Glucocorticoid functional reserve in full-spectrum intensity of primary hypothyroidism

Low-Dose ACTH Stimulation Test in Obesity: A Randomized Dose Assessment

BACKGROUND

The short cosyntropin test is widely used for adrenal insufficiency screening and diagnosis. Lower cosyntropin doses may have greater sensitivity vs. the standard dose in detecting adrenal dysfunction. Obesity and overweight are increasing, impacting the clinical presentation of some diseases. Currently more than 50% of the subjects diagnosed with autoimmune adrenal insufficiency have a BMI greater than 25, and hence individuals living with overweight and obesity are more frequently requiring evaluation of the adrenal cortical function. Fixed-dose cosyntropin stimulation may not be appropriate for individuals with obesity.

OBJECTIVE

The primary objective was to compare cortisol response to a weight-adapted cosyntropin dose vs. a fixed low dose (1 µg) and a more physiologically fixed dose (10 µg).

METHODS

Twenty individuals with obesity and 20 age-matched healthy controls underwent in a randomized sequence at least one-week apart, to the The short cosyntropin test with three different doses, 0.2 µg/kg of body weight, 1 or 10 µg fixed dose stimuli. The assessment and data analysis were blinded to the individual and the investigator.

RESULTS

Cortisol response was reduced in the group with obesity with the 1 µg fixed dose stimuli at 30 minutes (median, IQR) 649.6 µg, 567.3-738.4 µg for the control group vs. 568.6 µg, 528.4-623.13 µg, p=0.04; there was a lower cortisol peak at 60' in all the three evaluated doses, with a dose-dependent trend. A weight-adapted cosyntropin dose of 0.2 µg in obesity produces a similar response to the one observed in individuals without obesity. The 1 µg ACTH test falls short on stimulating the cortisol adrenal response in individuals with obesity.

Lack of Evidence for a Relationship Between the Hypothalamus-Pituitary-Adrenal and the Hypothalamus-Pituitary-Thyroid Axis in Adolescent Depression

In adults with major depressive disorder (MDD), a dysfunction between the hypothalamus-pituitary-adrenal (HPA) and the hypothalamus-pituitary-thyroid (HPT) axis has been shown, but the interaction of both axes has not yet been studied in adolescent major depressive disorder (MDD). Data from 273 adolescents diagnosed with MDD from two single center cross-sectional studies were used for analysis. Serum levels of thyrotropin (TSH), free levothyroxine (fT4), and cortisol were determined as indicators of basal HPT and HPA axis functioning and compared to that of adolescent controls by t-tests. Quantile regression was employed in the sample of adolescents with MDD to investigate the relationship between both axes in the normal as well as the pathological range of cortisol levels, considering confounders of both axes. In adolescent MDD, cortisol levels and TSH levels were significantly elevated in comparison to controls (p = <.001, d = 1.35, large effect size, and p = <.001, d = 0.79, moderate effect size, respectively). There was a positive linear relationship between TSH and cortisol (p = .003, d = 0.25, small effect size) at the median of cortisol levels (50^th percentile). However, no relationship between TSH and cortisol was found in hypercortisolemia (cortisol levels at the 97.5^th percentile). These findings imply that HPT and HPA axis dysfunction is common in adolescents with MDD and that function of both axes is only loosely related. Moreover, the regulation of the HPA and HPT axis are likely subjected to age-related maturational adjustments since findings of this study differ from those reported in adults.

Adrenal steroids in female hypothyroid neonates: Unraveling an association between thyroid hormones & adrenal remodeling

CONTEXT

The adrenal gland undergoes significant remodeling during the neonatal period, an essential developmental process that still remains incompletely understood. With respect to control over the remodeling process and, specifically, the role of thyroid hormones (TH), no human studies have been published. The effect of both hypo- and hyper-thyroidism has only been evaluated in adults, focusing on the mature adrenal. Recently, Huang et al identified expression of the TH receptor β1 in the mouse adrenal X-zone and demonstrated that TH administration could alter the postnatal adrenal remodeling process.

OBJECTIVE

To address whether TH influence adrenal steroid profiles and adrenal remodeling during the neonatal period.

METHODS

We compared the adrenal steroid profile of a naturally occurring prototype, female neonates with severe congenital hypothyroidism (CH, n=22, upon diagnosis of CH), with that of euthyroid neonates (n=20).

RESULTS

Significantly higher levels of adrenal steroids (17-OH-progesterone, DHEAS, Δ4- androstenedione and testosterone) were measured in neonates with severe CH compared to euthyroid neonates, returning within normal range after euthyroid state had been established on L-thyroxine replacement therapy whereas cortisol levels did not differ. TSH values in the CH group were positively, while FT4 levels were negatively correlated with circulating adrenal steroids.

CONCLUSIONS

The hormonal profile of female neonates with severe CH suggests a more active adrenal fetal zone than controls. These data indirectly associate TH with the adrenal remodeling and maturation process in humans. Based on our results we suggest that severe hypothyroidism decelerates the involution of the adrenal fetal zone that normally occurs postnatally.

New insights into morphological, stereological and functional studies of the adrenal gland under exposure to the potent goitrogen thiourea

Thiourea (thiophen-3-yl-acetic acid) is a well established antithyroid drug used for treating hyperactivity of the thyroid gland as it blocks the conversion of thyroxine (T4) to triiodothyronine (T3) in peripheral tissues. Human exposures to thiourea include contaminated drinking water and vegetables for its extensive use in fertilizers. Chronic thiourea exposure can cause thyroid dysfunction leading to redox imbalance. However, such effects on morphological, quantitative, functional and hypothalamo-pituitary-adrenocortical axis (HPA) analysis of the adrenal gland are yet to be explored. The aim was to explore the effect of thiourea on structural and functional status of the adrenocortical region with special reference to the HPA axis. Control rats were fed a normal laboratory standardized diet whereas to experimental rats, thiourea at a dose of 0.3 mg/day/Kg body weight was administered orally, once every day for consecutive 28 days. Histology and histometry, including morphometry of the adrenal, adrenal Δ5 3β HSD and 17β HSD activity, LPO level and serum corticosterone profile were assessed. Statistical significance was studied by ‘Mann-Whitney U’ test at p<0.05. Hypertrophy and hyperplasia of the adrenocortical cells was found especially in the layer zona fasciculata (p=0.0027) and enhanced adrenal Δ5 3β HSD activity (p=0.0067) in comparison to that of the control. Increased lipid peroxidation (p=0.0054) and up-regulated corticosterone release (p=0.0064) through adrenocortical stress signalling pathway were also noted. Stereological analysis of the left adrenal gland showed significant increase in volume (p=0.0025) and mass of cells (p=0.0031) in adrenocortical region in comparison to that of control animals. This study concludes that thiourea, in addition to its antithyroidal activity, develops stress in the adrenal as evident by enhanced lipid peroxidation in the gland that in turn through the HPA axis causes hypertrophy and hyperplasia of adrenocortical cells to enhance synthesis and release of corticosterone secretion to counteract the stress developed under the influence of this potent chemical agent.