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La enfermedad de Addison es una patología endocrinológica ocasionada por la disminución en la secreción de hormonas esteroideas por parte de la corteza adrenal; debida a múltiples etiologías (más comúnmente la tuberculosis en países en vías de desarrollo); con una evolución lenta, insidiosa y progresiva. Pudiendo llegar a una insuficiencia adrenal aguda, misma que puede llegar a ser de extrema gravedad; y en caso de no ser diagnosticada y tratada adecuadamente puede llevar a la muerte. El tratamiento primordial lo constituye la terapia hormonal sustitutiva con fármacos corticoesteroideos.
Addison's disease is an endocrinological pathology caused by the decrease in the secretion of steroid hormones by the adrenal cortex, due to multiple etiologies (most commonly tuberculosis in developing countries); with a slow, insidious and progressive evolution. Being able to reach an acute adrenal insufficiency, which can become extremely serious, and if it is not diagnosed and treated properly, it can lead to death. The primary treatment is hormone replacement therapy with corticosteroid drugs
Subject(s)
Humans , Female , Adult , Addison Disease , Adrenal Cortex Hormones , Adrenal Insufficiency , Tuberculosis , Hormone Replacement Therapy , Hormones , HypothyroidismABSTRACT
Objective To observe the effect of bloodletting at Jing-well points on the recovery of cognitive function and prognosis in patients with post-stroke cognitive impairment. Method One hundred patients with post-stroke cognitive impairment were enrolled and divided by the random number table into two groups, with 51 cases in the observation group and 49 cases in the control group. The control group was intervened by conventional treatment, while the observation group was additionally given bloodletting at Jing-well points. The two groups were observed and compared in terms of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Barthel Index (BI), and the plasma cortisol level before and after treatment. The therapeutic efficacy and occurrence rate of adverse reactions of the two groups were also compared. Result After treatment, the MMSE, MoCA and BI scores all increased in the two groups, but the scores of MMSE, MoCA and BI in the observation group were higher than those in the control group (P<0.05). The total effective rate was 94.1％ in the observation group, higher than 71.4％ in the control group (P<0.05). The plasma cortisol level dropped after treatment in both groups (P<0.05), and the level in the observation group was lower than that in the control group (P<0.05). The occurrence rate of adverse reactions was 7.8％ in the observation group, lower than 22.4％ in the control group (P<0.05). Conclusion Bloodletting at Jing-well points as assistant can effectively improve the mental state, cognitive function and activities of daily living, and to some extent reduce the happening of adverse reactions in the treatment of post-stroke cognitive impairment.
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Objective To improve the diagnosis and treatment of ACTH-independent macronodular adrenal hyperplasia(AIMAH).Methods A 51-year-old female patient with Cushing's syndrome caused by AIMAH was reported.Elevated early morning plasma cortisol levels,increased 24 h urinary free cortisol excretion,and loss of the normal circadian rhythm in cortisol secretion were presented.There was no suppression of cortisol secretion by administration of low-and high-dose overnight dexamethasone suppression test.Cardio-pulmonary function was very bad with the highest blood pressure reaching 300/120 mm Hg( 1 mm Hg=0.133 kPa).Initially,she was treated with mitotane(60 mg/d),but was not effective.After taking ketoconazole (800 mg/d)for 5 days,cardio-pulmonary function was not effectively improved with blood pressure only descending to 180/120 mm Hg.Orthopnoea appeared and Spo2fell once to 75％.The patient had to undergo right total adrenalectomy immediately.ResultsThe mass resected was 10 cm× 10 cm in size and weighted 67.5 g.Histological examination of the removed adrenal revealed nonpigmented macronodular cortical hyperplasia.The patient continued to take ketoconazole (400-800 mg/d)from the 6th day of the operation without steroid replacement therapy in that period.With normal cortisol levels( plasma cortisol at 8:00 was 18.65 μg/dl,24 h urinary free cortisol was 78.75 μmol),she left hospital after the general condition had been improved.During the following updated 10 months follow up,the indexes of her laboratory examination were maintained normal.ConclusionIndividualized therapy should be adopted for the patient with AIMAH.The medication is useful to suppress the adrenal gland cortisol production for those with progression of symptoms,very high blood pressure,hypokalemia and hypoproteinemia.Once the cardio-pulmonary function improves,the target organ should be resected as soon as possible.The supplement of cortisol is not appropriate during the perioperative period.The unilateral adrenalectomy is an effective treatment for AIMAH.
