Bilateral giant adrenal myelolipoma associated with congenital adrenal hyperplasia / Mielolipoma adrenal gigante bilateral associado a hiperplasia adrenal congênita

Adrenal myelolipomas are rare benign tumors, often non-functioning, located in the adrenal cortex, consisting mainly of mature adipose tissue and hematopoietic tissue. Although uncommon, the number of reported cases has increased due to the greater use of diagnostic imaging techniques. This tumor is usually unilateral and found as an adrenal incidentaloma, although there is a predominance of bilaterality in patients with congenital adrenal hyperplasia (CAH). In this study, we report the case of a 33-year-old male patient with CAH due to 21-hydroxylase deficiency, in non-regular use of the control medication, with bilateral giant adrenal myelolipoma and subsequent evolution of bilateral testicular adrenal rest tumors. He underwent bilateral adrenalectomy by video laparoscopy. The anatomopathological analysis, which confirmed myelolipomas' diagnosis, revealed the right adrenal with 430 g and 12.5 x 9.3 cm and the left with 257 g and 11.5 x 10.4 cm. This tumor may be accompanied by adrenocortical adenoma and carcinoma, ganglioneuroma, pheochromocytoma, Addison's disease, Cushing's syndrome, or CAH. Among the hypotheses of its pathogenesis, we highlight an association between the development of adrenal myelolipoma and chronic hormonal stimulation by the adrenocorticotrophic hormone (ACTH), especially in CAH. The non-regular treatment of CAH with glucocorticoids may have contributed to the chronic and elevated secretion of ACTH and, consequently, to the development of bilateral giant adrenal myelolipoma (AU).

Mielolipomas adrenais são tumores benignos raros, com frequência não-funcionantes, localizados no córtex da adrenal, constituídos, principalmente, por tecido adiposo maduro e tecido hematopoético. Apesar de incomum, o número de casos relatados tem aumentado devido ao maior uso de técnicas diagnósticas de imagens. Esse tumor é geralmente unilateral e encontrado como um incidentaloma adrenal, embora haja predominância de bilateralidade em casos de portadores de hiperplasia adrenal congênita (HAC). Neste estudo, relatamos o caso de um paciente do sexo masculino, de 33 anos, portador de HAC por deficiência de 21-hidroxilase, em uso não-regular da medicação de controle, com mielolipoma adrenal gigante bilateral e posterior evolução de tumor bilateral testicular de restos de adrenais. Ele foi submetido à adrenalectomia bilateral por videolaparoscopia. A análise anátomo-patológica, que confirmou o diagnóstico de mielolipomas, revelou adrenal direita com 430 g e 12,5 x 9,3 cm, e esquerda com 257 g e 11,5 x 10,4 cm. Esse tumor pode vir acompanhado de adenoma e carcinoma adrenocortical, glanglioneuroma, feocromocitoma, doença de Addison, Síndrome de Cushing ou HAC. Dentre as hipóteses de sua patogênese, des-tacamos uma associação entre o desenvolvimento do mielolipoma adrenal e a estimulação hormonal crônica pelo hormônio adrenocorticotrófico (ACTH), especialmente na HAC. O tratamento não-regular da HAC com glicocorticoides pode ter contribuído para a secreção crônica e elevada de ACTH e, consequentemente, para o desenvolvimento do mielolipoma adrenal gigante bilateral (AU).

Atypical pituitary hormone-target tissue axis / 医学前沿

A long-held belief is that pituitary hormones bind to their cognate receptors in classical target glands to actuate their manifold functions. However, a number of studies have shown that multiple types of pituitary hormone receptors are widely expressed in non-classical target organs. Each pituitary gland-derived hormone exhibits a wide range of nonconventional biological effects in these non-classical target organs. Herein, the extra biological functions of pituitary hormones, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, adrenocorticotrophic hormone, and prolactin when they act on non-classical organs were summarized, defined by the novel concept of an "atypical pituitary hormone-target tissue axis." This novel proposal explains the pathomechanisms of abnormal glucose and lipid metabolism, obesity, hypertension, fatty liver, and atherosclerosis while offering a more comprehensive and systematic insights into the coordinated regulation of environmental factors, genetic factors, and neuroendocrine hormones on human biological functions. The continued exploration of the physiology of the "atypical pituitary hormone-target tissue axis" could enable the identification of novel therapeutic targets for metabolic diseases.

