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1.
AJR Am J Roentgenol ; 214(4): 800-807, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32069079

RESUMO

OBJECTIVE. Adrenal incidentalomas occur in 5% of adults and can produce autonomous cortisol secretion that increases the risk of metabolic syndrome and cardiovascular disease. The objective of our study was to evaluate the relationship between adrenal nodule size measured on CT and autonomous cortisol secretion. SUBJECTS AND METHODS. In a prospective study of 73 patients 22-87 years old with incidentalomas, unilateral in 52 patients and bilateral in 21 patients, we measured maximum nodule diameter on CT and serum cortisol levels at 8:00 am, 60 minutes after the adrenocorticotropic hormone stimulation test, and after the dexamethasone suppression test. We also studied 34 age-, sex-, and body mass index-matched control subjects. Statistics used were Spearman correlation coefficients, t tests, ANOVA test, and multivariate analysis. RESULTS. The mean maximum diameter of unilateral nodules measured on CT was larger on the right (2.47 ± 0.98 [SD] cm) than on the left (2.04 ± 0.86 cm) (p = 0.01). In the bilateral cases, the mean diameter of the right nodules was 2.69 ± 0.93 cm compared with 2.13 ± 0.89 cm on the left (p = 0.06). Mean baseline serum cortisol level was significantly higher in the patients with incidentalomas (bilateral, 13.1 ± 4.5 mcg/dL [p < 0.001]; unilateral, 9.7 ± 3.2 mcg/dL [p = 0.019]) than in the control subjects (7.5 ± 3.6 mcg/dL). After dexamethasone suppression test, serum cortisol levels were suppressed to less than 1.8 mcg/dL in 100% of control subjects, 33% of patients with bilateral incidentalomas, and 62% of patients with unilateral incidentalomas (p < 0.001). There were significant correlations between maximum nodule diameter on CT and serum cortisol levels after the dexamethasone suppression test (ρ = 0.500; p < 0.001) and at baseline (ρ = 0.373; p = 0.003). CONCLUSION. Increasing size of adrenal nodules is associated with more severe hyper-cortisolism and less dexamethasone suppression; these cases need further evaluation and possibly surgery because of increased risks of metabolic syndrome and cardiovascular mortality.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias das Glândulas Suprarrenais/patologia , Hormônio Adrenocorticotrópico/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Feminino , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
2.
Eur J Endocrinol ; 182(2): R15-R27, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31995340

RESUMO

Glucocorticoids (GC) such as cortisol regulate multiple physiological functions, notably those involved in development, metabolism, inflammatory processes and stress, and exert their effects upon binding to the glucocorticoid receptor (GR, encoded by NR3C1 gene in humans). GC signaling follows several consecutive steps leading to target gene transactivation, including ligand binding, nuclear translocation of ligand-activated GR complexes, DNA binding, and recruitment of functional transcriptional machinery. Generalized glucocorticoid resistance syndrome, due to GR loss-of-function mutations, may be related to the impairment of one of the GC signaling steps. To date, 31 NR3C1 loss-of-function mutations have been reported in patients presenting with various clinical signs such as hypertension, adrenal hyperplasia, hirsutism or metabolic disorders associated with biological hypercortisolism but without Cushing syndrome signs and no negative regulatory feedback loop on the hypothalamic-pituitary-adrenal axis. Functional characterization of GR loss-of-function mutations often demonstrates GR haploinsufficiency and a decrease of GR target gene induction in relevant cell types. The main signs at presentation are very variable from resistant hypertension, bilateral adrenal hyperplasia likely related to increased ACTH levels but not exclusively, hirsutism to isolated renin-angiotensin-aldosterone system abnormalities in a context of 11ßHSD2 deficiency. Some mutated GR patients are obese or overweight together with a healthier metabolic profile that remains to be further explored in future studies. Deciphering the molecular mechanisms altered by GR mutations should enhance our knowledge on GR signaling and ultimately facilitate management of GC-resistant patients. This review also focuses on the criteria facilitating identification of novel NR3C1 mutations in selected patients.


