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1.
Afr Health Sci ; 19(2): 1947-1952, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656478

RESUMO

Background: Infection with the human immune deficiency virus (HIV) is still a prevalent problem in Africa. Objectives: The aim of this study was to determine the prevalence of hypocortisolism among patients with HIV and their clinical profile at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Method: Three hundred and fifty adult patients with HIV infection were recruited from the HIV clinic of AKTH, Kano. Blood samples for serum electrolytes, and cortisol both before and after the short Synacthen test were taken for estimation. Data were analyzed using the SPSS version 20.0 software. Results: One hundred and eight (30.9%) of participants had low baseline serum cortisol levels, while 57 (16.3%) had a low serum cortisol after short synacthen test. There was no significant relationship between the cortisol levels and clinical features of hypocortisolism, WHO clinical stage of HIV, hypernatremia or HAART regimen. There was a negative correlation between the stimulated serum cortisol and duration of diagnosis of HIV, participants BMI and CD4 counts. Conclusion: The biochemical evidence of hypocortisolism was common among patients infected with HIV, associated with a longer duration of HIV infection. However, none of CD4 counts, clinical features or HAART regimen were associated with hypocortisolism.


Assuntos
Insuficiência Adrenal/sangue , Infecções por HIV/sangue , Hidrocortisona/deficiência , Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/etiologia , Adulto , Estudos Transversais , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Adulto Jovem
2.
Br J Nurs ; 28(11): 698-701, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31188658

RESUMO

Graft versus host disease (GvHD) is a serious and common complication of allogenic haematopoietic stem cell transplant. Corticosteroids are considered the standard care for initial treatment of GvHD but a significant proportion of patients will need long-term steroid treatment for control of GvHD. Extracorporeal photopheresis (ECP) is a cell-based immunomodulatory therapy that is an accepted second line treatment in patients with steroid refractory, dependent or intolerant GvHD and has shown efficacy in allowing steroid dose reduction and discontinuation in this cohort of patients. Adrenal cortical insufficiency is defined by the inability of the adrenal cortex to produce sufficient amounts of glucocorticoids and/or mineralocorticoids leading to a severe and potentially life-threatening condition. The most common cause of drug-induced adrenal insufficiency is the suppression of the hypothalamic-pituitary-adrenal axis by exogenous glucocorticoid doses ≥5 mg prednisolone equivalent for more than 4 weeks. The aim of the study was to ascertain the number of patients with GvHD receiving ECP that are affected by adrenocortical insufficiency.


Assuntos
Insuficiência Adrenal/epidemiologia , Doença Enxerto-Hospedeiro/terapia , Fotoferese , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
3.
Zhonghua Zhong Liu Za Zhi ; 41(6): 466-470, 2019 Jun 23.
Artigo em Chinês | MEDLINE | ID: mdl-31216835

RESUMO

Objective: To investigate the adrenocortical function changes of patients with advanced solid tumors who received the anti- programmed cell death protein-1 (PD-1) antibody, SHR-1210 therapy. Methods: The clinical data of 98 patients with advanced solid tumors who were enrolled in a prospective phase I trial of SHR-1210 therapy at our institution between April 27, 2016 and June 8, 2017 were collected. The levels of plasma adrenocorticotropic hormone (ACTH) and cortisol were evaluated in 96 patients. The clinical manifestations, laboratory tests and radiologic data were collected to define the immune-related adrenal insufficiency. Results: Until December 14th, 2018, no SHR-1210 related primary adrenal insufficiency occurred, and the incidence of immune-related secondary adrenal insufficiency was 1.0% among the 96 patients, which was identified as grade 2. No patient developed grade 3-4 adrenal insufficiency. The main clinical manifestations of the patient who was diagnosed as secondary adrenal insufficiency were grade 2 fatigue, anorexia and headache.The patient developed fatigue and anorexia at the 267th day after receiving the first dose of SHR-1210, the hypocortisolism occurred on the 279th day, and the headache emerged on the 291th day. The anorexia of patient who treated by physiological replacement doses of glucocorticoid since the 457th day was attenuated.The patient whose cortisol level was still below the normal limit continued to accept the hormone replacement therapy up to 776 days after the initial administration of SHR-1210. Conclusions: The incidence of SHR-1210 related adrenal insufficiency of patients with advanced solid tumors is low, and the symptoms can be effectively ameliorated by hormone replacement therapy. The potential adverse outcome of adrenal insufficiency following immunotherapy should be noticed by clinicians to avoid the occurrence of adrenal crisis.


