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Serum Cortisol (serum + cortisol)

Distribution by Scientific Domains

Medical Sciences	88%

Terms modified by Serum Cortisol

serum cortisol concentration

serum cortisol level

Selected Abstracts

Greater growth hormone and insulin response in women than in men during repeated bouts of sprint exercise

ACTA PHYSIOLOGICA, Issue 2 2009
M. Esbjörnsson
Abstract Aim:, In a previous study, sprint training has been shown to increase muscle cross-sectional area in women but not in men [Eur J Appl Physiol Occup Physiol 74 (1996) 375]. We hypothesized that sprint exercise induces a different hormonal response in women than in men. Such a difference may contribute to explaining the observed gender difference in training response. Method:, Metabolic and hormonal response to three 30-s sprints with 20-min rest between the sprints was studied in 18 physically active men and women. Results:, Accumulation of blood lactate [interaction term gender (g) × time (t): P = 0.022], and plasma ammonia (g × t: P < 0.001) after sprint exercise was greater in men. Serum insulin increased after sprint exercise more so in women than in men (g × t: P = 0.020), while plasma glucose increased in men, but not in women (g × t: P < 0.001). Serum growth hormone (GH) increased in both women and men reaching similar peak levels, but with different time courses. In women the peak serum GH level was observed after sprint 1, whereas in men the peak was observed after sprint 3 (g × t; P < 0.001). Serum testosterone tended to decrease in men and increase in women (g × t: P = 0.065). Serum cortisol increased approx. 10,15% after sprint exercise, independent of gender (time: P = 0.005). Conclusion:, Women elicited a greater response of serum GH and insulin to sprint exercise. This may contribute to explaining the earlier observed muscle hypertrophy in women in response to sprint training. [source]

Adrenal Insufficiency in Critically Ill Emergency Department Patients: A Taiwan Preliminary Study

ACADEMIC EMERGENCY MEDICINE, Issue 7 2001
Shy-Shin Chang MD
Objective: Unrecognized adrenal insufficiency can have serious consequences in critically ill emergency department (ED) patients. This prospective pilot study of adrenal function in patients with severe illness was undertaken to determine the prevalence of adrenal dysfunction and any relation to prior herbal drug use. Methods: In a high-volume urban tertiary care ED, adult patients with sepsis or acute myocardial infarction (AMI) were eligible for the study. Over a two-month period, a convenience sample was enrolled by the authors on arrival to the ED. Inclusion criteria were systemic inflammatory response syndrome (SIRS) criteria plus evidence of at least one organ dysfunction or cardiac marker plus electrocardiogram-proven AMI. Exclusion criteria included known corticosteroid use. Serum cortisol was measured on arrival and for those patients with a level of <15 ,g/dL (<414 nmol/L), an adrenocorticotropic hormone (ACTH) stimulation test was performed. Results: Of the 30 enrolled patients, 23 (77%) were suffering from severe sepsis and the other seven (23%) had an AMI. Thirteen of the 30 patients (43%; 95% CI = 25% to 65%) had serum cortisol levels of <15 ,g/dL, consistent with adrenal insufficiency, nine with severe sepsis and four with an AMI. Eight (62%; 95% CI = 32% to 86%) of the 13 patients with low cortisol levels reported using herbal medications, while only two (12%; 95% CI = 1% to 36%) of the 17 with normal cortisol levels reported taking herb drugs (p = 0.01). Only two (15%; 95% CI = 2% to 45%) of the patients with low cortisol levels failed their corticotropin stimulation test, suggestive of true adrenocortical insufficiency. Both reported using herbal preparations. Conclusions: These results indicate that adrenal dysfunction is common among a group of critically ill patients seen in this Taiwanese ED. Moreover, the use of herbal drugs was high in the patients with low serum cortisols. Further studies are required to both confirm these findings and clarify whether a number of herbal medications contain corticosteroids. [source]

The efficacy of orally dosed ketamine and ketamine/medetomidine compared with intramuscular ketamine in rhesus macaques (Macaca mulatta) and the effects of dosing route on haematological stress markers

