The Cortisol and ACTH response to Dex/CRH testing in Women with and without Perimenopausal Depression

2021 ◽  
Author(s):  
Gioia M Guerrieri ◽  
Rivka Ben Dor ◽  
Xiaobai Li ◽  
Shau-Ming Wei ◽  
Pedro E Martinez ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Rating Scales ◽  
Stressful Life Events ◽  
Urinary Free Cortisol ◽  
Group Differences ◽  
Increased Risk ◽  
Free Cortisol ◽  
And Control ◽  
Hpa Axis Activity

Abstract Background Abnormalities in the hypothalamic pituitary-adrenal (HPA) axis are frequent accompaniments of depression, and studies have documented the role of stress and stressful life events in the ontogeny of perimenopausal depressions (PMD). Since HPA axis function in women is further modulated by both aging and ovarian steroids, it is possible that a dysregulated HPA axis contributes to the increased risk of PMD. Objective We examined HPA axis function in perimenopausal women with and without depression using the combined dexamethasone-CRH (Dex/CRH) test. Methods Dex/CRH tests were performed on 20 women with PMD and 20 women who were also perimenopausal but without current or past depression (control women). Main outcome measures were plasma levels of cortisol and ACTH and 24-hour urinary free cortisol. Five women took chronic stable medications, otherwise all women were medically healthy, and both groups were comparable with respect to reproductive stage and age. Standardized symptom rating scales were administered to each woman prior to Dex/CRH testing. Results No group differences were present in either baseline or stimulated ACTH and cortisol secretion. Baseline plasma measures of estradiol, progesterone and 24-hour UFC levels similarly did not differ in PMD and control women. Discussion Despite reports of increased stress responsiveness in PMD, we observed no abnormalities of HPA axis activity associated with PMD compared with women without depression. These findings suggest that PMD is not uniformly associated with HPA dysregulation and could reflect underlying pathophysiologic processes that are distinct from women with non-reproductive-related depressions.

scholarly journals Post-surgical hypocortisolism after removal of an adrenal incidentaloma: is it predictable by an accurate endocrinological work-up before surgery?

2010 ◽  
Vol 162 (1) ◽  
pp. 91-99 ◽  
Author(s):  
Cristina Eller-Vainicher ◽  
Valentina Morelli ◽  
Antonio Stefano Salcuni ◽  
Massimo Torlontano ◽  
Francesca Coletti ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Adrenal Incidentaloma ◽  
Serum Cortisol ◽  
Urinary Free Cortisol ◽  
Tolerance Test ◽  
Surgical Removal ◽  
Acth Stimulation ◽  
Unilateral Adrenalectomy ◽  
Free Cortisol ◽  
Few Data

ObjectiveFew data are available regarding the need of steroid substitutive therapy after unilateral adrenalectomy for adrenal incidentaloma (AI). It is unknown whether, before surgery, the hypothalamic–pituitary–adrenal (HPA) axis secretion parameters can predict post-surgical hypocortisolism.AimThis study aimed to evaluate whether, in AI patients undergoing unilateral adrenalectomy, post-surgical hypocortisolism could be predicted by the parameters of HPA axis function.DesignProspective, multicenter.MethodsA total of 60 patients underwent surgical removal of AI (surgical indication: 29 subclinical hypercortisolism (SH); 31 AI dimension). Before surgery, SH was diagnosed in patients presenting at least three criteria out of urinary free cortisol (UFC) levels>60 μg/24 h, cortisol after 1-mg dexamethasone suppression test (1 mg-DST)>3.0 μg/dl, ACTH levels<10 pg/ml, midnight serum cortisol (MSC)>5.4 μg/dl.Two months after surgery, HPA axis function was assessed by low dose ACTH stimulation test or insulin tolerance test when needed: 39 patients were affected (Group B) and 21 were not affected (Group A) with hypocortisolism. The accuracy in predicting hypocortisolism of pre-surgical HPA axis parameters or their combinations was evaluated.ResultsThe presence of >2 alterations among 1 mg-DST>5.0 μg/dl, ACTH<10 pg/ml, elevated UFC and MSC has the highest odds ratio (OR) for predicting post-surgical hypocortisolism (OR 10.45, 95% confidence interval, CI 2.54–42.95, P=0.001). Post-surgical hypocortisolism was predicted with 100% probability by elevated UFC plus MSC levels, but not ruled out even in the presence of the normality of all HPA axis parameters.ConclusionPost-surgical hypocortisolism cannot be pre-surgically ruled out. A steroid substitutive therapy is indicated after unilateral adrenalectomy for SH or size of the adenoma.