Assuntos
Insuficiência Adrenal/epidemiologia , Anticorpos Monoclonais/efeitos adversos , Imunoterapia/efeitos adversos , Neoplasias/terapia , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Humanos , Estudos Prospectivos
4.
PLoS One ; 14(2): e0212259, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30779776

RESUMO

BACKGROUND: Biochemical adrenal insufficiency induced by glucocorticoid treatment is prevalent, but data on the clinical implications are sparse. We investigated clinical consequences of glucocorticoid-induced adrenal insufficiency after oral glucocorticoid cessation. METHODS: We conducted a Danish population-based self-controlled case series utilizing medical registries. In this design each individual serves as their own control allowing event rates to be compared as a function of time and treatment. Clinical indicators of adrenal insufficiency were defined as diagnoses of gastrointestinal symptoms, hypotension, cardiovascular collapse, syncope, hyponatremia, and hypoglycaemia. We included 286,680 persons who discontinued long-term (≥ 3 months) oral glucocorticoid treatment. We defined five risk periods and a reference period (before treatment): period 0 (on treatment), withdrawal period (1 month before and after cessation), followed by three consecutive 2 month-risk periods after withdrawal (periods 2-4). RESULTS: Median age at cessation was 69 years and 57% were female. Median treatment duration was 297 days and median cumulative dose was 3000 mg prednisolone equivalents. The incidence rates of hypotension, gastrointestinal symptoms, hypoglycemia and hyponatremia were increased in the withdrawal period compared to before treatment started (reference period). Incidence rate ratios comparing the withdrawal period with the reference period were 2.5 [95% confidence interval (CI): 1.4-4.3] for hypotension, 1.7 (95% CI: 1.6-1.9) for gastrointestinal symptoms, 2.2 (95% CI: 0.7-7.3) for hypoglycemia, and 1.5 (95% CI: 1.1-2.0) for hyponatremia. During 7 months of follow up, the rates of hypotension and gastrointestinal symptoms remained elevated compared to the reference period. Risk factors included use of antibiotics, increasing average daily dose of glucocorticoids, cumulative dose, and age. CONCLUSION: Oral glucocorticoid withdrawal was associated with adverse outcomes attributable to adrenal insufficiency. Our study underscores the need for future research to establish evidence-based clinical guidance on management of patients who discontinue oral glucocorticoids.


Assuntos
Insuficiência Adrenal , Glucocorticoides/administração & dosagem , Prednisolona/administração & dosagem , Sistema de Registros , Autorrelato , Administração Oral , Adolescente , Insuficiência Adrenal/tratamento farmacológico , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dinamarca , Feminino , Glucocorticoides/efeitos adversos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prednisolona/efeitos adversos
5.
Eur J Pediatr ; 178(5): 731-738, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30806790

RESUMO

The aim of the study was to assess the epidemiology and risk factors of adrenal crises (AC) in children with adrenal insufficiency (AI). Children diagnosed with AI between 1990 and 2017 at four Israeli pediatric endocrinology units were studied. Demographic and clinical data were retrieved retrospectively from their files. The study population consisted of 120 children (73 boys, 47 girls) and comprised 904 patient years. Median age at diagnosis was 0.3 years (0-17.5). Thirty-one AC events in 26 children occurred during the study period, accounting for a frequency of 3.4 crises/100 patient years. Fifty-two percent of AC events occurred at presentation. The significant risk factors for developing AC were the following: younger age at diagnosis (P = 0.003), primary AI vs. secondary AI (P = 0.016), specific diagnosis of autoimmune AI, adrenal hypoplasia congenita and salt wasting congenital adrenal hyperplasia (P < 0.001), mineralocorticoid treatment (P < 0.001), and recurrent hospital admissions (P > 0.001). After applying a stepwise logistic regression model, only the group of diagnoses, including salt wasting CAH, AHC, and Addison's disease, remained significant predictor of AC (OR 17.5, 95% CI 4.7-64.9, P < 0.001). There was no AC-associated mortality during the study period.Conclusions: Since significant percent of AC events occurred at presentation, measures to increase the awareness to signs and symptoms of AI among primary care physicians should be taken. Efforts to prevent AC should be focused on younger patients, especially those with primary AI. What Is Known: • Diagnosis and long-term management of pediatric patients with adrenal insufficiency (AI) remain a challenge. • Adrenal crises (AC) pose life-threatening emergencies in affected youngsters. Studies on the rate and risk factors of AC in children with AI are scarce, and they were done mainly on children with congenital adrenal hyperplasia (CAH). What Is New: • The rate of AC was relatively low and there was no AC-associated mortality during the study period. • Children with primary AI were at higher risk for AC than children with secondary AI. Specifically, children with salt wasting CAH, adrenal hypoplasia congenita, and Addison's disease at the highest risk.


Assuntos
Insuficiência Adrenal/epidemiologia , Adolescente , Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Israel/epidemiologia , Modelos Logísticos , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
6.
Dig Dis Sci ; 64(6): 1686-1694, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30659471

