.06.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 05/15/2011] [Accepted: 06/24/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adequate adrenal response is fundamental for the maintenance of physiological homeostasis in the setting of trauma and severe illness. Patients with neurogenic shock are at risk of severe consequences if adrenal insufficiency (AI) is not rapidly identified and treated. OBJECTIVE To analyze the incidence of AI in patients with acute cervical spinal cord injury and its effect on in-hospital complications. METHODS The medical records of patients older than 18 years who were admitted to the adult neurosurgery service at the University District Hospital as the result of neurogenic shock after acute cervical spinal cord injury from January 2004 to December 2009 were reviewed retrospectively. RESULTS One hundred ninety-nine patients were admitted with acute cervical spinal cord injury. A total of 37 patients met the pre-established criteria for neurogenic shock. The incidence of AI in patients with neurogenic shock was 22%. The average random cortisol was 9.3 μg/dL in patients with AI versus 29.2 μg/dL in non-AI. The presence of AI was positively correlated with complications and an increase in the risk of intubation (P = 0.01 and P = 0.002). The 30-day mortality rate in patients with AI was 13% compared with the 3% in the non-AI group (P = 0.39). CONCLUSIONS Adrenal insufficiency is a poorly recognized complication in patients with acute cervical spinal cord injury and its aggressive treatment is of utmost importance to avoid further neurological injury.
Collapse
|
6
|
Faber M, Flachs H, Frimodt-Møller N, Lindholm J. Hyponatremia and Adrenocortical Function in Patients with Severe Bacterial Infections. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/00365549309169677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
7
|
Wu JY, Hsu SC, Ku SC, Ho CC, Yu CJ, Yang PC. Adrenal insufficiency in prolonged critical illness. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:R65. [PMID: 18466605 PMCID: PMC2481448 DOI: 10.1186/cc6895] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 04/30/2008] [Accepted: 05/08/2008] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Adrenal insufficiency is common in critically ill patients and affects their prognosis, but little is known about how adrenal function changes during prolonged critical illness. This study was conducted to investigate dynamic changes in cortisol levels in patients with critical illness who do not improve after treatment. METHODS This observational cohort study was performed in the intensive care units of a university hospital. We studied acutely ill patients with initial cortisol level above 34 microg/dl, but who did not improve after treatment and in whom follow-up cortisol levels were determined during critical illness. All clinical information and outcomes were recorded. RESULTS Fifty-seven patients were included. Ten patients had follow-up cortisol levels above 34 microg/dl, 32 patients had levels between 34 and 15 microg/dl, and 15 patients had levels under 15 microg/dl. Outcomes did not differ significantly among the three groups with different follow-up cortisol levels. In Cox regression analysis, those patients who survived to hospital discharge with second cortisol levels under 15 microg/dl had a longer hospital length of stay (odds ratio = 14.8, 95% confidence interval = 2.4 to 90.0; P = 0.004). CONCLUSION The majority of acutely ill patients who remained in a critical condition had decreased serum cortisol levels. Depressed cortisol levels at follow up may lead to worse clinical outcomes. We propose that repeated adrenal function testing be conducted in patients with prolonged critical illness.
Collapse
Affiliation(s)
- Jenn-Yu Wu
- Department of Internal Medicine, National Taiwan University Hospital, Chung-Shan South Road, Taipei, Taiwan 100, Republic of China
| | | | | | | | | | | |
Collapse
|
8
|
Annane D, Maxime V, Ibrahim F, Alvarez JC, Abe E, Boudou P. Diagnosis of Adrenal Insufficiency in Severe Sepsis and Septic Shock. Am J Respir Crit Care Med 2006; 174:1319-26. [PMID: 16973979 DOI: 10.1164/rccm.200509-1369oc] [Citation(s) in RCA: 247] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Diagnosis of adrenal insufficiency in critically ill patients has relied on random or cosyntropin-stimulated cortisol levels, and has not been corroborated by a more accurate diagnostic standard. OBJECTIVE We used the overnight metyrapone stimulation test to investigate the diagnostic value of the standard cosyntropin stimulation test, and the prevalence of sepsis-associated adrenal insufficiency. METHODS This was an inception cohort study. MEASUREMENTS AND RESULTS In two consecutive septic cohorts (n = 61 and n = 40), in 44 patients without sepsis and in 32 healthy volunteers, we measured (1) serum cortisol before and after cosyntropin stimulation, albumin, and corticosteroid-binding globulin levels, and (2) serum corticotropin, cortisol, and 11beta-deoxycortisol levels before and after an overnight metyrapone stimulation. Adrenal insufficiency was defined by postmetyrapone serum 11beta-deoxycortisol levels below 7 microg/dl. More patients with sepsis (31/61 [59% of original cohort with sepsis] and 24/40 [60% of validation cohort with sepsis]) met criteria for adrenal insufficiency than patients without sepsis (3/44; 7%) (p < 0.001 for both comparisons). Baseline cortisol (< 10 microg/dl), Delta cortisol (< 9 microg/dl), and free cortisol (< 2 microg/dl) had a positive likelihood ratio equal to infinity, 8.46 (95% confidence interval, 1.19-60.25), and 9.50 (95% confidence interval, 1.05-9.54), respectively. The best predictor of adrenal insufficiency (as defined by metyrapone testing) was baseline cortisol of 10 microg/dl or less or Delta cortisol of less than 9 microg/dl. The best predictors of normal adrenal response were cosyntropin-stimulated cortisol of 44 microg/dl or greater and Delta cortisol of 16.8 microg/dl or greater. CONCLUSIONS In sepsis, adrenal insufficiency is likely when baseline cortisol levels are less than 10 microg/dl or delta cortisol is less than 9 microg/dl, and unlikely when cosyntropin-stimulated cortisol level is 44 microg/dl or greater or Delta cortisol is 16.8 microg/dl or greater.
