Comparison of hematological parameters between single and twin pregnancies in Dorper ewes during gestation, lambing, and postpartum

ABSTRACT: The hematopoietic system changes during the pregnancy to carry fetal development and maternal needs. This study compared the hematological parameters between ewes with single and twin pregnancies during gestation, delivery, and postpartum. The experiment was conducted on 60 healthy pregnant Dorper ewes that were divided into two experimental groups: Group 1 (G1), with single pregnancies (n=30), and Group 2 (G2), with twin pregnancies (n=30). Blood samples were collected from all ewes at different times: immediately before fixed-time artificial insemination (AI); on day 30, 90, 120, 130, and 140 of pregnancy; immediately after delivery; and at 24h and 48h postpartum. Statistical analysis compared the two groups at different times (P<0.05). Mild, normocytic, and hypochromic anemia was detected in all ewes from AI time and throughout pregnancy from both groups, but did not prove to be of clinical relevance. In the peripartum stage (from the 140th day of pregnancy to 48h postpartum), the ewes with twin pregnancies (G2) exhibited higher erythrogram values and neutrophil:lymphocyte ratio than did ewes with single pregnancies (G1). This indicated a greater hematopoietic adaptation in the body during the development of two fetuses. Except for the eosinophil numbers, all leukogram parameters were influenced by pregnancy in a similar way in both groups, and was characterized mainly by leukocytosis with neutrophilia during peripartum due to the high presence of endogenous cortisol at delivery. Thus, these findings showed that pregnancy was a stressful physiological event that increased the leukocyte count with a slight alteration in the erythrogram of Dorper ewes.

111 The Systemic Effects of Intra-Articular Steroid Injections- Should COVID-19 Change Our Practice?

Aim The COVID-19 pandemic prompted us to review and often suspend services, while patients continue to suffer with painful musculoskeletal conditions. The diagnostic and therapeutic value of intra-articular corticosteroid injections (IACSI) cannot be denied. Current BOA guidelines advise giving the lowest effective dose for inflammatory arthritis and limit use in osteoarthritis to patients with high levels of pain and disability. We aimed to evaluate the literature pertaining to the use of IACSI and the potential systemic immunosuppressive effects. Method We searched Medline, using the terms “systemic effects of intra-articular steroid” and “clinical course of Coronavirus infection in patients with steroid use”, between 1997 and 2020. Results No studies specifically looked at the systemic effects of intra-articular steroids in the presence of COVID-19 infection; however, four studies were identified which concluded that intra-articular steroid injections resulted in sufficient systemic absorption to cause suppression of the hypothalamic-pituitary-adrenal axis and endogenous cortisol production. These effects are dose dependent and are more common in patients with inflammatory joint diseases. A further four RCT’s, including one systematic review, showed that suppressed cortisol concentration was associated with a significant increase in mortality. Conclusions There is a lack of evidence in relation to the use of intra-articular steroids in COVID-19. However, evidence suggests that intra-articular steroids can result in systemic absorption and suppression of endogenous cortisol production thus increasing the potential risk of complications of COVID-19. We therefore support cautious use of low dose steroid injections in patients with inflammatory arthritis, where no alternative treatment is available.

Adrenal Cushing syndrome in a patient with corticosteroid-treated asthma and worsening diabetes mellitus

A 55-year-old woman with poor diabetic control and a long history of corticosteroid-treated asthma was admitted. Hypertension and dyslipidaemia developed 9 and 6 years ago, respectively, and both were poorly controlled. Three years ago, her asthma control improved, and oral/intravenous steroids were switched to inhalers. Around this time, she was diagnosed as diabetes mellitus and heavily treated with insulin and other drugs thereafter. Physical examination showed central obesity, moon face appearance, abdominal striae and purpura. Endocrinological examination revealed suppressed adrenocorticotropic hormone, but unsuppressed endogenous cortisol levels. Right adrenal mass with isotope uptake revealed by CT scan and 131I-adosterol scintigraphy was compatible with cortisol-producing adenoma, leading to the diagnosis of adrenal Cushing syndrome. A history of corticosteroid usage sometimes prevents us from the timely detection of endogenous cortisol excess. Our current case tells us a lesson of the importance of suspecting non-iatrogenic causes of Cushing syndrome even in patients heavily treated with corticosteroids.

