Insuficiência adrenal aguda / Acute adrenal insufficiency

A insuficiência adrenal (IA) consiste em síndrome clínica rara, decorrente da deficiência de glicocorticoides e/ou mineralocorticoides, podendo ser primária. A insuficiência adrenal aguda consiste em emergência endócrina rara, resultante da diminuição súbita do cortisol circulante, ou de aumento significativo da demanda por esse hormônio em pacientes com algum grau de disfunção adrenal, ocorrendo mais frequentemente no contexto da IA primária. O prognóstico da doença depende do reconhecimento e intervenção terapêutica precoces

Adrenal insuficiency (AI) consists of a rare clinical syndrome resulting from glucocorticoids and/or mineralocorticoids deficiency. Adrenal insufficiency may be primary. The acute AI is a rare endocrine emergency resulting from sudden decrease of circulating cortisol or, elevated demand for this hormone in patients with some degree of adrenal disfunction, occuring more frequently in primary AI. The prognosis depends on early recognition and precocious therapeutic intervention

Effects of triptolide on hypothalamic-pituitary-adrenal axis of rats / 法医学杂志

OBJECTIVE@#To observe the effects of triptolide on the hypothalamic-pituitary-adrenal axis (HPAA) of rats in light of morphological and functional changes.@*METHODS@#Thirty Sprague-Dawley (SD) male rats were randomized into 3 groups and given 2% propylene glycol, mixture of propylene glycol and prednisone acetate or compounds of propylene glycol and triptolide by gavage, respectively, for consecutive 7 weeks. Determination in the 3 groups was conducted concerning the contents of blood plasma cortisol (COR), adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) besides measurement of the rats' body weight, coefficient of the adrenal gland and observation of the histopathological changes in fascicular zone of adrenal cortex. Immunohistochemical staining technique was used to detect the expression of ACTH in pituitary in the 3 groups.@*RESULTS@#(1) The content of COR in the groups of triptolide and prednisone acetate appeared lower and serum ACTH showed no significant difference, but CRH in the group of triptolide was augmented as compared with the control group (P < 0.05). (2) The rats' weight in the groups of triptolide and prednisone acetate was declined, and yet, the coefficient of the adrenal gland remained no significant change in comparison with the controls. HE staining and electron microscopy examination revealed thinned and constricted zona fasciculata in adrenal gland in the rats of triptolide and prednisone acetate, with hypofunction. ACTH expression in the group of triptolide was higher than that of the control group (P < 0.05).@*CONCLUSION@#Morphologically and functionally, the findings suggest that long-term use of triptolide may result in atrophied cortex and hypofunction of the adrenal gland, leading to augmented production and secretion of CRH and ACTH from respective hypothalamic and pituitary.

Adrenal function in 23 children with paracoccidioidomycosis

Adrenal involvement by Paracoccidioides brasiliensis was described at necropsies and in many clinical studies, but only in adults. Therefore, the aim of this study was to evaluate adrenal function in children with paracoccidioidomycosis. Twenty-three children with the systemic form of paracoccidioidomycosis were evaluated and divided in two Groups: Group A (n = 8) included children before treatment and Group B (n = 15) children after the end of treatment. Plasma cortisol (basal and after ACTH test), ACTH, renin activity, aldosterone, sodium and potassium were measured. They were within normal range in all cases, except for renin activity and aldosterone, which were elevated in some cases. Group A patients showed basal and post-ACTH cortisol levels significantly greater than Group B patients. The results showed that adrenal function was not compromised in these children with paracoccidioidomycosis.

O acometimento adrenal pelo Paracoccidioides brasiliensis é descrito em necropsias e em estudos clínicos, mas apenas em adultos. Portanto, o objetivo deste estudo foi avaliar a função adrenal em crianças com paracoccidioidomicose. Vinte e três crianças com forma sistêmica de paracoccidioidomicose foram avaliadas e divididas em dois grupos: Grupo A (n = 8) pacientes antes de iniciar o tratamento e Grupo B (n = 15) pacientes após o termino do tratamento. Dosagens plasmáticas de cortisol (basal e após teste com ACTH), ACTH, atividade de renina, aldosterona, sódio e potássio foram realizadas. Estas dosagens foram normais em todos os casos, com exceção da atividade da renina e da aldosterona que foram elevadas em alguns casos. Os pacientes do Grupo A mostraram valores de cortisol basal e após-ACTH significativamente maiores que os do Grupo B. Os resultados demonstraram que a função adrenal não foi comprometida neste grupo de crianças com paracoccidioidomicose.

