MedWorm: Adrenal Insufficiency

Adrenal function in newborns undergoing surgery

Journal of Perinatology — Thu, 18 Mar 2010 00:00:00 +0100

Authors: E F Fernandez, R Montman & K L Watterberg (Source: Journal of Perinatology)

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A Prospective Multi-Center Study of Adrenal Function in Critically Ill Children.

American Journal of Respiratory and Critical Care Medicine — Thu, 18 Mar 2010 00:00:00 +0100

CONCLUSION: Adrenal insufficiency occurs in many disease conditions in critically ill children and is associated with an increased use of catecholamines and fluid boluses. It is likely multi-factorial in etiology and is associated with high baseline cortisol levels. Further research is necessary to determine which of these critically ill children are truly cortisol deficient before any treatment recommendations can be made. PMID: 20299532 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

Intra familial phenotypical variations in adrenoleukodystrophy

Neurology India — Tue, 09 Mar 2010 15:01:56 +0100

We report a family of three siblings diagnosed with ALD confirmed with the mutations in ABCD1 gene having phenotypical variability ranging from pure adrenal insufficiency to progressive neurodegeneration in the same family. The mother was identified as the carrier and maternal uncle was diagnosed with Adrenomyeloneuropathy. We discuss the variable presentation in our family and the possible causes of phenotypical variability. (Source: Neurology India)

Two Patients with an Identical Novel Mutation in the AAAS Gene and Similar Phenotype of Triple A (Allgrove) Syndrome

Experimental and Clinical Endocrinology and Diabetes — Thu, 04 Mar 2010 14:23:38 +0100

Exp Clin Endocrinol DiabetesDOI: 10.1055/s-0030-1247516Abstract Triple A syndrome, also known as Allgrove syndrome, is a rare autosomal recessive disorder characterized by three cardinal symptoms: adrenal insufficiency due to ACTH insensitivity, achalasia and alacrima. Various progressive neurological abnormalities and skin changes have been described in association with the syndrome. The disease is caused by mutation in the gene on chromosome 12q13. encodes a protein named ALADIN which is part of the nuclear pore complex (NPC). The mislocalization of mutated ALADIN proteins in the cytoplasm and/or the nucleus results in an impaired protein function. Phenotypes of previously reported patients with triple A syndrome varied within and between affected families so that no genotype-phenotype c...

National UK audit of the Short Synacthen(R) Test

Annals of Clinical Biochemistry — Tue, 02 Mar 2010 17:36:02 +0100

Conclusions The audit has shown that though the preanalytical procedures were similar in most laboratories, there is a requirement to recognize the effect that method bias may have on the reference ranges and consequently on the diagnosis of adrenal insufficiency. There is a need to develop consensus guidelines, which can aid both clinicians and laboratories. (Source: Annals of Clinical Biochemistry)

Antithymocyte globulin: Cytomegalovirus infection leading to adrenal insufficiency?: case report

Reactions — Mon, 01 Mar 2010 14:50:10 +0100

(Source: Reactions)

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Cushing’s syndrome and adrenal insufficiency after intradermal triamcinolone acetonide for keloid scars

European Journal of Pediatrics — Thu, 25 Feb 2010 20:31:47 +0100

Abstract A 6-year-old girl was admitted to our hospital for excessive weight gain. On presentation, she had a typical Cushingoid appearance and hypertension. Laboratory analysis was indicative for an exogenous glucocorticoid source, showing values that were low for serum cortisol and adrenocorticotropin and for 24-h urinary glucocorticoid (metabolite) excretion. Five and 2 months before presentation, she was treated with intradermal triamcinolone acetonide for keloid scars. Recovery of intrinsic cortisol production occurred 12 months after the last steroid dose. Intradermal triamcinolone acetonide for keloid scars in children should be used with care taking into account the here reported complication. Content Type Journal ArticleCategory Short ReportDOI 10.10...

An unusual case of hyponatraemia

Nephrology Dialysis Transplantation — Thu, 25 Feb 2010 08:19:39 +0100

The differential diagnosis of hyponatraemia is manifold and includes hormonal disorders such as primary adrenal insufficiency or hypothyroidism. The diagnosis of adrenal insufficiency is always suggestive in cases of hypotension associated with hyponatraemia, hyperkalaemia and metabolic acidosis. We herein report a case of severe hyponatraemia in a patient with Addison's disease. The underlying cause was disseminated adrenal tuberculosis without any evidence of other organ involvement. To date, tuberculosis remains a frequent cause of adrenal insufficiency although the pathophysiology of adrenal tropism is poorly understood. (Source: Nephrology Dialysis Transplantation)

Flexion contractures possibly reflect the existence of hypocortisolism: two case reports

Journal of Neurology — Mon, 15 Feb 2010 17:59:36 +0100

Abstract The diagnosis of adrenal insufficiency is discussed in case of low blood pressure and digestive symptoms. Rare inaugural abdomino-crural muscle contracture can be a misleading symptom. Here we report two new cases. A 50-year-old woman presenting a leaning forward walking attitude and negligence for the past 2 months was referred to the neurologic unit. Abdomino-crural contracture, clinical hypogonadism, and hyponatremia directed towards a panhypopituitarism, which was confirmed by subsequent investigations. Pituitary MRI found an empty sella turcica. The outcome was dramatic after hormone replacement therapy, with drawing up of the trunk and re-establishment of walking after a few days. The second case is a 58-year-old man, hospitalized with altered general c...

Fentanyl: Secondary adrenal insufficiency: case report

Reactions — Mon, 15 Feb 2010 14:06:03 +0100

(Source: Reactions)

Cushing Syndrome in the McCune-Albright Syndrome.

The Journal of Clinical Endocrinology and Metabolism — Mon, 15 Feb 2010 00:00:00 +0100

Conclusions: Comorbid heart and liver disease were poor prognostic markers and may indicate the need for prompt adrenalectomy. The high incidence of cognitive disorders indicates a need for close developmental follow-up and parental counseling. Patients with spontaneous resolution of CS may develop adrenal insufficiency, and they require long-term monitoring. PMID: 20157193 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

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HPA-suppressive effects of aqueous clobetasol propionate in the treatment of patients with oral lichen planus

Journal of the European Academy of Dermatology and Venereology — Wed, 10 Feb 2010 00:00:00 +0100

Conclusions Hypothalamus[ndash]pituitary[ndash]adrenal inhibition is substantial during initial treatment with aqueous CP three times daily. (Source: Journal of the European Academy of Dermatology and Venereology)

Determining Relevant Cortisol Concentrations in Critically Ill Patients

Critical Care — Mon, 08 Feb 2010 00:00:00 +0100

: The importance of adrenal function to survival in critically ill patients has been established; however, identifying the best method to diagnose adrenal insufficiency has been problematic. Multiple methods of determining adrenal function have been developed, each with its advantages and disadvantages. Serum free cortisol levels are probably the most accurate though obtaining this result is technically demanding. Cohen et al (1) investigated the feasibility of measuring tissue cortisol levels in burn patients, and investigated if tissue cortisol levels could be used as a surrogate for plasma free cortisol levels. (Source: Critical Care)

Postnatal Changes in Adrenal Size in Very Low-Birth-Weight Infants: Sonographic Evaluation for the Prediction of Late-Onset Glucocorticoid-Responsive Circulatory Collapse

American Journal of Perinatology — Sat, 30 Jan 2010 02:51:22 +0100

Amer J PerinatolDOI: 10.1055/s-0030-1247604ABSTRACTWe investigated the postnatal pattern of changes in adrenal size in very low-birth-weight (VLBW) infants and its relation to late-onset glucocorticoid-responsive circulatory collapse (LGCC) that may be associated with adrenal insufficiency. In 36 VLBW infants born at <33 weeks' gestation, ultrasound examinations of postnatal changes in adrenal size during the first 3 weeks of life were performed. VLBW infants were classified into three groups: group A ( = 6), the actual adrenal area was greater than or equal to the predicted value at birth and unchanged at 3 weeks; group B ( = 24), the actual adrenal area was greater than or equal to the predicted value and decreased at 3 weeks; and group C ( = 6), th...

Incidence of Biochemical and Clinical Adrenal Insufficiency in Trauma Patients

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:35 +0100

Background: Acute adrenal insufficiency (AI) is a condition frequently expressed by critically ill patients. This is a mayor health concern, resulting in severe morbidity and increased mortality if prompt diagnosis is not made. Underlying risk factors that led to acute AI include, but not limited to: age, co-morbidities, mechanism of trauma, EBL, TISS, surgeries, etc. The reported incidence of AI varies widely (0-77%) depending on the population of patients studied and the diagnostic criteria, but the incidence in trauma patients presenting AI has yet to be determined. Purpose: To determine the incidence of acute AI in trauma patients; find out the morbidity rates and associated factors and evaluate the possible correlation between biochemical predictors (laboratory data) and the occurrenc...

Diabetes Mellitus: Observations, Theoretical and Practical: Bessman SP. J Pediatr 1960;56:191-203

The Journal of Pediatrics — Mon, 25 Jan 2010 15:34:19 +0100

In this article, written by Bessman in 1959, emphasis is first placed on the limited number of diabetic children experiencing coma (ie, diabetic ketoacidosis) at diagnosis (2 of 20 patients, in the author's experience). Such small prevalence was due, according to the author, to the “detection programs….identifying most of the early cases.” Interestingly, in a recent study on diabetic children and adolescents, the prevalence of ketoacidosis was not negligible (25.5%). This prevalence, which has not significantly changed in the past 50 years, suggests the need for more effective measures to prevent diabetic ketoacidosis. A few years ago, a community intervention to raise awareness of the symptoms of diabetes was found to reduce the prevalence of diabetic ketoacidosis from 78% to 12.5%....

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Iatrogenic adrenal insufficiency associated with calcipotriol–betamethasone topical combination in psoriasis

Clinical And Experimental Dermatology — Mon, 18 Jan 2010 00:00:00 +0100

(Source: Clinical And Experimental Dermatology)

Congenital Lipoid Adrenal Hyperplasia: Functional Characterization of Three Novel Mutations in the STAR Gene.

The Journal of Clinical Endocrinology and Metabolism — Fri, 15 Jan 2010 00:00:00 +0100

Conclusion: The mutations p.N148K and p.P129fs cause adrenal insufficiency in both cases and lead to a disorder of sex development with complete sex reversal in the 46, XY case. The mutation p.Q128R, which is not relevant for the patient's phenotype, is the first reported variant showing a gain of function. We speculate that the substitution of hydrophilic glutamine with basic arginine at the surface of the molecule may accelerate cholesterol transfer. PMID: 20080861 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

The effects of far-infrared irradiation on the antioxidant activity of licorice (glycyrrhiza uralensis fisch) root

Journal of Food Biochemistry — Wed, 13 Jan 2010 00:00:00 +0100

Licorice (Glycyrrhiza uralensis Fisch) roots (LR) powders were far-infrared (FIR)-irradiated for 30 min at 120[sim]200C. After irradiation, a 50% ethanol extract of LR (LRE) (0.5 g/50 mL) was prepared, and total phenolic content (TPC), total flavanol content (TFC) and radical scavenging activity (RSA) were determined. The antioxidant activities of the LRE were significantly affected by FIR irradiation. For example, the FIR irradiation of LR at 120C increased the TPC, TFC and RSA of the LRE from 22.85 to 29.81 mg/g, 5.61 to 13.31 mg/g and 24.59 to 52.24%, respectively, as compared with the nonirradiated control. The main functional chemical components of LR such as glycyrrhizin, glycyrrhetic acid and liquiritin, were also significantly affected by irradiation. These results indicate that th...