Unilateral Adrenalectomy for Primary Bilateral Macronodular Adrenal Hyperplasia: Analysis of 71 Cases

2019 ◽  
Vol 128 (12) ◽  
pp. 827-834
Author(s):  
Mohammad Sheikh-Ahmad ◽  
Gabriel Dickstein ◽  
Ibrahim Matter ◽  
Carmela Shechner ◽  
Jacob Bejar ◽  
...  
Keyword(s):  
Medical Center ◽  
Urinary Free Cortisol ◽  
Adrenal Hyperplasia ◽  
Unilateral Adrenalectomy ◽  
Long Period ◽  
Pubmed Database ◽  
Free Cortisol ◽  
Adrenal Masses ◽  
Current Article

Abstract Objective Primary bilateral macronodular adrenal hyperplasia (PBMAH) is characterized by benign bilateral enlarged adrenal masses, causing Cushing’s syndrome (CS). The aim of the current article is to define the role of unilateral adrenalectomy (UA) in treating patients with CS related to PBMAH. Methods A PubMed database search was conducted to identify articles reporting UA to treat PBMAH. We also report cases of PBMAH from our medical center treated by UA. Results A total number of 71 cases of PBMAH (62 cases reported in the literature and 9 cases from our center) are presented. Most patients were women (73.2%) and most UA involved the left side (64.3%). In most cases, the resected gland was the larger one. Following UA, 94.4% of cases had remission of hypercortisolism. Recurrence rate of CS was 19.4% and hypoadrenalism occurred in 29.6%. After UA, when the size of the remained adrenal gland was equal or greater than 3.5 cm, CS persisted in 21.4% of cases, and recurrence occurred in 27.3% of cases (after 20±9.2 months). However, when the size of the remained gland was less than 3.5 cm, CS resolved in all cases and recurrence occurred in 21.2% of cases after a long period (65.6±52.1 months). High levels of urinary free cortisol (UFC) were not correlated with post-surgical CS recurrence or persistence. Conclusions UA leads to beneficial outcomes in patients with CS related to PBMAH, also in cases with pre-surgical elevated UFC or contralateral large gland.

A further exploration of the relationships between immune parameters and the HPA-axis activity in depressed patients

1991 ◽  
Vol 21 (2) ◽  
pp. 313-320 ◽  
Author(s):  
M. Maes ◽  
E. Bosmans ◽  
E. Suy ◽  
B. Minner ◽  
J. Raus
Keyword(s):  
Hpa Axis ◽  
Blast Transformation ◽  
Depressed Patients ◽  
Immune Parameters ◽  
Baseline Cortisol ◽  
Free Cortisol ◽  
Psychotic Features ◽  
Lymphocyte Responses ◽  
Hpa Axis Activity

SYNOPSISIn order to investigate the relationship between the immune apparatus and the hypothalamic–pituitary–adrenal (HPA)-axis activity in depressed patients, we measured in vitro lymphocyte responses to the mitogens Phytohaemagglutinin (PHA), Pokeweed (PWM) and Concanavalin A (Con A) and 8 a.m. baseline cortisol values in plasma, free cortisol excretion in 24 h urine (UFC), basal and post-dexamethasone βendorphin values. Major depressed patients with melancholia/psychotic features exhibited a significantly lower mitogen-induced blast transformation as compared to minor and simple major depressed patients. The lymphocyte responses to the three mitogens were significantly inversely related to baseline cortisol values and postdexamethasone β-endorphin values. The proliferative capacity of lymphocytes to stimulation with PHA and PWM was significantly and positively related to UFC excretion. Up to 45% of the variance in the immune responses to the mitogens was explained by the baseline cortisol, post-dexamethasone β-endorphin and UFC values.