Collapse
Affiliation(s)
- Djillali Annane
- Service de Réanimation, Hôpital Raymond Poincaré (AP-HP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104 Boulevard Raymond Poincaré, 92380 Garches, France.
| | | | | | | | | | | |
Collapse
|
9
|
Goodman S, Sprung CL, Ziegler D, Weiss YG. Cortisol changes among patients with septic shock and the relationship to ICU and hospital stay. Intensive Care Med 2005; 31:1362-9. [PMID: 16151722 DOI: 10.1007/s00134-005-2770-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2004] [Accepted: 07/25/2005] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate adrenal function in patients with severe sepsis or septic shock. DESIGN A prospective study of unstimulated and high-dose ACTH stimulated cortisol levels on days 1 and 2 following ICU admission and day 28 or last day of hospitalization (herein day 28). SETTING General intensive care unit. PATIENTS 34 septic patients. INTERVENTIONS On days 1, 2, and 28 of sepsis unstimulated and ACTH stimulated cortisol levels were evaluated. End-points were length of ICU and hospital stay and 28 day all cause mortality. MEASUREMENTS AND RESULTS Eight patients on days 1 and 2 had criteria of adrenal insufficiency defined as unstimulated cortisol levels less than 15 microg/dl. Patients with unstimulated cortisol levels less than 15 microg/dl on day 1 or change of 9 microg/dl or less had longer ICU stays. Patients with unstimulated cortisol levels less than 15 microg/dl on day 1 also demonstrated longer hospital stay. On day 1 regression analysis revealed that unstimulated cortisol levels had a significant inverse correlation with length of ICU and hospital stay. The proportional change between unstimulated cortisol and post-ACTH cortisol (Delta%) is a new modality; the higher this Delta% value, the longer is the patient's ICU and hospital stay. A significant positive correlation was found in survivors when comparing unstimulated cortisol vs. day 28 changes. CONCLUSIONS The present study highlights the wide range of cortisol levels among patients with sepsis. We observed a difference in cortisol response pattern between survivors and nonsurvivors on day 28. The proportional change between unstimulated cortisol and post-ACTH cortisol was used as a method to evaluate the relative change in cortisol levels between patients.
Collapse
Affiliation(s)
- Sergei Goodman
- Department of Anesthesiology and Critical Care Medicine, Hadassah University Hospital, Hadassah Medical School, Hebrew University, P.O.B. 12000, 91120 Jerusalem, Israel
| | | | | | | |
Collapse
|
10
|
Affiliation(s)
- Mark S Cooper
- Division of Medical Sciences, University of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
| | | |
Collapse
|
11
|
De Kleijn ED, Joosten KFM, Van Rijn B, Westerterp M, De Groot R, Hokken-Koelega ACS, Hazelzet JA. Low serum cortisol in combination with high adrenocorticotrophic hormone concentrations are associated with poor outcome in children with severe meningococcal disease. Pediatr Infect Dis J 2002; 21:330-6. [PMID: 12075765 DOI: 10.1097/00006454-200204000-00013] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study the correlation between serum concentrations of adrenocorticotrophic hormone (ACTH) and cortisol in relation to severity of disease in children with meningococcal sepsis. METHODS Subjects were children with meningococcal sepsis, admitted to the pediatric intensive care unit. Clinical data, laboratory values and blood samples were selected. Arterial cortisol, ACTH, interleukin 6 and tumor necrosis factor alpha concentrations were measured on admission and studied for their relation to severity of disease (sepsis, septic shock/survivors, septic shock/nonsurvivors). RESULTS Seventy-two patients fulfilled the criteria for meningococcal sepsis. Sixty-two of these children with positive blood cultures of Neisseria meningitidis, who were not treated with corticosteroids before admission, were included. Fifty of the 62 patients had septic shock. Twelve of those children (24%) died. The median age of the subjects was 2.6 years (range, 0.3 to 16.1 years). Cortisol values were significantly lower in non-survivors (median, 654 nmol/l) than in survivors (median, 2184 nmol/l) (P < 0.01). ACTH values were significantly higher in children who died (median, 1271 ng/l) than in survivors (85 ng/l) (P < 0.01). The median cortisol:ACTH ratio decreased significantly depending on the disease severity categories. CONCLUSIONS Low serum cortisol concentrations in combination with high ACTH concentrations are associated with poor outcome in children with severe meningococcal disease.