Management of Cushing's Syndrome due to Ectopic Adrenocorticotropin Secretion with 1,Ortho-1, Para'-Dichloro-Diphenyl-Dichloro-Ethane: Findings in 23 Patients from a Single Center.

The Journal of Clinical Endocrinology and Metabolism — Fri, 08 Jan 2010 00:00:00 +0100

Conclusion: With close monitoring, O,p'DDD could be a potent medical treatment for long-term control and management of EAS. PMID: 20061433 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Adrenal Insufficiency in Newborns with Congenital Diaphragmatic Hernia

The Journal of Pediatrics — Fri, 08 Jan 2010 00:00:00 +0100

Newborns with congenital diaphragmatic hernia frequently have catecholamine-unresponsive systemic hypotension and respiratory failure. We found that adrenal insufficiency frequently complicates the clinical course of infants with congenital diaphragmatic hernia and was associated with increased severity of illness. (Source: The Journal of Pediatrics)

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Triple A syndrome: A novel compound heterozygous mutation in the AAAS gene in an Italian patient without adrenal insufficiency

Journal of the Neurological Sciences — Wed, 06 Jan 2010 00:00:00 +0100

We describe a 42-year-old patient who presented with neuropathy and was found to have alacrima, achalasia, mild autonomic dysfunction with significant central and peripheral nervous system involvement. She was later diagnosed with oligosymptomatic triple A syndrome. Sequencing of the AAAS gene identified two heterozygous mutations within exon 14 and its donor splice site (p.L430F−c.1288C>T and c.1331+1G>T), one of which is novel. Allgrove syndrome should be suspected in patients with neurological impairment associated with two or more of the main symptoms (alacrima, achalasia or adrenal insufficiency). (Source: Journal of the Neurological Sciences)

On the diagnosis and investigation of adrenal insufficiency in adults

Annals of Clinical Biochemistry — Wed, 30 Dec 2009 01:10:41 +0100

(Source: Annals of Clinical Biochemistry)

Transient adrenal insufficiency in the premature newborn

Current Opinion in Endocrinology, Diabetes and Obesity — Thu, 24 Dec 2009 14:09:23 +0100

Purpose of review: Relative adrenal insufficiency is a controversial phenomenon described in adults and children with critical illness, especially septic shock. In the past 2 decades, relative adrenal insufficiency has also been reported in the critically ill premature as well as term newborn. The present study will review the initial and more recent studies addressing adrenal insufficiency in the premature infant. Recent findings: Studies suggest that 'relative adrenal insufficiency' is a contributing factor to hemodynamic instability in the sick preterm newborn. Many ill preterm newborns have inappropriately low serum cortisol concentrations and respond to steroid administration. Adrenal insufficiency is transient and likely reflects normal adrenal physiology at younger gestational ages...

Serum macrophage migration inhibitory factor reflects adrenal function in hypothalamo-pituitary-adrenal axis in septic patients: an observational study

BMC Infectious Diseases — Mon, 21 Dec 2009 00:00:00 +0100

Conclusions: The inverse correlation between serum MIF and delta max cortisol or the delta max cortisol/albumin ratio suggests that high serum MIF reflects an insufficient adrenal response in the HPA axis. Serum MIF could be a valuable clinical marker of adrenal insufficiency in sepsis patients. (Source: BMC Infectious Diseases)

Supplemental perioperative steroids for surgical patients with adrenal insufficiency

NeLM - Drug Specific Reviews — Fri, 18 Dec 2009 00:00:00 +0100

Source: Cochrane Library Area: Evidence > Drug Specific Reviews Background Adrenal crisis is a life threatening condition which can be induced by stress during surgery in patients with adrenal insufficiency. This may be prevented by perioperative administration of high doses of steroids. There is disagreement on whether supplemental perioperative steroids are required and, when administered, on the amount and frequency of doses. Objectives To assess whether it is necessary to administer supplemental perioperative steroids in adult patients on maintenance doses of glucocorticoids because of adrenal insufficiency. Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 1); MEDLINE (1966 to January 2009)...

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Hedgehog signaling: Endocrine gland development and function

American Journal of Medical Genetics Part A — Thu, 10 Dec 2009 00:00:00 +0100

The role of hedgehog signaling is analyzed in relation to the developing endocrine glands: pituitary, ovary, testis, adrenal cortex, pancreas, prostate, and epiphyseal growth. Experimental and pathological correlates of these organs are also discussed. The second section addresses a number of topics. First, the pituitary gland, no matter how hypoplastic, is present in most cases of human holoprosencephaly, unlike animals in which it is always said to be absent. The difference appears to be that animal mutations and teratogenic models involve both copies of the gene in question, whereas in humans the condition is most commonly heterozygous. Second, tests of endocrine function are not reported with great frequency, and an early demise in severe cases of holoprosencephaly accounts for this tr...

Diagnostic utility of the glucagon stimulation test (GST) in comparison to the insulin tolerance test (ITT) in patients following pituitary surgery.

European Journal of Endocrinology — Tue, 08 Dec 2009 00:00:00 +0100

CONCLUSION: In our prospective series of patients with pituitary disease, GST is a potential alternative test for assessment of GH reserve, but poor for ACTH reserve. Test-specific cut-offs should be applied to avoid misinterpretation. PMID: 19996199 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

Pitfalls in the Diagnosis of Central Adrenal Insufficiency in Children.

Endocrine Development — Sat, 05 Dec 2009 18:58:26 +0100

Authors: Kazlauskaite R, Maghnie M The diagnosis of central adrenal insufficiency relies heavily on laboratory testing of cortisol levels in the systemic circulation. The lack of cortisol assay standardization challenges the reliability of dynamic tests of the hypothalamic-pituitary adrenal axis. Although the insulin-induced hypoglycemia or metyrapone tests remain the accepted standards for evaluating central adrenal insufficiency in children their associated risks and inconvenience make them unattractive for routine use. Corticotropin testing is an effective first step to evaluate for chronic central adrenal insufficiency for children older than 2 years who are ambulatory, have normal sleep-wake cycle and normal serum protein levels. The low-dose (1 mug) corticotropin test may be supe...

High-Calorie Glucose-Rich Food Attenuates Neuroglycopenic Symptoms in Patients with Addison's Disease.

The Journal of Clinical Endocrinology and Metabolism — Fri, 04 Dec 2009 00:00:00 +0100

Conclusions: High-calorie comfort food reduces symptoms of neuroglycopenia in Addison patients, suggesting that Addison's disease is associated with a deficit in cerebral energy supply that can partly be alleviated by intake of palatable food. It will be important to investigate whether additional oral glucose supply may be helpful in improving patients' well-being. PMID: 19965917 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

A Case of Human Intramuscular Adrenal Gland Transplantation as a Cure for Chronic Adrenal Insufficiency

American Journal of Transplantation — Wed, 02 Dec 2009 00:00:00 +0100

We describe here the case of a 5-year-old girl with renal failure who had adrenal insufficiency following fulminant meningococcemia that led to requirements for both stress-dose steroid and mineralocorticoid replacement. Ten months after the onset of her disease, she received a simultaneous renal and adrenal gland transplant from her mother. The adrenal gland allograft was morselized into 1 mm3 segments and implanted into three 2 cm pockets created in her rectus abdominis muscle. Three years after surgery, her allograft remains fully functional, responding well to adrenocorticotropin hormone stimulation and the patient does not require any steroid or mineralcorticoid supplementation. We believe this case represents the first description of successful functional intramuscular adrenal allogr...

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[Fatigue and anemia.]

Praxis — Wed, 02 Dec 2009 00:00:00 +0100

Authors: Ivanova K, Zeller A We herein report on an 80-year old male patient with a history of muscle weakness, fatigue and weight loss since several months. Because of a pathologic synacthen test in combination with decreased levels of ACTH, we diagnosed a secondary chronic adrenal insufficiency. Because of a normochromic, normocytic, and hypoproliferativ anemia, bone marrow puncture was performed, showing an anemia of chronic disease. We initiated Hydrocortison and anemia and patients' symptoms were fully reconstituted. PMID: 19953473 [PubMed - in process] (Source: Praxis)

Epidemiology of adrenal crisis in chronic adrenal insufficiency - the need for new prevention strategies.

European Journal of Endocrinology — Wed, 02 Dec 2009 00:00:00 +0100

Conclusion: AC occurs in a substantial proportion of patients with chronic AI, mainly triggered by infectious disease. Only a limited number of risk factors suitable for targeting prevention of AC were identified. These findings indicate the need for new concepts of crisis prevention in patients with AI. PMID: 19955259 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

Adrenal Insufficiency in the Pediatric Emergency Department

Clinical Pediatric Emergency Medicine — Tue, 01 Dec 2009 00:00:00 +0100

Adrenal insufficiency is an important and potentially life-threatening condition that may present to the emergency department. Seven clinical scenarios of adrenal insufficiency that the emergency physician should be able to recognize and confidently manage are reviewed. Epidemiology and mortality, etiology, and pathophysiology are addressed. Clinical presentation, diagnosis, and management of acute and chronic adrenal disease are also covered. In particular, adrenal suppression due to exogenous steroid use, adrenal suppression in septic shock, and adrenal suppression associated with etomidate are reviewed. (Source: Clinical Pediatric Emergency Medicine)

Diagnosis of Adrenal Insufficiency Using the GHRP-6 Test: Comparison with the Insulin Tolerance Test in Patients with Hypothalamic-Pituitary-Adrenal Disease

Hormone and Metabolic Research — Sat, 28 Nov 2009 02:44:22 +0100

Horm Metab ResDOI: 10.1055/s-0029-1243184AbstractThe insulin tolerance test (ITT) is considered the gold standard for the diagnosis of adrenal insufficiency (AI). However, the test is unpleasant to perform and has the risk of serious complications. We therefore evaluated the clinical applicability of GHRP6, which is a known activator of the hypothalamic-pituitary-adrenal (HPA) axis, to test for AI. For this purpose a comparative clinical study was designed. Forty-nine patients with suspected dysfunction of the HPA axis and 20 healthy controls were enrolled. The ITT was performed in patients, and GHRP6 (1 μg/kg) testing in patients and controls. Serum cortisol over 90 min after GHRP6, in comparison to the ITT, was the main outcome measure. Thirty-one patients had a peak cor...

Surgery in the Patient with Endocrine Dysfunction

Anesthesiology Clinics — Fri, 27 Nov 2009 13:42:06 +0100

This article focuses on 4 of the most common endocrinopathies: diabetes mellitus, hyperthyroidism, hypothyroidism, and adrenal insufficiency. Perioperative challenges in patients presenting with pheochromocytoma are also discussed. (Source: Anesthesiology Clinics)

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Perioperative Steroid Dosing in Patients Receiving Chronic Oral Steroids, Undergoing Outpatient Hand Surgery

The Journal of Hand Surgery — Fri, 27 Nov 2009 00:00:00 +0100

Historically, patients who are receiving oral glucocorticoids and undergo surgical procedures were administered supplemental intravenous steroids during the perioperative period. This practice remains controversial, however, for less invasive outpatient procedures such as those performed by hand surgeons on a routine basis. To date, there are no evidence-based treatment guidelines that provide firm recommendations for the administration of perioperative steroids; rather, present management is based on case reports and observational studies. In this article, we discuss the pathophysiology behind acute adrenal insufficiency, the stress response and its suppression, patients who may be at risk, the effect of inhaled and topical steroids, and published data that guide our practice concerning t...