JOURNAL OF MEDICAL PRIMATOLOGY, Issue 3 2008
Andrew N Winterborn
Abstract Background, This study compared the efficacy of two orally-dosed (PO) anaesthetic regimens for chemical immobilization in rhesus macaques (Macaca mulatta), versus the standard protocol of intramuscular (TM) ketamine. In addition, the effects of dosing route on haematological stress markers were evaluated. Methods, Testing was conducted on 18 chronically housed animals. Animals were trained to accept oral dosing and then randomly assigned to one of three drug regimens: (1) ketamine IM, (2) ketamine PO, (3) Ketamine/medetomidine PO. Sedation levels for each regimen were evaluated. Results, Oral dosing alone was not sufficient to achieve a plane of sedation that allowed for safe handling. Serum cortisol and glucose levels were unchanged across groups, although differences were observed in the leukogram profiles. Conclusion, The oral dosages used in this study fell short in providing adequate sedation for safe handling for routine veterinary procedures. Leukogram profiles indicated that orally dosed animals experienced a higher level of stress. [source]

Oral beclometasone dipropionate in the treatment of active ulcerative colitis: a double-blind placebo-controlled study

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2002
F. Rizzello
Summary Aim : To evaluate efficacy and safety of oral beclometasone dipropionate (BDP) when added to 5-ASA in the treatment of patients with active ulcerative colitis. Methods : In a 4-week, placebo-controlled, double-blind study, patients with extensive or left-sided mild to moderate active ulcerative colitis were randomized to receive oral 5-ASA (3.2 g/day) plus BDP (5 mg/day) or placebo. Clinical, endoscopic and histologic features, and haematochemical parameters were recorded at baseline and at the end of the study. Results : One hundred and nineteen patients were enrolled and randomly treated with BDP plus 5-ASA (n = 58) or placebo plus 5-ASA (n = 61). Both treatment groups showed a statistically significant decrease of disease activity index (DAI) and histology score at the end of treatment (P = 0.001, each). DAI score was lower in the BDP group than in the placebo group (P = 0.014), with more patients in clinical remission in the BDP group (58.6% vs. 34.4%, P = 0.008). Serum cortisol levels significantly decreased in BDP group vs. baseline (P = 0.002), but without signs of pituitary-adrenal function depletion. A low incidence of adverse events was observed in both groups. Conclusions : Oral BDP in combination with oral 5-ASA is significantly more effective than 5-ASA alone in the treatment of patients with extensive or left-sided active ulcerative colitis. [source]

HPA axis safety of fluticasone furoate nasal spray once daily in children with perennial allergic rhinitis

PEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 3 2009
Ita Tripathy
The effects of intranasal corticosteroids (INSs) on the hypothalamic,pituitary,adrenal (HPA) axis should be assessed for any to be marketed INS. The objective of this study was to assess the effects of fluticasone furoate nasal spray (FFNS) on cortisol production (as a measure of HPA axis function) following 6 wk of treatment with FFNS 110 ,g once daily (QD) compared with placebo in pediatric patients with perennial allergic rhinitis (PAR). In this double-blind, parallel-group study, patients (n = 112) aged 2,11 yr with a 1-yr history of PAR (6 months for patients aged 2,3 yr) were randomized in a 1:1 ratio to either placebo or FFNS. Serum cortisol (SC) concentrations and urinary cortisol (UC) excretion were measured over a 24-h period at the randomization (baseline) and final treatment (week 6) visits for HPA axis evaluation in a domiciled environment (overnight in the clinic). Plasma samples were collected for FFNS at several time points over the 24 h after the final dose for pharmacokinetic analyses. FFNS was non-inferior to placebo with respect to change from baseline (expressed as a ratio) in 24-h SC weighted mean. The lower limit of the two-sided 95% confidence interval (CI) for the treatment ratio was greater than the pre-specified non-inferiority margin of 0.8 (treatment ratio = 0.97, 95% CI 0.88,1.07). UC excretion over 24 h at baseline and end of treatment was similar between treatment groups; no patients had 24-h excretion levels below normal range after 6 wk of treatment. Plasma concentrations of FFNS were generally non-quantifiable (<10 pg/ml). Results of the current study indicate that FFNS 110 ,g QD has no significant effect on HPA axis function in 2- to 11-yr-old pediatric patients with PAR. [source]

Weight-related dosing, timing and monitoring hydrocortisone replacement therapy in patients with adrenal insufficiency