Collapse
Affiliation(s)
- Ester D De Kleijn
- Erasmus Medical Center, Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
12
|
Burchard K. A review of the adrenal cortex and severe inflammation: quest of the "eucorticoid" state. THE JOURNAL OF TRAUMA 2001; 51:800-14. [PMID: 11586182 DOI: 10.1097/00005373-200110000-00033] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- K Burchard
- Department of Surgery, Section of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA.
| |
Collapse
|
13
|
Venn RM, Bryant A, Hall GM, Grounds RM. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in post-operative patients needing sedation in the intensive care unit. Br J Anaesth 2001; 86:650-6. [PMID: 11575340 DOI: 10.1093/bja/86.5.650] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We have compared the effects of dexmedetomidine and propofol on endocrine, metabolic, inflammatory and cardiovascular responses in patients in the intensive care unit (ICU) after major surgery. Twenty patients who were expected to require 8 h of post-operative sedation and ventilation were allocated randomly to receive either an infusion of dexmedetomidine 0.2-2.5 microg kg(-1) h(-1) or propofol 1-3 mg kg(-1) h(-1). Arterial pressure, heart rate and sequential concentrations of circulating cortisol, adrenocorticotrophic hormone (ACTH), growth hormone, prolactin, insulin, glucose and interleukin 6 were measured. An ACTH stimulation test was performed in all patients who received dexmedetomidine. Heart rate was significantly lower in the dexmedetomidine patients. There were no differences in arterial pressure, cortisol, ACTH, prolactin and glucose concentrations between the two groups. A positive response to the ACTH stimulation test varied depending on the diagnostic criteria used. The insulin concentration was significantly lower in the dexmedetomidine group at 2 h (P=0.021), although this did not affect blood glucose concentrations. Growth hormone concentrations were significantly higher in dexmedetomidine-treated patients overall (P=0.036), but circulating concentrations remained in the physiological range. Interleukin 6 decreased in the dexmedetomidine group. We conclude that dexmedetomidine infusion does not inhibit adrenal steroidogenesis when used for short-term sedation after surgery.
Collapse
Affiliation(s)
- R M Venn
- Department of Anaesthesia and Intensive Care, Worthing Hospital, West Sussex, UK
| | | | | | | |
Collapse
|
14
|
Riordan FA, Thomson AP, Ratcliffe JM, Sills JA, Diver MJ, Hart CA. Admission cortisol and adrenocorticotrophic hormone levels in children with meningococcal disease: evidence of adrenal insufficiency? Crit Care Med 1999; 27:2257-61. [PMID: 10548217 DOI: 10.1097/00003246-199910000-00032] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To measure admission cortisol and adrenocorticotrophic hormone (ACTH) levels in children with meningococcal disease to try and determine the prevalence of adrenal insufficiency. DESIGN Prospective observational study. SETTING Pediatric departments of four hospitals in Merseyside, United Kingdom. PATIENTS Ninety-six children with meningococcal disease; 29 with hypotension, ten of whom died. MEASUREMENTS AND MAIN RESULTS Admission cortisol, ACTH, and proinflammatory cytokine levels were measured. Serial cortisol levels also were measured during the first 48 hrs. Significantly lower cortisol levels were found in those who died compared with survivors. Significantly higher ACTH levels also were found in those who died. However, no child had a cortisol level <5 microg/dL (<138 nmol/L) implying definite adrenal insufficiency. Three of 29 children with hypotension had plasma cortisol levels implying possible adrenal insufficiency (<18 microg/dL [<497 nmol/L]), but high ACTH levels were only found in one of those three. Cortisol levels decreased significantly after antibiotic treatment, unless steroid therapy was administered. ACTH levels did not correlate with cortisol or proinflammatory cytokine levels. CONCLUSIONS Children with meningococcal disease have a wide range of initial plasma cortisol levels, with lower levels found in those who die. Many factors may affect cortisol levels, but adrenal insufficiency is probably uncommon.