RESUMO

BACKGROUND: The accuracy of diagnosis and clinical implications of the hepatoadrenal syndrome, as currently diagnosed using total cortisol, remain to be validated. AIM: The aim of this study was to assess adrenal function using free cortisol in stable cirrhosis and study the potential implications of any abnormalities for renal and/or cardiac function. METHODS: Sixty-one stable consecutively enrolled patients with cirrhosis underwent assessment of adrenal function using the low-dose short Synacthen test, renal function by 51Cr-EDTA glomerular filtration rate (GFR), and cardiac function by two-dimensional echocardiography. RESULTS: Eleven patients (18%) had total peak cortisol (PC) < 500 nmol/L, but no patient had free PC < 33 nmol/L indicating that diagnosis of AI using total cortisol is not confirmed using free cortisol. Free cortisol did not correlate with GFR or parameters of cardiac function. Patients with higher Child-Pugh class had progressively lower free cortisol. Patients with low GFR < 60 mL/min (N = 22) had more frequently grade II-III diastolic dysfunction (66.7% vs. 17.6%; p = 0.005) and had higher Child-Pugh and MELD score compared to those with normal GFR. CONCLUSIONS: Diagnosis of AI using total cortisol is not confirmed using free cortisol and is thus considered unreliable in cirrhosis. Free cortisol is not associated with renal or cardiac dysfunction. Lower free cortisol in more advanced stages of liver disease might be secondary to decreased synthesis due to lower cholesterol levels. Irrespective of free cortisol, parameters of cardiac dysfunction are associated with renal impairment supporting the cardio-renal hypothesis.


Assuntos
Testes de Função do Córtex Suprarrenal , Córtex Suprarrenal/metabolismo , Insuficiência Adrenal/diagnóstico , Taxa de Filtração Glomerular , Síndrome Hepatorrenal/diagnóstico , Hidrocortisona/sangue , Rim/fisiopatologia , Cirrose Hepática/diagnóstico , Insuficiência Adrenal/sangue , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/fisiopatologia , Adulto , Idoso , Biomarcadores/sangue , Feminino , Grécia/epidemiologia , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Cardiopatias/fisiopatologia , Síndrome Hepatorrenal/sangue , Síndrome Hepatorrenal/epidemiologia , Síndrome Hepatorrenal/fisiopatologia , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/epidemiologia , Cirrose Hepática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Prognóstico , Reprodutibilidade dos Testes , Adulto Jovem
7.
J Neuromuscul Dis ; 6(1): 31-41, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30614808

RESUMO

Long-term glucocorticoid therapy has improved outcomes in patients with Duchenne muscular dystrophy. However, the recommended glucocorticoid dosage suppresses the hypothalamic-pituitary-adrenal axis, leading to adrenal insufficiency that may develop during severe illness, trauma or surgery, and after discontinuation of glucocorticoid therapy. The purpose of this review is to highlight the risk of adrenal insufficiency in this patient population, and provide practical recommendations for management of adrenal insufficiency, glucocorticoid withdrawal, and adrenal function testing. Strategies to increase awareness among patients, families, and health care providers are also discussed.


Assuntos
Insuficiência Adrenal/terapia , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Distrofia Muscular de Duchenne/tratamento farmacológico , Fármacos Neuromusculares/efeitos adversos , Fármacos Neuromusculares/uso terapêutico , Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/fisiopatologia , Gerenciamento Clínico , Humanos , Distrofia Muscular de Duchenne/epidemiologia , Distrofia Muscular de Duchenne/fisiopatologia , Guias de Prática Clínica como Assunto , Gestão de Riscos
8.
Burns ; 45(1): 42-47, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30477817

RESUMO

INTRODUCTION: Successful burn care should facilitate comprehensive, functional recovery after an injury. But we have a poor understanding of which risk factors influence long-term outcomes after burn injury. Studies have correlated hospital-acquired complications (HACs) with poor long-term outcomes in some populations. The purpose of this study was to determine whether HACs alter patient-reported quality of life in adult burn survivors. METHODS: We followed 496 adults with major burn injury longitudinally as part of a burn outcomes study (1993-2014). Study participants completed SF-12® Health Surveys providing mental (MCS) and physical (PCS) component summary scores at discharge, 12- and 24-months following injury. We reviewed inpatient medical records for complications during the acute care of a thermal injury. Complications were identified using discharge summary and chart ICD-9 codes. We used descriptive statistics to compare demographic and injury characteristics. Stepwise linear regression analyses determined the impact of significant variables on longitudinal MCS and PCS scores. Burn and graft total body surface area, age, and gender were included as predictor variables in univariate models and added to multivariate models when they were significant. RESULTS: Patients who suffered urinary tract infection, venousthromboembolism, pulmonary complications and renal failure during hospitalization for their burn injury reported decreased quality of life as indicated by lower SF-12® PCS scores at 12 and 24months after injury. CONCLUSIONS: We demonstrate that inpatient complications negatively impact long-term quality of life, especially physical functioning for patients with burn injuries. Our data confirm the need to consider the influence of hospital-acquired complications on patient-reported long-term outcomes and to support national efforts to reduce complications in burn patients.