CLINICAL ENDOCRINOLOGY, Issue 3 2004
Peak M. Mah
Summary objective, The objective of this study was to examine the variables determining hydrocortisone (HC) disposition in patients with adrenal insufficiency and to develop practical protocols for individualized prescribing and monitoring of HC treatment. design and patients, Serum cortisol profiles were measured in 20 cortisol-insufficient patients (09·00 h cortisol < 50 nmol/l) given oral HC as either a fixed or ,body surface area-adjusted' dose in the fasted or fed state. Endogenous cortisol levels were measured in healthy subjects. Pharmacokinetic analysis was performed using P-Pharm software, and computer simulations were used to assess the likely population distribution of the data. results, Body weight was the most important predictor of HC clearance. A fixed 10-mg HC dose overexposed patients to cortisol by 6·3%, whereas weight-adjusted dosing decreased interpatient variability in maximum cortisol concentration from 31 to 7%, decreased area under the curve (AUC) from 50 to 22% (P < 0·05), and reduced overexposure to < 5%. Food taken before HC delayed its absorption. Serum cortisol measured 4 h after HC predicted cortisol AUC (r2 = 0·78; P < 0·001). conclusions, We recommend weight-adjusted HC dosing, thrice daily before food, monitored with a single serum cortisol measurement using a nomogram. This regimen was prospectively examined in 40 cortisol-insufficient patients, 85% of whom opted to remain on the new thrice-daily treatment regimen. [source]

Lymphopenia and neutrophilia in SARS are related to the prevailing serum cortisol

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 5 2004
N. S. Panesar
No abstract is available for this article. [source]

11b-hydroxysteroid dehydrogenase activity in proteinuric patients and the effect of angiotensin-II receptor blockade

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 7 2002
M. N. Kerstens
Abstract Background It has been suggested that an altered setpoint of the 11,HSD-mediated cortisol to cortisone interconversion towards cortisol contributes to sodium retention in nephrotic syndrome patients. We studied the parameters of 11,HSD activity in proteinuric patients, in particular its activity at the kidney level. We also studied the effect of angiotensin-II receptor blockade on the parameters of 11,HSD activity. Materials and methods Serum cortisol/cortisone ratio and the urinary ratios of (tetrahydrocortisol + allo-tetrahydrocortisol)/tetrahydrocortisone [(THF + allo-THF)/THE] and of urinary free cortisol/free cortisone (UFF/UFE) were measured in eight proteinuric patients and compared with eight matched, healthy subjects. Patients were subsequently studied after 4 weeks' treatment with losartan 50 mg day,1 and placebo, respectively. Results No significant differences between the proteinuric patients and the healthy subjects were observed in the serum cortisol, serum cortisone, serum cortisol to cortisone ratio, or in the urinary excretions of THF, allo-THF, THE, sum of cortisol metabolites, or the (THF + allo-THF)/THE ratio. Urinary free cortisol excretion and the UFF/UFE ratio were lower in the proteinuric patients than in the healthy subjects (56 ± 21 vs. 85 ± 24 pmol min,1, P < 0·05, and 0·39 ± 0·07 vs. 0·63 ± 0·28, P < 0·05, respectively). Mean arterial pressure and proteinuria were reduced significantly during losartan treatment, but without concomitant changes in peripheral cortisol metabolism. Conclusions Increased renal inactivation of cortisol in proteinuric patients does not support the contention that altered 11,HSD activity contributes to sodium retention in patients with nephrotic syndrome. Losartan 50 mg d.d. reduces mean arterial pressure and proteinuria, but does not exert a significant effect on the cortisol to cortisone interconversion. [source]

Synergistic regulation of neuropeptide levels by internal and external stimuli

EXPERIMENTAL DERMATOLOGY, Issue 9 2004
J. Hosoi
The skin is the most peripheral organ confronting the external environment. We found that the level of substance P is regulated by both internal and external stimuli. Mock interview induced the acute stress in human assessed by the measurement of serum cortisol. The serum level of substance P increased within 1 h after the mock interview. Interestingly, the increase was suppressed by inhalation of 1,3-dimethoxy-5-methylbenzene. Similar regulation was observed in mice. Furthermore, restraint or the intravenous administration of substance P induced the activation of cutaneous mast cells. Housing under the condition of lower humidity (about 30%) for 24 h caused the increase in the substance P level both in peripheral blood and in the skin. Restraint for 2 h during the housing under the condition of lower humidity increased the substance P level further. The activation of cutaneous mast cells under the dry condition was reported. These data suggest that cutaneous neuropeptide level is regulated by both psychological and environmental mechanisms. The regulation may cause the downregulation of the threshold of the induction of itch and inflammation. [source]

Changes in serum cortisol, metabolites, osmotic pressure and electrolytes in response to different blood sampling procedures in cultured sea bass (Dicentrarchus labrax L.)