Adrenocorticotrophic hormone stimulation in adrenal vein sampling / 中华内分泌代谢杂志

Objective:To explore the value of adrenocorticotrophic hormone (ACTH) stimulation in adrenal vein sampling (AVS) with its effect on the sampling success rate and lateralization determination.Methods:The clinical data of 54 patients with primary aldosteronism (PA) who underwent AVS in Nanjing Drum Tower Hospital from July 2018 to June 2020 were collected retrospectively. Blood samples from bilateral adrenal veins were collected simultaneously at baseline and after ACTH stimulation. The selectivity index (SI), lateralization index (LI), and relative aldosterone secretion index (RASI) were examined.Results:The concentration of serum cortisol level in left and right adrenal vein and peripheral vein increased significantly after ACTH stimulation ( P<0.001). SI of left adrenal vein increased from 18.00 (2.29, 20.29) to 34.76 (12.10, 46.86) , and the SI of right adrenal vein increased from 26.61(5.24, 31.85) to 28.40 (27.65, 56.05, P<0.001). The bilateral vein sampling success rate increased from 80%(43/54) to 93%(50/54). LI decreased from 2.85(1.78, 6.20) at baseline to 2.45(1.40, 6.10) after ACTH stimulation without significant difference( P>0.05). Eleven patients who identified unilateral secretion at baseline demonstrated bilateral after ACTH stimulation, and the RASI of these patients decreased from 0.50 (0.38, 1.25 ) to 0.37 (0.22, 0.84, P=0.019). Conclusion:ACTH stimulation significantly increased SI and the AVS success rate in patients with PA: ACTH stimulation decreased the relative aldosterone secretion in the dominant side of some patients with aldosterone producing adenoma, thus reduced the proportion of identified unilateral PA.

Progress on treating of glomerular diseases with adrenocorticotrophic hormone / 中华实用儿科临床杂志

Adrenocorticotrophic hormone(ACTH)is a pituitary neuroimmunoendocrine polypeptide that belongs to the melanocortin system.Glomerular disease is common in children with kidney disease and may progress to renal insufficiency or even renal failure.The application of ACTH in the treatment of glomerular disease is a hot topic.Studies have shown that ACTH has a significant protective effect on podocytes, and plays a role in anti-urine protein and lipid-lowering.ACTH may play these roles through steroid and non- steroid mechanisms.This article reviews the types, mechanism and study progress of ACTH in the treatment of glomerular disease.

Progress on treating of glomerular diseases with adrenocorticotrophic hormone / 中华实用儿科临床杂志

Adrenocorticotrophic hormone (ACTH) is a pituitary neuroimmunoendocrine polypeptide that belongs to the melanocortin system.Glomerular disease is common in children with kidney disease and may progress to renal insufficiency or even renal failure.The application of ACTH in the treatment of glomerular disease is a hot topic.Studies have shown that ACTH has a significant protective effect on podocytes,and plays a role in anti-urine protein and lipid-lowering.ACTH may play these roles through steroid and non-steroid mechanisms.This article reviews the types,mechanism and study progress of ACTH in the treatment of glomerular disease.

Moxibustion improved gastric ulcer by reducing contents of corticotrophin-releasing hormone and adrenocorticotropic hormone in serum and hypothalamus-pituitary tissues in rats with stress-induced gastric ulcer / 针刺研究

OBJECTIVE: To observe the effect of moxibustion of "Zhongwan" (CV12) and "Zusanli" (ST36) on histopathological changes of the gastric mucosa and contents of corticotropin-releasing hormone(CRH) and adrenocorticotrophic hormone(ACTH) in the serum, hypothalamus and pituitary tissues in rats with stress-induced gastric ulcer(SGU), so as to reveal its mechanisms underlying improvement of SGU. METHODS: A total of 28 male SD rats were randomly divided into blank control, model, moxibustion, and medication groups, with 7 rats in each group. The SGU model was established by water immersion restraint stress for 3 h. Moxibustion was applied to "Zhongwan"(CV12) and bilateral "Zusanli" (ST36) for 20 min, once a day for 5 days, and rats of the medication group were treated by gavage of Omeprazole enteric-coated tablets (0.2 mg/kg) once a day for 5 days. The gastric mucosal damage index (ulcer index, UI) was measured to assess the injury severity according to Guth's me-thods. Histopathological changes of the gastric mucosa were determined by H．E. staining. The contents of CRH in serum and hypothalamus and ACTH in serum and pituitary gland tissue were assayed by using ELISA. RESULTS: Outcomes of H．E. staining showed gastric mucosal epithelia defect, disordered arrangement of glands, obvious mucosal hyperemia and edema, exudation of a large number of red blood cells, swelling of mucosal cells with necrosis of nuclei in the model group. These situations were relatively milder in the moxibustion and medication groups. After modeling, the UI, and the contents of CRH in the serum and hypotha-lamus, and ACTH in the serum and pituitary tissue were significantly increased in comparison with the blank control group (P0.05)．. CONCLUSION: Moxibustion can relieve gastric mucosal injury induced by stress in water immersion restraint stress rats, which may be associated with its effects in down-regulating the levels of CRH and ACTH in se-rum, hypothalamus and pituitary tissues (inhibition of activities of hypothalamic-pituitary-adrenocortical axis)．.