Collapse
Affiliation(s)
- F A Riordan
- Institute of Child Health, University of Liverpool, United Kingdom
| | | | | | | | | | | |
Collapse
|
15
|
Dinneen S, Alzaid A, Miles J, Rizza R. Metabolic effects of the nocturnal rise in cortisol on carbohydrate metabolism in normal humans. J Clin Invest 1993; 92:2283-90. [PMID: 8227343 PMCID: PMC288409 DOI: 10.1172/jci116832] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Glucocorticoid concentrations vary throughout the day. To determine whether an increase in cortisol similar to that present during sleep is of physiologic significance in humans, we studied the disposition of a mixed meal when the nocturnal rise in cortisol was mimicked or prevented using metyrapone plus either a variable or constant hydrocortisone infusion. When glucose concentrations were matched with a glucose infusion, hepatic glucose release (2.6 +/- 0.2 vs. 1.5 +/- 0.4 nmol/kg per 6 h) was higher (P < 0.05) while glucose disappearance (5.9 +/- 0.3 vs. 7.3 +/- 0.9 mmol/kg per 6 h) and forearm arteriovenous glucose difference (64 +/- 24 vs. 231 +/- 62 mmol/dl per 6 h) were lower (P < 0.05) during the variable than basal infusion. The greater hepatic response during the variable cortisol infusion was mediated (at least in part) by inhibition of insulin and stimulation of glucagon secretion as reflected by lower (P < 0.05) C-peptide (0.29 +/- 0.01 vs. 0.38 +/- 0.04 mmol/liter per 6 h) and higher (P < 0.05) glucagon (42.7 +/- 2.0 vs. 39.3 +/- 1.8 ng/ml per 6 h) concentrations. In contrast, the decreased rates of glucose uptake appeared to result from a state of "physiologic" insulin resistance. The variable cortisol infusion also increased (P < 0.05) postprandial palmitate appearance as well as palmitate, beta-hydroxybutyrate, and alanine concentrations, suggesting stimulation of lipolysis, ketogenesis, and proteolysis. We conclude that the circadian variation in cortisol concentration is of physiologic significance in normal humans.
Collapse
Affiliation(s)
- S Dinneen
- Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota 55905
| | | | | | | |
Collapse
|
16
|
Bain RJ, Fox JP, Jagger J, Davies MK, Littler WA, Murray RG. Serum cortisol levels predict infarct size and patient mortality. Int J Cardiol 1992; 37:145-50. [PMID: 1452369 DOI: 10.1016/0167-5273(92)90201-d] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We have investigated prospectively the serum cortisol response to acute myocardial infarction in 70 consecutive patients admitted to a coronary care unit and we have shown that the levels are significantly raised early in the course of the illness and prior to elevation of the cardiac specific enzyme fraction, creatine kinase MB. The magnitude of the cortisol response is related to the size of the ensuing infarction (rs = 0.54) as calculated from the total creatine kinase MB release (P < 0.001) and very high levels (> 2000 mumol/l) are predictive of mortality (P < 0.05). Serum cortisol levels may have a role in the early identification of myocardial infarction and in predicting those patients with a poor prognosis.
Collapse
Affiliation(s)
- R J Bain
- Department of Cardiovascular Medicine, East Birmingham Hospital, UK
| | | | | | | | | | | |
Collapse
|
17
|
Pénicaud L, Robin D, Robin P, Kandé J, Picon L, Girard J, Ferré P. Effect of insulin on the properties of liver carnitine palmitoyltransferase in the starved rat: assessment by the euglycemic hyperinsulinemic clamp. Metabolism 1991; 40:873-6. [PMID: 1861636 DOI: 10.1016/0026-0495(91)90018-r] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The effect of insulin on the properties of liver carnitine palmitoyltransferase I (CPT I) was assessed in conscious starved rats with the euglycemic hyperinsulinemic clamp. A 24-hour clamp was necessary to fully reverse the effect of starvation on liver malonyl-CoA concentration, CPT I maximal activity, and apparent km and Ki for malonyl-CoA. Since glucagon was not decreased during the clamp, insulin is the major factor involved in the regulation of CPT I.
Collapse
Affiliation(s)
- L Pénicaud
- Centre de Recherche sur la Nutrition, CNRS, Meudon-Bellevue, France
| | | | | | | | | | | | | |
Collapse
|
18
|
Bain RJ, Poeppinghaus VJ, Jones GM, Peaston MJ. Cortisol level predicts myocardial infarction in patients with ischaemic chest pain. Int J Cardiol 1989; 25:69-72. [PMID: 2793263 DOI: 10.1016/0167-5273(89)90164-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Serum cortisol levels were studied in twenty patients with confirmed myocardial infarction and in twenty patients with severe chest pain admitted to the coronary care unit with suspected myocardial infarction but in whom a diagnosis of angina was subsequently made. Cortisol levels were significantly elevated in patients within five hours of the onset of symptoms in myocardial infarction (857 +/- 74 nmol/l; mean +/- SE) but remained within the normal range for those with angina (340 +/- 55 nmol/l). It is concluded that hypercortisolaemia accompanies myocardial infarction, but not angina, and that the psychological stresses of ischaemic chest pain and admission to the coronary care unit produce little, if any, elevation in serum cortisol levels unless there is significant myocardial necrosis. This observation may be of value to those conducting intervention studies in myocardial infarction since the early elevation of the cortisol levels to above the normal range in patients with ischaemic chest pain is both sensitive (70%) and specific (85%) for myocardial infarction.