Assuntos
Erros Inatos do Metabolismo/diagnóstico , Erros Inatos do Metabolismo/genética , Receptores de Glucocorticoides/deficiência , Hormônio Adrenocorticotrópico/sangue , Hormônio Adrenocorticotrópico/genética , Glucocorticoides/sangue , Glucocorticoides/genética , Humanos , Hidrocortisona/sangue , Hidrocortisona/genética , Erros Inatos do Metabolismo/sangue , Receptores de Glucocorticoides/sangue , Receptores de Glucocorticoides/genética
3.
Metabolism ; 104: 154050, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31863780

RESUMO

BACKGROUND AND OBJECTIVES: Cushing's disease (CD) patients have metabolic abnormalities in the brain caused by excessive exposure to endogenous cortisol. However, the reversibility of brain metabolism of CD patients after treatment remains largely unknown. METHODS: This study recruited 50 CD patients seeking treatment and 34 matched normal controls (NCs). The patients were treated with Transsphenoidal Adenomectomy (TSA) and reexamined 3 months later. Cerebral blood flow (CBF) of the patients was assessed using 3D pseudo-continuous arterial spin labelling (PCASL) imaging before the treatment and at the 3-month follow-up and were compared with CBF measure of the NCs using a whole-brain voxelwise group comparison method. For remitted patients, their CBF measures and hormone level measures, including adrenocorticotropic hormone (ACTH), 24-hour urinary free cortisol (24hUFC) and serum cortisol, were compared before and after the treatment. Finally, a correlation analysis was carried out to explore the relationship between changes of CBF and hormone level measures of the remitted CD patients. RESULTS: After the treatment, 45 patients reached remission. Compared with the NCs, the CD patients before the treatment exhibited significantly reduced CBF in cortical regions, including occipital lobe, parietal lobe, superior/middle/inferior temporal gyrus, superior/middle/inferior frontal gyrus, orbitofrontal cortex, precentral gyrus, middle/posterior cingulate gyrus, and rolandic operculum, as well as significantly increased CBF in subcortical structures, including caudate, pallidum, putamen, limbic lobe, parahippocampal gyrus, hippocampus, thalamus, and amygdala (p < 0.01, false discovery rate corrected). For the remitted patients, the change in CBF before and after the treatment displayed a spatial pattern similar to the difference between the NCs and the CD patients before the treatment, and no significant difference in CBF was observed between the NCs and the remitted CD patients after the treatment. The changes of 24hUFC were significantly correlated with the changes of averaged CBF within the subcortical region in the remitted patients (p = 0.01). CONCLUSIONS: Our findings demonstrate that the brain metabolic abnormalities of CD patients are reversible when their hormone level changes towards normal after surgery treatment.


Assuntos
Circulação Cerebrovascular , Procedimentos Neurocirúrgicos/métodos , Hipersecreção Hipofisária de ACTH/fisiopatologia , Hipersecreção Hipofisária de ACTH/cirurgia , Hormônio Adrenocorticotrópico/sangue , Adulto , Encéfalo/metabolismo , Feminino , Humanos , Hidrocortisona/sangue , Hidrocortisona/urina , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Hipersecreção Hipofisária de ACTH/diagnóstico por imagem , Marcadores de Spin , Resultado do Tratamento , Adulto Jovem
6.
J Vet Diagn Invest ; 31(6): 856-858, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31646941

RESUMO

We investigated the stability of adrenocorticotropic hormone (ACTH) in plasma after freezing for different lengths of time. The plasma ACTH concentrations of 12 horses were measured on day 0 (baseline) and over time, after stimulation with thyrotropin-releasing hormone. Samples were stored at -80°C for 3, 7, 30, 60, and 90 d, or at -20°C for 3, 7, 30, and 60 d, or between ice packs at -20°C for 3 and 7 d prior to determination of ACTH concentration. ACTH concentrations were compared to baseline (non-frozen day 0 plasma) for each storage method using a mixed model with repeated measures in which each horse served as its own control and day was the repeated effect. Statistical significance was set at p ≤ 0.05, and 0.05 < p < 0.10 was considered a trend. Plasma ACTH frozen at -20°C or at -80°C resulted in degradation of ACTH compared to baseline samples at 60 and 90 d respectively. There was no degradation of ACTH after 7 d when stored between ice packs, or before 30 d at -20°C, or before 60 d at -80°C.