De novo NFκB2 gene mutation associated common variable immunodeficiency / 中华儿科杂志

Objective@#To investigate the clinical, immunological, and molecular manifestations of nuclear factor kappa-B subunit 2 (NFκB2) gene mutation associated common variable immunodeficiency (CVID) .@*Methods@#A 14-month-old boy diagnosed with NFκB2-mutated CVID was admitted into Children's Hospital of Chongqing Medical University in December 2015. The clinical manifestations, biochemical tests, immunological function, molecular features, treatment, and follow-up of the patient were analyzed. The Chinese and PUBMED databases were searched with the key words "NFκB2" and "immune deficiency" and related literatures were reviewed.@*Results@#The patient had 4 episodes of pneumonias and one otitis media since the age of 6 months. The serum immunoglobulin levels were IgG 2.73 g/L, IgA<0.07 g/L, and IgM 0.12 g/L. The percentage of peripheral lymphocyte subsets demonstrated increased CD3+T lymphocyte (81.8%), increased CD4+ naïve T cell (39.1%), normal B cell (14.1%), low switched memory B and plasmablast B (respectively 0.1% and 0), and lightly diminished natural killer(NK) cell (4.13%). Within the peripheral CD4+T cells, the percentage of regulatory T cells (1.49% (control 4.08%)), T follicular helper (3.66% (control 11.0%)), and T helper 17 (9.65% (control 15.7%)) were decreased, while the percentage of T helper 2 (60.9% (control 46.5%)) was elevated. T lymphocyte proliferative response and T cell receptor repertoire diversity were normal. NK-cell cytotoxic activity was impaired. The whole-exome sequencing harbored a de novo heterozygous nonsense mutation in exon 22 (c.2557C>T; p. Arg853X) in the C-terminus of NF-κB2. The western blotting confirmed the decreased expression of NF-κB2 (p52) protein. The patient received intravenous immunoglobulin infusion monthly (400-600 mg/kg), followed by improvement of pulmonary infection. After searching the databases, a total of 28 cases (1 Chinese and 27 non-Chinese) were identified. There were 12 cases of nonsense mutation (5 were gain-of-function mutation), and 8 cases of missense and frameshift mutations, respectively. The main clinical manifestation was respiratory infection, followed by autoimmune diseases such as alopecia and trachyonychia. Fifteen cases developed adrenocorticotrophic hormone (ACTH) deficiency.@*Conclusions@#NF-κB2 signaling pathway played an important role in T and B lymphocyte differentiation, and NK-cell cytotoxic activity. NFκB2 mutation should be considered in cases with recurrent infections, hypogammaglobulinemia, and decreased memory B cells and plasma cells, especially when combined with ACTH deficiency.

Serum cortisol concentration in the Colombian creole horse / Concentración del cortisol sérico en el caballo criollo colombiano / Concentração de cortisol sérico no cavalo crioulo colombiano

Abstract Background: Cortisol is indicative of adaptation to physiological factors, disease and environmental stress in equines. Cortisol recently gained attention for its prognostic value in critical disease and as an indicator of fitness and athletic performance. Objective: To determine baseline serum cortisol (SC) morning concentrations in the Colombian creole horse (CCH). Methods: Blood serum was taken from 62 CCH of both genders with and average age of 8.8 years (± 5.3), which were clinically healthy and had different performance levels. Results: The overall SC average determined by sandwich ELISA was 13.3 ± 7.4 mg/dL. No significant differences were attributed to gender, age, or performance. Conclusion: This concentration can be used as a reference value for CCH maintained in low physical activity.