Collapse
Affiliation(s)
- R J Bain
- Department of Medicine, Countess of Chester Hospital, Cheshire, U.K
| | | | | | | |
Collapse
|
19
|
Hägg E, Asplund K, Lithner F. Value of basal plasma cortisol assays in the assessment of pituitary-adrenal insufficiency. Clin Endocrinol (Oxf) 1987; 26:221-6. [PMID: 3311477 DOI: 10.1111/j.1365-2265.1987.tb00780.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A basal plasma cortisol value taken in a physically unstressed state in 68 patients with or without hypothalamic-pituitary-adrenocortical disease was compared with the maximal plasma cortisol concentration during an insulin tolerance test. There was a strong positive correlation between the values. Basal cortisol levels above 300 nmol/l (RIA method) almost excluded ACTH-cortisol insufficiency and those below 100 nmol/l strongly suggested dysfunction. A repeated basal cortisol estimation within a month was especially valuable in categorizing patients with levels between 100 and 200 nmol/l. We suggest that a basal cortisol measurement may be used as a first laboratory test in patients evaluated for possible hypothalamic-pituitary-adrenocortical insufficiency; in many patients, this approach obviates more sophisticated and expensive testing.
Collapse
Affiliation(s)
- E Hägg
- Department of Medicine, University Hospital, Umeå, Sweden
| | | | | |
Collapse
|
20
|
Patel DG, Kalhan SC. Diabetic ketoacidosis. Indian J Pediatr 1986; 53:559-72. [PMID: 3102368 DOI: 10.1007/bf02748659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
21
|
Pernet A, Johnston DG, Hammond V, Orskov H, Alberti KG. Interactions of stress hormones on lipid and carbohydrate metabolism in man with partial insulin deficiency. Eur J Clin Invest 1986; 16:310-5. [PMID: 2875880 DOI: 10.1111/j.1365-2362.1986.tb01347.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The metabolic responses to 4-h infusions of adrenaline (3 micrograms kg-1 h-1) and cortisol (10 mg m-2 h-1 for 2 h followed by 5 mg m-2 h-1 for 2 h), separately and in combination, have been studied in six healthy subjects with concurrent somatostatin infusion (250 micrograms h-1). A combined infusion of adrenaline, cortisol, glucagon (180 ng kg-1 h-1) and somatostatin has also been studied. Somatostatin plus adrenaline and somatostatin plus cortisol resulted in hyperglycaemia (at 240 min, somatostatin plus adrenaline 11.4 +/- 0.4 mmol l-1, P less than 0.001; somatostatin plus cortisol 6.7 +/- 0.3 mmol l-1, P less than 0.05; somatostatin alone 4.9 +/- 0.4 mmol l-1). No synergistic effect on blood glucose was seen with adrenaline and cortisol together. When glucagon was added, blood glucose rose more rapidly than without glucagon (9.3 +/- 0.4 mmol l-1 v. 7.2 +/- 0.5 mmol l-1 at 45 min, P less than 0.001), but plateau values were similar. Plasma NEFA levels were raised by somatostatin plus adrenaline (0.55 +/- 0.04-1.82 +/- 0.11 mmol l-1 at 60 min). Somatostatin plus cortisol had no more effect on plasma NEFA than somatostatin alone. During the combined infusion of somatostatin plus adrenaline plus cortisol, a synergistic effect on plasma NEFA was observed (2.30 +/- 0.11 mmol l-1 at 60 min, P less than 0.01 v. somatostatin plus adrenaline). This occurred despite a small escape of insulin secretion. The lipolytic actions of adrenaline are potentiated by elevated circulating cortisol levels in insulin-deficient man.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
|
22
|
Prabhu V, el-Guebaly N. Cortisol secretion and DST in affective disorders--methodological concerns. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1983; 28:602-11. [PMID: 6661709 DOI: 10.1177/070674378302800803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the wake of a large number of studies seeking biological markers for a variety of psychiatric disorders including affective disorders, the enthusiasm over Cortisol Secretion and Dexamethasone Suppression test lead the authors to review critically the data collected so far. The research designs involved, the samples studied and the reliability of the data collected along major variables such as diagnostic criteria, sampling characteristics, procedural differences, length of follow-up and the role of environmental stressors were evaluated. A useful exercise was to compare the literature published in the 50's and 60's with the more recent publications. The potential usefulness of DST as a diagnostic and management tool remains open for scrutiny. Whether the abnormalities in cortisol levels and DST responses evidenced by many researchers are an epiphenomenon or have a diagnostic and management value still remains unclear. From their analysis, the authors point out the lack of well controlled sequential studies using standardized procedures, and large age specific samples. Difficulty arising from the use of various terminologies and criteria for diagnosis of depressive disorders is recognized. The limitations of the use of DST in general clinical practice along with directions for future research are outlined.