Primary adrenal failure due to viral infection in an infant

European Journal of Pediatrics — Thu, 19 Nov 2009 20:00:50 +0100

Abstract Acquired primary adrenal insufficiency is a rare disorder in childhood. The most common cause is autoimmune adrenalitis, especially as a part of polyendocrinopathy syndromes. Impaired adrenal function is seen in patients infected with HIV. In adult patients with AIDS, cytomegalovirus (CMV)-associated adrenal insufficiency is a well-known condition, whereas CMV infection as a causing adrenal insufficiency in children is very rare. Here, we report an infant with transient adrenal insufficiency associated with CMV infection but without HIV. She was treated successfully with steroid replacement and ganciclovir. Early diagnosis and treatment is lifesaving in these patients. Content Type Journal ArticleCategory Short ReportDOI 10.1007/s00431-009-1103-0Authors Leyla ...

Clinical profile of adrenoleukodysrophy

Indian Journal of Pediatrics — Wed, 11 Nov 2009 19:13:58 +0100

Abstract X-linked Adrenoleukodystrophy (ALD) is the most common of the peroxisomal disorder and is associated with functional defect of the very long chain fatty acid (VLCFA) oxidation leading to the accumulation of VLCFA in the white matter and adrenal cortex. Retrospective evaluation of medical records of ALD patients were carried out. In all the 5 patients the duration of the symptoms varied from 1–7 years. Most of them presented with Addisonian crisis (4/5) and hyperpigmentation (5/5), white half of them (3/5) had neurological symptoms. All patients had biochemical evidence of the adrenal insufficiency. All siblings of patients should be screened for the possibility of ALD with VLCFA. Content Type Journal ArticleCategory Clinical BriefDOI 10.1007/s12098-009-0220-0A...

Megestrol: Adrenal insufficiency in an elderly patient: case report

Reactions — Wed, 11 Nov 2009 14:08:04 +0100

(Source: Reactions)

Long-Term Safety of Recombinant Human Growth Hormone in Children.

The Journal of Clinical Endocrinology and Metabolism — Wed, 11 Nov 2009 00:00:00 +0100

Conclusion: After more than 20 yr, leukemia, a major safety issue initially believed associated with GH, has not been confirmed, but other signals, including risk of second malignancies in patients previously treated with irradiation, have been detected or confirmed through the NCGS. These data further clarify the events associated with rhGH and, although confirming a favorable overall safety profile, they also highlight specific populations at potential risk. PMID: 19906787 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

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Hypoglycaemic seizure and neonatal acute adrenal insufficiency after maternal exposure to prednisone during pregnancy: a case report

European Journal of Pediatrics — Mon, 09 Nov 2009 19:14:00 +0100

We report a case of AAI following maternal exposure to moderate doses of corticosteroids during pregnancy. The neonate, born at term, presented with hypoglycaemia complicated by seizures. The AAI was confirmed by endocrine tests and after exclusion of differential diagnoses. Early diagnosis and treatment led to full recovery. Content Type Journal ArticleCategory Short ReportDOI 10.1007/s00431-009-1095-9Authors Pierre-Jean Saulnier, CHU de Poitiers Department of Clinical Pharmacology and Regional Center of Pharmacovigilance Poitiers FranceXavier Piguel, CHU de Poitiers Department of Endocrinology and Diabetology Poitiers FranceMarie Christine Perault-Pochat, CHU de Poitiers Department of Clinical Pharmacology and Regional Center of Pharmacovigilance Poitiers FranceCassandra Csizmadi...

Identification of a novel mutation in DAX1/NR0B1A gene in two siblings with severe clinical presentation of adrenal hypoplasia congenita

Arquivos Brasileiros de Endocrinologia e Metabologia — Fri, 06 Nov 2009 14:11:07 +0100

CONCLUSION: A novel frameshift mutation of DAX1 gene, which established the molecular etiology of the AHC in the siblings, was identified. Obtaining a precise genetic diagnosis of this adrenal disorder, which, sometimes, cannot be confirmed only by clinical aspects, may have important implications for the long-term management of the disease.OBJETIVO: Pesquisar mutações no gene DAX1/NR0B1A em dois irmãos com suspeita de hipoplasia adrenal congênita (HAC), rara doença potencialmente fatal, para estabelecer sua etiologia molecular. RELATO DOS CASOS: São apresentados os relatos de dois irmãos com síndrome perdedora de sal no período neonatal que receberam terapia de reposição hormonal para insuficiência adrenal primária. O diagnóstico de HAC foi suspeitado porque as crianças man...

Serum total cortisol and free cortisol index give different information regarding the hypothalamus-pituitary-adrenal axis reserve in patients with liver impairment

Annals of Clinical Biochemistry — Wed, 04 Nov 2009 19:16:54 +0100

Conclusion When total cortisol alone is used to interpret SST in patients with liver impairment, 46% may have been classified as having adrenal insufficiency because of low CBG. FCI may be better for the evaluation of HPA axis insufficiency in patients with liver impairment. (Source: Annals of Clinical Biochemistry)

An unusual case of profound hyponatraemia and bilateral adrenal calcifications

Annals of Clinical Biochemistry — Wed, 04 Nov 2009 19:16:54 +0100

We report a case of a 65-year-old lady who presented with acute confusion and profound hyponatraemia (plasma sodium of 97 mmol/L). Five years earlier she had developed sepsis and was found to have hyponatraemia, thought to be due to syndrome of inappropriate antidiuretic hormone secretion. The patient was lost to follow-up. The patient was covered with steroids and investigations confirmed primary adrenal failure with flat response of cortisol to adrenocorticotropic hormone (ACTH) stimulation and very high level of ACTH. Adrenal auto-antibodies were negative and a computed tomography of the adrenals showed bilateral adrenal calcifications, suggestive of previous haemorrhage or infarction. Bilateral adrenal calcification due to haemorrhage/infarction usually does not present with severe hyp...

T Cell Responses to Steroid Cytochrome P450 21-Hydroxylase in Patients with Autoimmune Primary Adrenal Insufficiency.

The Journal of Clinical Endocrinology and Metabolism — Wed, 04 Nov 2009 00:00:00 +0100

Conclusion: Patients with autoimmune Addison's disease have circulating 21OH-specific T cells, with amino acids 342-361 of 21OH possibly constituting a disease-specific epitope presented by HLA-DRB1*0404. PMID: 19890026 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

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Cytotoxic T lymphocyte antigen-4 Ala17 polymorphism is a genetic marker of autoimmune adrenal insufficiency: Italian association study and meta-analysis of European studies.

European Journal of Endocrinology — Mon, 02 Nov 2009 00:00:00 +0100

Conclusions: The CTLA4 +49 polymorphism is strongly associated with genetic risk for AAD, independentenly from the well known association with HLA class II genes. PMID: 19884265 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies.

European Journal of Endocrinology — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Filipsson H, Johannsson G Severe GH deficiency (GHD) in adults has been described as a clinical entity. However, some of the features associated with GHD could be due to unphysiological and inadequate replacement of other pituitary hormone deficiencies. This may be true for glucocorticoid replacement that lacks a biomarker making dose titration and monitoring difficult. Moreover, oral estrogen replacement therapy decreases IGF1 levels compared with the transdermal route, which attenuates the responsiveness to GH replacement therapy in women. In addition, in untreated female hypogonadism, oral estrogen may augment the features associated with GHD in adult women. Important interactions between the hormones used for replacing pituitary hormone deficiency occur. Introducing GH rep...

Type 1 diabetes and autoimmune polyglandular syndrome: a clinical review.

The Netherlands Journal of Medicine — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Van den Driessche A, Eenkhoorn V, Van Gaal L, De Block C Type 1 diabetes mellitus (T1DM) results from autoimmune destruction of insulin-producing β; cells and is characterised by the presence of insulitis and β;-cell autoantibodies. Up to one third of patients develop an autoimmune polyglandular syndrome. Fifteen to 30% of T1DM subjects have autoimmune thyroid disease (Hashimoto's or Graves' disease), 5 to 10% are diagnosed with autoimmune gastritis and/or pernicious anaemia (AIG /PA), 4 to 9% present with coeliac disease (CD), 0.5% have Addison's disease (AD), and 2 to 10% show vitiligo. These diseases are characterised by the presence of autoantibodies against thyroid peroxidase (for Hashimoto's thyroiditis), TSH receptor (for Graves' diseas...

Corticomedullary mixed tumor of the adrenal gland.

Annales d'Endocrinologie — Wed, 28 Oct 2009 00:00:00 +0100

Authors: Trimeche Ajmi S, Chadli Chaieb M, Mokni M, Braham R, Ach K, Maaroufi A, Chaieb L A 34-year-old woman presented with weight gain, hirsutism, recent hypertension and secondary amenorrhea. Laboratory findings showed hypokalemia, elevated cortisol and androgen levels with normal urine metanephrines and normal aldosteronemia. Abdominal magnetic resonance imaging showed a right heterogeneous adrenal mass measuring 4x6cm with mixed component of fat and adrenal tissue suggesting corticosurrenaloma. After right adrenalectomy, blood pressure normalized and hypokalemia resolved. In the postoperative course, the patient presented adrenal insufficiency treated with hydrocortisone hemisuccinate. Histological examination showed a single tumor mass composed of an admixed population of adrenal...

Clinical, Immunological, and Genetic Features of Autoimmune Primary Adrenal Insufficiency: Observations from a Norwegian Registry.

The Journal of Clinical Endocrinology and Metabolism — Mon, 26 Oct 2009 00:00:00 +0100

Conclusions: AD is almost exclusively autoimmune, with high autoimmune comorbidity. Both anti-21-hydroxylase antibodies and HLA class II can be clinically relevant predictors of AD. HRQoL is reduced, especially among diabetes patients, whereas thyroid disease did not have an impact on HRQoL. Treatment modalities that improve HRQoL are needed. PMID: 19858318 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

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[Correspondence] Etomidate versus ketamine for sedation in acutely ill patients

LANCET — Thu, 08 Oct 2009 23:00:00 +0100

In their study of sedative drugs for emergency intubation, Patricia Jabre and colleagues conclude that etomidate is associated with an increased incidence of adrenal insufficiency, defined as a random serum cortisol concentration of less than 276 nmol/L or an increase in serum cortisol concentration of less than 250 nmol/L after adrenocorticotropin stimulation. This conclusion might not be warranted, since current clinical testing for adrenocortical function in critically ill patients is unreliable. (Source: LANCET)

[Correspondence] Etomidate versus ketamine for sedation in acutely ill patients – Authors' reply

LANCET — Thu, 08 Oct 2009 23:00:00 +0100

Nicolas Mongardon, Mervyn Singer, and David Kaufman all address questions related to the adrenal insufficiency seen in our trial. We agree with Mongardon and Singer that it is important to note patients who received corticosteroids during follow-up. 73 of 469 patients analysed received corticosteroids after admission to the intensive-care unit. 28-day mortality in the etomidate group did not differ significantly between steroid-treated patients and non-steroid-treated patients (13/42 [31%] vs 68/192 [35%]; p=0·58). These results are in accordance with those reported by Cuthbertson and colleagues in their CORTICUS substudy of hydrocortisone in septic shock. (Source: LANCET)

Homozygosity of the Polymorphism MICA5.1 Identifies Extreme Risk of Progression to Overt Adrenal Insufficiency among 21-Hydroxylase Antibody-Positive Patients with Type 1 Diabetes.