Resumen Antecedentes: El cortisol es un indicador de adaptación a factores de estrés fisiológico, patológico y ambiental en equinos. Recientemente, esta hormona ha ganado interés por su valor en la prognosis de enfermedades críticas y como indicador del nivel de acondicionamiento y rendimiento atlético. Objetivo: Determinar la concentración del cortisol sérico (CS) matinal para el caballo criollo colombiano (CCC). Métodos: Se tomó suero sanguíneo de 62 CCC de ambos sexos, edad promedio 8,8 años (± 5,3), clínicamente saludables, divididos en grupos según edad, sexo y tipo de actividad física. Resultados: La media del CS general determinada por ELISA tipo sándwich fue 13,3 ± 7,4 μg/dL. No hubo diferencias significativas atribuibles a género, edad o desempeño. Conclusión: Esta concentración puede ser utilizada como valor de referencia en CCC que desarrollen actividades de baja exigencia física.

Resumo Antecedentes: O cortisol nos equinos considera-se um hormônio indicador da adaptação a fatores de estresse fisiológico, patológico e ambiental. Recentemente, tem incrementado o interesse por seu valor prognóstico em doenças críticas e como indicador de acondicionamento e rendimento atlético. Objetivo: Determinar a concentração do cortisol sérico (SC) matinal no cavalo crioulo colombiano (CCC). Métodos: Soro sanguíneo foi coletado de 62 CCC, de ambos sexos, idade média de 8,8 anos (± 5,3), clinicamente sadios, divididos em grupos segundo idade, sexo e tipo de atividade física. Resultados: A média geral da SC determinada pela ELISA tipo sanduiche foi 13,3 ± 7,4 μg/dL. Não houve diferenças significativas atribuíveis ao sexo, idade ou desempenho. Conclusão: A concentração determinada pode ser utilizada como valor de referência no CCC que desenvolvem atividades de baixa exigência física.

Effect of arthroscopic arthroplasty on short-term efficacy and stress factors in patients with primary primary osteoarthritis of the elbow / 中国综合临床

Objective To investigate the effect of arthroscopic arthroplasty on the short-term efficacy and stress factors in patients with primary osteoarthritis of the elbow and to guide the clinical application.Methods From February 2013 to February 2016,32 patients with primary primary osteoarthritis of the elbow underwent arthroscopic arthroplasty in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology.The levels of serum TNF-α,IL-6,IL-10,adrenocorticotrophic hormone(ACTH) and other stress factors were measured before and after the operation.The ROM,MEPS and VAS were used to evaluate the curative effect before,3 months and 6 months after operation.Results All patients were followed up successfully.The excellent rate was 96.9%(31/32) 1 year after the operation.Preoperative ROM,MEPS score,VAS score were (83.2±18.6) °,(63.2±14.5) points,(3.2±1.8) points;3 months,6 months postoperative ROM were (102.3±18.9) °,(124.3±15.4) °,and MEPS scores were (75.4±16.8) points and (89.5±14.3) points respectively,which were significantly higher than those before operation (ROM F value of 43.19,P0.05).Conclusion For the modest primary osteoarthritis of the elbow,arthroscopy arthroplasty can achieve good therapeutic effect,improve the patient′s motor function and life quality,and minimally invasive surgical approach is conducive to relieve systemic stress.

Surgical treatment of adrenocorticotropic hormone independent macronodular adrenal hyperplasia / 中华泌尿外科杂志

Objective To study the surgical treatment of adrenocorticotropic hormone independent macronodular adrenal hyperplasia (AIMAH).Methods The clinical data of 12 AIMAH patients were analyzed retrospectively.There were 3 males and 9 females, with an average age of 55 years (range, 39-67 years).10 cases had typical clinical features of Cushing syndrome.Endogenous hypercortisolism was confirmed on the basis of loss of circadian rhythm of serum cortisol, high late-night serum cortisol level and inadequate cortisol suppression after overnight low-dose dexamethasone suppression test.ACTH independence was established on the basis of suppressed serum ACTH levels and inadequate cortisol suppression after overnight high-dose dexamethasone suppression test.CT scan showed bilateral enlargement of the adrenal glands with multiple macronodules.Steroid supplement was given after operation.Results Surgical intervention was performed in all the patients.Seven patients underwent bilateral adrenalectomy,and unilateral adrenalectomy was performed in 5 patients, one of whom had the history of contralateral adrenalectomy.Pathological examination confirmed multinodular hyperplastic adrenal enlargement.The average duration of postoperative follow-up was 50 months (range, 1-105 months).One patient undergoing bilateral adrenalectomy died from respiratory failure and pulmonary infection one month after operation.Remission of Cushing syndrome symptoms was obtained after surgery in other 11 patients.For these 11 cases,the serum cortisol declined into normal ranges, but suppressed serum ACTH levels and inadequate cortisol suppression after overnight low-dose dexamethasone suppression test were still present.Two patients received contralateral adrenalectomy due to recurrent overt Cushing syndrome after one year and 5 years, respectively.Conclusions Unilateral adrenalectomy might be an effective and safe treatment modality for AIMAH, but subclinical hypercortisolism would be present postoperatively.Contralateral adrenalectomy may be performed in case of the recurrence of overt Cushing syndrome.

