Effect of Vitamin C on adrenal suppression by etomidate induction in patients undergoing cardiac surgery: A randomized controlled trial.

Introduction: Etomidate is usually preferred in the induction of cardiac compromised patients due to its relative cardiovascular stability. However, the use of this drug has been limited as etomidate induces suppression of cortisol biosynthesis as a result of blockade of 11‑beta‑hydroxylation in the adrenal gland, mediated by the imidazole radical of etomidate. This study was carried out to observe the effect of Vitamin C on adrenal suppression after etomidate induction in patients undergoing cardiac surgery. Materials and Methods: A total of 78 patients were randomly distributed into two groups. Group‑I received oral Vitamin C (500 mg) twice daily and Group‑II received antacid tablet as placebo twice daily instead of Vitamin C for 7 consecutive days prior to surgery till morning of surgery. Patients of both the groups induced with etomidate (0.1–0.3 mg/kg). Blood cortisol was estimated at different points of time till 24th postinduction hour/blood lactate, glucose, hemodynamic parameters, and perioperative outcomes were assessed. Results: Data of seventy patients (n = 35 in each group) were finally analyzed. Cortisol level is statistically significantly higher in Group‑I (69.51 ± 7.65) as compared to Group‑II (27.74 ± 4.72) (P < 0.05) in the 1st postinduction hour. In Group‑II, cortisol was consistently lower for 1st 24 postinduction hour. Total adrenaline requirement was statistically significantly high in Group‑II. Time of extubation, length of Intensive Care Unit stay arrhythmia was similar in both the groups. Conclusion: Vitamin C effectively inhibits etomidate‑induced adrenal suppression in cardiac patients, thereby etomidate can be used as a safe alternative for induction in cardiac surgery under cardiopulmonary bypass when pretreated with Vitamin C.

Alopecia androgenética femenina: Parte II: tratamiento / Female androgenetic alopecia: Part II: treatment

Como en el varón, el tratamiento tópico de alopecia de patrón femenino (AF) es con minoxidil al 3 por ciento - 5 por ciento dos veces al día. También puede usarse el minoxidil combinado con α-tocoferol o con otros tratamientos tópicos que elevan localmente el factor de crecimiento vascular endotelial. Comentamos nuestra experiencia con esta asociación. Los efectos secundarios más frecuentes en mujeres son la dermatitis de contacto y la hipertricosis de cara y antebrazos. Cuando la alopecia femenina se asocia a elevados niveles de andrógenos hay que utilizar terapéutica antiandrogénica. El síndrome de persistencia de la adrenarquía (SAHA suprarrenal) y alopecia en hiperandrogenismo suprarrenal deben tratarse con supresión suprarrenal y antiandrógenos. La supresión suprarrenal la efectuamos con glucocorticoides como dexametasona, prednisona o deflazacort. La terapia antiandrogénica incluye acetato de ciproterona, drospirenona, espironolactona, flutamida y finasterida. El síndrome por exceso de eliminación de andrógenos ováricos (SAHA ovárico) y alopecia del hiperandrogenismo ovárico pueden tratarse con supresión ovárica y andriandrógenos. La supresión ovárica incluye el uso de anticonceptivos que contengan un estrógeno, etinilestradiol, y un progestágeno. El antiandrógeno acetato de ciproterona, siempre acompañado de un anticonceptivo tricíclico, es la mejor terapéutica de la alopecia femenina. Los antagonistas de las hormonas liberadoras de gonadotropinas (GnRH) como el acetato de leuprolida suprimen la función hipofisaria y gonadal mediante la reducción de los niveles de LH y FSH, y como consecuencia se reducen los niveles de esteroides ováricos, especialmente en el síndrome de los ovarios poliquísticos. El SAHA hiperprolactinémico y alopecia del hiperandrogenismo de procedencia hipofisaria deben tratarse con bromocriptina o cabergolina. Las mujeres con alopecia posmenopáusica y altos niveles séricos de andrógenos en la premenopausia...