Assuntos
Hormônio Adrenocorticotrópico/sangue , Criopreservação/veterinária , Congelamento , Cavalos/sangue , Hormônio Adrenocorticotrópico/química , Animais , Feminino , Masculino , Fatores de Tempo
8.
Vet J ; 252: 105343, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31554584

RESUMO

Hyperadrenocorticism is a relatively common endocrine disorder in dogs that has been extensively described. However, its diagnosis remains challenging because there is no true reference standard test, and a myriad factors can affect the diagnostic performance of the commonly used adrenal function tests. Ultimately, the diagnosis is based on a combination of signalment, history and clinical findings, and a variety of diagnostic test results. The second part of this review aims to appraise available data on diagnostic performance of adrenal function tests in naturally occurring canine hyperadrenocorticism.


Assuntos
Testes de Função do Córtex Suprarrenal/veterinária , Hiperfunção Adrenocortical/veterinária , Hormônio Adrenocorticotrópico/sangue , Doenças do Cão/diagnóstico , Hiperfunção Adrenocortical/diagnóstico , Animais , Doenças do Cão/sangue , Cães
9.
J Vet Intern Med ; 33(5): 2249-2256, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31498947

RESUMO

BACKGROUND: The thyrotropin-releasing hormone (TRH) stimulation test and the 2-step insulin sensitivity test are commonly used methods to diagnose, respectively, pituitary pars intermedia dysfunction (PPID) and insulin dysregulation (ID). OBJECTIVES: To investigate the diagnostic value of combining the TRH stimulation test and the 2-step insulin sensitivity test to diagnose PPID and ID simultaneously. ANIMALS: Twenty-seven adult horses, 10 control horses without PPID or ID, 5 horses with PPID only, 5 horses with ID only, and 7 horses with PPID and ID. METHODS: Randomized prospective study. Horses underwent a TRH stimulation test alone, a 2-step insulin sensitivity test alone, and combined testing with simultaneous TRH and insulin injection in the same syringe. Data were compared by 2-way repeated measures analysis of variance and 2 1-sided tests to demonstrate equivalence. Bland-Altman plots were generated to visualize agreement between combined and independent testing. RESULTS: The effect of combined testing on plasma adrenocorticotropic hormone, blood glucose concentration, or percentage decrease in blood glucose concentration was not significantly different from the effect obtained with independent testing. One control horse appeared falsely positive for PPID, 2 PPID-only horses appeared falsely positive for ID, and 1 PPID and ID horse appeared falsely negative for ID when tests were performed simultaneously. Bland-Altman plots supported the agreement between combined and independent testing. CONCLUSIONS AND CLINICAL IMPORTANCE: Combining the TRH stimulation test and the 2-step insulin sensitivity test appears to be a useful diagnostic tool for equine practitioners in the field, allowing testing of a horse for both PPID and ID simultaneously.


Assuntos
Hormônio Adrenocorticotrópico/sangue , Doenças dos Cavalos/diagnóstico , Resistência à Insulina , Doenças da Hipófise/veterinária , Animais , Glicemia , Feminino , Doenças dos Cavalos/sangue , Doenças dos Cavalos/metabolismo , Cavalos , Masculino , Doenças da Hipófise/sangue , Doenças da Hipófise/diagnóstico , Adeno-Hipófise Parte Intermédia/patologia , Estudos Prospectivos , Distribuição Aleatória , Hormônio Liberador de Tireotropina/administração & dosagem , Hormônio Liberador de Tireotropina/farmacologia
10.
J Vet Intern Med ; 33(5): 2257-2266, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31512777

RESUMO

BACKGROUND: Plasma adrenocorticotropic hormone (ACTH) and serum cortisol concentrations increase with illness-associated stress. Dynamics of plasma ACTH and serum cortisol concentrations in adult horses with systemic illness are undocumented. HYPOTHESIS/OBJECTIVE: To determine whether ACTH and cortisol concentrations and the ACTH/cortisol ratio vary with survival, the presence of systemic inflammatory response syndrome (SIRS), or ischemic gastrointestinal lesions at admission, or throughout hospitalization. ANIMALS: One hundred fifty-one adult horses. METHODS: Prospective study measuring serum cortisol and plasma ACTH at admission and on days 2, 4, and 6 of hospitalization. Horses were grouped by outcome (survival, SIRS status, number of SIRS criteria [SIRS score], SIRS severity group, and the presence of an ischemic lesion). Differences between groups and over time for ACTH, cortisol, and ACTH/cortisol ratio were investigated with a mixed effect model. Receiving operator characteristic curves and odds ratios were calculated for survival and ischemia. RESULTS: In all groups, ACTH, cortisol, and ACTH/cortisol ratio significantly decreased over time (P < .0001). ACTH, cortisol, and ACTH/cortisol ratio were higher at admission in nonsurvivors, and ACTH and cortisol were higher in horses with ischemic lesions (P < .01). Horses with ACTH above reference interval at admission were 6.10 (2.73-13.68 [95% confidence interval]) times less likely to survive (P < .0001). No significant difference in ACTH, cortisol, and ACTH/cortisol ratio between horses with different SIRS status, scores, or groups were detected, although nonsurvivors had a higher SIRS score (P < .0001). CONCLUSIONS AND CLINICAL IMPORTANCE: Pituitary and adrenal responses are altered in nonsurviving horses and those with an ischemic gastrointestinal lesion.