The surgical treatment of severe ectopic adrenocorticotrophic hormone syndrome / 中华泌尿外科杂志

Objective To investigate the surgical treatment of severe ectopic adrenocorticotrophic hormone(ACTH) syndrome.Methods The clinical data of 12 cases of severe ecotopic ACTH syndrome from January 1996 to December 2016 were retrospectively analyzed.The cases include 7 males and 5 females with a mean age 38 years(range 11 to 64 years).12 cases demonstrated typical Cushing syndrome(CS),accompanied by hypertension, diabetes, hypokalemia and severe osteoporosis.9 cases were complicated with thoracolumbar compression fractures.8 cases presented with pulmonary infection and fever during operation.7 cases had cardiac dysfunction.Laboratory tests showed elevated serum cortisol(695.0 ～ 1 661.5 nmol/L,mean 1 055.7 nmol/L), high urinary free cortisol excretion (807.3 ～ 28 240.0 nmol/24 h, mean 5 270.5 nmol/24h)and high ACTH plasma levels(16.5 ～ 273.9 pmol/L, mean 80.4 pmol/L).Source of ectopic ATCH were not identified and CT showed bilateral enlargement of adrenal in 12 patients.Results We performed emergency bilateral or unilateral adrenalectomy in 12 cases.Among them, one-stage bilateral adrenalectomy were given to 6 cases, staged bilateral adrenalectomy was performed in 3 cases, and unilateral adrenalectomy were given to 3 cases.The patients were treated with hormone replacement therapy after bilateral adrenalectomy.The excised adrenal gland showed diffuse thickening and multiple nodular.Pathological diagnosis were adrenal cortical hyperplasia.They have been followed up for 1 to 8years(median 2.5 years), 9 cases survived, 2 cases died of diabetes and severe pulmonary infection, and 1 case was lost to follow-up.Conclusions Severe ectopic ACTH syndrome is difficult to treat.Emergency adrenalectomy is effective for the management of severe ectopic ACTH syndrome especially for those patients with severe Cushing syndrome but primary tumor can not be located.

Comparison of efficacy of adrenocorticotrophic hormone and methylprednisolone on rat models of infantile spasm / 中华实用儿科临床杂志