The Journal of Clinical Endocrinology and Metabolism — Thu, 08 Oct 2009 23:00:00 +0100

Conclusions: Identifying extreme risk should facilitate monitoring of progression from 21OH antibody positivity to overt AD. The HLA-DR3/0404 genotype defines high-risk subjects for adrenal autoimmunity. MICA5.1/5.1 may define those at highest risk for progression to overt AD, a feature unique to AD and distinct from T1D. PMID: 19820007 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Flexion contractures in secondary adrenal insufficiency

Clinical Rheumatology — Thu, 01 Oct 2009 05:48:05 +0100

We report the case of a 55-year-old male with flexion contractures of the hips and the knees due to an isolated adrenocorticotropin (ACTH) deficiency, a rare cause of secondary adrenal insufficiency. The presenting symptoms and signs, the laboratory investigations and the treatment are described. The case description is followed by a brief overview of ACTH deficiency and its symptoms and causes. Our case is then compared with other case reports available in the literature. The aetiology of the flexion contractures in adrenal insufficiency is still unclear. The authors want to draw attention to adrenal insufficiency as the cause of unexplained flexion contractures. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10067-009-1289-6Authors Jan Berger, ZNA Middelheim Depar...

Adrenal insufficiency in acute coronary syndrome.

Singapore Medical Journal — Thu, 01 Oct 2009 00:00:00 +0100

Conclusion: Utilising the LDT, adrenal insufficiency is present in 21.6 percent of patients admitted with ACS. However, this is not associated with any significant morbidity and mortality. PMID: 19907885 [PubMed - in process] (Source: Singapore Medical Journal)

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Technical details influence the diagnostic accuracy of the 1 mcg ACTH stimulation test.

European Journal of Endocrinology — Wed, 30 Sep 2009 23:00:00 +0100

Conclusions: The high rate of abnormal results, especially in the afternoon, and loss of ACTH through tubing, suggest that morning testing and minimal tubing should be adopted to avoid an inappropriate diagnosis of adrenal insufficiency. Earlier time-points and standardized protocols would facilitate comparison of studies. PMID: 19797501 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

Prevalence of occult adrenal insufficiency and the prognostic value of a short corticotropin stimulation test in patients with septic shock

Indian Journal of Critical Care Medicine — Sat, 26 Sep 2009 17:49:00 +0100

Conclusion:</b> A short corticotropin test using low-dose corticotropin (1 &#956;g) has a good prognostic value. High basal cortisol and a low increase in cortisol on corticotropin stimulation test are predictors of a poor outcome in patients with septic shock. (Source: Indian Journal of Critical Care Medicine)

Hypopituitarism following traumatic brain injury: the prevalence is affected by the use of different dynamic tests and different normal values.

European Journal of Endocrinology — Thu, 24 Sep 2009 23:00:00 +0100

Conclusion: The reported variations in the prevalence rates of hypopituitarism after TBI are in part caused by differences in definitions, endocrine assessments of hypopituitarism and confounding factors. These methodological issues prohibit simple generalizations of results of original studies on TBI-associated hypopituitarism in the perspective of meta-analyses or reviews. PMID: 19783619 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

Pulmonary hypertension in a patient with Schmidt syndrome

The American Journal of Emergency Medicine — Thu, 24 Sep 2009 16:29:48 +0100

We describe a 26-year-old patient with long-standing autoimmune hypothyroidism. She was doing well until she developed Addisonian crisis accompanied by severe metabolic acidosis, hypoglycemia, hypomagnesemia, and hypokalemia. Subsequently she developed a life-threatening cardiac arrhythmia due to QT prolongation secondary to electrolyte imbalance. The association of autoimmune hypothyroidism and adrenal insufficiency in our patient suggests the diagnosis of autoimmune polyglandular syndrome type II or Schmidt syndrome. An echocardiography that was performed detected pulmonary hypertension without apparent cardiac or lung pathology. The association of pulmonary hypertension and Schmidt syndrome is rare and may be explained by a generalized immune activation leading to pulmonary endothelial ...

A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials of DHEA Treatment Effects on Quality of Life in Women with Adrenal Insufficiency.

The Journal of Clinical Endocrinology and Metabolism — Mon, 21 Sep 2009 23:00:00 +0100

Conclusions: DHEA may improve, in a small and perhaps trivial manner, HRQOL and depression in women with adrenal insufficiency. There was no significant effect of DHEA on anxiety and sexual well-being. The evidence appears insufficient to support the routine use of DHEA in women with adrenal insufficiency. PMID: 19773400 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

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Factors Contributing to Hospitalization for Gastroparesis Exacerbations

Digestive Diseases and Sciences — Thu, 17 Sep 2009 12:37:33 +0100

Conclusions Poor glycemic control, infection, noncompliance with/intolerance of medications, and, perhaps, adrenal insufficiency were contributory factors leading to hospitalizations of gastroparetic patients. Hospitalized patients with gastroparesis exacerbations had elevated ESR and CRP levels. Although many patients with elevated inflammatory markers had evidence of infection, some did not. Assessment of inflammatory markers may help indicate those gastroparetic patients in whom a search for infection should be undertaken. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10620-009-0975-1Authors Sesha S. Uppalapati, Temple University School of Medicine Gastroenterology Section, Department of Medicine Parkinson Pavilion, 8th Floor, 3401 North Broad...

The ACTH-induced cortisol response in acute pancreatitis

Critical Care — Tue, 15 Sep 2009 23:00:00 +0100

The evidence that severe acute pancreatitis can result in critical illness related corticosteroid insufficiency following impaired adrenal secretion is accumulating. The study by Peng and coworkers in Critical Care certainly contributes to that idea, even though the question whether relative adrenal insufficiency should prompt for treatment by substitution doses of corticosteroids remains unresolved. The study is discussed in terms of the risk factors, circumstances and significance of impaired corticosteroid secretion by adrenals in severe acute pancreatitis. (Source: Critical Care)

Activities against hemostatic proteins and adrenal gland ultrastructural changes caused by the brown widow spider Latrodectus geometricus (Araneae: Theridiidae) venom.

Comparative biochemistry and physiology. Toxicology and pharmacology : CBP — Fri, 11 Sep 2009 23:00:00 +0100

Authors: Guerrero B, Finol HJ, Reyes-Lugo M, Salazar AM, Sánchez EE, Estrella A, Roschman-González A, Ibarra C, Salvi I, Rodríguez-Acosta A Brown widow spider (BrWS) (Latrodectus geometricus) venom produces intense systemic reactions such as cramps, harsh muscle nociceptive, nauseas, vomiting and hypertension. The proposed pathogenic mechanisms resulting in these accidents have principally been damages occuring at the nervous system. However, it is suspected that there is also damage of the adrenal glands, as a result of the experimental animal's clinical manifestations, which developed symptoms compatible with acute adrenal insufficiency. We have currently found that the adrenal gland is damaged by this venom gland homogenates (VGH) producing severe alterations on corte...

Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method

Alimentary Pharmacology and Therapeutics — Thu, 03 Sep 2009 23:00:00 +0100

Conclusions Corticosteroid withdrawal using this protocol had a high success rate and durable effect and was effective in patients with long-standing (up to 45 years) dependency. As symptoms of CWS mimic symptoms of IBD disease flares, gastroenterologists may have difficulty distinguishing them, which may be a contributory factor to the frequency of corticosteroid dependency in IBD patients. (Source: Alimentary Pharmacology and Therapeutics)

John F. Kennedy had the most complex medical history of any U.S. president, likely had polyendocrine syndrome type II

Clinical Cases and Images — Wed, 02 Sep 2009 10:37:00 +0100

From the Annals of Internal Medicine:In an Era of Less Media Scrutiny, John F. Kennedy Hid Serious Health Problems from the Public.At the age of 43, he was the youngest man ever elected president. During his campaign and presidency, the media portrayed him as the epitome of youth and vigor. However, a recent review of his medical records reveals that Kennedy had the most complex medical history of any U.S. president.Unbeknownst public, Kennedy was diagnosed with Addison's disease, a rare endocrine disorder in which the adrenal glands do not produce enough of the hormone cortisol.Later, when Kennedy was a senator, he was found to have hypothyroidism. During the 1960 campaign for the presidency, Kennedy's physician denied the Addison's diagnosis.Today, with newly available evidence, research...

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Current controversies in critical illness-related corticosteroid insufficiency and glucocorticoid supplementation.

Orthopedics — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Gross AK, Winstead PS The stress response, which is triggered by a number of factors, including surgery, results in activation of the hypothalamic pituitary adrenal axis and subsequent release of cortisol from the adrenal glands. Critical illness-related corticosteroid insufficiency is an inadequate corticosteroid response relative to a patient's illness; patients with critical illness-related corticosteroid insufficiency have both insufficient circulating cortisol and impaired cellular use of glucocorticoids. Corticosteroids, such as hydrocortisone, have been cited to improve survival, oxygenation, duration of mechanical ventilation, and intensive care unit-free days in critically ill patients. Perioperative glucocorticoid supplementation is also recommended in patients with ...

Cytomegalovirus-Induced Adrenal Insufficiency in a Renal Transplant Recipient

Transplantation Proceedings — Mon, 31 Aug 2009 23:00:00 +0100

Abstract: Cytomegalovirus (CMV) is an important pathogen in organ-transplant recipients. There have been frequent reports of CMV-induced adrenal insufficiency in patients with human immunodeficiency virus infection. Herein, we report CMV-induced renal insufficiency in a renal transplant recipient. A 24-year-old woman had gradual onset of weakness, anorexia, nausea, hypotension, and skin hyperpigmentation at 5 months after renal transplantation. The immunosuppression regimen included cyclosporine, mycophenolate mofetil, and corticosteroid (prednisolone, 5 mg/d). Recent history included acute CMV infection, which was treated with ganciclovir. Basal serum cortisol concentration was 4 μg/dL, and stimulated serum cortisol concentration was less than 10 μg/dL. All clinical signs and symptoms a...

Severe sepsis in cirrhosis

Hepatology — Mon, 31 Aug 2009 00:00:00 +0100

Sepsis is physiologically viewed as a proinflammatory and procoagulant response to invading pathogens. There are three recognized stages in the inflammatory response with progressively increased risk of end-organ failure and death: sepsis, severe sepsis, and septic shock. Patients with cirrhosis are prone to develop sepsis, sepsis-induced organ failure, and death. There is evidence that in cirrhosis, sepsis is accompanied by a markedly imbalanced cytokine response ("cytokine storm"), which converts responses that are normally beneficial for fighting infections into excessive, damaging inflammation. Molecular mechanisms for this excessive proinflammatory response are poorly understood. In patients with cirrhosis and severe sepsis, high production of proinflammatory cytokines seems to play a...