JOURNAL OF APPLIED ICHTHYOLOGY, Issue 3 2001
Marino
This study investigated the effect of five sampling procedures on serum cortisol, glucose, total protein, osmolality, Na+, Cl,, K+ and Ca++ concentrations in 2-year-old cultured sea bass (Dicentrarchus labrax L). Mild disturbance caused by rapid removal of fish and brief handling did not induce significant variation in any of the blood parameters investigated. Confinement and crowding elicited a high and significant increase in serum cortisol, glucose, osmolality, Na+, Cl,, and Ca++ concentrations. Exposure to MS 222 (140 mg L,1) significantly increased osmolality, but not ionic concentration. Site of blood withdrawal (cardiac sinuses/caudal vein) had no effect on the concentration of analysed blood constituents, except for K+ levels. Scattered literature of sea bass blood chemistry is reviewed and compared with ,normal' ranges of blood constituents measured in this study. We conclude that it is necessary to select and rigorously execute an opportune blood sampling procedure whenever blood constituents are used as indicators of fish functional state. [source]

Normalization of Serum Cortisol Concentration With Opioid Treatment of Severe Chronic Pain

PAIN MEDICINE, Issue 2 2002
Forest Tennant MD
Serum cortisol concentrations may be altered in severe, chronic pain due to excess stimulation of the hypothalamic-pituitary-adrenal axis. Among 40 consecutive patients with severe, chronic pain 26 (65.0%) demonstrated abnormal serum cortisol concentration. After 90 days of treatment, only 7 (17.5%; p<0.01) continued to show abnormal serum cortisol concentration indicating that serum cortisol and other serologic abnormalities may serve as biologic markers of severe, chronic pain. [source]

(229) Serum Cortisol Concentrations and Adrenal Reserve May Be Altered by Severe Chronic Pain

PAIN MEDICINE, Issue 3 2001
Forest Tennant
It has been postulated that chronic pain over-stimulates the hypothalamus-pituitary-adrenal axis to produce an extended stress response. If this assumption is true, patients with severe, chronic pain should demonstrate abnormalities of the pituitary-adrenal axis. To evaluate this premise, we screened 40 adult, chronic pain patients in the first week of treatment with serum cortisol concentrations taken between 8:00 and 10:00 AM. Criteria for inclusion in this study required that pain be present for at least one year and be constant, incurable, interfere with sleep, and cause the patient to be bed or house-bound without opioid treatment. Sixteen (16) of the subjects were challenged with cosyntropin, 0.25mg, given intramuscularly immediately after blood was drawn for determination of baseline serum cortisol concentration. Normal serum cortisol concentrations was considered to range from 5.0 to 25.0 ug/dl at baseline, and normal cortisol reserve was considered to be at least a doubling of the baseline concentration determined one hour after cosyntropin administration. Ten (25%) of the patients had evaluated serum cortisol concentrations above 25ug/dl with the highest being 54.4 ug/dl. Nine (20%) demonstrated low serum cortisol concentrations under 5 ug/dl, and 5 of 16 (31.25%) given cosyntropin challenge demonstrated inadequate adrenal reserve by failing to double their baseline cortisol concentration. All patients with high or low serum cortisol concentration demonstrated a normal cortisol concentration following pain control with a long-acting opioid including methadone, extended-length morphine or oxycodone, or transdermal fentanyl. This study suggests that severe, chronic pain may produce profound abnormalities of serum cortisol and cortisol reserve, and normalization of these alterations may require pain treatment with long-acting opioids. [source]

Adrenal function testing in pediatric cancer survivors

PEDIATRIC BLOOD & CANCER, Issue 7 2009
Briana C. Patterson MD
Abstract Background Central adrenal insufficiency is observed after cranial radiation therapy for cancer. Screening at risk patients is recommended, but the best screening strategy is unknown. Methods 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. Results Seventy-eight subjects (56% male, mean age at diagnosis 6.5 years) underwent testing. 67.9% had been treated with radiotherapy to the hypothalamus/pituitary. Mean time to diagnosis of adrenal insufficiency was 6.8 years after cancer diagnosis. Adequate adrenal function was found in 65% of patients by LDCT and 89% by SDCT. Only 21% of patients had basal serum cortisols collected at 8 a.m. Agreement between 8 a.m. baseline cortisol and LDCT was fair. Agreement between random baseline cortisol and LDCT was poor. Prevalence of central adrenal insufficiency diagnosed by LDCT increased with radiotherapy dose (8% for 10,19.9,Gy; 83% for ,40,Gy) and the number of endocrine comorbidities. Conclusions In pediatric cancer survivors, central adrenal insufficiency was common even in patients receiving <40,Gy to the hypothalamus/pituitary. We recommend use of LDCT, not 8 a.m. serum cortisol to screen patients who received >30,Gy of radiotherapy and those with other central endocrinopathies. Pediatr Blood Cancer 2009; 53:1302,1307. © 2009 Wiley-Liss, Inc. [source]