Objective To compare the efficacy of adrenocorticotrophic hormone (ACTH) and methylprednisolone on the rat models of infantile spasms (IS).Methods The SD rats on postnatal 10 day (P10) were divided into blank group (n =18),control group (n =18) and model group (n =110) according to the random number table method.The rats of model group were prepared by adopting prenatal stress exposure and N-methyl-D aspartate (NMDA) injection.In the model group,after inducing epileptic seizures,the rats were divided into different groups (18 rats in each group) according to the random number table method as following:model group Ⅰ (subcutaneous injection ofACTH,50 IU/kg,at P10:14:00,21:00;P11,P12:7:00,14:00,21:00;P13:7:00),model group Ⅱ (subcutaneous injection of 9 g/L saline),model group Ⅲ (intraperitoneal injection of methylprednisolone,60 mg/kg,at P11,P12,P13:9:00,once per day),model group Ⅳ (intraperitoneal injection of 9 g/L saline) and model group Ⅴ (positive control group,with no drug or saline injection).Three days later,epilepsy was induced again,and the rats of model group were intraperitoneally injected with NMDA (12 mg/kg) at P13 (10:00).The rats of control group were injected intraperitoneally with same volume of 9 g/L saline,but the rats of blank group were not treated.Behaviors of rats with epilepsy seizures were observed and epilepsy scores were given.The expression of corticotropin-releasing hormone (CRH) in the hypothalamus of each group was detected by using immunohistochemistry and fluorescence quantitative polymerase chain reaction.The learning and memorizing capacity of the rats were measured by Y-maze experiment.Results There was no death in the model group after the onset of seizure.In the model group Ⅰ,13 cases were attacked(72.22％),and 14 cases were attacked in the model group Ⅲ (78.78％).The level of attack was decreased.The buckling state was not observed in model group and Ⅲ,but the latency period of epilepsy was prolonged and the epilepsy scores were significantly decreased.There were no significant differences of onset latency [(2 369.38 ± 628.70) s vs.(1 922.93 ± 462.36) s] and epilepsy score [(2.15 ± 1.14) scores vs.(2.07 ± 0.83) scores] between the 2 groups (all P ＞ 0.005).The rats of model group Ⅱ,Ⅳ,Ⅴ were all attacked completely and presented buckling state.There was no onset or death in blank group and control group.The number of CRH positive cells and CRH mRNA relative expression of each model group were higher than those in the blank group and control group.The number of CRH positive cells and CRH mRNA expression of model group Ⅰ and Ⅲ were lower than those in model group Ⅱ,Ⅳand Ⅴ,and the differences were significant (all P ＜ 0.002 4).There was no significant difference in the number of CRH-positive cells(39.12 ± 5.98 vs.41.48 ± 7.61) and CRH mRNA relative expression (1.92 ± 0.16 vs.2.06 ± 0.39) between model group Ⅰ and Ⅲ (all P ＞ 0.002 4).No significant difference was found between blank group and control group,or among model group Ⅱ,Ⅳ and Ⅴ (all P ＞ 0.002 4).There were no significant differences in the learning capacity among all groups (F =2.196,P ＞ 0.002 4).The correct response rate after 24 hours of the model group was lower than the blank group and control group,and ACTH and methylprednisolone pretreatment did not influence the memorizing capacity (P ＞ 0.002 4).Conclusion The effect of pretreatment of ACTH is similar to that of methylprednisolone in the rat model of IS.

Study on Mechanism of Protective Effects of Baicalin on Male Rats with Ischemic Brain Injury / 中国中医药信息杂志

Objective To investigate the productive effects of baicalin on the male rats with ischemic brain injury and its effects on serum progesterone level in rats; To explore the possible mechanism of baicalin in brain protection. Methods Adult SD male rats were used to create a permanent left middle cerebral artery occlusion model. The rats were evenly divided into model group, baicalin group, inhibitor group, and sham-operation group (without inserted into the intraluminal thread) according to the neurological function scores. At different time points after modeling, the neurological function scores and the grip strength of double foreleg were measured, and the reduction rate of grip strength was calculated. Serum progesterone and adrenocorticotrophic hormone (ACTH) were detected by ELISA. Results Compared with the sham-operation group, the neurological function of rats in the model group was impaired, the grip strength of double foreleg was significantly reduced. 7 days after treatment, compared with the model group, the neurological function score of baicalin group was lowered, grip strength of double foreleg was recovered, reduction rate of grip strength was reduced (P<0.05); compared with the baicalin group, protective effects of baicalin on neurological function was lowered in inhibitor group (P<0.05). 7 days after treatment, compared with the model group, the serum progesterone level in baicalin group was significantly higher (P<0.01), and ACTH level showed an increasing trend; compared with the baicalin group, serum progesterone and ACTH levels in the inhibitor group decreased (P<0.05). Conclusion The protective effects of baicalin on the male rats with ischemic brain injury may be related to the regulation of progesterone.

Effect of sample type and storage conditions on stability of adrenocorticotrophic hormone detection results / 国际检验医学杂志

Objective To study the influence of sample type and storage conditions on the stability of adrenocorticotrophic hor-mone(ACTH) detection results .Methods The samples were divided into the plasma and serum groups ,57 cases in each group .The ACT H concentration was detected within 1 h after blood collection ;30 samples of sufficient plasma amount were extracted from the plasma group and re-divided into the room temperature ,refrigeration and frozen groups ,30 cases in each group .The ACTH concen-tration in the room temperature and refrigeration groups were detected at the time points of 2 ,24 ,121 h ,while which in the frozen group was detected at 24 ,121 h .Then the detection results were compared with the setting standard values .Results The ACTH level in the serum group was obviously lower than that in the plasma group ,the results showed statistically significant difference be-tween the two groups(P<0 .05) .The detection results at 2 ,24 ,121 h had statistical difference between the room temperature group and the standard value(P<0 .05);the detection results at 2 ,24 h had no statistical difference between the refrigeration group and standard value(P>0 .05) ,while which at 121 h had statistical difference between the refrigeration group and standard value (P<0 .05);the detection results at 24 ,121 h had no statistical difference between the frozen group and standard value (P>0 .05) .Con-clusion Adopting EDTA-K2 anticoagulation samples for detecting ACTH level should complete the detection within 1 h under low temperature ;if the detection can not be completed within 24 h ,the separated plasma should be stored by freezing at -20 ℃ ,the de-tection results change is relatively stable within 121 h .