Assuntos
Gastroenteropatias/veterinária , Doenças dos Cavalos/sangue , Isquemia/veterinária , Síndrome de Resposta Inflamatória Sistêmica/veterinária , Hormônio Adrenocorticotrópico/sangue , Animais , Feminino , Gastroenteropatias/sangue , Cavalos , Hidrocortisona/sangue , Isquemia/sangue , Masculino , Estudos Prospectivos , Análise de Sobrevida , Síndrome de Resposta Inflamatória Sistêmica/sangue
11.
Comput Methods Programs Biomed ; 178: 59-75, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31416563

RESUMO

BACKGROUND AND OBJECTIVE: In this study, a presentation is made for the automatic control of the hypothalamus-pituitary-adrenal axis which plays an important role in the immune stress responses and the circadian rhythms of mammalian organisms. METHODS: Control approaches are implemented on a novel second order nonlinear system which accepts adrenocorticotropin hormone as an input and models the variation of plasma concentrations of adrenocorticotropin and cortisol respectively. The control methods are based on back-stepping and input-output feedback linearization techniques. The controllers adjust the adrenocorticotropin injection to maintain the daily rhythm of the cortisol concentration. In accordance with the periodicity of biological clock mechanism, we provide a sinusoidally varying cortisol reference to the controllers. RESULTS: Numerical simulations are performed (on MATLAB) to demonstrate the closed loop performance of the controllers. Major concerns in the selection of the control gains are chattering and negative concentration in responses. The simulation results showed that one can successfully find gain levels which do not lead to those issues. However, the gains lie in different ranges for back-stepping and feedback linearization based controllers. CONCLUSION: The results showed that, both back-stepping and feedback linearization based controllers fulfilled their duty of synchronization of the cortisol concentration to a reference daily periodic rhythm. In addition to that, the risk of negative valued adrenocorticotropin injection can be eliminated by properly choosing the controller gains.


Assuntos
Hormônio Adrenocorticotrópico/sangue , Hidrocortisona/sangue , Sistema Hipotálamo-Hipofisário/fisiologia , Sistema Hipófise-Suprarrenal/fisiologia , Algoritmos , Relógios Biológicos , Simulação por Computador , Síndrome de Cushing/sangue , Humanos , Modelos Teóricos
12.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439558

RESUMO

The increased use of immune checkpoint inhibitors (ICIs) has led to the observation of a variety of immune-related adverse events (irAEs). These irAEs occur usually within the first months after ICIs onset and can involve theorically all organs. We describe two rare irAEs occurring in a 70-year-old caucasian man who was treated with nivolumab for an advanced urothelial cancer of the left kidney. He developed an isolated adrenocorticotropic hormone deficiency that was diagnosed at week 19 and a neurological complication that appeared at week 79 and initially confounded with a lumbar spinal stenosis. Diagnosis of Guillain-Barré syndrome was finally confirmed with the complete resolution of symptoms after 5 days of intravenous immunoglobulin and corticosteroids. We highlight the importance of quickly recognising these potential life-threatening irAEs such as cortisol insufficiency and neurologic adverse events whose initially presentation could be non-specific.