Improved safety with equivalent asthma control in adults with chronic severe asthma on high-dose fluticasone propionate

RESPIROLOGY, Issue 3 2001
Norbert Berend
Objective: High-dose inhaled corticosteroids (ICS) have been associated with the same side-effects as oral corticosteroids. Beclomethasone dipropionate (BDP) and budesonide (BUD) in doses greater than 2000 ,g/day are used regularly in severe asthma, despite the fact that safety and efficacy data at such high doses are limited. Fluticasone propionate (FP) has been promoted as being twice as potent clinically as BDP or BUD at doses of 2000 ,g/day or less with a similar safety profile. The aim of this study was to compare the efficacy and safety of FP with BDP and BUD in 133 symptomatic adult asthmatics requiring at least 1750 ,g/day of BDP or BUD. Methodology: Patients fulfilling the entry criteria were randomized to receive either their regular ICS medication or FP at approximately half the microgram dose for 6 months in an open, parallel group study. The primary efficacy measure was based on morning peak expiratory flow measurements recorded by patients on daily record cards, while determination of safety was based on a number of endpoints including changes in bone turnover indices, the incidence of topical side-effects and assessments of quality of life. Results: It was shown that patients who were switched to FP, but not those continuing with BDP or BUD, had significant increases in levels of morning serum cortisol and the urine cortisol:creatinine ratio while maintaining asthma control. Serum osteocalcin and the pyridinoline:creatinine ratio, as well as the deoxypyridinoline:creatinine ratio, were also shown to increase only in the FP group. Subjective assessments such as quality of life score, the incidence and ease of bruising, and reports of hoarseness also favoured the FP group. Conclusions: It is concluded that, at the doses studied and with the delivery devices used clinically, FP is at least as effective as BDP/BUD in the management of severe asthma and may offer clinical advantages with respect to steroid-related adverse effects. [source]

Cardiovascular risk factors correlate with prostate size in men with bladder outlet obstruction

BJU INTERNATIONAL, Issue 1 2003
L. Sandfeldt
OBJECTIVE To study whether the risk profile for cardiovascular disease correlates with prostate size in elderly men seeking medical attention for lower urinary tract symptoms (LUTS), by assessing physiological, biochemical and personality traits. PATIENTS AND METHODS Fifty-two men (mean age 68 years, range 52,85) with bladder outlet obstruction, as verified by urodynamic testing, had their prostate size measured by transrectal ultrasonography. Their blood and urine was also examined, and their personality and heart rate variability tested. The measured variables were assessed statistically in relation to whether the prostate volume was smaller (22 men) or larger (30 men) than 50 mL. RESULTS Patients with a large prostate (mean 104 mL) had a higher mean arterial pressure (105 vs 95 mmHg, P < 0.01), and serum glucose (5.3 vs 4.8 mmol/L, P < 0.01) and serum cortisol (423 vs 362 nmol/L, P = 0.06) concentrations than those with a small gland (mean 31 mL). The personality test showed that they were also less assertive than the others (P < 0.03). The components of the heart rate variability indicated that men with a large prostate had increased sympathetic activity. CONCLUSION Men with LUTS caused by a very large prostate have more risk factors for cardiovascular disease than those with a smaller gland. [source]

Response of the hypothalamic,pituitary,adrenal axis to psychological stress in patients with psoriasis