Changes and clinical significance of serum cortisol and adrenocorticotrophic hormone levels in children with steroid-sensitive nephritic syndrome / 中华实用儿科临床杂志

Objective To investigate the changes in serum cortisol and adrenocorticotrophic hormone(ACTH) levels in children with steroid-sensitive nephritic syndrome (SSNS) and the clinical significance of intervention.Methods According to whether a child with SSNS would relapse,48 children with SSNS were divided into non-recurrence group(n =19) and recurrence group(n =29),at the same time 14 age-matched healthy children were enrolled as the healthy control group.Serum cortisol and ACTH were measured in patients with SSNS by using electrochemiluminesence methods.In recurrence group,methylpredisolone or methylprednisolone combined with ACTH injection therapy was used on 15 patients with their serum cortisol and ACTH below normal.Results Before standard glucocorticoid treatment,the serum levels of cortisol and ACTH had no difference among 3 groups (all P ＞ 0.05).By the end of remission phase,the serum levels of cortisol and ACTH in recurrence group were statistically lower than those of the non-recurrence group[(113.03 ± 80.02) μg/L vs (251.54 ± 185.05) μg/L,t =-2.925,P ＜ 0.05 ; (12.81 ± 10.14) ng/L vs (23.53 ± 12.05) ng/L,t =-0.885,P ＜ 0.05].Eight to 12 weeks after being adjusted,the serum level of cortisol and the average monthly time of recurrent were both significantly improved in 15 abnormal children in recurrence group [(168.90 ± 133.43) μg/L vs (73.62 ± 58.04) μg/L,t =3.016,P ＜ 0.05 ; (0.09 ± 0.08) times vs (0.35 ± 0.11) times,t =-7.560,P ＜0.05],but as to the serum level of ACTH,there was no significant difference in abnormal children in recurrence group [(14.05 ± 10.99) ng/L vs (8.72 ± 4.11) ng/L,t =1.991,P ＞ 0.05].Conclusions The concentrations of serum cortisol and ACTH can reveal the risk of recurrence for children with SSNS to some extent,and effective intervention can reduce the recurrence rate and shorten the course of disease.

Application of 18 FDG PET/CT in diagnosis of ectopic ACTH syndrome induced by lung cancer / 吉林大学学报(医学版)

Objective To investigate the value of 18 F-fluorodeoxyglucose (18 FDG)positron emission tomography and computer tomography (PET/CT)in the diagnosis and localization of ectopic ACTH syndrome (EAS)induced by lung cancer,and to increase the accuracy rate of diagnosis of EAS.Methods 8 patients were histopathologically proven to be lung cancer.18 FDG PET/CT wholebody and brain scan were performed;magnetic resonance imaging (MRI),99m Tc-octreotide (OCT)imaging and inferior petrosal sinus sampling (IPSS)were done in all patients.On 18 FDG PET/CT images,the SUVmax values of lesions and the SUVmax ratio of lesion tissue to normal lung tissue were calculated.Results ① 8 patients with EAS included 2 cases of carciniod,4 cases of atypical carciniod,and 2 cases of small cell lung cancer.The ACTH levels in inferior petrosal sinus and peripheral veins of 8 patients had no difference.②The chest CT showed there were pulmonary nodules in 6 cases (75%),among them 2 cases were atypical lesions.5 cases of pituitary adenomas were found by MRI (25%),and OCT imaging was positive in 2 cases (25%).③The 18 FDG PET/CT showed nodular,mass like or patch samples with high metabolic activity in 8 cases (100%)of pulmonary lesions.The SUVmax of tumor was 0.72 to 14.05 (3.67±4.68),and the ratio of SUVmax of lesion tissue to normal lung tissue was 1.69 to 27.54 (8.14 ± 9.63).18 FDG hypermetabolism was found in 8 cases of bilateral adrenal hyperplasia,while 4 cases showed pituitary tumor.Conclusion Lung cancer is a common source of EAS,especially carcinoid.18 FDG PET may show lower glucose metabolism.18 FDG PET/CT should be used as an assisted method to diagnose EAS.