Assuntos
Hormônio Adrenocorticotrópico/deficiência , Antineoplásicos Imunológicos/efeitos adversos , Doenças do Sistema Endócrino/diagnóstico , Doenças Genéticas Inatas/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Hipoglicemia/diagnóstico , Nivolumabe/efeitos adversos , Hormônio Adrenocorticotrópico/sangue , Idoso , Diagnóstico Diferencial , Doenças do Sistema Endócrino/sangue , Doenças do Sistema Endócrino/induzido quimicamente , Doenças Genéticas Inatas/sangue , Doenças Genéticas Inatas/induzido quimicamente , Síndrome de Guillain-Barré/induzido quimicamente , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Masculino , Neoplasias Uretrais/tratamento farmacológico , Neoplasias Uretrais/cirurgia
13.
Int J Hyperthermia ; 36(1): 905-914, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31466482

RESUMO

Objective: To investigate the feasibility and efficacy of localized, subtotal, cortical-sparing microwave thermal ablation (MTA) as a potential curative management for primary aldosteronism. The study investigated with equal importance the selected ablation of small volumes of adrenal cortex while sparing adjacent cortex. Method: An in-vivo study was carried out in swine (n = 8) where MTA was applied under direct visualization, to the adrenal glands at 45 W or 70 W for 60 s, using a lateral, side-firing probe and a non-penetrative approach. Animals were survived for 48 h post-procedurally. Animals were investigated for markers of histological, immunohistochemical and biochemical evidence of adrenal function and adrenal damage by assessing samples drawn intra-operatively and at the time of euthanasia. Results: Selected MTA (70 W for 60 s) successfully ablated small adrenocortical volumes (∼0.8 cm3) characterized by coagulative necrosis and abnormal expression of functional markers (CYP11B1 and CYP17). Non-ablated, adjacent cortex was not affected and preserved normal expression of functional markers, without increased expression of markers of heat damage (HSP-70 and HMGB-1). Limited adrenal medullary damage was demonstrated histologically, clinically and biochemically. Conclusion: MTA offers potential as an efficient methodology for delivering targeted subtotal cortical-sparing adrenal ablation. Image-guided targeted MTA may also represent a safe future modality for curative management of PA, in the setting of both unilateral and bilateral disease.


Assuntos
Técnicas de Ablação , Hiperaldosteronismo/terapia , Hipertermia Induzida , Micro-Ondas/uso terapêutico , Córtex Suprarrenal/cirurgia , Hormônio Adrenocorticotrópico/sangue , Aldosterona/sangue , Animais , Hidrocortisona/sangue , Hiperaldosteronismo/sangue , Masculino , Metanefrina/sangue , Normetanefrina/sangue , Suínos
14.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466960

RESUMO

Cancer immunotherapy has been used in several malignancies with clinical benefit. Despite the clinical success, immune-related adverse events are frequent and endocrinopathies can be particularly severe. We report a 55-year-old male patient with stage IV pulmonary carcinoma treated with nivolumab who presented with thyroid dysfunction after the sixth administration of the drug. One year after thyroid dysfunction, the patient complained of severe fatigue, asthenia and weight loss. Laboratory testing showed low morning cortisol with undetected adrenocorticotropic hormone; other pituitary hormones were normal and MRI showed homogeneous enhancement of the pituitary gland and no space-occupying lesions. The diagnosis of nivolumab-induced hypophysitis was made and replacement treatment with hydrocortisone was started with clinical improvement. This case demonstrates that patients under immunotherapy are at risk for a large spectrum of endocrine dysfunctions that may worsen their prognosis. Close monitoring of these patients is warranted.


Assuntos
Hormônio Adrenocorticotrópico/deficiência , Antineoplásicos Imunológicos/efeitos adversos , Doenças do Sistema Endócrino/etiologia , Doenças Genéticas Inatas/etiologia , Hipoglicemia/etiologia , Hipotireoidismo/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Nivolumabe/efeitos adversos , Hormônio Adrenocorticotrópico/sangue , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Carcinoma , Doenças do Sistema Endócrino/sangue , Doenças do Sistema Endócrino/diagnóstico , Doenças Genéticas Inatas/sangue , Doenças Genéticas Inatas/diagnóstico , Humanos , Hidrocortisona/administração & dosagem , Hidrocortisona/uso terapêutico , Hipoglicemia/sangue , Hipoglicemia/diagnóstico , Hipofisite/induzido quimicamente , Hipofisite/diagnóstico por imagem , Hipofisite/tratamento farmacológico , Hipotireoidismo/complicações , Neoplasias Pulmonares/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Nivolumabe/uso terapêutico , Resultado do Tratamento
15.
J Vet Intern Med ; 33(5): 2272-2279, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31432575