scholarly journals Decreased pituitary sensitivity to glucocorticoids in endurance-trained men

2001 ◽  
pp. 363-368 ◽  
Author(s):  
M Duclos ◽  
JB Corcuff ◽  
F Pehourcq ◽  
A Tabarin
Keyword(s):  
Hpa Axis ◽  
Low Dose ◽  
Urinary Free Cortisol ◽  
Test Results ◽  
O2 Uptake ◽  
Plasma Acth ◽  
Free Cortisol ◽  
Suppression Test ◽  
Cortisol Levels ◽  
Dexamethasone Suppression

OBJECTIVE: Muscular exercise induces hypothalamo-pituitary-adrenal (HPA) axis activation and when regularly repeated, as in endurance training, leads to HPA axis adaptation. To assess whether non-professional endurance-trained (ET) men with a substantial training load and no clinical or biological features of HPA axis overactivity can present subtle alterations of HPA axis sensitivity to glucocorticoid negative feedback, nine ET men were subjected to HPA axis testing using the dexamethasone-corticotrophin-releasing hormone (CRH) test. DESIGN: Nine endurance-trained men and eight healthy age-matched sedentary men were studied. Morning plasma cortisol and 24 h urinary free cortisol (UFC) were determined and a low dose dexamethasone suppression test (LDDST) was performed followed by CRH stimulation (dexamethasone-CRH test). RESULTS: After a day without physical exercise, at 0800 h, plasma ACTH and cortisol concentrations, and the 24 h UFC and UFC/urinary creatinine (UC) ratio were similar in ET and sedentary men. By contrast, clear differences between the groups were seen in cortisol and ACTH responses to the dexamethasone-CRH test. In eight ET subjects, after LDDST, basal ACTH and cortisol levels were similar to those of sedentary men, whereas one ET subject displayed a poor suppression of cortisol level (131 nmol/l). After injection of CRH, however, three of nine ET men's cortisol levels were not suppressed by dexamethasone but instead displayed significant CRH-induced increase (peak cortisol: 88, 125 and 362 nmol/l). No sedentary subject exhibited any increase in cortisol levels. CONCLUSION: Three of nine ET men with a mean maximum rate of O2 uptake (VO2, max) of 61 ml/kg per min, running 50-70 km per week, were resistant to glucocorticoid suppression during the combined dexamethasone-CRH test.

Obstetric antiphospholipid syndrome is not associated with an increased risk of subclinical atherosclerosis

Rheumatology ◽  
2020 ◽  
Vol 59 (12) ◽  
pp. 3709-3716 ◽  
Author(s):  
Alessandra Bettiol ◽  
Giacomo Emmi ◽  
Martina Finocchi ◽  
Elena Silvestri ◽  
Maria Letizia Urban ◽  
...  
Keyword(s):  
Subclinical Atherosclerosis ◽  
Intima Media Thickness ◽  
Control Groups ◽  
Carotid Plaques ◽  
Increased Risk ◽  
Obstetric Antiphospholipid Syndrome ◽  
Obstetric Aps ◽  
Negative Controls ◽  
And Control