Topical treatment of female patgten hair loss (FPHL) is with minoxidil 3 percent-5 percent twice daily. Combination of minoxidil with α-tocopherol or with other topical treatment with possibility to enhance VEGF can be used. Our experience with this association is commented. Side effect of minoxidil is contact dermatitis and hipertricosis on face and forearm. When FPHL is associated with high levels of androgens systemic antiandrogenic therapy must be used. Persistent adrenarche syndrome (adrenal SAHA) and alopecia of adrenal hiperandrogenism must be treated with adrenal suppression and antiandrogens. Adrenal suppression is achieved with glucocorticosteroids such as dexametasona, prednisone ordeflazacort. Antiandrogen therapy includes cyproterone acetate, drospirenone, spironolactone, flutamide and finasteride. Excess release of ovarian androgens (ovarian SAHA) and alopecia of ovarian hiperandrogenism must be treated with ovarian suppression and antiandrogens. Ovarian suppression includes the use of contraceptives containing an estrogen, ethinyl estradiol, and a progestogen. Antiandrogens such as cyproterone acetate, always accompanied by tricyclic contraceptives, are the best antiandrogen to use in FPHL. Gonadotropin-releasing hormone (GnRH) agonists such as leuprolide acetate suppress pituitary and gonadal function through a reduction in LH andFSH levels. Subsequently, ovarian steroids levels will also be reduced, especially in patients with polycystic ovary syndrome. SAHA with hyperprolactinemia and alopecia of hyperprolactinemic hiperandrogenism should be treated with bromocriptineor cabergoline. Postmenopausal alopecia, with previous high levels of androgens or with PSA over 0.02 ng/ml improves with 2.5 mg/day of finasteride or 0,25 mg/day of Dutasteride. Although we do not know the reason, postmenopausal alopecia in normoandrogenic women also improves, probably in relation with the doses of 2.5 mg day that received...

The Efficacy and Safety of Inhaled Steroid Therapy for Prevention of Recurrent Wheezing after Bronchiolitis / 소아알레르기및호흡기학회지

PURPOSE: The purpose of this study was to evaluate the efficacy and metabolism of inhaled steroids to prevent recurrent wheezing after bronchiolitis. METHODS: Sixty two patients were randomly divided into study (n=31) and control (n=31) groups. All of them received budesonide 500 microgram and salbutamol 1.25 mg 4 times a day via nebulizer during admission period (5.5+/-2.5 days). After discharge, the study group patients received fluticasone 50 microgram twice a day with metered dose inhaler with mask spacer for 12 weeks, and the control group received none of inhaled steroids. Serum cortisol and dehydroepiandrosterone sulfate (DHEA-S) concentrations were measured at admission and at the end of the inhaled corticosteroid (ICS) therapy. Weight and height of all patients were checked during the follow-up period. RESULTS: Atopic dermatitis of the patient and allergy family history proved statistically significant. Among high risk group patients, the attack rate of recurrent wheezing in the study group was significantly reduced as compared with the control group. Cortisol levels checked at the end of the ICS therapy were not significantly different from the level checked at admission. In the study group, there was no statistically significant difference between dehydroepiandrosterone sulfate (DHEA-S) level at admission and at the end of the ICS therapy. There was no statistically significant difference of height and weight SDS (standard deviation score) between baseline and 12 weeks later. CONCLUSION: This study suggest that inhaled corticosteroid can be used prophylactically for reducing recurrent wheezing after bronchiolitis in high risk group for asthma.

The Maternal and Fetal Adrenal Effect of 1 cycle Dexamethasone on women with Preterm Labor / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to determine whether 1 cycle of dexamethasone administration to women at risk of preterm delivery causes adrenal suppression METHODS: Nonpregnant ten control subjects were checked baseline cortisol and stimulated cortisol level after low-dose (1 microgram) ACTH stimulation test. Ten women at risk of preterm delivery had two weekly low-dose (1 microgram) ACTH stimulation tests with the first one at admission. Immediately after the first ACTH stimulation test, we gave each women a 5 mg dexamethasone dose intramuscularly and repeated it 12 hours later for two days. Serum cortisol levels were measured before (baseline) and 30 minutes after ACTH administration. RESULTS: All ten subjects had normal baseline and stimulated cortisol levels for the first ACTH stimulation test. The adrenal suppressed Group was composed of 5 patients. But the remainders was not suppressed. Mean baseline serum cortisol levels decreased from 38.52 microgram/dL (before dexamethasone) to 33.26 microgram/dL (1 week after 1 cycle of dexamethasone) in adrenal suppressed Group. The mean stimulated cortisol levels also decreased from 46.40 microgram/dL (before dexamethasone) to 45.02 microgram/dL (1 week after 1 cycle of dexamethasone) in adrenal suppressed Group. CONCLUSIONS: Antenatal administration of 1 cycle dexamethasone produced slightly adrenal suppression, but no adrenal insufficiency, in some women at risk of preterm delivery and may be harmless to maternal and fetal adrenal function.