The diagnosis and investigation of adrenal insufficiency in adults

Annals of Clinical Biochemistry — Sun, 30 Aug 2009 23:00:00 +0100

There is considerable variation in the methods used to diagnose and investigate adrenal insufficiency in clinical practice. These include a range of adrenocorticotropin (ACTH) stimulation and other dynamic testing protocols, serum cortisol cut-off values for diagnosis and tests used for differential diagnosis. With the introduction of modern cortisol and ACTH assays, the interpretation of tests used for diagnosis and differential diagnosis has become more complex and requires local validation. This review examines the basis of normal hypothalamic–pituitary–adrenal axis function and adrenal insufficiency states based upon an evidence base accumulated over the past four decades. The role of the laboratory in the differential diagnosis and interpretation based upon assay methodolo...

[Ascending hyperkaliemic paralysis revealing adrenal insufficiency.]

Annales Francaises d'Anesthesie et de Reanimation — Fri, 28 Aug 2009 23:00:00 +0100

Authors: Lehot JJ, Cahen R PMID: 19720495 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

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Acute adrenal crisis mimicking familial Mediterranean fever attack in a renal transplant FMF patient with amyloid goiter

Rheumatology International — Thu, 27 Aug 2009 16:33:23 +0100

We describe a 21-year-old-FMF amyloidosis case with a well-functioning allograft who presented to the emergency clinic with the complaints of abdominal pain, vomiting and diarrhea mimicking FMF attack. adrenocorticotrophic hormone stimulation test was performed due to resistant hyponatremia and disclosed Addison disease. In countries with a high prevalence of FMF, adrenal crisis should be borne in mind in long standing FMF patients. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00296-009-1115-0Authors Hamdi Emeksiz, Gazi University Ankara TurkeySevcan Bakkaloglu, Gazi University Ankara TurkeyOrhun Camurdan, Gazi University Ankara TurkeyMehmet Boyraz, Gazi University Ankara TurkeyOguz Soylemezoglu, Gazi University Ankara TurkeyEnver Hasanoglu, Gazi University Ankara ...

Effects of glucose infusion on neuroendocrine and cognitive parameters in Addison disease

Metabolism - Clinical and Experimental — Wed, 26 Aug 2009 00:00:00 +0100

Abstract: Sucrose intake has been shown to suppress increased adrenocorticotropic hormone (ACTH) levels in adrenalectomized rats, suggesting that increased cerebral energy supply can compensate for the loss of glucocorticoid feedback inhibition of the hypothalamo-pituitary-adrenal axis. We hypothesized that glucose infusion might acutely down-regulate increased ACTH secretion in patients with Addison disease. We studied 8 patients with primary adrenal insufficiency (Addison group) with short-term discontinuation of hydrocortisone substitution and 8 matched healthy controls in 2 randomized conditions. Subjects received either intravenous glucose infusion (0.75 g glucose per kilogram body weight for 2.5 hours) or placebo. Concentrations of ACTH, cortisol, catecholamines, growth hormone, gluc...

Recent Advances in Adrenal Autoimmunity

Medscape Diabetes Headlines — Tue, 25 Aug 2009 21:36:42 +0100

Primary adrenal insufficiency (PAI), also known as Addison’s disease, is the result of the destruction or impaired function of adrenocortical cells. An autoimmune process is responsible. Expert Review of Endocrinology and Metabolism (Source: Medscape Diabetes Headlines)

Predisposing Factors for Adrenal Insufficiency

New England Journal of Medicine — Tue, 18 Aug 2009 23:00:00 +0100

To the Editor: The review of predisposing factors for adrenal insufficiency by Bornstein (May 28 issue)1 includes a welcome discussion ... (Source: New England Journal of Medicine)

Addison’s disease due to tuberculosis that required differentiation from SIADH

Journal of Infection and Chemotherapy — Mon, 17 Aug 2009 19:00:10 +0100

Abstract A 77-year-old man was admitted to our hospital complaining of general fatigue. Serum sodium was 116 mEq/l and serum antidiuretic hormone (ADH) was elevated. Radiologic examination revealed nodules in the brain as well as in both adrenal glands. Based on the findings of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), we had considered that the cause of the hyponatremia was syndrome of inappropriate secretion of antidiuretic hormone (SIADH) due to active extrapulmonary tuberculosis. Against our expectations, the patient’s condition got worse just after he began antituberculous therapy; we finally diagnosed Addison’s disease by additional hormonal tests. His condition recovered immediately with the administration of high-dose hydrocortisone,...

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Levothyroxine sodium: Adrenal insufficiency: case report

Reactions — Mon, 17 Aug 2009 10:19:17 +0100

(Source: Reactions)

Growth hormone replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies.

European Journal of Endocrinology — Thu, 13 Aug 2009 23:00:00 +0100

Authors: Filipsson H, Johannsson G Severe growth hormone deficiency (GHD) in adults has been described as a clinical entity. Some of the features associated with GHD could, however, be due to unphysiological and inadequate replacement of other pituitary hormone deficiencies. This may be true for glucocorticoid replacement that lacks a biomarker making dose titration and monitoring difficult. Moreover, oral oestrogen replacement therapy decreases insulin growth factor 1 (IGF-I) levels compared to transdermal route, which attenuates the responsiveness to GH replacement therapy in women. In addition, in untreated female hypogonadism, oral oestrogen may augment the features associated with GHD in adult women. Important interactions between the hormones used for replacing pituitary hormone ...

[Adrenal function after induction of cardiac surgery patients with etomidate: A retrospective study.]

Annales Francaises d'Anesthesie et de Reanimation — Thu, 13 Aug 2009 23:00:00 +0100

CONCLUSION: A high incidence of relative adrenal failure was observed in selected cardiac surgery patients with acute postoperative circulatory failure. PMID: 19683891 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Researching nature's venoms and poisons

Transactions of the Royal Society of Tropical Medicine and Hygiene — Thu, 13 Aug 2009 12:40:54 +0100

Summary: Our environment hosts a vast diversity of venomous and poisonous animals and plants. Clinical toxinology is devoted to understanding, preventing and treating their effects in humans and domestic animals. In Sri Lanka, yellow oleander (Thevetia peruviana, Sinhala ‘kaneru’), a widespread and accessible ornamental shrub, is a popular means of self-harm. Its toxic glycosides resemble those of foxglove, against which therapeutic antibodies have been raised. A randomised placebo-controlled trial proved that this treatment effectively reversed kaneru cardiotoxicity. There are strong scientific grounds for the use of activated charcoal, but encouraging results with multiple-dose activated charcoal were not confirmed by a recent more powerful study. Venom of Russell's viper (Daboia sia...

The Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy or Autoimmune Polyglandular Syndrome Type 1

Seminars in Liver Disease — Thu, 13 Aug 2009 10:53:53 +0100

Semin Liver Dis 2009; 29: 307-314DOI: 10.1055/s-0029-1233535ABSTRACTAutoimmune polyglandular syndromes are rare autoimmune endocrinopathies that are associated with nonendocrine autoimmunopathies. Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), also named autoimmune polyglandular syndrome type 1 (APS-1), is distinguished from autoimmune polyglandular syndrome 2 (APS-2). Major disease components of APECED are adrenal insufficiency, hypoparathyroidism, and candidiasis. The diagnosis is established by the presence of two out of the three components. Minor clinical features include autoimmune hepatitis, which occurs in up to 20% of APECED patients, and ranges from a mild to a fulminant course. The disease mostly affects juvenile patients from Sardegna, Italy, Finland, ...

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Surgery in the patient with endocrine dysfunction.

The Medical Clinics of North America — Thu, 13 Aug 2009 10:24:21 +0100

A novel mutation in DAX1 (NR0B1) causing X-linked adrenal hypoplasia congenita: clinical, hormonal and genetic analysis

Endocrine — Tue, 11 Aug 2009 17:06:19 +0100

We describe a family with three members affected, two adults and a neonate. The way of presentation of the adults was neonatal primary adrenal insufficiency and hypogonadotropic hypogonadism (one complete and another presenting as interrupted puberty). The genetic study revealed a new mutation in DAX1, p.Q76X gene (c.C226T), resulting in a truncated protein of 76 amino acids, the same in all three affected male patients and in the asymptomatic women of the family. These cases further expand the number of DAX1 mutations reported, as well as the description of infrequent forms of presentation of this disease as interrupted puberty. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s12020-009-9232-9Authors Katherine García-Malpartida, Doctor Peset University Hospital E...

Surgery in the Patient with Endocrine Dysfunction

Medical Clinics of North America — Sat, 08 Aug 2009 11:29:34 +0100

Antifungals/calcium channel antagonists/inhaled corticosteroids/protease inhibitors interaction: Cushing's syndrome and adrenal insufficiency: 15 case reports

Reactions — Mon, 03 Aug 2009 10:55:12 +0100

(Source: Reactions)

A prospective study on the incidence and predictive factors of relative adrenal insufficiency in Korean critically-ill patients.

J Korean Med Sci — Fri, 31 Jul 2009 23:00:00 +0100

This study was undertaken to evaluate the incidence and risk factors associated with relative adrenal insufficiency (RAI) in Korean critically-ill patients. All patients who were admitted to the Medical Intensive Care Unit (MICU) of Samsung Medical Center between January 1, 2006 and April 30, 2007 were prospectively evaluated using a short corticotropin stimulation test on the day of admission. RAI was defined as an increase in the serum cortisol level of <9 microg/dL from the baseline after administration of 250 microg of corticotropin. In all, 123 patients were recruited and overall the incidence of RAI was 44% (54/123). The presence of septic shock (P=0.001), the Simplified Acute Physiology Score (SAPS) II (P=0.003), the Sequential Organ Failure Assessment (SOFA) score (P=0.001), the...

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Addison's disease

Medicine — Fri, 31 Jul 2009 11:53:27 +0100

Abstract: Addison's disease or primary adrenocortical failure is a rare condition, most commonly caused in the UK by autoimmune destruction of the adrenal glands. The insidious onset of symptoms over many months means there is often a delay in diagnosis and patients can first present in adrenal crisis. The diagnosis is made by measurement of a low serum cortisol at 9 a.m. in the presence of an elevated adrenocorticotrophic hormone (ACTH) or by a poor cortisol response to exogenous ACTH on provocation testing. There are many possible causes of adrenal failure and once the diagnosis of adrenal insufficiency has been made these should be differentiated further. Replacement with hydrocortisone and fludrocortisone should approximate physiological levels as closely as possible and be monitored c...

International Perspectives: Late-onset Circulatory Collapse in Very Low-birthweight Infants: A Japanese Perspective

NeoReviews recent issues — Thu, 30 Jul 2009 23:00:00 +0100

The number of reports of sudden deterioration in blood pressure with concomitant decrease of urine output among extremely low-birthweight (ELBW) infants whose general condition is stable have increased recently in Japan. This disorder is clearly different from an unstable circulatory status during the acute phase soon after delivery. The disorder usually occurs more than 1 week after birth, when the infant's circulatory status already is stable. Blood pressure in such hypotensive infants cannot be restored with volume expanders or inotropic agents; it only improves with glucocorticoid administration. The efficacy of steroids in preterm infants who develop hypotension soon after birth is widely known, but the time of onset of this paroxysmal hypotension is apparently different. Relative adr...