Abstract Objectives The persistent positivity of aPLs, either isolated or associated with thrombotic and/or obstetric events (APS), has been associated with the increase of intima-media thickness (IMT) and carotid plaques. Despite the fact that aPLs can promote both thrombotic and obstetric complications, some pathogenic differences have been documented between the two entities. This study aimed to evaluate whether the atherosclerotic risk differs between subjects with obstetric and thrombotic APS. Methods A total of 167 APS women (36 obstetric and 131 thrombotic) were compared with 250 aPLs negative controls. IMT of the common carotid artery (CCA) and of the bulb and the prevalence of carotid plaques were assessed. Results CCA- and bulb-IMT were significantly higher in women with thrombotic APS, while being similar between the obstetric APS and the controls [CCA-IMT: mean (s.d.) 0.97 (0.49), 0.78 (0.22) and 0.81 (0.12) mm for the thrombotic, obstetric and control groups, respectively, P &lt; 0.001 between thrombotic and controls, P = 0.002 between thrombotic and obstetric; bulb-IMT: mean (s.d.) 1.38 (0.79), 0.96 (0.27) and 0.96 (0.51) mm for the thrombotic, obstetric and control groups, P &lt; 0.001]. Women with thrombotic APS had significantly increased risk of presenting carotid plaques. This risk was significantly lower in obstetric APS. Conclusion Unlike thrombotic APS, obstetric APS is not associated with an increase of markers of subclinical atherosclerosis. If confirmed on wider populations, these results could suggest different pathogenetic role of aPLs in promoting atherosclerosis in vascular and obstetric APS, and raise questions on the risk–benefit profile of thromboprophylaxis in obstetric APS outside pregnancy periods.

FC13-03 - Stress, suicidal behaviour and genes

2011 ◽  
Vol 26 (S2) ◽  
pp. 1884-1884
Author(s):  
D. Wasserman ◽  
Y. Ben-Efraim ◽  
J. Wasserman ◽  
M. Sokolowski
Keyword(s):  
Hpa Axis ◽  
Suicidal Behaviors ◽  
Brain Functions ◽  
Genes And Environment ◽  
Hpa Axis Dysregulation ◽  
Systemic Stress ◽  
Suicide Behaviors ◽  
Hpa Axis Activity ◽  
Higher Brain Functions

According to a stress diathesis model, genes and environment, as well as possible interactions in-between (GxE), may result in vulnerability towards suicidal behaviors (SB), characterized by behavioral trigger endophenotypes such as increased depression-intensity and aggression/ anger/ impulsivity. Excessive stress has the potential to induce unfavorable effects in a variety of higher brain-functions, incurred as side effects to maladaptive responses in the genetically controlled stress-responsive neurosystems e.g. in the hypothalamic- pituitary-adrenal (HPA) axis. HPA-axis dysregulation is regarded as an endophenotype of depression-, anxiety- and alcohol abuse disorders, commonly found also in suicide behaviors. Various neurobiological alterations, suggesting abnormal HPA-axis activity and reactivity, have also been demonstrated to occur in suicidal behaviors incl. completed suicides. The HPA axis is a major systemic stress-modulator being mainly controlled by the regulatory corticotrophin releasing hormone receptor 1 (CRHR1) gene. An overview will be presented of the role of the HPA axis in suicidal behaviors with a focus on CRHR1 gene.

scholarly journals Serum Adiponectin Level as a Predictor of Subclinical Cushing’s Syndrome in Patients with Adrenal Incidentaloma

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Asli Dogruk Unal ◽  
Semra Ayturk ◽  
Derya Aldemir ◽  
Neslihan Bascil Tutuncu
Keyword(s):  
Cushing’S Syndrome ◽  
Adiponectin Level ◽  
Adrenal Incidentaloma ◽  
Signs And Symptoms ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Subclinical Cushing’S Syndrome ◽  
Free Cortisol ◽  
Detailed Medical History ◽  
And Control

Subclinical Cushing’s syndrome (SCS) is a condition of slight but chronic cortisol excess in patients with adrenal incidentaloma (AI) without typical signs and symptoms of Cushing’s syndrome. Adiponectin has potent roles in modulating energy balance and metabolic homeostasis and acts in opposition to glucocorticoids. This study aimed to evaluate adiponectin level in SCS and nonfunctional AI (NAI) patients and its relation with metabolic parameters. Patients with AI (n=40) and metabolically healthy controls (n=30) were included. In AI patients and controls, detailed medical history assessment, physical examinations, anthropometric measurements, and laboratory measurements were performed. Age, body mass index, waist circumference, and lipid profiles were significantly higher and waist-to-hip ratio and adiponectin level were significantly lower in the AI patients than in the controls. The midnight cortisol and urinary free cortisol levels were significantly higher in the SCS patients (n=8) than in the NAI patients (n=32). Adiponectin level of the SCS group was significantly lower than those of the NAI and control groups. The sensitivity and specificity for an adiponectin level of ≤13.00 ng/mL in predicting the presence of SCS were 87.5% and 77.4%, respectively. In conclusion, adiponectin is valuable in predicting the presence of SCS in AI patients.