Assuntos
Queimaduras/fisiopatologia , Nível de Saúde , Qualidade de Vida , Sobreviventes , Insuficiência Adrenal/epidemiologia , Adulto , Idoso , Superfície Corporal , Queimaduras/epidemiologia , Queimaduras/psicologia , Queimaduras/terapia , Infecções Relacionadas a Cateter/epidemiologia , Infecções por Clostridium/epidemiologia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hematoma/epidemiologia , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Lesão por Pressão/epidemiologia , Embolia Pulmonar/epidemiologia , Insuficiência Renal/epidemiologia , Fatores de Risco , Sepse/epidemiologia , Transplante de Pele , Infecções Urinárias/epidemiologia , Tromboembolia Venosa/epidemiologia , Infecção dos Ferimentos/epidemiologia
9.
J Clin Endocrinol Metab ; 104(1): 118-126, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30252065

RESUMO

Context: Primary adrenal insufficiency is an important clinical manifestation of X-linked adrenoleukodystrophy (ALD). Other manifestations include spinal cord disease and/or inflammatory demyelinating cerebral disease. Implementation of newborn screening requires natural history data to develop follow-up recommendations. Objective: To delineate the natural history of adrenal insufficiency in male patients with ALD and to assess associations between the risk for developing adrenal insufficiency, spinal cord disease, or cerebral disease and plasma C26:0/C22:0 and C24:0/C22:0 ratios, which are diagnostic biomarkers for ALD. Design: Retrospective review of medical records. Setting: Two international tertiary referral centers of expertise for ALD. Patients: Male patients with ALD followed at the centers between 2002 and 2016. Main Outcome Measures: The primary endpoint was adrenal insufficiency; secondary endpoints were spinal cord and cerebral disease. Results: Data on 159 male patients was available. The probability of developing adrenal insufficiency was described with survival analysis. Median time until adrenal insufficiency was 14 years (95% CI, 9.70 to 18.30 years). The cumulative proportion of patients who developed adrenal insufficiency was age-dependent and highest in early childhood [0 to 10 years, 46.8% (SEM 0.041%); 11 to 40 years, 28.6% (SEM, 0.037%); >40 years, 5.6% (SEM, 0.038%)]. No association between clinical manifestations and plasma ratios was detected with Cox model or Spearman correlation. Conclusions: Lifetime prevalence of adrenal insufficiency in male patients with ALD is ~80%. Adrenal insufficiency risk is time-dependent and warrants age-dependent follow-up. Besides on-demand testing if symptoms manifest, we suggest a minimum of adrenal testing every 4 to 6 months for patients age ≤10 years, annual testing for those age 11 to 40 years, and solely on-demand testing for those age >40 years.


Assuntos
Insuficiência Adrenal/etiologia , Insuficiência Adrenal/patologia , Adrenoleucodistrofia/complicações , Adrenoleucodistrofia/patologia , Adolescente , Insuficiência Adrenal/epidemiologia , Adrenoleucodistrofia/epidemiologia , Adulto , Idoso , Biomarcadores , Encefalopatias/epidemiologia , Encefalopatias/etiologia , Criança , Pré-Escolar , Determinação de Ponto Final , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Doenças da Medula Espinal/etiologia , Análise de Sobrevida , Adulto Jovem
10.
Ann Allergy Asthma Immunol ; 121(6): 711-716, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30194971

RESUMO

BACKGROUND: Previous reports suggest a higher prevalence of comorbid diseases in patients with eosinophilic esophagitis (EoE), although few have systematically quantified comorbidities in pediatric patients. OBJECTIVE: To define the rate of comorbid diagnoses in pediatric EoE patients compared with rates in those without EoE. METHODS: Retrospective cross-sectional review of electronic medical records for patients seen in a single large pediatric primary care network between January 2007 and December 2016 (n = 456,148). International Classification of Diseases, Ninth and Tenth Revision codes were used to determine prevalence rates for coexisting diagnoses. RESULTS: A total of 428 patients held a diagnosis for EoE. Significant differences in rate of comorbid diseases included allergic rhinoconjunctivitis (60.0% of EoE cohort vs 17.4% of non-EoE cohort, P < .0001); asthma (59.8% of EoE, 21.4% of non-EoE, P < .0001); atopic dermatitis (17.8% of EoE, 6.6% of non-EoE, P < .0001); adrenal insufficiency (2.6% of EoE, 0.4% of non-EoE, P < .0001); autism spectrum disorder (7.5% of EoE, 1.9% of non-EoE, P < .0001); celiac disease (5.6% of EoE, 0.9% of non-EoE, P < .0001); connective tissue diseases (1.4% of EoE, 0.1% of non-EoE, P < .0001); cystic fibrosis (0.9% of EoE, 0.05% of non-EoE, P < .0001); inflammatory bowel disease (0.7% of EoE, 0.2% of non-EoE, P = .03); type 1 diabetes mellitus (1.2% of EoE, 0.3% of non-EoE, P = .0069). CONCLUSION: Children with EoE have markedly higher rates of both atopic and non-atopic diseases compared with children without EoE. These associations have important implications for comprehensive EoE care and future research regarding associated disease mechanisms.