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The study of hypothalamic, pituitary adrenal axis function requires complex tests. However, themeasurement of basal morning serum cortisol levels may be a simple measure to evaluate this axis. AIM: To determine if an isolated morning measurement of basal serum cortisol levels in the absence of stress, may predict the indemnity of the hypothalamic, pituitary adrenal axis. MATERIAL AND METHODS: Morning cortisol levels in the basal period and 30 minutes after the injection of 50 ug ACTH were measured in 76 patients with a mean age of 52 years (48 females), operated of a pituitary tumor, without cushing syndrome and not using steroids or oral estrogens. Twenty healthy volunteers with a mean age of 30 years (11 males) were studied as controls. In this last group, the lower limit of normal stimulated cortisol levels was defined as the mean value less two standard deviations and corresponded to 17 ug/dL. RESULTS: Based on stimulated cortisol levels, 15 percent of operated patients had a hypothalamic, pituitary adrenal axis dysfunction. Using cut-off levels of less than 5, 7.5 and 10 ug/dL, basal cortisol levels had a sensitivity for the diagnosis of hypothalamic, pituitaryadrenal axis dysfunction of 64, 81 and 100 percent, respectively. The figures were 100, 95 and 66 percent for specificity respectively, 100, 75 and 34 percent for positive predictive value and 94, 97 and 100 percent for negative predictive value. CONCLUSIONS: A basal morning cortisol value over 10 ug/dL discards the presence of hypothalamic, pituitary adrenal axis dysfunction and a value lower than 5 ug/dL confirmed alteration in all of the cases.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Hydrocortisone/blood , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/blood , Pituitary-Adrenal System/physiopathology , Prospective Studies , Hydrocortisone , Adrenocorticotropic Hormone , Luminescent Measurements , Sensitivity and Specificity , Predictive Value of TestsABSTRACT
<i>Objective</i>: The purpose of this study was to compare the performance of the salivary cortisol immunoassay kits that were manufactured by DRG International, Inc., Salimetrics, LLC., and IBL Hamburg, which were widely used in neuroendocrine research. Correlations between plasma and salivary cortisol concentrations and between enzyme-linked immunosorbent assay (ELISA) and luminescence immunoassay (LIA) were investigated.<br> <i>Methods</i>: Saliva and plasma samples were collected in eight participants who took part in the study of the exercise stress testing. In total, forty salivary cortisol samples were assayed by means of the three salivary cortisol immunoassay kits. Plasma cortisol concentrations were determined by ELISA kit (IBL).<br> <i>Results</i>: Salivary cortisol concentrations measured by the three immunoassay kits were significantly and highly correlated with plasma cortisol concentrations (r ≥ .863). Scattergrams also indicated that exponential curve well explained the relationship between salivary and plasma cortisol concentrations (r ≥ .925). Salivary cortisol concentrations measured by LIA (IBL) was correlated with salivary cortisol concentrations measured by ELISA (DRG and Salimetrics: r=.943 and .985, respectively). Values of cortisol concentration measured by ELISA (DRG) were higher than those by ELISA (Salimetrics) and LIA (IBL).<br> <i>Conclusion</i>: Salivary cortisol concentrations that were measured by the three immunoassay kits reflected the variations of plasma cortisol concentration. Differences in immunoassay methods (ELISA and LIA) did not influence the values of cortisol concentration. These findings indicated that it is possible to assess stress by measuring salivary cortisol without the need for blood sampling.<br>
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PURPOSE: The purpose of this study was to ascertain the effects of preoperative information on postoperative state anxiety, plasma cortisol, and pain for patients under total knee arthroplasty, and to provide generic data with nursing intervention for total knee arthroplasty. METHODS: Data were collected from 34 patients who had total knee arthroplasty from January 3, 2003 to January 15, 2004. An experiment group of 17 patients was provided with pre-operative information prepared by the researchers; a control group of another 17 patients was provided with general information. Data were analyzed through Chi-squared test, t-test, paired t-test and ANCOVA using SPSS WIN 11.0. RESULTS: There was no significant differences between the experiment group and the control group in post operative state anxiety(p=.612). However, there was statistically a significant difference between the above two groups in post operative plasma cortisol(p=.012). There was a statistically significant difference between the above two groups in post operative pain(p=.041). CONCLUSION: According to the results of the study, the authors concluded that the preoperative information for patients under total knee arthroplasty had the effect on the decrease of postoperative plasma cortisol and pain.
