Morning serum cortisol role in the adrenal insufficiency diagnosis with modern cortisol assays.

PURPOSE: To investigate the accuracy of cutoff values of the morning serum cortisol (MSC) using the cortisol stimulus test (CST) insulin tolerance test (ITT) and 250 mcg short Synacthen test (SST) as the reference standard tests, to better define its clinical role as a tool in the diagnostic investigation of adrenal insufficiency (AI) AI. METHODS: An observational study was conducted with a retrospective analysis of MSC in adult patients who had been submitted to a CST to investigate AI between January 2014 and December 2020. The normal cortisol response (NR) to stimulation was defined based on the cortisol assay. RESULTS: 371 patients underwent CST for suspected AI, 121/371 patients (32.6%) were diagnosed with AI. ROC curve analysis showed an area under the curve (AUC) for MSC of 0.75 (95% CI 0.69 - 0.80). The best MSC cutoff values to confirm AI were < 3.65, < 2.35 and < 1.5 mcg/dL with specificity of 98%, 99%, and 100%, respectively. MSC > 12.35, > 14.2 and > 14.5 mcg/dL had sensitivity of 98%, 99%, and 100%, respectively, being the best cutoff values to exclude AI. Almost 25% of patients undergoing CST for possible AI had MSC values between < 3.65 mcg/dL (6.7% of patients) and > 12.35 mcg/dL (17.5% of patients), making the formal CST testing unnecessary if we consider these cutoff values. CONCLUSION: With the most modern cortisol assays, MSC could be used as a diagnostic tool, with high accuracy to confirm or exclude AI, avoiding unnecessary CST; thus, reducing expenses and safety risks during AI investigation.

Ipilimumab-induced hypophysitis: review of the literature.

PURPOSE: Ipilimumab is a human monoclonal antibody against cytotoxic T-lymphocyte antigen 4 available as an immunotherapy mainly for advanced melanoma. It induces an activation of T cells, resulting in an immune-mediated anti-tumor response and also immune-related adverse events, including hypophysitis. The aim of this review is to identify and discuss features concerning ipilimumab-induced hypophysitis (IIH). DESIGN: A MEDLINE research of all years of publication of IIH was conducted. We gathered information regarding clinical, radiologic and laboratory features of 71 cases recorded in the literature. RESULTS: In our review, IIH was more frequent among older and male patients. Fatigue and headache were the most frequent initial clinical manifestations of IIH and enlargement of the pituitary gland at MRI was present in the majority of patients. Those who received more than 3 cycles of ipilimumab had more fatigue (p = 0.04) and arthritis (p = 0.04). Adrenal insufficiency was more prevalent in men (p = 0.007). Glucocorticoid therapy and hormone replacement were required in most patients and pituitary function recovery was uncommon. Low prolactin at diagnosis tended to predict permanent pituitary dysfunction (p = 0.07). CONCLUSION: Hypopituitarism as a consequence of IIH, if not promptly recognized, can lead to potentially fatal events, such as adrenal insufficiency. IIH can be easily managed with glucocorticoids and hormonal replacement; therefore, physicians should be familiar with the key aspects of this condition. More studies to develop screening protocols and therapeutic intervention algorithms should be performed to decrease morbidity related to IIH.

Dosagem sérica do marcador tumoral CA 15. 3 em cadelas portadoras de neoplasias mamárias pelo método de eletroquimioluminescência / Serum dosage of the tumor marker Ca 15. 3 in bitches presenting mammary neoplasia with the chemiluminescence method

The objective of the present study was to analyze the serum levels of the tumor marker Ca15.3 in healthy bitches and those with mammary neoplasms, correlating results with tumor type, clinical staging, time until presentation, and presence of ulceration and vascularization. For the study, 30 bitches with mammary tumors and 30 healthy bitches (control group) were selected. Histopathology was performed for identification of tumor type, and blood was collected for measurement of serum concentration of the marker via the chemiluminescence method using a commercial kit. A higher frequency of malignant neoplasms was observed (76.7%), with a higher quantity of carcinoma in mixed tumor (26.7%). Regarding serum concentration of the marker Ca15.3, there was no difference in serum values when comparing the means from bitches with neoplasia and healthy bitches, nor when comparing the other characteristics. The majority of results for serum concentration of Ca15.3, whether in bitches with neoplasia or in healthy bitches, was zero. It is concluded that the measurement of the marker Ca15.3 using the chemiluminescence method and commercial kits for humans did not offer significant results that would make this method or this marker a useful tool for patient monitoring and evaluation of the prognosis of bitches with mammary neoplasms.(AU)

Reproduction of Cubaris murina (Crustacea: Isopoda) under laboratory conditions and its use in ecotoxicity tests.

Reproduction of the isopod Cubaris murina was studied in the laboratory in order to observe the offspring number per brood, the number and duration of the incubation periods, and the influence of repeated mating on number of young per brood. An experiment was conducted with two different groups: female/male pairs and females that were isolated after mating. No significant difference was found between the two reproductive female groups for the mean number of young per brood (x = 25) and the duration of the incubation periods (x = 17 days). One mating was enough for at least five broods, with no reduction in brood size. There was no significant difference between the number of adult males and females. Low-density cultures had a significantly higher growth rate compared to high-density cultures. Furthermore, the experimental results for optimization isopod culture conditions for terrestrial ecotoxicity testing are reported.

Reproduction of Cubaris murina (Crustacea: Isopoda) under laboratory conditions and its use in ecotoxicity tests / Reprodução de Cubaris murina (Crustacea: Isopoda) em condições de laboratório e seu uso em testes de ecotoxicidade

Reproduction of the isopod Cubaris murina was studied in the laboratory in order to observe the offspring number per brood, the number and duration of the incubation periods, and the influence of repeated mating on number of young per brood. An experiment was conducted with two different groups: female/male pairs and females that were isolated after mating. No significant difference was found between the two reproductive female groups for the mean number of young per brood (x = 25) and the duration of the incubation periods (x = 17 days). One mating was enough for at least five broods, with no reduction in brood size. There was no significant difference between the number of adult males and females. Low-density cultures had a significantly higher growth rate compared to high-density cultures. Furthermore, the experimental results for optimization isopod culture conditions for terrestrial ecotoxicity testing are reported.

A reprodução do isópodo Cubaris murina foi investigada em laboratório para observar: o número de filhotes por ninhada, número e duração dos períodos de incubação, e se repetidas cópulas influenciam o número de juvenis por ninhada. Um experimento foi conduzido com dois diferentes grupos: pares com uma fêmea e um macho e fêmeas mantidas individualmente depois da cópula. Não foram encontradas diferenças estatisticamente significantes entre os dois grupos de fêmeas em relação ao número de filhotes por ninhada (x = 25) e a duração dos períodos de incubação (x = 17 dias). Uma cópula foi suficiente para ao menos cinco ninhadas, sem redução em seu tamanho. A proporção sexual dos adultos de C. murina em laboratório não apresentou diferenças significativas entre a proporção de machos e fêmeas nos cultivos. A densidade influencia o crescimento dos isópodos de forma significativa: culturas com baixa densidade têm maior taxa de crescimento do que culturas com alta densidade. Os resultados experimentais sobre a eficiência dos cultivos em laboratório para ensaios ecotoxicológicos terrestres são apresentados.