Collapse
|
23
|
Johnston D, Alberti K. 3 Hormonal control of ketone body metabolism in the normal and diabetic state. ACTA ACUST UNITED AC 1982. [DOI: 10.1016/s0300-595x(82)80019-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
24
|
Sainsbury JR, Stoddart JC, Watson MJ. Plasma cortisol levels. A comparison between sick patients and volunteers given intravenous cortisol. Anaesthesia 1981; 36:16-21. [PMID: 7468958 DOI: 10.1111/j.1365-2044.1981.tb08594.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The plasma cortisol levels of 30 very sick patients were measured to determine whether evidence of suprarenal failure could be found. Volunteers were given 100 mg hydrocortisone intravenously and their plasma cortisol levels were measured. The results suggest that suprarenal failure is a very uncommon occurrence. The results obtained from the volunteers imply that relatively small amounts of hydrocortisone given intravenously cause a marked elevation of plasma cortisol levels.
Collapse
|
25
|
Stockigt JR, Hewett MJ, Topliss DJ, Higgs EJ, Taft P. Renin and renin substrate in primary adrenal insufficiency: contrasting effects of glucocorticoid and mineralocorticoid deficiency. Am J Med 1979; 66:915-22. [PMID: 222144 DOI: 10.1016/0002-9343(79)90445-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
26
|
Hall SE, Saunders J, Sönksen PH. Glucose and free fatty acid turnover in normal subjects and in diabetic patients before and after insulin treatment. Diabetologia 1979; 16:297-306. [PMID: 456773 DOI: 10.1007/bf01223618] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Turnover rates of glucose and free fatty acids were measured, using 3H-glucose and 14C-l-palmitic acid as tracers, in insulin-requiring diabetic patients at presentation and after insulin treatment. Correlations were sought with rates of substrate oxidation, determined independently from respiratory exchange, and with plasma hormone concentrations. The rates of appearance of glucose and of free fatty acids were increased in the diabetics to 17.6 and 10.2 micronmol min-1 kg-1 respectively. Both rates fell to normal (13.3 and 7.1 micronmol min-1 kg-1) after insulin. In the untreated state there was an inverse relationship between the rates of utilisation of glucose and free fatty acids (r = 0.61; p less than 0.05). It is suggested that this relationship represents the impairment of peripheral glucose utilisation by free fatty acids and by ketone bodies in vivo, so far only demonstrated in vitro. The tracer calculated rates of glucose utilisation correlated well over a wide range with the respiratory quotient in untreated diabetics, while respiratory quotient was inversely related to free fatty acid turnover rates. In untreated diabetics plasma cortisol and 3,3', 5'-triiodothyronine (rT3) were increased whereas thyroxine and 3,5,3'-triiodothyronine (T3) were decreased. 3,5,3'-Triiodothyronine concentration was closely related to the metabolic clearance rate of glucose (p less than 0.05), while cortisol concentrations correlated with glucose production (p less than 0.02) and blood ketone body concentration (p less than 0.02). It is concluded that glucose overproduction is the major contributor to the hyperglycaemia of untreated diabetes.
Collapse
|
27
|
Bolli G, Compagnucci P, Cartechini MG, De Feo P, Santeusanio F, Puxeddu A, Brunetti P. Urinary excretion and plasma levels of norepinephrine and epinephrine during diabetic ketoacidosis. ACTA DIABETOLOGICA LATINA 1979; 16:157-67. [PMID: 113975 DOI: 10.1007/bf02581095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sympathetic activity was determined in 13 ketoacidotic diabetics by evaluation of plasma and urinary catecholamines, before and in the course of medical management. Patients were divided into two groups. Group A (severe ketoacidosis, n = 5) and Group B (moderate ketoacidosis, = 8), depending on plasma glucose, pH and plasma bicarbonate levels. The results showed an enhanced sympathetic activity in all patients before treatment, with significant decrease during therapy. In Group A plasma catecholamines were higher than in Group B, both before and in the course of therapy. A significant correlation was found between basal plasma catecholamines and initial plasma glucose, plasma bicarbonate, hours of therapy and insulin dosage required to obtain plasma glucose levels below 150 mg/100 ml .These results, suggesting a close correlation between glycometabolic control and adrenergic activity, emphasize the role of the sympathetic nervous system as a powerful contrainsular factor in the pathogenesis and metabolic derangement of diabetic ketoacidosis.
Collapse
|
28
|
|
29
|
Barnes AJ, Kohner EM, Bloom SR, Johnston DG, Alberti KG, Smythe F. Importance of pituitary hormones in aetiology of diabetic ketoacidosis. Lancet 1978; 1:1171-4. [PMID: 77942 DOI: 10.1016/s0140-6736(78)90965-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The role of pituitary hormones in the aetiology of diabetic ketoacidosis was examined by withdrawing insulin from five pituitary-ablated diabetics for a 12-hour period. The rise in blood glucose and ketone-body concentrations was markedly retarded in these patients when compared with five matched juvenile-type diabetic controls with normal pituitary function. When cortisol replacement in the pituitary-ablated patients was increased to reproduce the high plasma concentrations found in severe ketoacidosis, blood ketones and glucose were increased but were still significantly lower than in the control diabetics. It is concluded that pituitary hormones may be important in the development of diabetic ketoacidosis.