Subject(s)
Humans , Anxiety , Arthroplasty , Hydrocortisone , Knee , Nursing , PlasmaABSTRACT
The effect of ingestion of a chilled carbohydrate and electrolyte solution on metabolic and hormonal responses and water-electrolyte balance was studied after two 5-km runs in hot outdoor conditions (Temp, 30.6-30.9°C ; humidity, 61.3-62.4%) . Eight healthy females (mean age 21.8 years) participated in : 1) a control experiment (Copt) with no fluid intake, 2) an experiment with 500 ml of tap water (WI), and 3) an experiment with 500 ml of sports beverage (SB) containing carbohydrate and electrolytes each of which were given after the 1st 5-km run, followed by a second 5-km run with an equivalent to 68.7-72.3% of VO<SUB>2</SUB>max. In the Cont, decreases in %ΔPV and blood glucose (BS) and increases in serum osmolality (Sosm), free fatty acid (sFFA) and plasma hormone concentrations related to regulation of the water-electrolyte balance in the body persisted after the 2 nd run. The intake of the sports beverage prevented hypoglycemia and ketoacidosis, as shown by an increase in sFFA and positive results for qualitative analysis of ketone body in the urine, and quick recovery of plasma volume following an endurance run under a hot environment. This study suggests that fluid replacement with a sports beverage containing carbohydrate and electrolytes was superior to plain water or no fluid ingestion in terms of metabolic and hormonal responses and the recovery of plasma volume and elevated rectal temperature following an endurance run under hot conditions.
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To clarify possible involvement of hot spring bathing in the occurrence of acute myocardial infarction and cerebral infarction at Kusatsu, its effects on blood pressure, heart rate, plasma cortisol and hematocrit were examined in 9 healthy young men. Abrupt increase in systolic blood pressure was observed immediately after starting a 3-minute 47°C or a 10-minute 42°C hot-spring bath. Both systolic and diastolic blood pressure were abruptly decreased one minute after completing either 47°C or 42°C bathing. The heart rate was increased gradually after the start of either 47°C or 42°C bathing and was decreased gradually after the completion of either 47°C or 42°C bathing. It was considered that the plasma Cortisol level was increased 15 minutes after starting 47°C bathing and the hematocrit was increased 15 minutes after starting 42°C bathing. We have already reported that fibrinolytic activity was decreased and platelet function was activated by 47°C bathing. Taken together, it is suggested that the mechanism of the occurrence of thrombotic diseases after hot spring bathing may be explained by considering transient changes in blood pressure, heart rate, blood viscosity, fibrinolytic activity and platelet function induced by hyperthermal stress.
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Fasting free fatty acids (FFA), plasma cortisol (F) were determined in newly diagnosed patients with type 2 diabetes. The results show that FFA, F and HOMA-IR are significantly higher in patients with type 2 diabetes than those in controls(all P
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The osmotic threshold for vasopressin release was studied in normal patients (n = 7) and in patients with the chronic form of Chagas'disease (n = 11). Positive correlation between osmotic threshold and plasma cortisol concentration was obtained for the Controls (y1 = 273,30 + 0,75x i; r = 0,78;P < 0,05), suggesting a modulating effect of cortisol on vasopressin release. The lack of correlation between the two parameters for the chronic chagasic patients was interpreted, on the basis of the general denervation associated with Chagas ' disease, to be the result of neuronal destruction in hypothalamic and/or extrahypothalamic centers related to the secretory control of vasopressin.
O limiar osmótico para liberação da vaso- pressina foi estudado em pacientes normais (n = 7) e em pacientes com a forma crônica da moléstia de Chagas (n = 11). Verificou-se a existência de uma correlação positiva entre o limiar osmótico e a concentração plasmática do cortisol endógeno para os controles (y1 = 273,30 + 0,75 x i; r = 0,78, p < 0,05), sugerindo um efeito modulador do cortisol na liberação da vasopressina. A falta de correlação entre os dois parâmetros, para os pacientes chagásicos crônicos, interpretou-se, baseando-se na desnervação geral associada com a doença de Chagas, como sendo o resultado da destruição neuronal em centros hipotalâmicos ejou extra-hipotalâmicos relacionados com o controle secretário da vosopressina.