BRITISH JOURNAL OF DERMATOLOGY, Issue 6 2005
H.L. Richards
Summary Background, Psoriasis may, in some patients, be triggered and/or exacerbated by stress. Objectives, As activation of the hypothalamic,pituitary,adrenal (HPA) axis is critical to a successful stress response we investigated this in patients with psoriasis. Methods, Forty patients with chronic plaque psoriasis and 40 age-matched normal controls experienced three randomly presented acute psychological stressors (cognitive, emotional and social). Serial serum cortisol, pulse rate and blood pressure assessments were undertaken at baseline and following each of the stressors. Salivary cortisol samples were collected at 09·00 h on the day of testing. Results, In control subjects there was a significant (r = 0·38; P < 0·05) correlation between pulse rate and serum cortisol level following the social performance stressor; this was not evident in the psoriasis group (r = 0·07; not significant). Patients who believed that their psoriasis was highly stress responsive had significantly lower salivary cortisol levels at baseline (P < 0·01) and lower serum cortisol levels following the social performance stressor (P = 0·016) than patients with nonstress-responsive disease who believed that stress had no impact. In contrast, there was no difference between the groups for change in pulse rate poststressor. Conclusions, This study shows that patients with psoriasis, and in particular those whose disease appears to be stress responsive, exhibit an altered HPA response to acute social stress. The implication is that such patients may perhaps be primed to flares of their psoriasis. Whether this is genetically predetermined and/or a consequence of the distress of living with psoriasis remains to be determined. [source]

Modified-release hydrocortisone for circadian therapy: a proof-of-principle study in dexamethasone-suppressed normal volunteers

CLINICAL ENDOCRINOLOGY, Issue 1 2008
J. Newell-Price
Summary Background All existing long-term glucocorticoid replacement therapy is suboptimal as the normal nocturnal rise and waking morning peak of serum cortisol is not reproduced. Aim To test whether it is possible to reproduce the normal overnight rise and morning peak in serum cortisol using an oral delayed and sustained release preparation of hydrocortisone (Cortisolds). Subjects and methods Six healthy normal male volunteers attended on two occasions, in a single-dose, open-label, nonrandomized study. Endogenous cortisol secretion was suppressed by administration of dexamethasone. Cortisolds (formulation A or B) was administered at 2200 h on day 1. Blood samples for measurement of cortisol were taken from 2200 h every 30 min until 0700 h, then hourly until 2200 h on day 2. Fifteen body mass index (BMI)-matched control subjects had serum cortisol levels measured at 20-min intervals for 24 h. Serum cortisol profiles and pharmacokinetics after Cortisolds were compared with those in controls. Results Formulations A and B were associated with delayed drug release (by 2 h and 4 h, respectively), with median peak cortisol concentrations at 4·5 h (0245 h) and 10 h (0800 h), respectively, thereby reproducing the normal early morning rise in serum cortisol. Total cortisol exposure was not different from controls. Conclusions For the first time we have shown that it is possible to mimic the normal circadian rhythm of circulating cortisol with an oral modified-release formulation of hydrocortisone, providing the basis for development of physiological circadian replacement therapy in patients with adrenal insufficiency. [source]

Cortisol levels and measures of body composition in middle-aged and older men

CLINICAL ENDOCRINOLOGY, Issue 1 2007
Thomas G. Travison
Summary Introduction, Similarities in the symptomatic expressions of excess adiposity and hypercortisolaemic conditions suggest that elevated glucocorticoid exposure may influence the pathogenesis of obesity. Circulating cortisol levels are not typically elevated in obese subjects, but data from large prospective samples are rare. We undertook an analysis to determine both cross-sectional and longitudinal associations between body composition and serum cortisol concentrations in a randomly chosen group of 999 community-dwelling men, aged 40,79 years. Methods, Data were obtained from the two follow-up waves of the Massachusetts Male Ageing Study (T2: 1995,97; T3: 2002,04). Partial correlation and multivariate regression analyses were used to estimate cross-sectional (T2) and longitudinal associations between serum cortisol concentrations and a range of measures of subjects' body composition, including weight, body mass index (BMI), waist circumference (WC), waist-to-hip girth ratio (WHR), and percentage body fat (measured by bioelectrical impedance at T3); similar analyses were conducted to assess the association between change (T2 to T3) in serum cortisol and simultaneous change in body composition parameters. Results, We observed weak negative associations between cortisol concentrations and all body composition parameters, with the exception of percentage body fat. Longitudinal results demonstrated similar relationships but associations were of lesser magnitude. T2 cortisol concentrations were not associated with change in body composition over time, whereas T2 body size was positively associated with longitudinal changes in cortisol concentrations, providing limited evidence that weight change drives changes in cortisol concentrations, rather than vice versa. Results were unchanged when age and other covariate effects were controlled. Conclusions, Circulating cortisol concentrations are somewhat lower in obese than in nonobese community-dwelling men. There is some evidence that excess adiposity presages increases in cortisol concentrations, rather than the reverse. However, this observation should be greeted with caution, as age-related weight loss , and not gain , was associated with simultaneous increases in serum cortisol concentrations. [source]