Assuntos
Comorbidade , Esofagite Eosinofílica/diagnóstico , Adolescente , Insuficiência Adrenal/epidemiologia , Adulto , Asma/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Criança , Pré-Escolar , Doenças do Tecido Conjuntivo/epidemiologia , Estudos Transversais , Fibrose Cística/epidemiologia , Dermatite Atópica/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Humanos , Lactente , Doenças Inflamatórias Intestinais/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Adulto Jovem
11.
J Pediatr Endocrinol Metab ; 31(7): 809-814, 2018 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-29959886

RESUMO

Background Individuals with Prader-Willi syndrome (PWS) have hypothalamic dysfunction and may have central adrenal insufficiency (CAI). The prevalence of CAI in PWS remains unknown. Methods Twenty-one subjects with PWS aged 4-53 years underwent a low dose adrenocorticotropic hormone (ACTH) stimulation test (LDAST) (1 µg/m2, maximum 1 µg) followed by an overnight metyrapone test (OMT). Metyrapone (30 mg/kg, maximum 3 g) was administered at 2400 h. Cortisol, 11-deoxycortisol (11-DOC) and ACTH levels were collected the following morning at 0800 h. OMT was the standard test for comparison. Peak cortisol ≥15.5 µg/dL (427.6 nmol/L) on LDAST and 0800 h 11-DOC ≥7 µg/dL (200 nmol/L) on OMT were classified as adrenal sufficiency. Results Twenty subjects had 0800 h 11-DOC values ≥7 µg/dL on OMT indicating adrenal sufficiency. One subject had an inconclusive OMT result. Six of the 21 (29%) subjects had peak cortisol <15.5 µg/dL on LDAST. Conclusions We found no evidence of CAI based on OMT, yet 29% of our PWS population failed the LDAST. This suggests that the LDAST may have a high false positive rate in diagnosing CAI in individuals with PWS. OMT may be the preferred method of assessment for CAI in patients with PWS.


Assuntos
Insuficiência Adrenal/diagnóstico , Metirapona , Síndrome de Prader-Willi/complicações , Adolescente , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/etiologia , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Testes Diagnósticos de Rotina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
12.
Medicine (Baltimore) ; 97(26): e11046, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29952944

RESUMO

It is well known that adrenal insufficiency is common in septic shock or hemodynamically unstable patients. But, there is as yet no sufficient clinically significant data about the exact prevalence or differences in the cause of cirrhosis with adrenal insufficiency. To investigate adrenal insufficiency prevalence in hemodynamically stable patients with cirrhosis and determine differences based on cirrhosis severity or etiology.From July 2011 to December 2012, 69 hemodynamically stable patients with cirrhosis without infection admitted at Hallym University Medical Center were enrolled. Adrenal insufficiency was defined as a peak cortisol level < 18 µg/dL, 30 or 60 minutes after 250 µg Synacthen injection.The study included 55 male patients (79.7%), and the mean age was 57.9 ±â€Š12.9 years. Cirrhosis etiology was alcohol consumption, HBV, HCV, both viral and alcohol related, and cryptogenic in 49, 15, 7, 11, 9 patients, respectively. Adrenal insufficiency occurred in 24 patients (34.8%). No differences were found in age, sex, mean arterial pressure, heart rate, HDL, cirrhosis etiology, degree of alcohol consumption, encephalopathy, variceal bleeding history, or hepatocellular carcinoma between patients with or without adrenal insufficiency. Serum albumin level was lower (P < .05), and INR was higher (P < .05) in patients with than in those without adrenal insufficiency. However, multivariate analysis revealed no independent adrenal insufficiency predictor. Significant negative correlations were found between Child-Pugh score and peak cortisol levels (γ=-0.365, P = .008).Adrenal insufficiency was frequent even in hemodynamically stable patients with cirrhosis and tended to be associated with only liver disease severity, being unrelated to cirrhosis etiology.


Assuntos
Insuficiência Adrenal/complicações , Monitorização Hemodinâmica/tendências , Hidrocortisona/sangue , Cirrose Hepática/etiologia , Fígado/patologia , Insuficiência Adrenal/sangue , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/patologia , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Cosintropina/administração & dosagem , Feminino , Hormônios/administração & dosagem , Humanos , Coeficiente Internacional Normatizado/métodos , Coeficiente Internacional Normatizado/tendências , Fígado/virologia , Cirrose Hepática/epidemiologia , Cirrose Hepática/patologia , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Albumina Sérica/análise , Índice de Gravidade de Doença
13.
Pan Afr Med J ; 29: 30, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29875912

RESUMO

Rheological modifications observed in sickle cell anemia are associated with ischemic complications that can cause target organ functional impairment. The objective was to investigate adrenal function of adult patients with sickle cell disease. In this cross-sectional study conducted in a tertiary referral hospital of the capital city of Cameroon, we enrolled ten crisis-free adult patients with sickle cell disease (SCD) and ten age- and sex-matched healthy individuals. We assessed adrenal function by testing basal cortisol levels and 60 min after tetracosactide (Synacthen®) injection using immuno-chemiluminescence method. Post-stimulatory cortisol was defined as primary endpoint and secondary endpoints include basal cortisol levels, post-stimulatory cortisol increments and the fold increase of cortisol one hour after stimulation. Sickle cell patients had an impairment of adrenal function despite no significant difference between patients' and controls' for basal or post-stimulatory cortisol levels. In fact, one patient in two failed to achieve a two-fold increase in cortisol levels after stimulation (5/10) as opposed to 1 in 10 in the control population (1/10), P = 0.070. The percent increment of cortisol after stimulation was lower in patients versus controls (133 vs 207, P = 0.047). Relative adrenal insufficiency is frequent in sub-Saharan adult patients with sickle cell disease despite normal basal cortisol levels. Our results suggest that adrenal function require further investigation during SCD crises as these represent an important stress and may worsen the prognosis.