Collapse
|
30
|
Drew SI, Joffe B, Vinik A, Seftel H, Singer F. The first 24 hours of acute pancreatitis. Changes in biochemical and endocrine homeostasis in patients with pancreatitis compared with those in control subjects undergoing stress for reasons other than pancreatitis. Am J Med 1978; 64:795-803. [PMID: 645743 DOI: 10.1016/0002-9343(78)90519-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
31
|
Alberti KG, Hockaday TD. Diabetic coma: a reappraisal after five years. CLINICS IN ENDOCRINOLOGY AND METABOLISM 1977; 6:421-55. [PMID: 19185 DOI: 10.1016/s0300-595x(77)80046-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
32
|
Sibbald WJ, Short A, Cohen MP, Wilson RF. Variations in adrenocortical responsiveness during severe bacterial infections. Unrecognized adrenocortical insufficiency in severe bacterial infections. Ann Surg 1977; 186:29-33. [PMID: 195542 PMCID: PMC1396190 DOI: 10.1097/00000658-197707000-00005] [Citation(s) in RCA: 192] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Plasma cortisol levels and their response to .25 mg synthetic A.C.T.H. (Cortrosyn) were studied in 26 septic patients. Four (15.4%) of these patients appeared to have greatly increased adrenocortical activity with plasma cortisol levels averaging 65.4 +/- 14.8 microgram/dl (normal = 8-18 microgram/dl. All four of these patients were agonal and died within five days. Seventeen (65.4%) of these 26 patients appeared to have an appropriate adrenocortical response to severe infection in that their plasma cortisol levels increased (averaging 19.2 +/- 6.0 microngram/dl) following synthetic A.C.T.H. The remaining five patients, who constituted 19.2% of the 26 patients studied, appeared to have some impairment of adrenocortical function. In spite of severe bacterial infections and no history to support Addison's disease, their plasma cortisol levels (averaging 13.8 +/- 3.3 microgram/dl) were not increased above normal and their response to Cortrosyn was much less than would be expected; the increase in plasma cortisol levels in these patients following the synthetic A.C.T.H. averaged 1.1 +/- 3.6 microgram/dl. It is reemphasized that patients with severe sepsis who are not responding adequately to standard therapy should be suspected of having adrenocortical insufficiency and treated accordingly.
Collapse
|
33
|
Abstract
Twelve diabetic children--eight in ketoacidosis, three with insulin refractory hyperglycemia, and one postoperative patient--were treated with continuous, low-dose, intravenous infusion of insulin. The eight ketoacidotic children with a mean serum glucose concentration on admission of 631 mg/dl and bicarbonate value of 6.8 mM/1 were given regular insulin, 0.1 U/kg, slowly by bolus injection followed by a sustaining infusion of 0.1 U/kg/hour. Plasma glucose concentration fell at a mean rate of 82 mg/dl/hour. Euglycemia with concomitant improvement in the metabolic disorder was achieved with a mean dose of insulin, 0.68 U/kg, given over four to 10 hours. Mean plasma insulin in those children who had not previously received insulin was 55 muU/ml, well within the normal physiologic range. Growth hormone and serum triglyceride levels, low initially, rose with insulin therapy before returning to control values. Continuous low-dose insulin infusion is simple, safe, and effective, avoids confusion and empiricism, and appears to be the method of choice for the treatment of diabetic ketoacidosis or insulin resistance.
Collapse
|
34
|
Axelrod L, Trzepacz PT, Zusman RM, Martin DB. Antilipolytic effect of prostaglandin E2 analogues: therapeutic implications. Life Sci 1976; 18:627-32. [PMID: 1263747 DOI: 10.1016/0024-3205(76)90343-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
35
|
Abstract
Recent studies of hypothalamo--pituitary--adrenal (HPA) suppression in depressed patients indicate that these subjects often show abnormal early escape of plasma cortisol levels following an initial suppression. Non-depressed psychiatric inpatients usually show normal sustained HPA suppression. The responses of 49 depressed and 30 non-depressed patients have been analysed to develop criteria which can make the dexamethasone suppression test suitable for outpatient studies. The cortisol levels measured in a 24-hour urine collection and a single blood sample post-dexamethasone were sufficient to enable 61% of the depressed patients to be identified correctly at a confidence level of 90%, on the basis of at least one abnormal cortisol value. When both cortisol values were abnormal 35% of the depressed patient were identified correctly at a confidence level of 100%. Patients with "endogenous" depressive profiles had the most abnormal results. A normal response to this test will not necessarily exclude the diagnosis of primary depressive illness. An abnormal response to the test may be of help in confirming the diagnosis. With the simplified procedure outpatient studies may become possible.