Anti-CTLA-4 antibody therapy associated autoimmune hypophysitis: serious immune related adverse events across a spectrum of cancer subtypes

Pituitary — Tue, 28 Jul 2009 18:23:31 +0100

We describe the first two cases of hypopituitarism in prostate cancer subjects undergoing experimental therapy with ipilimumab. The clinical evidence strongly suggests that the prostate cancer subjects developed autoimmune hypophysitis as a consequence of anti-CTLA-4 treatment. High dose glucocorticoid treatment resulted in markedly improved symptoms, and resolution of focal symptoms and diabetes insipidus. One subject recovered pituitary-thyroid axis function after 9 months; however, both continue to require GC replacement. These cases highlight the importance of early screening and treatment for hypopituitarism in all subjects undergoing treatment with anti-CTLA-4 therapy to prevent a potentially fatal outcome from secondary adrenal insufficiency, a readily treatable disease....

Adrenal function testing in pediatric cancer survivors

Pediatric Blood and Cancer — Sun, 26 Jul 2009 23:00:00 +0100

Central adrenal insufficiency is observed after cranial radiation therapy for cancer. Screening at risk patients is recommended, but the best screening strategy is unknown.A retrospective review of pediatric cancer survivors who underwent hypothalamic/pituitary/adrenal axis testing was conducted. Data included: cancer diagnosis, radiotherapy dose, other endocrinopathies, and adrenal function testing. Adrenal testing included sequential low-dose corticotropin test (LDCT) and standard-dose corticotropin test (SDCT). 8 a.m. serum cortisol levels were compared to LDCT results. LDCT results were compared by radiotheroapy dose and according to the presence of endocrine comorbidities.Seventy-eight subjects (56% male, mean age at diagnosis 6.5 years) underwent testing. 67.9% had been treated with ...

[Articles] Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial

LANCET — Thu, 23 Jul 2009 23:00:00 +0100

Critically ill patients often require emergency intubation. The use of etomidate as the sedative agent in this context has been challenged because it might cause a reversible adrenal insufficiency, potentially associated with increased in-hospital morbidity. We compared early and 28-day morbidity after a single dose of etomidate or ketamine used for emergency endotracheal intubation of critically ill patients. (Source: LANCET)

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Lipoid Congenital Adrenal Hyperplasia: Pathologic Features of the Testis

Urology — Fri, 17 Jul 2009 00:00:00 +0100

This article describes testicular histopathology in a patient with 46, XY lipoid CAH who underwent orchiectomy at the age of 8 years. (Source: Urology)

Utility of Salivary Cortisol Measurements in Cushing's Syndrome and Adrenal Insufficiency.

The Journal of Clinical Endocrinology and Metabolism — Mon, 13 Jul 2009 23:00:00 +0100

Conclusions. It is expected that the use of the measurement of salivary cortisol will become routine in the evaluation of patients with disorders of the HPA axis. PMID: 19602555 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

Acitretin/mometasone: Cushing's syndrome, and adrenal insufficiency on mometasone withdrawal: case report

Reactions — Mon, 13 Jul 2009 10:50:06 +0100

(Source: Reactions)

Acitretin/mometasone: Cushing's syndrome, and adrenal insufficiency on mometasone withdrawal: case report.

Reactions Weekly — Sat, 11 Jul 2009 10:50:03 +0100

Page: 5 (Source: Reactions Weekly)

Diagnosis of Secondary Adrenal Insufficiency: Unstimulated Early Morning Cortisol in Saliva and Serum in Comparison with the Insulin Tolerance Test

Hormone and Metabolic Research — Wed, 08 Jul 2009 10:55:05 +0100

The objective of this study was to evaluate the diagnostic value of BSeC and BSaC in comparison to the insulin tolerance test (ITT). Seventy-seven patients with hypothalamic-pituitary disease and 184 healthy controls were enrolled. ITT were performed in patients, and BSeC as well as BSaC levels were measured in patients and controls. Upper and lower thresholds (with ≥95% specificity either for adrenal sufficiency or adrenal insufficiency) were calculated by ROC analysis both for BSeC and BSaC. The ITT identified 41 patients as adrenal insufficient and 36 patients as adrenal sufficient. Upper and lower cutoffs were 470 and 103 nmol/l for BSeC, and 21.1 and 5.0 nmol/l for BSaC, respectively. Thereby, basal cortisol allowed a highly specific diagnosis (i.e., similar to the I...

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Mifepristone: Adrenal insufficiency, hypokalaemia and other toxicities in patients with Cushing's syndrome: 13 case reports.

Reactions Weekly — Tue, 07 Jul 2009 10:50:55 +0100

Page: 22 (Source: Reactions Weekly)

Mifepristone: Adrenal insufficiency, hypokalaemia and other toxicities in patients with Cushing's syndrome: 13 case reports

Reactions — Mon, 06 Jul 2009 10:49:38 +0100

(Source: Reactions)

Etomidate or ketamine for emergency intubation?

NeLM - Anaesthesia — Tue, 30 Jun 2009 23:00:00 +0100

This study intended to compare outcomes between single doses of etomidate and ketamine in critically ill patients who required sedation for intubation. Participants ... (Source: NeLM - Anaesthesia)

DuoCort: New chronotherapy for adrenal insufficiency

Drugs.com - Clinical Trials — Tue, 30 Jun 2009 20:04:27 +0100

Helsingborg, Sweden, June 29th 2009 / b3c newswire - DuoCort publishes data from its Phase I study for the rare and life threatening disease adrenal insufficiency. The release profile of... (Source: Drugs.com - Clinical Trials)

DuoCort: New Chronotherapy For Adrenal Insufficiency

Health News from Medical News Today — Tue, 30 Jun 2009 09:00:00 +0100

DuoCort publishes data from its Phase I study for the rare and life threatening disease adrenal insufficiency. The release profile of DuoCort's new form of treatment with once-a-day hydrocortisone dosing closely resembles the physiological secretion pattern. The data is published in the European Journal of Endocrinology, a leading scientific journal for endocrinology. (Source: Health News from Medical News Today)

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Intracranial compound odontome

Journal of Cranio-Maxillofacial Surgery — Sun, 21 Jun 2009 23:00:00 +0100

Summary: An exceedingly rare case of an extragnathic odontome is described arising within the brain. A 10-year-old boy complained of progressive frontal headache for 5 years. Axial computerized tomography the head revealed a solid, calcified lesion with well-defined borders localized in the sellar and suprasellar region composed of multiple calcified structures resembling teeth. The diagnosis was compound odontome. Physical examination and blood analysis revealed hypopituitarism. The patient was submitted for radical tumour resection. He developed persistent diabetes insipidus, hypothyroidism and adrenal insufficiency for which appropriate replacement therapy has been necessary. This case demonstrates that an odontogenic lesion may arise in brain tissues due to the embryological relationsh...

Targeted disruption of Sonic Hedgehog in the mouse adrenal leads to adrenocortical hypoplasia

genesis — Tue, 16 Jun 2009 23:00:00 +0100

Development of the mammalian adrenal gland is regulated by a diverse network of growth and transcription factors. Disruptions in these pathways often result in adrenal insufficiency because of adrenal hypoplasia. Several lines of evidence have suggested that the Hedgehog signaling pathway, which controls many aspects of tissue and organ patterning, may play a direct role in adrenal morphogenesis as well. Therefore, we examined the role of Sonic Hedgehog (Shh), a member of the Hedgehog family, in mouse adrenal development. We show that Shh and its downstream effectors Gli1, Gli2, and Gli3 are expressed in the adrenal cortex throughout development, and that Shh is required for normal adrenal organogenesis. Conditional inactivation of Shh in the adrenal cortex using a Cre-loxP system resulted...

Successful phase II/III trial of new therapy for adrenal insufficiency

Drugs.com - Clinical Trials — Mon, 15 Jun 2009 23:21:13 +0100

Helsingborg Sweden/ Washington DC June 12th 2009 / b3c newswire / - DuoCort gained promising data from its Phase II/III study for the rare and life threatening disease adrenal insufficiency. DuoCort’s new form of physiological treatment with... (Source: Drugs.com - Clinical Trials)

Predisposing factors for adrenal insufficiency

The Aspergillus Website - articles — Thu, 11 Jun 2009 04:00:00 +0100

Bornstein SR (Source: The Aspergillus Website - articles)

Adrenal Insufficiency as a Presenting Manifestation of Nonsmall Cell Lung Cancer.

Southern Medical Journal — Sun, 07 Jun 2009 21:56:57 +0100

We report the case of a previously healthy man who presented with hypotension, abdominal pain, and weight loss and was found to have primary adrenal insufficiency secondary to lung adenocarcinoma.Page: 665DOI: 10.1097/SMJ.0b013e3181a56042Authors: Mohammad, Khalid MD; Sadikot, Ruxana T. MD, MRCP (UK) (Source: Southern Medical Journal)

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Effects of short-term nocturnal cortisol replacement on cognitive function and quality of life in patients with primary or secondary adrenal insufficiency: a pilot study.

Applied Psychophysiology and Biofeedback — Sun, 31 May 2009 23:00:00 +0100

Authors: Harbeck B, Kropp P, Mönig H Cortisol replacement in patients with adrenal insufficiency usually consists of hydrocortisone (HC) given orally during day time. Due to the short half-life of hydrocortisone, cortisol levels between midnight and early morning are very low in contrast to the physiological rise of cortisol serum levels during this time. We investigated whether short-term cortisol replacement during the night improves cognitive function and well-being in these patients. Fourteen patients with adrenal insufficiency were put on HC infusion between midnight and 8 a.m. They subsequently underwent neurocognitive testing to measure intellectual functioning, concentration, memory and fine motor skills. Quality of life and mood were also evaluated. All tests were repeate...

Metabolic derangement after injection of triamcinolone into the hip of an HIV-infected patient receiving ritonavir.

Orthopedics — Sun, 31 May 2009 23:00:00 +0100

This article describes a case of a 44-year-old HIV-infected man taking ritonavir who required admission to the intensive care unit (ICU) for hyperosmolar hyperglycemic state following injection of triamcinolone acetonide 80 mg into his right hip for osteoarthritis. Within 3 days of the injection, he developed polydipsia, polyphagia, polyuria, fatigue, and malaise and lost 10 lbs. Laboratory evaluation revealed a blood glucose of 766 mg/dL, and serum pH was 7.36 (normal, 7.31-7.41). After 3 days in the ICU, he was discharged on detemir insulin 15 units subcutaneously daily and sliding scale insulin aspart. Seven weeks after the injection, his detemir insulin had been titrated to 41 units daily, and his serum triamcinolone acetonide concentration was 0.39 mcg/dL (normal, <0.03 mcg/dL). Hi...