RESUMO

BACKGROUND: The use of parallel dynamic tests to identify insulin dysregulation (ID) and pituitary pars intermedia dysfunction (PPID) in horses could have better diagnostic utility than measuring baseline hormone concentrations, if the tests do not alter diagnostic interpretation of one another. HYPOTHESIS: Performing a thyrotropin-releasing hormone (TRH) stimulation test before an oral sugar test (OST) would not affect results of OST. ANIMALS: Twenty-six healthy university-owned horses. METHODS: A prospective randomized placebo-controlled, crossover design was used to evaluate 3 OST protocols: OST alone, TRH followed by OST (TRH + OST), and placebo followed by OST (placebo + OST). Agreement for plasma insulin concentrations and diagnostic interpretation were assessed with Bland-Altman and logistic regression analyses, respectively. RESULTS: Bland-Altman analysis of TRH + OST versus OST alone showed good agreement between testing protocols, with bias ± SD for insulin concentrations at baseline 0.4 ± 4.7 µIU/mL (95% limits of agreement [LOA], -8.8 to 9.7), 60 minute -0.5 ± 22.6 µIU/mL (95% LOA, -44.7 to 43.8), and 90 minute 1.9 ± 20.6 µIU/mL (95% LOA, -38.5 to 42.4) after OST, similar to placebo + OST versus OST alone. Diagnostic interpretation (positive/negative) was not different between protocols (TRH + OST versus OST alone [P = .78], placebo + OST versus OST alone [P = .77], or TRH + OST versus placebo + OST [P = .57]). CONCLUSIONS AND CLINICAL IMPORTANCE: Concurrent testing for PPID and ID with a TRH stimulation test before an OST is an acceptable diagnostic tool for investigation of endocrinopathies in horses and allows accurate testing to be performed efficiently in 1 visit.


Assuntos
Teste de Tolerância a Glucose/veterinária , Cavalos/sangue , Insulina/sangue , Hormônio Liberador de Tireotropina/farmacologia , Hormônio Adrenocorticotrópico/sangue , Animais , Estudos Cross-Over , Feminino , Cavalos/metabolismo , Masculino , Adeno-Hipófise Parte Intermédia/fisiologia , Estudos Prospectivos , Distribuição Aleatória
16.
J Surg Res ; 244: 444-455, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31326711

RESUMO

BACKGROUND: Current perioperative patient care aims to maintain homeostasis by attenuation of the stress response to surgery, as a more vigorous stress response can have detrimental effects on postoperative recovery. This systematic review and meta-analysis aims to assess the effect of perioperative music on the physiological stress response to surgery. METHODS: The Embase, Medline Ovid, Cochrane Central, Web of Science, and Google Scholar databases were searched from inception date until February 5, 2019, using a systematic literature search following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines for randomized controlled trials investigating the effect of music before, during, and/or after surgery in adult surgical patients on the stress response to surgery. Meta-analysis was performed using a random effects model and pooled standardized mean differences were calculated with 95% confidence intervals. This study was registered in the PROSPERO database (CRD42018097060). RESULTS: The literature search identified 1076 articles. Eighteen studies (1301 patients) were included in the systematic review, of which eight were included in the meta-analysis. Perioperative music attenuated the neuroendocrine cortisol stress response to surgery (pooled standardized mean difference -0.30, [95% confidence interval -0.53 to -0.07], P = 0.01, I2 = 0). CONCLUSIONS: Perioperative music can attenuate the neuroendocrine stress response to surgery.


Assuntos
Música , Assistência Perioperatória , Estresse Psicológico/prevenção & controle , Procedimentos Cirúrgicos Operatórios/psicologia , Hormônio Adrenocorticotrópico/sangue , Viés , Humanos , Hidrocortisona/sangue
17.
Drug Des Devel Ther ; 13: 2127-2134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31308626