Collapse
|
36
|
|
37
|
Gerich JE, Lorenzi M, Bier DM, Schneider V, Tsalikian E, Karam JH, Forsham PH. Prevention of human diabetic ketoacidosis by somatostatin. Evidence for an essential role of glucagon. N Engl J Med 1975; 292:985-9. [PMID: 804137 DOI: 10.1056/nejm197505082921901] [Citation(s) in RCA: 278] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To evaluate the role of glucagon in the pathogenesis of diabetic ketoacidosis in man, we studied the effect of suppression of glucagon secretion by somatostatin on changes in plasma beta-hydroxybutyrate and glucose concentrations (as well as changes in their precursors) after acute withdrawal of insulin from seven patients with juvenile-type diabetes. Suppression of glucagon secretion prevented the development of ketoacidosis for 18 hours after acute insulin withdrawal, whereas in control studies mild ketoacidosis occurred 10 hours after insulin was stopped. Plasma beta-hydroxybutyrate, glucose, free fatty acid, and glycerol levels were all markedly lower during suppression of glucagon secretion (p smaller than 0.001), whereas plasma alanine levels were higher (p smaller than 0.001). These studies indicate that insulin lack per se does not lead to fulminant diabetic ketoacidosis in man and that glucagon, by means of its gluconeogenic, ketogenic, and lipolytic actions, is a prerequisite to the development of this condition.
Collapse
|
38
|
Prakash R, Chhablani R. Immunoreactive serum insulin and growth hormone response in patients with preinfarction angina and acute myocardial infarction. Chest 1974; 65:408-14. [PMID: 4274259 DOI: 10.1378/chest.65.4.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
39
|
Sönksen PH, Soeldner JS, Gleason RE, Boden G. Abnormal serum growth hormone responses in genetically potential-diabetic male patients with normal oral glucose tolerance: evidence for an insulin-like action of growth hormone in vivo. Diabetologia 1973; 9:426-37. [PMID: 4773203 DOI: 10.1007/bf01239440] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
40
|
Odell WD. The role of carbohydrate and oral agents in the treatment of diabetes mellitus. Calif Med 1973; 119:37-47. [PMID: 4749311 PMCID: PMC1455263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
41
|
|
42
|
Argüelles AE, Hoffman C, Chekherdemian M, Cervetto A. Corticoadrenal and adrenergic overactivity in male patients with chronic myocardial infarction. JOURNAL OF STEROID BIOCHEMISTRY 1973; 4:427-32. [PMID: 4270621 DOI: 10.1016/0022-4731(73)90013-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
43
|
Muggeo M, Crepaldi G, Fedele D, Tiengo A. [Growth hormone secretion in diabetic retinopathy]. ACTA DIABETOLOGICA LATINA 1973; 10:737-55. [PMID: 4777510 DOI: 10.1007/bf02590686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
44
|
|
45
|
|
46
|
Chopra MP, Thadani U, Aber CP, Portal RW, Parkes J. Plasma cortisol, urinary 17-hydroxycorticoids, and urinary vanilyl mandelic acid after acute myocardial infarction. Heart 1972; 34:992-7. [PMID: 5086981 PMCID: PMC458536 DOI: 10.1136/hrt.34.10.992] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
47
|
Sönksen PH, Srivastava MC, Tompkins CV, Nabarro JD. Growth-hormone and cortisol responses to insulin infusion in patients with diabetes mellitus. Lancet 1972; 2:155-9. [PMID: 4114062 DOI: 10.1016/s0140-6736(72)91328-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
48
|
Davies AG, Dingle HR. Observations on cardiovascular and neuroendocrine disturbance in the Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 1972; 35:176-9. [PMID: 4113954 PMCID: PMC494032 DOI: 10.1136/jnnp.35.2.176] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiovascular disturbances were found to be a common feature of patients with the Guillian-Barré syndrome who were severely paralysed, requiring assisted ventilation. Glycosuria was noted in association with these disturbances, and in five patients investigated we found impaired glucose tolerance tests at the height of the paralysis. Catecholamine and 17-hydroxycorticosteroid urinary excretions were found to be high in four patients investigated when the neuropathy was most severe, and in one patient plasma cortisol levels were high with loss of diurnal variation. With recovery from paralysis cardiovascular disturbances became less marked, catecholamine and 17-hydroxycorticosteroid urinary excretions reverted to normal, glucose tolerance improved but remained abnormal in three patients during the period of observation. It is suggested that increased levels of catecholamines and cortisol contributed to the development of impaired glucose tolerance and cardiovascular disturbances.
Collapse
|
49
|
|
50
|
Von der Nahmer D, Miss HD, Jahnke K. [Function of the adrenal cortex in diabetic coma. Studies of 11-OHCS levels in plasma]. KLINISCHE WOCHENSCHRIFT 1971; 49:578-83. [PMID: 4996167 DOI: 10.1007/bf01485329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|