Monitoring Endocrine Function

Anesthesiology Clinics — Sun, 31 May 2009 23:00:00 +0100

This article reviews current knowledge concerning the monitoring of endocrine function in patients in the clinical setting. Monitoring techniques are discussed and literature is reviewed regarding diabetes mellitus, thyroid, and parathyroid disorders, pheochromocytoma, adrenal insufficiency, and carcinoid tumors. (Source: Anesthesiology Clinics)

[Mini-Review] Steroid Hormone Analysis by Tandem Mass Spectrometry

Clinical Chemistry — Thu, 28 May 2009 04:00:00 +0100

Conclusions: LC-MS/MS now affords the specificity, imprecision, and limits of quantification necessary for the reliable measurement of steroids in human fluids, enhancing diagnostic capabilities, particularly when steroid profiles are available. (Source: Clinical Chemistry)

Steroid Hormone Analysis by Tandem Mass Spectrometry [Mini-Review]

Clinical Chemistry — Wed, 27 May 2009 23:00:00 +0100

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REVIEW ARTICLE: Current Concepts: Predisposing Factors for Adrenal Insufficiency

New England Journal of Medicine — Wed, 27 May 2009 04:00:00 +0100

Clinicians must be aware of the growing list of causes and predisposing factors that may lead to the life-threatening disorder of acute adrenal insufficiency. This review provides a guide to the recognition and treatment of adrenal insufficiency, whether it is primary or secondary to disease, hereditary disorders, medication use, or critical illness. (Source: New England Journal of Medicine)

CME: Predisposing Factors for Adrenal Insufficiency

New England Journal of Medicine — Wed, 27 May 2009 04:00:00 +0100

(No abstract is available for this citation) (Source: New England Journal of Medicine)

Caution: All “Medrols” Are Not the Same

Journal of Emergency Nursing: JEN — Tue, 19 May 2009 23:00:00 +0100

Corticosteroids are a classification of drugs that are widely used both systemically and locally to treat a number of acute and chronic disease states. In emergency departments these medications are commonly used for the treatment of inflammatory respiratory disorders, as well as allergic reactions in adults and children. These drugs can also be used to treat other forms of severe inflammation, shock, and adrenal insufficiency, and in the management of acute spinal cord injury. Acute, episodic treatment is often accomplished by use of oral, intramuscular (IM), or intravenous (IV) preparations. Although these medications can produce a dramatic improvement in the patient’s condition, they are not entirely without risk. Some practitioners do not recognize that the formulations of all these ...

Secondary Adrenal Insufficiency due to Opiate Therapy – Another Differential Diagnosis Worth Consideration

Experimental and Clinical Endocrinology and Diabetes — Fri, 15 May 2009 08:15:16 +0100

We report on a 64-year-old patient in whom fentanyl therapy was found to be responsible for the induction of secondary adrenal insufficiency as clearly demonstrated by re-exposure. We conclude that given the widespread use of opiates in chronic pain management physicians should raise their level of awareness for adrenal insufficiency and look for it generously. Opiates should be added to the list of differential diagnoses to be considered routinely in patients with newly diagnosed secondary adrenal insufficiency.[...]© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: Experimental and Clinical Endocrinology and Diabetes)

Successful treatment with hydrocortisone for heat stroke with critical illness-related corticosteroid insufficiency: transitional changes in serum cytokine and cortisol concentrations

Journal of Anesthesia — Fri, 15 May 2009 06:10:56 +0100

Abstract A 37-year-old man was transferred to our emergency center because of heat stroke with circulatory shock. Despite aggressive body cooling, massive intravenous transfusion, and supply of inotropic agents, shock was persistent. To evaluate adrenal function, an adrenocorticotropic hormone stimulation test was conducted and the results indicated that he had critical illness-related corticosteroid insufficiency (CIRCI) as a result of adrenal insufficiency. Continuous hydorocortisone administration was started and he recovered from shock within a few hours. He was discharged on the thirty-seventh hospital day. Serum cortisol and cytokine concentrations were initially high and the cytokines decreased subsequent to hydrocortisone administration. It is speculated that CIRCI...

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[Research Articles] Scavenger receptor class B type I-mediated uptake of serum cholesterol is essential for optimal adrenal glucocorticoid production

The Journal of Lipid Research — Fri, 15 May 2009 04:00:00 +0100

In conclusion, we have shown that CETP-mediated transfer of HDL-CE is not able to reverse adrenal insufficiency in SR-BI knockout mice. Thus, SR-BI-mediated uptake of serum cholesterol is essential for optimal adrenal function. (Source: The Journal of Lipid Research)

Scavenger receptor class B type I-mediated uptake of serum cholesterol is essential for optimal adrenal glucocorticoid production [Research Articles]

The Journal of Lipid Research — Thu, 14 May 2009 23:00:00 +0100

The spectrum of phenotypes associated with mutations in steroidogenic factor 1 (SF-1, NR5A1, Ad4BP) includes severe penoscrotal hypospadias in 46,XY males without adrenal insufficiency.

European Journal of Endocrinology — Tue, 12 May 2009 23:00:00 +0100

Conclusions: SF-1 (NR5A1) mutations should be considered in 46,XY individuals with severe (penoscrotal) hypospadias, especially if undescended testes, low testosterone or low inhibin B/AMH levels are present. SF-1 mutations in milder forms of idiopathic hypospadias are unlikely to be common. PMID: 19439508 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

Adrenal Insufficiency Risk Low in Infants With Hemangiomas Following Glucocorticoid Therapy

Medscape Allergy Headlines — Tue, 12 May 2009 16:00:00 +0100

The prevalence of adrenal insufficiency following systemic glucocorticoid therapy in infants with hemangiomas is minimal, according to a new study published in the Archives of Dermatology. Medscape Dermatology (Source: Medscape Allergy Headlines)

Adrenal Insufficiency and Other Adrenal Oncologic Emergencies

Emergency Medicine Clinics of North America — Fri, 01 May 2009 04:00:00 +0100

Normal function of the adrenal gland can be disrupted not only by metastases of nonadrenal cancers but also by their treatment. In addition, tumors of the adrenal gland itself can cause disease by hypersecretion of a variety of hormones, adrenal gland destruction with inadequate production of cortisol, and by metastasis to other sites. Although rare, abnormal adrenal function should be considered in the appropriate clinical settings as failure to recognize and treat can result in significant morbidity and mortality. The adrenal “incidentaloma” is a frequent finding of abdominal radiologic studies. All patients with an unexpected adrenal mass should be referred for further evaluation. (Source: Emergency Medicine Clinics of North America)

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Clinical inquiries. What's the most practical way to rule out adrenal insufficiency?

The Journal of Family Practice — Thu, 30 Apr 2009 23:00:00 +0100

Authors: Satre TJ, Kovach F A morning serum cortisol level >13 mcg/dL reliably rules out adrenal insufficiency, and the test is easy and safe to perform. Because of low specificity, patients with a level of < or =13 mcg/dL need further evaluation with the cosyntropin stimulation test (CST). The 250 mcg CST requires intravenous (IV) or intramuscular (IM) administration of cosyntropin and multiple blood draws; a normal response reliably rules out primary adrenal insufficiency and moderately decreases the likelihood of secondary adrenal insufficiency. The 1 mcg CST has better diagnostic discrimination, but requires an extra step to dilute the cosyntropin. PMID: 19442385 [PubMed - indexed for MEDLINE] (Source: The Journal of Family Practice)

Distal gastric bypass surgery for the treatment of hypothalamic obesity after childhood craniopharyngioma.

European Journal of Endocrinology — Thu, 30 Apr 2009 23:00:00 +0100

Conclusions: Our case demonstrates that within a multidisciplinary team approach, a distal gastric bypass operation can be a safe and highly effective therapy for patients with hypothalamic obesity. Also, our findings hint at an effect of gastric bypass surgery on hunger and eating behaviour that may not essentially rely on hypothalamic mechanisms. PMID: 19411299 [PubMed - as supplied by publisher] (Source: European Journal of Endocrinology)

Low-Dose and High-Dose Synacthen Tests and the Hemodynamic Response to Hydrocortisone in Acute Traumatic Brain Injury

Neurocritical Care — Thu, 30 Apr 2009 05:51:11 +0100

Conclusions In the low-dose tetracosactide test, it is sufficient to determine cortisol concentrations at baseline and at 30 min. Low-dose and high-dose tests give discordant results in a significant proportion of cases when using the same diagnostic threshold. Neither test can be used to guide the initiation of corticosteroid therapy in acute TBI. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s12028-009-9217-9Authors R. S. Wijesurendra, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital University Division of Anaesthesia Box 93 Hills Road Cambridge CB2 2QQ UKF. Bernard, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital University Division of Anaesthesia Box 93 Hills Road Cambridge CB2 2QQ ...

Ritonavir/triamcinolone interaction: Cushing's syndrome and adrenal insufficiency: 3 case reports.

Reactions Weekly — Wed, 29 Apr 2009 00:48:54 +0100

Page: 40 (Source: Reactions Weekly)

Ritonavir/triamcinolone interaction: Cushing's syndrome and adrenal insufficiency: 3 case reports

Reactions — Sun, 26 Apr 2009 04:55:40 +0100

(Source: Reactions)

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[Endocrinology and Metabolism] Day 5 Morning Serum Cortisol Predicts Hypothalamic-Pituitary-Adrenal Function after Transsphenoidal Surgery for Pituitary Tumors

Clinical Chemistry — Fri, 24 Apr 2009 04:00:00 +0100

Conclusions: A day 5 post-TSS 9 AM serum cortisol <111 nmol/L reliably detects secondary adrenal insufficiency, and concentrations >392 nmol/L support intact HPA function. Because concentrations of 111–392 nmol/L are poorly predictive of HPA function, glucocorticoid replacement should continue in such cases until definitive testing is performed using an ITT. (Source: Clinical Chemistry)

Salivary steroid assays - research or routine?

Annals of Clinical Biochemistry — Thu, 23 Apr 2009 04:00:00 +0100

Salivary concentrations of unconjugated steroids reflect those for free steroids in serum although concentrations may differ because of salivary gland metabolism. Samples for salivary steroid analysis are stable for up to 7 days at room temperature, one month or more at 4°C and three months or more at –20°C. When assessed against strict criteria, the evidence shows that salivary cortisol in evening samples or following dexamethasone suppression provides a reliable and effective screen for Cushing's syndrome. Sequential salivary cortisol measurements are also extremely helpful for the investigation of suspected cyclical Cushing's syndrome. There is potential for the identification of adrenal insufficiency when used with Synacthen stimulation. Salivary 17-hydroxyprogesterone an...

Fine Tuning for Quality of Life: 21st Century Approach to Treatment of Addison's Disease

Endocrinology and Metabolism Clinics of North America — Tue, 21 Apr 2009 08:34:22 +0100

Despite treatment with glucocorticoids and mineralocorticoids, the ability to work and quality of life of patients who have adrenal insufficiency remains low. There are no helpful objective measures of optimal glucocorticoid replacement, so this is best achieved by careful clinical assessment. Adequacy of mineralocorticoid replacement may be judged by assessing postural change in blood pressure, serum electrolytes, and plasma renin activity. Novel delayed-release and sustained-release formulations of hydrocortisone seem to more closely mimic diurnal serum cortisol rhythms than conventional hydrocortisone tablets. Such preparations are currently being evaluated and may play a role in management of patients who have adrenal insufficiency. (Source: Endocrinology and Metabolism Clinics of Nort...

Betamethasone abuse: Adrenal insufficiency: case report

Reactions — Sat, 18 Apr 2009 03:29:34 +0100

(Source: Reactions)

Betamethasone abuse: Adrenal insufficiency: case report.

Reactions Weekly — Sat, 18 Apr 2009 03:28:23 +0100

Page: 8 (Source: Reactions Weekly)

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Aberrant adrenocortical tissue in hernia sac occurring in an adult: case report and review of the literature

Hernia — Wed, 15 Apr 2009 08:01:20 +0100

We report a rare case of aberrant adrenocortical tissue in hernial sac. We review the literature and highlight the clinical implications of this incidental finding. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s10029-009-0501-6Authors D. El Demellawy, Northern Ontario School of Medicine Department of Pathology and Laboratory Medicine, William Osler Health Center, Brampton Civic Hospital 2100 Bovaird East Drive Brampton ON CanadaA. Nasr, University of Toronto Department of Pediatric Surgery, Sick Kids Hospital Toronto ON CanadaA. Samkari, McMaster University Department of Pathology and Molecular Medicine, Hamilton Health Sciences Center Hamilton ON CanadaP. Pastolero, University of Toronto Faculty of Science Toronto ON CanadaS. Alowami, McMaster University Department of...