Assuntos
Insuficiência Adrenal/epidemiologia , Anemia Falciforme/fisiopatologia , Hidrocortisona/sangue , Adulto , Camarões , Estudos de Casos e Controles , Cosintropina/administração & dosagem , Estudos Transversais , Feminino , Humanos , Medições Luminescentes , Masculino , Prognóstico , Centros de Atenção Terciária , Adulto Jovem
14.
Postgrad Med ; 130(5): 501-506, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29863435

RESUMO

OBJECTIVES: Some older individuals who present with gastrointestinal symptoms as their chief complaint were ultimately diagnosed with hypopituitarism instead of gastrointestinal diseases. The aim of this study was to find the characteristics of biochemical indicators in these patients so as to reduce early misdiagnosis. METHODS: We conducted a retrospective review of 45 patients with hypopituitarism who were at least 60 years of age. Two groups were included: group of hypopituitarism patients with gastrointestinal symptoms (Group G) included 23 patients with gastrointestinal symptoms and group of hypopituitarism patients without gastrointestinal symptoms (Group N) included 22 patients without these symptoms. In Group G, we investigated the prevalence of different gastrointestinal symptoms, the response of these symptoms to treatment, the occurrence of electrolyte disorders, and target gland dysfunction. Then, we compared the electrolyte and target gland function indices between the two groups. RESULTS: Nausea and vomiting were the most common complaints, accounting for 69.57% of the gastrointestinal symptoms in Group G. Hyponatremia was the most common electrolyte disorder, occurring in 72.86% (n = 18) of patients in Group G. Hypoadrenalism and hypothyroidism were reported by 69.57% and 60.78% of patients, respectively, in Group G. None of the gastrointestinal symptoms were relieved by 4 weeks of treatment with antacid and motility drugs. As mentioned, 18 patients also experienced refractory hyponatremia during early treatment including regular sodium supplements; however, their gastrointestinal symptoms and hyponatremia improved after only a week of treatment for hypopituitarism. Regarding the biochemical indicators, only serum sodium and cortisol in Group G were statistically lower compared with those in Group N (P < .05). CONCLUSION: Nausea and vomiting were the most common gastrointestinal symptoms in older patients with hypopituitarism, which were associated with lower serum sodium and cortisol. In addition, we hope to share the research to our gastroenterologists that serum sodium and cortisol should be tested when meeting elder patients with unexplained gastrointestinal symptoms.


Assuntos
Insuficiência Adrenal/epidemiologia , Gastroenteropatias/epidemiologia , Hiponatremia/epidemiologia , Hipopituitarismo/epidemiologia , Hipotireoidismo/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Equilíbrio Hidroeletrolítico
15.
Ann Endocrinol (Paris) ; 79(3): 164-166, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29716733

RESUMO

Despite established replacement therapy, mortality in patients suffering from chronic adrenal insufficiency is increasing. This may be partly explained by the fact that lack of adrenal stress hormones impairs the body's capacity to deal adequately with stress situations, resulting in life-threatening adrenal crises. Since many such situations are of rapid onset, concepts that allow for quick response to emergencies are particularly important. Optimal education for patients and relatives, improved awareness on the part of health professionals and the development of new easy-to-use drugs for acute therapy are of prime importance.


Assuntos
Doença de Addison/mortalidade , Doença de Addison/terapia , Insuficiência Adrenal/mortalidade , Insuficiência Adrenal/terapia , Doença Aguda , Doença de Addison/epidemiologia , Insuficiência Adrenal/epidemiologia , Consenso , Endocrinologia/normas , Endocrinologia/tendências , Glucocorticoides/uso terapêutico , Terapia de Reposição Hormonal/métodos , Humanos
16.
J Clin Endocrinol Metab ; 103(7): 2707-2719, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29718281

RESUMO

Background: Alström syndrome (AS), a monogenic form of obesity, is caused by recessive mutations in the centrosome- and basal body-associated gene ALMS1. AS is characterized by retinal dystrophy, sensory hearing loss, cardiomyopathy, childhood obesity, and metabolic derangements. Objective: We sought to characterize the endocrine and metabolic features of AS while accounting for obesity as a confounder by comparing patients with AS to body mass index (BMI)-matched controls. Methods: We evaluated 38 patients with AS (age 2 to 38 years) who were matched with 76 controls (age 2 to 48 years) by age, sex, race, and BMI. Fasting biochemistries, mixed meal test (MMT), indirect calorimetry, dual-energy X-ray absorptiometry, and MRI/magnetic resonance spectroscopy were performed. Results: Frequent abnormalities in AS included 76% obesity, 37% type 2 diabetes mellitus (T2DM), 29% hypothyroidism (one-third central, two-thirds primary), 3% central adrenal insufficiency, 57% adult hypogonadism (one-third central, two-thirds primary), and 25% female hyperandrogenism. Patients with AS and controls had similar BMI z scores, body fat, waist circumference, abdominal visceral fat, muscle fat, resting energy expenditure (adjusted for lean mass), free fatty acids, glucagon, prolactin, ACTH, and cortisol. Compared with controls, patients with AS were shorter and had lower IGF-1 concentrations (Ps ≤ 0.001). Patients with AS had significantly greater fasting and MMT insulin resistance indices, higher MMT glucose, insulin, and C-peptide values, higher HbA1c, and higher prevalence of T2DM (Ps < 0.001). Patients with AS had significantly higher triglycerides, lower high-density lipoprotein cholesterol, and a 10-fold greater prevalence of metabolic syndrome (Ps < 0.001). Patients with AS demonstrated significantly greater liver triglyceride accumulation and higher transaminases (P < 0.001). Conclusion: Severe insulin resistance and T2DM are the hallmarks of AS. However, patients with AS may present with multiple other endocrinopathies affecting growth and development.