Evaluation of Hormone-Induced Stress Responses Using Endogenous Cortisol in Carp (Cyprinus carpio)

With stress studies in fish it is often difficult to determine the degree of response to various stressors, and the interpretation of this influence is usually based on an increase in endogenous cortisol levels. Simulation of stress with synthetic corticosteroids is widely used in ichthyological practice, which raises the question of whether endogenous cortisol is the most appropriate parameter for measuring stress levels in such studies. This work presents the dynamics of the plasma cortisol level in simulating acute and chronic stress in 24 carps by a single injection of dexamethasone in the first experimental group and betamethasone in the second experimental group, in comparison with the control group (without injection) for 21 days. The analysis was performed before injection, as well as after 7, 14 and 21 days of treatment. The hormonal response was compared with that of fish stressed by natural factors (hypoxia). It was found that betamethasone inactivates the production of endogenous cortisol during all subsequent days of the experiment after injection from 353.68±66.39 ng/ml to 7.28±1.27 ng/ml by day 21, while the effect of dexamethasone caused multidirectional fluctuations in its level: from 346.25±43.16 ng/ml to 242.25±58.49 ng/ml on the 7th day, 388.25±37.51 ng/ml on the 14th day and 264.25±21.21 ng/ml on day 21 compared with smooth dynamics in control fish: 376.25±44.04 ng/ml, 366.75±42.82 ng/ml, 335.33±8.57 ng/ml and 366.00±89.22 ng/ml, respectively. It was concluded that measuring the level of endogenous cortisol is not recommended when assessing the degree of stress imitation by these hormones, and in studies of this type it is necessary to search for other indicators. Keywords: carp, cortisol, stress, dexamethasone, betamethasone, hormone

Rationale and design of the cardiovascular status in patients with endogenous cortisol excess study (CV-CORT-EX): a prospective non-interventional follow-up study

Background Endogenous Cushing’s syndrome (CS) results in increased cardiovascular (CV) morbidity and mortality. So far, most studies focussed on distinct disease entities rather than the integrity of the CV system. We here describe the design of the Cardiovascular Status in Endogenous Cortisol Excess Study (CV-CORT-EX), a study aiming to comprehensively investigate the health status of patients with endogenous CS (with a particular focus on CV phenotypes, biochemical aspects, quality of life, and psychosocial status). Method A prospective non-interventional cohort study performed at a German tertiary referral centre. At the time of enrolment, patients will be categorised as: (1) newly diagnosed overt CS, (2) recurrent overt CS, (3) CS in remission, (4) presence of mild autonomous cortisol excess (MACE). The target cohorts will be n = 40 (groups 1 + 2), n = 80 (group 3), and n = 20 (group 4). Patients with overt CS at the time of enrolment will be followed for 12 months after remission (with re-evaluations after 6 and 12 months). At each visit, patients will undergo transthoracic echocardiography, cardiac magnetic resonance imaging, 24-h electrocardiogram, 24-h blood pressure measurement, and indirect evaluation of endothelial function. Furthermore, a standardised clinical investigation, an extensive biochemical workup, and a detailed assessment of quality of life and psychosocial status will be applied. Study results (e.g. cardiac morphology and function according to transthoracic echocardiography and cardiac magnetic resonance imaging; e.g. prevalence of CV risk factors) from patients with CS will be compared with matched controls without CS derived from two German population-based studies. Discussion CV-CORT-EX is designed to provide a comprehensive overview of the health status of patients with endogenous CS, mainly focussing on CV aspects, and the holistic changes following remission. Trail registration ClinicalTrials.gov (https://clinicaltrials.gov/) NCT03880513, registration date: 19 March 2019 (retrospectively registered). Protocol Date: 28 March 2014, Version 2.

High Prevalence of Adrenal Remnant Tissue in Patients Undergoing Bilateral Adrenalectomy for Cushing’s Disease

Bilateral adrenalectomy (BLA) is a treatment option for patients with Cushing’s Disease (CD) if transsphenoidal pituitary surgery fails or is not a therapeutic option. For most patients, BLA eliminates endogenous glucocorticoid and mineralocorticoid production, but for a small number of patients, endogenous secretion of adrenal hormones from adrenal tissue continues or recurs, leading to signs and symptoms of hypercortisolism. If adrenal tissue is confined to the adrenal bed, it is considered adrenal remnant tissue, while if it is outside the adrenal bed, it is considered adrenal rest tissue. We retrospectively evaluated morning serum cortisol, nighttime serum cortisol, nighttime salivary cortisol, and 24-h urine free cortisol on at least three occasions in 10 patients suspected of having endogenous cortisol production. Imaging of adrenal remnant tissue was also reviewed. Ten of 51 patients who underwent BLA during this time period had adrenal remnant/rest tissue marked by detectable endogenous glucocorticoid production; 9 of the 10 patients had signs and symptoms of hypercortisolism. Localization and treatment proved difficult. We conclude that the incidence of adrenal remnant/rest tissue in those undergoing BLA following unsuccessful pituitary surgery was 12% although there may have been a selection bias affecting this prevalence. The first indication of remnant tissue occurrence is a reduction in glucocorticoid replacement with symptoms of hypercortisolism. If this occurs, endogenous cortisol production should be tested for by cortisol measurements using a highly specific cortisol assay while the patient is taking dexamethasone or no glucocorticoid replacement. Endocrinologists need to monitor the development of both adrenal remnant tissue and Nelson’s syndrome following BLA.