Silenciamento de genes com RNA interferência: um novo instrumento para investigação da fisiologia e fisiopatologia do córtex adrenal / Gene silencing with RNA interference: a novel tool for the study of physiology and pathophysiology of adrenal cortex

A inativação de genes por knock-out ou por bloqueio da tradução de seus transcritos (silenciamento) constitui uma estratégia extremamente poderosa tanto para atribuir função aos genes como para mapear a inter-relação dos diferentes componentes das vias regulatórias intracelulares. Um dos meios para se obter o silenciamento pós-transcricional consiste na ativação de um mecanismo mediado por RNAs fita-dupla (dsRNA) conhecido como RNA interferência (RNAi). O RNAi se mostrou um instrumento extremamente versátil em pesquisa biomédica, podendo ser utilizado em experimentos de silenciamento pontual de genes ou ser adaptado para estudos em larga escala de genômica funcional, podendo, inclusive, ser utilizado como meio de terapia gênica. Neste trabalho, os autores discutem as vias intracelulares envolvidas no RNAi, bem como as principais estratégias e limitações técnicas para se obter o silenciamento em células de mamíferos. Fazem, também, uma revisão das principais aplicações do RNAi na terapêutica de doenças humanas e na investigação de fenômenos fisiológicos e fisiopatológicos do córtex adrenal.

A preliminary report on basal & stimulated plasma cortisol in patients with acquired immunodeficiency syndrome.

BACKGROUND & OBJECTIVES: Structural and/or functional alterations in adrenal glands have been reported in human immunodeficiency virus (HIV) infection. However, no information has been reported from India. Hence a study was undertaken to assess the basal and circadian variations in plasma cortisol, and cortisol response to bolus ACTH in patients with AIDS. METHODS: Basal and stimulated plasma cortisol levels at 0800 h and 1600 h and, at 30 and 60 min following an intravenous bolus of 250 micrograms ACTH (short synacthen test, SST) were estimated in 15 patients with AIDS (CD4 < or = 200/microliter) and 12 healthy controls. The nature of the opportunistic infections and/or associated disease in each patient was also studied. RESULTS: The patients had higher median basal plasma cortisol levels as compared to the controls at 0800 h (540 nmol/l vs 415 nmol/l, P < 0.005) and at 1600 h (420 nmol/l vs 285 nmol/l, P < 0.003). Five patients (33%) exhibited abnormal circadian cortisol rhythms. All subjects in the control group and all but one (6.6%) in the patients group had normal peak plasma cortisol response (> or = 550 nmol/l) to SST. The lone patient with subnormal cortisol response had no feature of adrenal insufficiency. On the contrary, 3 patients clinically suspected to have adrenal insufficiency, had normal plasma cortisol response. INTERPRETATION & CONCLUSIONS: These findings suggest that most patients with AIDS have elevated basal plasma cortisol levels with abnormal circadian rhythm in some and normal adrenocortical reserve irrespective of the symptoms/signs of adrenal insufficiency.

Supresión adrenal grave en pacientes reumatológicos: análisis de 25 casos consecutivos / Severe adrenal insuficiency in rheumatological patients: analysis of 25 consecutive cases