Profile, mean residence time of ACTH and cortisol responses after low and standard ACTH tests in healthy volunteers

CLINICAL ENDOCRINOLOGY, Issue 3 2006
P. Alía
Objective, No consensus exists until now about the suitable dose of tetracosactin in the ACTH stimulation test for detecting adrenal insufficiency. Our aim was to characterize both the ACTH(1,24) and the cortisol profiles after standard high-dose test (250 µg) (HDT) and low-dose test (1 µg) (LDT) in healthy subjects in order to provide a deeper knowledge about the relationship between stimulus and response. Design and patients, ACTH tests were performed in 10 healthy volunteers (five men, five women) with at least 1 week of difference. Measurements, Plasma ACTH(1,24) and ACTH(1,39) and serum cortisol were measured before tetracosactin i.v. injection and at 5, 15, 30, 45, 60, 75 and 90 min after stimulus. Area under the curve (AUC) of ACTH(1,24) and cortisol, as well as mean residence time (MRT) for ACTH(1,24) were calculated in both tests. Results, Elimination of ACTH(1,24) was faster in HDT than in LDT (MRTs of 0·14 vs 0·37, respectively, P = 0·008), but plasma concentrations were higher up to 60 min cortisol production in HDT reaching a higher maximum concentration (Cmax: 1144 vs 960 nmol/l) but delayed in time (75 vs 52·5 min). No significant relationship was observed between AUC or Cmax of ACTH(1,24) and AUC, Cmax and increment of cortisol in any of the tests. However, a negative correlation of basal cortisol values was observed with relative cortisol increment (HDT: r = 0·77 P = 0·009; LDT: r = 0·94 P < 0·0001), but not so with Cmax (HDT: r = 0·22 P = 0·55; LDT: r = 0·57 P = 0·09). Conclusions, The elimination rate of ACTH in healthy volunteers was significantly lower in LDT than in HDT, but cortisol production rate appears to be identical in both tests, so that a maximum adrenal stimulation seems to exist. The use of LDT may be more adequate, although data from patients need studying. [source]

Long-term remission rates after pituitary surgery for Cushing's disease: the need for long-term surveillance

CLINICAL ENDOCRINOLOGY, Issue 5 2005
A. Brew Atkinson
Summary Objective, There have been a few reports on long-term remission rates after apparent early remission following pituitary surgery in the management of Cushing's disease. An undetectable postoperative serum cortisol has been regarded as the result most likely to predict long-term remission. Our objective was to assess the relapse rates in patients who underwent transsphenoidal surgery in order to determine whether undetectable cortisol following surgery was predictive of long-term remission and whether it was possible to have long-term remission when early morning cortisol was measurable but not grossly elevated. Endocrinological factors associated with late relapse were also studied. Patients, We reviewed the long-term outcome in 63 patients who had pituitary surgery for the treatment of Cushing's disease between 1979 and 2000. Measurements, Case notes were reviewed and the current clinical and biochemical status assessed. Our usual practice was that early after the operation, an 08:00 h serum cortisol was measured 24 h after the last dose of hydrocortisone. This was followed by a formal low-dose dexamethasone suppression test. Current clinical status and recent 24-h urinary free cortisol values were used as an index of activity of the Cushing's disease. If there was evidence suggesting relapse, a low-dose dexamethasone suppression test was performed. In many patients, sequential collections of early morning urine specimens for urinary cortisol to creatinine ratio were also performed in an attempt to diagnose cyclical and intermittent forms of recurrent hypercortisolism. We did this if there was conflicting endocrine data, or if patients were slow to lose abnormal clinical features. Results, Mean age at diagnosis was 40·3 years (range 14,70 years). Mean follow-up up time was 9·6 years (range 1,21 years). Forty-five patients (9 males/36 females) achieved apparent remission immediately after surgery and were subsequently studied long term. Of these 45 patients, four have subsequently died while in remission from hypercortisolism. Ten of the remaining 41 patients have relapsed. Of those 10, six demonstrated definite cyclical cortisol secretion. Two of the 10 had undetectable basal serum cortisol levels in the immediate postoperative period. Thirty-one patients are still alive and in remission. Fourteen (45%) of the 31 who remained in remission had detectable serum cortisol levels (> 50 nmol/l) immediately postoperatively, and remain in remission after a mean of 8·8 years. Our relapse rate was therefore 10/45 (22%), after a mean follow-up time of 9·6 years, with mean time to relapse 5·3 years. Conclusions, The overall remission rate of 56% (35/63) at 9·6 years follow-up is disappointing and merits some re-appraisal of the widely accepted principle that pituitary surgery must be the initial treatment of choice in pituitary-dependent Cushing's syndrome. Following pituitary surgery, careful ongoing expert endocrine assessment is mandatory as the incidence of relapse increases with time and also with increasing rigour of the endocrine evaluation. A significant number of our patients were shown to have relapsed with a cyclical form of hypercortisolism. [source]