Assuntos
Síndrome de Alstrom/sangue , Índice de Massa Corporal , Diabetes Mellitus Tipo 2 , Resistência à Insulina , Síndrome Metabólica/epidemiologia , Adolescente , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/genética , Adulto , Síndrome de Alstrom/complicações , Estudos de Casos e Controles , Criança , Pré-Escolar , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Feminino , Humanos , Hiperandrogenismo/epidemiologia , Hiperandrogenismo/genética , Hipogonadismo/epidemiologia , Hipogonadismo/genética , Hipotireoidismo/epidemiologia , Hipotireoidismo/genética , Masculino , Síndrome Metabólica/genética , Obesidade/epidemiologia , Obesidade/genética , Prevalência , Adulto Jovem
17.
Can Respir J ; 2018: 3629031, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29731953

RESUMO

Background: The prevalence of adrenal insufficiency (AI) in cystic fibrosis (CF) is unknown. The frequent use of glucocorticoids (inhaled or systemic) may induce the long-term suppression of the hypothalamic-pituitary-adrenal axis. Methods: We reviewed the results of adrenocorticotropic hormone (ACTH) stimulation tests done over a 10-year period to evaluate adrenal function in 69 CF patients of the CHUM CF clinic. Clinical characteristics of AI patients were compared to adrenal-sufficient (AS) patients. Results: AI was confirmed in 33 of the 69 CF patients. A higher rate of dysglycemia (P=0.022) and of Aspergillus positive culture (P=0.006) was observed in AI patients compared to AS patients. Weight, CFTR genotype, and pulmonary function were comparable between AI and AS patients. The use of systemic corticosteroids (SC) prior to the diagnosis of AI was observed in 42.4% of patients. Compared to AI patients without SC, SC-treated AI patients were older and had a higher rate of allergic bronchopulmonary aspergillosis. Conclusion: This study is the first to systematically examine the presence of AI in the largest cohort of CF patients studied to date with a prevalence of 8%. Patients treated with corticosteroids and those colonized with Aspergillus have a greater risk of AI.


Assuntos
Insuficiência Adrenal/induzido quimicamente , Fibrose Cística/complicações , Glucocorticoides/efeitos adversos , Insuficiência Adrenal/epidemiologia , Adulto , Idoso , Estudos Transversais , Fibrose Cística/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Quebeque/epidemiologia , Estudos Retrospectivos , Adulto Jovem
18.
Indian J Med Res ; 147(2): 142-150, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29806602

RESUMO

Background & objectives: : Adrenal insufficiency (AI) is rarely diagnosed in patients with HIV infection, in spite of autopsy studies showing very high rates of adrenal involvement. This study was aimed to determine the presence, patterns and predictors of AI in patients with HIV infection. Methods: : Consecutive HIV patients, 18-70 yr age, without any severe co-morbid state, having at least one-year follow up at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays. Results: : From initially screened 527 patients, 359 patients having good immune function were analyzed. Basal morning cortisol <6 µg/dl (<165 nmol/l; Group 1), 6-11 µg/dl (165-300 nmol/l; Group 2), 11-18 µg/dl (300-500 nmol/l; Group 3) and ≥18 µg/dl (500 nmol/l; Group 4) were observed in 13, 71, 199 and 76 patients, respectively. Adrenocorticotropic hormone (ACTH) stimulation test revealed 87 patients (24.23%) to have AI. AI in groups 1-4 was 100, 56.34, 17.09 and 0 per cent, respectively. AI patients were more likely to be females (P< 0.05), having longer disease duration (P< 0.05), immune reconstitution inflammatory syndrome, hyperkalaemia (P< 0.01), lower fasting glucose (P< 0.01), dehydroepiandrosterone sulphate (DHEAS) and vitamin D. Regression analysis revealed morning cortisol and DHEAS to be best predictors of AI (P=0.004 and 0.028, respectively). Interpretation & conclusions: : AI is a significant problem in HIV-infected individuals, observed in nearly a quarter of patients. Diagnosis warrants high index of suspicion and low threshold for screening, especially in those having low DHEAS and hyperkalaemia. Morning cortisol is a reasonable screening test, with ACTH stimulation warranted to confirm diagnosis, especially in patients with morning cortisol <11 µg/dl (300 nmol/l).