RESUMO

Purpose: Episodes of acute emotional or physical stress can have significant adverse effects on the hippocampus. Ginsenoside Rb1, the most predominant ginsenoside present in Panax species, has been reported to show a neuroprotective effect. The purpose of this study was to investigate the influence of ginsenoside Rb1 on plasma corticosterone (CORT) and adrenocorticotropic hormone (ACTH) levels and hippocampal brain-derived neurotrophic factor (BDNF) and tyrosine kinase B (TrkB) levels in rats subjected to acute immobilization stress. Methods: Wistar rats were divided into controls treated with saline only (N), rats exposed to stress only (M), and rats pretreated with Rb1 (40 mg.kg (-1)) thirty minutes prior to stress exposure (R). In the model, animals were restrained in a plastic immobilizer for 2 h of acute immobilization stress at room temperature. ELISA was used to determine plasma levels of CORT and ACTH. The effect of Rb1 pretreatment on the expression of BDNF and TrkB was determined by immunofluorescence, real-time PCR, and Western blotting analysis. Results: The R group showed significantly increased plasma CORT and ACTH levels compared to the N and M groups. Acute stress stimulation suppressed BDNF and TrkB protein and mRNA expression in the hippocampus; otherwise, Rb1 pretreatment reversed the decreases. Conclusion: The results from this study demonstrate that Rb1 pretreatment reverses the decreases in hippocampal BDNF/TrkB and increases the plasma levels of CORT and ACTH, indicating a potential neuroprotective effect of Rb1 against acute stress.


Assuntos
Fator Neurotrófico Derivado do Encéfalo/metabolismo , Ginsenosídeos/farmacologia , Hipocampo/efeitos dos fármacos , Imobilização , Fármacos Neuroprotetores/farmacologia , RNA Mensageiro/genética , Receptor trkB/genética , Estresse Psicológico , Hormônio Adrenocorticotrópico/sangue , Animais , Fator Neurotrófico Derivado do Encéfalo/genética , Corticosterona/sangue , Ginsenosídeos/administração & dosagem , Hipocampo/metabolismo , Masculino , Fármacos Neuroprotetores/administração & dosagem , Ratos , Ratos Sprague-Dawley , Estresse Psicológico/genética , Estresse Psicológico/metabolismo
18.
Nutrients ; 11(8)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31357443

RESUMO

The purpose of this study was to explore the antidepressant-like effects of vitamin D3 at different doses (1.0, 2.5, and 5.0 mg/kg sc) on a model of depression produced by chronic unpredictable mild stress (CUMS) for 28 days in long-term (3 months) ovariectomized (OVX) adult rats. Sucrose preference (SPT), forced swimming (FST) and open-field (OFT) tests were conducted to examine the depression-like state. Serum corticosterone/adrenocorticotrophic hormone (ACTH) levels and hippocampal brain-derived neurotrophic factor (BDNF) and neurotrophin (NT)-3/NT-4 expressions by ELISA kits and/or western blotting were determined to assess the possible mechanisms of the vitamin D3 effects on the depression-like profile in long-term OVX rats subjected to CUMS. The results showed that vitamin D3 (5.0 mg/kg), as well as fluoxetine treatment, considerably reversed the depression-like state in the SPT and FST, decreased serum corticosterone/ACTH levels, and increased BDNF and NT-3/NT-4 levels in the hippocampus of long-term OVX rats compared to OVX rats with CUMS (p < 0.05). Thus, a high dose of vitamin D3 (5.0 mg/kg sc) could improve the depression-like profile in long-term OVX adult female rats subjected to the CUMS procedure, which might be mediated by the regulation of BDNF and the NT-3/NT-4 signaling pathways in the hippocampus, as well as the corticosterone/ACTH levels of the blood serum.


Assuntos
Antidepressivos/farmacologia , Comportamento Animal/efeitos dos fármacos , Fator Neurotrófico Derivado do Encéfalo/sangue , Colecalciferol/farmacologia , Depressão/tratamento farmacológico , Hipocampo/efeitos dos fármacos , Fatores de Crescimento Neural/sangue , Neurotrofina 3/sangue , Ovariectomia , Estresse Psicológico/tratamento farmacológico , Hormônio Adrenocorticotrópico/sangue , Animais , Biomarcadores/sangue , Doença Crônica , Corticosterona/sangue , Depressão/sangue , Depressão/psicologia , Modelos Animais de Doenças , Comportamento Alimentar/efeitos dos fármacos , Feminino , Hipocampo/metabolismo , Hipocampo/fisiopatologia , Locomoção/efeitos dos fármacos , Ratos Wistar , Estresse Psicológico/sangue , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia , Fatores de Tempo
19.
Endocrinology ; 160(7): 1719-1730, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31166572