The low-dose (1 ,g) adrenocorticotropin stimulation test in kidney and kidney,pancreas transplant patients: a potential guideline for steroid withdrawal

CLINICAL TRANSPLANTATION, Issue 1 2006
M Baz-Hecht
Abstract:, Chronic steroid treatment is known to impair the hypothalamic,pituitary adrenal axis (HPA) but the need to assess HPA function prior to withdrawal of steroid therapy in post-transplant patients has not been uniformly accepted. We evaluated the status of the HPA axis in 48 kidney or kidney,pancreas transplant patients who were considered for possible discontinuation of glucocorticoid therapy using a recently validated dynamic test of HPA integrity, the low-dose (1 ,g) adrenocorticotropin (ACTH) test. HPA suppression was detected in 29 (60%) of the patients, four of which had severe hypoadrenalism prohibitive of steroid withdrawal. Neither the duration of steroid treatment nor 8:00 am serum cortisol was a useful marker of hypoadrenalism. 8:00 am cortisol in subjects with normal HPA reserve and subjects with partial hypoadrenalism overlapped considerably but levels <5 ,g/dL were indicative of severe hypoadrenalism. Pre-withdrawal diagnosis of partial hypoadrenalism allowed the identification of subjects requiring no further steroid replacement under regular daily circumstances. However glucocorticoid supplementation was prescribed in the event of stress such as infection, exceptional effort, trauma or surgery. Individuals with partial HPA impairment, but not patients with severe HPA suppression, improved upon retesting 3 months later. Patients exhibiting normal response to 1 mcg ACTH enjoyed an uneventful course following steroid withdrawal. Since hypoadrenalism is extremely common in post-transplant patients, we recommend the use of the low-dose ACTH test as a convenient method to identify patients with various degrees of hypoadrenalism prior to steroid withdrawal. [source]

Changes in serum leptin concentration after corticosteroid treatment in preterm infants

ACTA PAEDIATRICA, Issue 6 2002
PC Ng
The aim of this study was to investigate the effect of postnatal systemic dexamethasone on serum leptin, insulin and hormones of the hypothalamic-pituitary-adrenal (HPA) axis in preterm, very low birthweight (VLBW) infants. Nineteen VLBW infants who received a 3 wk dose tapering course of dexamethasone for treatment of bronchopulmonary dysplasia were prospectively enrolled. Blood for hormone assays was collected immediately before the start of the dexamethasone course (Td-pre), 3 wk after commencement of the drug (Td-end) and 2 wk after dexamethasone treatment had been stopped (Td-post). In addition, 28 VLBW infants who participated in a concurrent longitudinal leptin study within the same period but did not receive corticosteroid had their serum leptin and insulin concentrations serially monitored. Blood specimens for the latter group of infants were obtained at 2 (Twk,2), 5 (Twk,5) and 7 (Twk,7) wk of postnatal age. Serum leptin and insulin at Td,end were significantly increased, whereas plasma ACTH and serum cortisol were significantly suppressed compared with the pretreatment (Td,pre) levels in the corticosteroid group (p > 0.0001 for leptin and insulin; p > 0.05 and p > 0.001 for ACTH and cortisol, respectively). In contrast, serum leptin and insulin at weeks 5 (Twk,5) and 7 (Twk,7) did not differ significantly from their respective levels at week 2 (Twk,2) in the non-treatment group. Conclusion: The administration of systemic corticosteroid resulted in significant increases in serum leptin and insulin, but marked suppression of hormones of the HPA axis. The effect of dexamethasone on the "adipoinsular" and HPA axes was transient and reversible. The adipoinsular axis in preterm infants is likely to be functional and active at an early stage of human development, and leptin may regulate energy balance in VLBW infants in the early postnatal period. Corticosteroids may, through the adipoinsular axis or its associated pathways, mediate in the regulation of body weight in preterm neonates. [source]