Assuntos
Insuficiência Adrenal/epidemiologia , Infecções por HIV/epidemiologia , Adolescente , Insuficiência Adrenal/complicações , Insuficiência Adrenal/tratamento farmacológico , Insuficiência Adrenal/virologia , Hormônio Adrenocorticotrópico/metabolismo , Adulto , Idoso , Sulfato de Desidroepiandrosterona/metabolismo , Feminino , HIV/patogenicidade , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/patologia , Humanos , Hidrocortisona/administração & dosagem , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
Clin Biochem ; 56: 26-32, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29673814

RESUMO

BACKGROUND: Inhaled corticosteroids (ICS) are the recommended long-term control therapy for asthma in children. However, concern exists regarding potential adrenal suppression with chronic ICS use. Our pilot study reported that hair cortisol in children was 50% lower during ICS therapy than prior to therapy, suggestive of adrenal suppression. OBJECTIVE: To evaluate hair cortisol concentration (HCC) as a potential biomarker for possible adrenal suppression from ICS use in children with asthma. METHODS: A retrospective observational study was performed at asthma clinics in Vancouver, Winnipeg, and Toronto, Canada. Children (n = 586) were recruited from July 2012 to December 2014 inclusive of those without asthma, with asthma not using ICS, and with asthma using ICS. The most recent three-month HCC was measured by enzyme immunoassay and compared among the groups. Quantile regression analysis was performed to identify factors potentially affecting HCC. RESULTS: The median HCC was not significantly different among the children: No ICS (n = 47, 6.7 ng/g, interquartile range (IQR) 3.7-9.8 ng/g), ICS Treated (n = 360, 6.5 ng/g, IQR 3.8-14.3 ng/g), and Controls (n = 53, 5.8 ng/g, IQR 4.6-16.7 ng/g). 5.6% of the children using ICS had hair cortisol <2.0 ng/g compared to none in the control groups (P < .05, comparing ICS Treated (20/360) to all Controls combined (0/100)) and only half had been exposed to systemic corticosteroids. Age, sex, BMI, and intranasal corticosteroid use were significantly associated with HCC. CONCLUSIONS: Results suggest HCC may be a potential biomarker for adrenal suppression as a population of children using ICS with HCC < 2.0 ng/g was identified compared to none in the control groups. Further research is needed to determine if those children have or are at risk of adrenal suppression or insufficiency.


Assuntos
Corticosteroides/efeitos adversos , Glândulas Suprarrenais/efeitos dos fármacos , Insuficiência Adrenal/induzido quimicamente , Anti-Inflamatórios/efeitos adversos , Asma/tratamento farmacológico , Cabelo/metabolismo , Hidrocortisona/metabolismo , Administração Intranasal , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Glândulas Suprarrenais/metabolismo , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/metabolismo , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Asma/metabolismo , Biomarcadores/metabolismo , Canadá/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Técnicas Imunoenzimáticas , Masculino , Ambulatório Hospitalar , Projetos Piloto , Análise de Regressão , Estudos Retrospectivos , Risco
20.
Endocr Pract ; 24(5): 437-445, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29498915

RESUMO

OBJECTIVE: Glucocorticoid (GC) pharmacotherapy is an effective treatment for a range of diseases, but exposure can suppress the hypothalamic-pituitary-adrenal axis, leading to glucocorticoid-induced adrenal insufficiency (GC-AI) in some patients. However, the incidence of diagnosed GC-AI and the associated health burden, including the incidence of adrenal crises (ACs), are unknown. Although GC-AI treatment is based on well-established principles, there are no agreed protocols regarding the peri-operative management of exposed patients. The aims of this study were to assess the incidence of diagnosed GC-AI in hospital patients and review current approaches to peri-operative management of surgical patients with GC exposure. METHODS: An analysis of hospital admission data concerning adult patients diagnosed with GC-AI and a review of published recommendations for peri-operative GC cover. RESULTS: Between 2001 and 2013, admission with a diagnosis of GC-AI in New South Wales, Australia was rare (annual average of 22.5 admissions/year) and ACs were even more rare (n = 3). Almost two-thirds (64.4%, n = 188) of the patients with diagnosed GC-AI were aged between 50 and 79 years and 45.2% (n = 132) had a comorbid infection. The current approach to peri-operative management of patients with GC exposure appears to be influenced by both the absence of clear guidelines and historic practices. This results in the exposure of some patients to supraphysiologic doses of GCs during the peri-operative period. CONCLUSION: Hospital admission with a diagnosis of GC-AI (with or without an AC) is very rare. Clear guidelines on peri-operative GC cover are necessary to avoid overreplacement with supraphysiologic doses in susceptible patients. ABBREVIATIONS: AC = adrenal crisis; ACTH = adrenocorticotropic hormone; AI = adrenal insufficiency; CI = confidence interval; GC = glucocorticoid; GC-AI = glucocorticoid-induced adrenal insufficiency; HPA = hypothalamic-pituitary-adrenal; OR = odds ratio.


Assuntos
Insuficiência Adrenal/induzido quimicamente , Glucocorticoides/efeitos adversos , Insuficiência Adrenal/epidemiologia , Insuficiência Adrenal/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Desprescrições , Feminino , Hospitalização , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Operatórios
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