scholarly journals Age Stratification in Genetic Variation of Lipoprotein Lipase in Metabolic Syndrome Javanese Ethnics of Indonesia

2019 ◽  
Vol 7 (21) ◽  
pp. 3540-3545
Author(s):  
Rosdiana Mus ◽  
Ahmad Hamim Sadewa ◽  
Pramudji Hastuti ◽  
Anggelia Puspasari ◽  
Citra Maharano ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Lipoprotein Lipase ◽  
Age Group ◽  
Gene Variation ◽  
Increased Risk ◽  
Pcr Rflp ◽  
And Control ◽  
Age Stratification ◽  
Genotype And Allele Frequencies

BACKGROUND: Metabolic syndrome (Met-S) that caused by heredity and Lipoprotein Lipase (LPL). LPL is involved in the metabolism of serum lipids. Variations in LPL alter enzyme activity, and the most common variations are LPL +495 T > G and LPL Pvu II C > T. AIM: This study aimed to identify the role of LPL +495 T > G and LPL PvuII C > T gene variations in subjects with Met-S in Javanese ethnic based on age stratification. METHODS: We recruited 160 participants of Javanese ethnicity consisting of 80 cases and 80 control subjects. Met-S was diagnosed according to the criteria of NCEP ATP III. Peripheral blood samples were collected to determine biochemical parameters. Screening for both polymorphisms was made by PCR-RFLP. RESULTS: Results found that genotype and allele frequencies for LPL +495 T > G were not significantly different between Met-S and controls with and without age stratification. In LPL PvuII C > T based on age stratification, there were significant differences between TT vs CC, recessive and dominant models in Met-S and control. In the age group > 45 years CC genotypes and TC+CC had increased risk of Met-S compared to TT genotypes. In summary, there was no significant association between LPL +495 T > G gene variation with Met-S. CONCLUSION: In LPL PvuII gene variation, TC + CC is the risk genotype of Met-S in the age group > 45 years.

Role of Ketoconazole Treatment in Urinary-Free Cortisol-to-Cortisone and Tetrahydrocortisol-to-Tetrahydrocortisone Ratios in Nonectopic Cushing's Syndrome

Endocrine ◽  
2002 ◽  
Vol 18 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Pablo Stiefel ◽  
José S García-Morillo ◽  
Luis Jimenez ◽  
Encarnación Pamies ◽  
María Luisa Miranda ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Free Cortisol

scholarly journals Interactions between the neuropeptide Y system and the hypothalamic-pituitary-adrenal axis

1999 ◽  
pp. 130-136 ◽  
Author(s):  
R Krysiak ◽  
E Obuchowicz ◽  
ZS Herman
Keyword(s):  
Neuropeptide Y ◽  
Hpa Axis ◽  
Animal Species ◽  
In Vivo Studies ◽  
Hypothalamic Pituitary Adrenal ◽  
Hpa Axis Activity ◽  
Pituitary Adrenal Axis

The aim of this paper is to review the present knowledge of interactions between the neuropeptide Y (NPY) system and the hypothalamic-pituitary-adrenal (HPA) axis. On the basis of in vitro and in vivo studies of various animal species, we review the effects of NPY on all levels of HPA axis activity. We also describe the effects of glucocorticosteroids on the NPY system in the hypothalamus, including interactions between glucocorticosteroids and insulin. On the basis of available literature, we discuss the role of these interactions in the control of food intake and in the pathogenesis of obesity.

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