Progress in the treatment of infantile spasms / 中华实用儿科临床杂志

Infantile spasms constitutes an unique,age-specific epilepsy syndrome of early infancy characterized by epileptic spasms often accompanied by neurodevelopmental regression and an electroencephalograph finding of hypsarrhythmia.For the complex and various etiologies,the pathogenesis remains unclear.Although the relevant guidelines and consensuses are being updated all the time,but proven therapies are still limited because of efficacy,tolerability,at times even availability.In this paper,the current findings regarding up-to-date advances in the treatment of infant spasms were reviewed,especially in use of the corticosteroid and vigabatrin as well as the quality-of-care indicators for infantile spasms.

Clinical value of video-EEG on adrenocorticotrophic hormone therapy for infantile spasms / 中国小儿急救医学

Objective To analyse the value of video-EEG (VEEG) in the infantile spasms (IS)children treated with adrenocorticotrophic hormone (ACTH). Methods The clinical data of 65 children with IS in our hospital from Jan 2005 to Dec 2009 were collected and the characteristics of VEEG were analyzed before and after treated with ACTH. Results All the 65 cases appeared hypsarrhythmia in the interphase before treated with ACTH. Cluster spasms and the characteristics of VEEG were recorded. After treated with ACTH,40 of 65 cases (61.5%) with epileptic seizure were controlled,in whom 27 cases (67.5% ,27/40)with hypsarrhythmia disappeared or improved obviously. The other 25 of 65 cases (38.5%) with epileptic seizure were uncontrolled,in whom only 5 cases (20. 0% ,5/25) with hypsarrhythmia disappeared. The rate of hypsarrhythmia disappeared or improved was significantly different between the epileptic seizure controlled and uncontrolled children (x2 = 13. 888, P ＜ 0. 000). Conclusion VEEG is not only important to make a definite diagnosis for IS,but also can provide an evidence in evaluating the effect of ACTH in IS children.

The diagnostic value of 18F-FDG PET/CT in the localization of ectopic adrenocorticotrophic hormone-secreting tumors / 中华核医学杂志

Objective To investigate the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT in the localization of ectopic adrenocorticotrophic hormone ( ACTH)-secreting tumors. Methods Seven patients with ectopic ACTH syndrome (confirmed by clinical symptom, biochemical data or bilateral simultaneous inferior petrosal sinus sampling) were included, 4 males and 3 females with age ranged 27-63 years old.All patients were examined with head MR, chest and abdomen CT, abdomen ultrasonography, and whole body 18F-FDG PET/CT. Location, size, and the maximum standardized uptake value (SUVmax) of the tumor were measured. Results 18 F-FDG PET/CT detected three ectopic ACTH-secreting tumors with the sizes 1. 1 cm×1.0 cm (SUVmax =9.4), 1.5 cm×1.1cm (SUVmax =6.4), and 1.6 cm ×1.5 cm (SUVmax =12.0). The pathological findings of the three tumors were thymoma, lung carcinoid, and mediastinal carcinoid respectively. Conclusion 18 F-FDG PET/CT may help the localization of ecto pic ACTH-secreting tumors .

The Effects of Supplemental Oxygen on Postoperative Nausea and Vomiting, Pain, and Stress Hormones / 대한마취과학회지

BACKGROUND: Supplemental oxygen has been reported to diminish postoperative nausea and vomiting (PONV). Surgical trauma causes increased response of stress hormones. Therefore, we aimed to investigate whether supplemental oxygen attenuates release of adrenocorticotrophic hormone (ACTH) and cortisol as well as PONV in patients undergoing thyroidectomy. METHODS: One hundred female patients were randomly assigned to two groups: 30% oxygen (Group 30) and 80% oxygen (Group 80). The incidence and the severity of PONV and pain score were evaluated 2, 6, 24 h postoperatively. PaO2, ACTH and cortisol were measured in 40 patients before tracheal intubation under 100% oxygen and at the end of surgery under designated oxygen concentration. RESULTS: The PaO2 at induction was similar between the groups, but significantly higher in the group 80 than group 30 at the end of surgery. There were no differences in the incidence and the severity of PONV and pain score postoperatively between the groups. ACTH increased significantly at the end of surgery in both groups, but cortisol did not. There were no differences in ACTH and cortisol between the groups. CONCLUSIONS: Supplemental oxygen during thyroidectomy did not reduce the incidence and severity of PONV, postoperative pain, and stress hormone responses.