Primary antiphospholipid syndrome presenting as hyponatremic hypertensive syndrome and acute adrenal insufficiency following it: a rare case

Rheumatology International — Tue, 14 Apr 2009 06:01:11 +0100

We reported a case of 43-year-old man with unilateral renal artery stenosis due to primary APS. He presented with a hypertensive hyponatremic episode. First, he was treated with antihypertensive drugs. Further, radiological imaging showed enlargement of bilaterally adrenal glands that mimic adrenal masses. Unilateral nephrectomy and adrenalectomy were performed. Pathological examination revealed necrosis in the adrenal tissue and thrombosis in its artery. After operation, acute adrenal insufficiency developed in the patient because of hemorrhagic infarction of bilaterally adrenal glands. He improved after intravenous hydrocortisone treatment. His therapy was maintained with oral prednisolone and fludrocortisone. This patient with HHS, due to primary APS, is the first case in literatu...

The Necessity of Adrenalectomy at the Time of Radical Nephrectomy: A Systematic Review

The Journal of Urology — Fri, 10 Apr 2009 12:04:15 +0100

Conclusions: The apparent benefit of ipsilateral adrenalectomy does not support it as a standard practice in all patients with normal imaging. However, it should be considered in select cases in which there are risk factors for adrenal involvement. (Source: The Journal of Urology)

Fine tuning for quality of life: 21st century approach to treatment of Addison's disease.

Endocrinology and Metabolism Clinics of North America — Tue, 07 Apr 2009 21:05:28 +0100

Authors: Reisch N, Arlt W Despite treatment with glucocorticoids and mineralocorticoids, the ability to work and quality of life of patients who have adrenal insufficiency remains low. There are no helpful objective measures of optimal glucocorticoid replacement, so this is best achieved by careful clinical assessment. Adequacy of mineralocorticoid replacement may be judged by assessing postural change in blood pressure, serum electrolytes, and plasma renin activity. Novel delayed-release and sustained-release formulations of hydrocortisone seem to more closely mimic diurnal serum cortisol rhythms than conventional hydrocortisone tablets. Such preparations are currently being evaluated and may play a role in management of patients who have adrenal insufficiency. PMID: 19328419 [Pub...

Triamcinolone: Secondary adrenal insufficiency: 2 case reports

Reactions — Tue, 07 Apr 2009 16:41:49 +0100

(Source: Reactions)

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Triamcinolone: Secondary adrenal insufficiency: 2 case reports.

Reactions Weekly — Tue, 07 Apr 2009 16:32:50 +0100

Page: 32 (Source: Reactions Weekly)

Congratulations Young Endocrinologist prize winners

Society for Endocrinology — Tue, 07 Apr 2009 12:00:00 +0100

Congratulations to the following Young Endocrinologists prize winners who were presented with their awards at the Awards Ceremony during SfE BES 2009: 'Alternative splicing of the thyroid hormone receptor alpha gene regulates skeletal development' (OC1), T Galliford, A Ghaffar, J Bassett & G Williams, University of Birmingham. 'Quality of life (QoL) in male and female patients with congenital adrenal hyperplasia (CAH) compared to healthy subjects and patients with primary adrenal insufficiency' (OC8), B Bleicken, S Hahner, M Loeffler, M Ventz, B Allolio & M Quinkler, Charite Univeristy Medicine Berlin. 'Novel hypothalamic regulation by the Vitamin A signalling pathway' (P218), K Shearer, T Goodman, A Ross, P Morgan, P McCaffery, University of Aberdeen. 'Mitosis regulate...

Congratulations Young Endocrinologist prize winners!

Society for Endocrinology — Tue, 07 Apr 2009 12:00:00 +0100

Congratulations to the following Young Endocrinologists who won prizes for their oral or poster presentations at the SfE BES 2009 meeting: 'Alternative splicing of the thyroid hormone receptor alpha gene regulates skeletal development' (OC1), T Galliford, A Ghaffar, J Bassett & G Williams, Imperial College, London. 'Quality of life (QoL) in male and female patients with congenital adrenal hyperplasia (CAH) compared to healthy subjects and patients with primary adrenal insufficiency' (OC8), B Bleicken, S Hahner, M Loeffler, M Ventz, B Allolio & M Quinkler, Charite University Medicine Berlin. 'Novel hypothalamic regulation by the Vitamin A signalling pathway' (P218), K Shearer, T Goodman, A Ross, P Morgan, P McCaffery, University of Aberdeen. 'Mitosis regulates GR traffic...

Steroids Pose Low Risk of Adrenal Insufficiency After Infantile Hemangioma Therapy

Medscape Dermatology Headlines — Mon, 06 Apr 2009 15:24:07 +0100

The prevalence of adrenal insufficiency following systemic glucocorticoid therapy does not appear to be at significantly increased risk in infants with hemangiomas, Ohio-based researchers report in the March issue of the Archives of Dermatology. Reuters Health Information (Source: Medscape Dermatology Headlines)

Adrenal insufficiency and thyroid replacement therapy.

Paediatric Anaesthesia — Wed, 01 Apr 2009 04:00:00 +0100

Authors: Eipe N, Murto K PMID: 19335366 [PubMed - in process] (Source: Paediatric Anaesthesia)

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Preface

Best Practice & Research. Clinical Endocrinology & Metabolism — Wed, 01 Apr 2009 04:00:00 +0100

Editing this issue was a pleasure and I am excited to have been involved in generating a volume that hopefully will stimulate readers by providing new answers but also by promoting new questions. This volume summarises most recent developments in key areas of adrenal research, covering adrenal insufficiency, congenital adrenal hyperplasia and adrenocortical tumours. (Source: Best Practice & Research. Clinical Endocrinology & Metabolism)

Pathogenesis of primary adrenal insufficiency

Best Practice & Research. Clinical Endocrinology & Metabolism — Wed, 01 Apr 2009 04:00:00 +0100

Autoimmune Addison's disease is caused by autoreactivity towards the adrenal cortex involving 21-hydroxylase autoantibodies and autoreactive T cells. Autoimmune destruction of the adrenal cortex is triggered by hitherto unknown environmental factors in individuals with genetic susceptibility. Several genes have been identified, of which the major histocompatibility complex haplotypes DR3-DQ2 and DR4-DQ8 are most strongly associated. In addition, other genes also implicated in other autoimmune diseases are linked to Addison's disease, such as cytotoxic T lymphocyte antigen 4 (CTLA-4), protein tyrosine phosphatase non-receptor type 22 (PTPN22), major histocompatibility complex class II transactivator (CIITA), and most recently the C-lectin type gene (CLEC16A). Studies employing T cells in hu...

Therapeutic management of adrenal insufficiency

Best Practice & Research. Clinical Endocrinology & Metabolism — Wed, 01 Apr 2009 04:00:00 +0100

Replacement therapy in adrenal insufficiency comprises treatment with glucocorticoids, mineralocorticoids and adrenal androgen precursors. Initiation of hormone replacement therapy in newly diagnosed adrenal insufficiency leads to rapid and impressive improvements. However, despite the use of established replacement concepts, well-being is often not fully restored in patients with adrenal insufficiency, and life expectancy may even be reduced. This has led to a reconsideration of current replacement strategies. Several studies demonstrate that addition of dehydroepiandrosterone (DHEA) to the treatment regimen may lead to further improvement of general well-being and also sexual function. However, long-term trials with DHEA are still lacking, and DHEA alone is not able to restore subjective...

Novel strategies for hydrocortisone replacement

Best Practice & Research. Clinical Endocrinology & Metabolism — Wed, 01 Apr 2009 04:00:00 +0100

Current therapy with immediate-release hydrocortisone is the most commonly used regimen for replacement in patients with primary and secondary adrenal insufficiency. However, conventional hydrocortisone cannot provide the physiological rhythm of cortisol release. Physicians have used fixed twice- or thrice-daily doses, but these regimens inevitably result in temporary over- or under-replacement. Patients with adrenal insufficiency, although on treatment, have a poor quality of life and an increased mortality. Optimization of current treatment has been attempted with thrice-daily, weight-related dosing, but this still fails to simulate the normal diurnal rhythm of cortisol. Recent research has investigated circadian hydrocortisone therapy imitating the physiological cortisol rhythm. Proof-o...

Acute adrenal insufficiency may affect outcome in the trauma patient.

The American Surgeon — Tue, 31 Mar 2009 23:00:00 +0100

Conclusions were: (1) treatment of acute adrenal insufficiency reduces mortality by almost 50 per cent in the trauma patient; and (2) acute adrenal insufficiency recognized by low random cortisol levels or nonresponse to a stimulation tests should be considered for treatment. PMID: 19385286 [PubMed - indexed for MEDLINE] (Source: The American Surgeon)

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Laparoscopic simultaneous bilateral partial and total adrenalectomy: a longer follow-up

BJU International — Tue, 31 Mar 2009 04:00:00 +0100

To examine the feasibility and safety of laparoscopic simultaneous bilateral adrenal surgery (LSBAS) and to compare the results between laparoscopic total adrenalectomy (TA) and partial adrenalectomy (PA). Between 1999 and January 2008, 12 patients underwent LBAS in our institution, with TA used in four with Cushing's disease refractory to pituitary surgery or radiation, in one with occult ectopic adrenocorticotropic hormone (ACTH) Cushing's syndrome, and one with bilateral adrenal macronodular hyperplasia. Six patients (five with primary aldosteronism and one with Cushing's syndrome) had bilateral functioning tumours had bilateral PAs. All 12 operations were completed with no intraoperative complication, conversion, re-operation or death. The mean (range) operative duration was 323 (180[n...

GC adrenal insufficiency risk low in infant hemangioma

MedWire News - Dermatology — Fri, 27 Mar 2009 00:00:00 +0100

Infants with hemangiomas who are treated with prednisolone are at low risk for adrenal insufficiency, a small trial published in the Archives of Dermatology suggests. (Source: MedWire News - Dermatology)

Researching nature's venoms and poisons.

Transactions of the Royal Society of Tropical Medicine and Hygiene — Thu, 26 Mar 2009 04:00:00 +0100

Authors: Warrell DA Our environment hosts a vast diversity of venomous and poisonous animals and plants. Clinical toxinology is devoted to understanding, preventing and treating their effects in humans and domestic animals. In Sri Lanka, yellow oleander (Thevetia peruviana, Sinhala 'kaneru'), a widespread and accessible ornamental shrub, is a popular means of self-harm. Its toxic glycosides resemble those of foxglove, against which therapeutic antibodies have been raised. A randomised placebo-controlled trial proved that this treatment effectively reversed kaneru cardiotoxicity. There are strong scientific grounds for the use of activated charcoal, but encouraging results with multiple-dose activated charcoal were not confirmed by a recent more powerful study. Venom of Russell's viper ...

Effects of DHEA replacement on vascular function in primary and secondary adrenal insufficiency: a randomized crossover trial.

The Journal of Clinical Endocrinology and Metabolism — Tue, 24 Mar 2009 04:00:00 +0100

Conclusions: Short-term DHEA supplementation does not significantly affect measures of arterial stiffness or endothelial function in patients with adrenal insufficiency. PMID: 19318448 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)