RESUMO

The control of steroidogenesis in the neonatal adrenal gland is of great clinical interest. We have previously demonstrated that the postnatal day (PD) 2 rat exhibits a large plasma corticosterone response to hypoxia in the absence of an increase in plasma ACTH measured by RIA, whereas the corticosterone response to exogenous ACTH is intact. By PD8, the corticosterone response to hypoxia is clearly ACTH-dependent. We hypothesized that this apparently ACTH-independent response to hypoxia in the newborn rat is due to an increase in a bioactive, nonimmunoassayable form of ACTH. To evaluate this phenomenon, we pretreated neonatal rats with a novel, specific, neutralizing anti-ACTH antibody (ALD1611) (20 mg/kg or 1 mg/kg IP) on the morning of PD1, PD7, and PD14. Twenty-four hours later, we measured hypoxia- or ACTH-stimulated plasma ACTH and corticosterone. For long-term effects, ALD1611 was given on PD1 and pups were studied on PD8 and PD15. Pretreatment with ALD1611 significantly decreased baseline corticosterone and completely blocked the corticosterone response to hypoxia and exogenous ACTH stimulation at all ages. The effect of 1 mg/kg ALD1611 on PD1 had dissipated by PD15. The decrease in corticosterone in ALD1611-treated pups was associated with decreases in baseline and hypoxia- and ACTH-stimulated adrenal Ldlr, Mrap, and Star mRNA expression at all ages. The adrenal response to hypoxia in the newborn rat is ACTH-dependent, suggesting the release of nonimmunoassayable, biologically active forms of ACTH. ALD1611 is useful as a tool to attenuate stress-induced, ACTH-dependent adrenal steroidogenesis in vivo.


Assuntos
Glândulas Suprarrenais/efeitos dos fármacos , Hormônio Adrenocorticotrópico/imunologia , Anticorpos Monoclonais/farmacologia , Anticorpos Neutralizantes/farmacologia , Corticosterona/sangue , Glândulas Suprarrenais/metabolismo , Hormônio Adrenocorticotrópico/sangue , Hormônio Adrenocorticotrópico/farmacologia , Animais , Animais Recém-Nascidos , Feminino , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Sistema Hipotálamo-Hipofisário/metabolismo , Hipóxia/metabolismo , Masculino , Fosfoproteínas/metabolismo , Sistema Hipófise-Suprarrenal/efeitos dos fármacos , Sistema Hipófise-Suprarrenal/metabolismo , Ratos , Ratos Sprague-Dawley , Receptores de LDL/metabolismo
20.
Trials ; 20(1): 372, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221225

RESUMO

BACKGROUND: Patients with moderate and severe persistent allergic rhinitis (AR) have long-term physical and mental stress, leading to dysfunction of the hypothalamus-pituitary-adrenal (HPA) axis, which results in recurrence of AR. Previous research has proved acupuncture can regulate the function of the neuron-endocrine-immune system and contribute to improving the quality of life of patients with AR. This research aims to investigate the mechanism of acupuncture on the HPA axis in patients with moderate or severe persistent AR. METHODS/DESIGN: This randomized controlled trial aims to study the impact of acupuncture on the HPA axis of patients with moderate and severe AR. This research also aims to compare the curative effects of different treatments in three groups of patients: those receiving western medicine, western medicine and conventional acupuncture, or western medicine and mind-regulating acupuncture. We will study the therapeutic effect of acupuncture and the correlation between the changes of therapeutic indexes and experimental indexes after the treatments. Therapeutic indexes include the Visual Analog Scale (VAS) of nasal symptoms and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) for AR patients; experimental indexes include corticotropin releasing hormone (CRH), adreno-corticotropic hormone (ACTH), cortisol (CORT), interleukin 4 (IL-4), and interferon-γ (IFN-γ). DISCUSSION: The results of this trial will provide evidence for the influence of chronic, long-term, repeated stimulation in patients with moderate and severe persistent AR and the impact of acupuncture on the HPA axis of these patients. TRIAL REGISTRATION: Acupuncture-Moxibustion Clinical Trial Registry, AMCTR-IOR-16000009 . Registered on 22 August 2016.


Assuntos
Terapia por Acupuntura , Sistema Hipotálamo-Hipofisário/fisiologia , Sistema Hipófise-Suprarrenal/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Rinite Alérgica/terapia , Terapia por Acupuntura/efeitos adversos , Adolescente , Hormônio Adrenocorticotrópico/sangue , Adulto , Humanos , Interferon gama/sangue , Pessoa de Meia-Idade , Qualidade de Vida , Projetos de Pesquisa , Rinite Alérgica/psicologia , Adulto Jovem
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