Los corticoesteroides (CE) son piedra angular en tratamiento del paciente con enfemedades difusas del tejido conjuntivo (EDTC); la supresión o aumento de los requerimientos de estos sin la terapia sustitutiva adecuada, se asocia a incremento en morbimortalidad. Pacientes y métodos. Se incluyeron en el presente análisis pacientes con EDTC, bajo tratamiento con CE, los que fueron suspendidos bruscamente por diversas causas; esto tradujo problema que requirió hospitalización. Resultados. Nuestro estudio incluye 25 pacientes consecutivos con EDTC y suspensión de CE que requirieron de internamiento a través del Servicio de Urgencias. La edad de los pacientes fue de 54 años en promedio (15 a 78). La mayoría fueron del género femenino (68 por ciento), con tiempo de empleo de los CE de 10 meses a 18 años y promedio de 8 años. El 60 por ciento de los pacientes recibían prednisona, 4 por ciento betametasona de depósito, 28 por ciento combinación de indometacina con betametasona y 8 por ciento dexametasona. El 28 por ciento de los pacientes tomaban este tratamiento por prescripción de reumatólogos, 36 por ciento por indicación de médicos generales, 12 por ciento por internistas, 4 por ciento por ortopedistas y 20 por ciento se autoprescribieron los CE. El 48 por ciento suspendió los CE por imposibilidad para la ingesta (vómito), 8 por ciento por falta de medicamento, 20 por ciento por indicación médica al tener el paciente algún proceso infeccioso concomitante, 12 por ciento por cambio de tratamiento y 12 por ciento por indicación médica ignorando que el paciente recibía CE. Todos presentaron taquipnea, mialgias, astenia y adinamia, 92 por ciento fiebre, 92 por ciento artralgias, 88 por ciento hipotensión arterial y 84 por ciento taquicardia. El 84 por ciento se presentó con hipoglucemia, 76 por ciento tuvieron leucocitosis, 56 por ciento hiponatremia y 48 por ciento hiperkaliemia. Un paciente falleció con cuadro concomitante de suboclusión intestinal y otro con neumonía, el que por prescripción de su médico suspendió el CE

Preliminary study of androgen, thyroid & adrenal status in alcoholic men during deaddiction.

To evaluate the status of the testes, thyroid, and adrenals in male alcoholics during the period of voluntary abstinence and therapy, chronic male drinkers undergoing a 4 wk inpatient deaddiction programme in a social hospital were recruited. Levels of a few serum and urinary hormones/metabolites viz., serum testosterone, total triiodothyronine (T3) and thyroxine (T4) and urinary total 17-ketosteroids (17-KS), estrone, estradiol, and 17-hydroxy corticosteroids (17-OHCS) were assessed in alcoholics thrice during the treatment programme at hospital i.e., on the zero (day of admission), 10th, and 20th day and compared to those of non-alcoholic controls. Alcoholics registered elevated serum total T3, and reduced total T4 and testosterone levels at admission, which persisted even after 20 days of the rehabilitative programme. Markedly high urinary levels of total 17-KS, estrone, and 17-OHCS were observed on zero day of admission. Urinary estrone and 17-OHCS, unlike total 17-KS, showed a trend to return to the normal range during the 20 days period. Urinary estradiol levels, however, recorded no significant alteration. The results of this preliminary study are suggestive of alcohol-induced perturbations on the functional integrity of the testes, thyroid, and adrenal in male alcohol addicts, wherein 20 days period of total alcohol abstinence and rehabilitative programme failed to reverse alcohol-induced hypoandrogenization and altered thyroidal status, but only partially restored certain biochemical events associated with the excretion of steroid metabolites.

Disturbance in the pressor and chronotropic effects of epinephrine and norepinephrine as well as in the function and structure of adrenal cortex induced by O,P'-DDt

The effect of O, P'-DDT on the cardiovascular effects of catecholamines and on the function and structure of the adrenal cortex was evaluated in rabbits. Administration of 50 mg/kg/day O, P'-DDT orally to rabbits for two and three weeks significantly decreased the mean arterial blood pressure and heart rate. The mean percentage increase in the pressor and chronotropic effects of intravenously injected graded doses of epinephrine and norepinephrine were markedly decreased in vagotomized rabbits pretreated with 50 mg/kg/day O, P'-DDT orally for two and three weeks. These effects of O,P'-DDT were more marked after three weeks than after two weeks of its administration. The administration of cortisol, but not aldosterone was found to be capable of potentiating the pressor and chronotropic effects of intravenously injected graded doses of catecholamines in vagotomized rabbits pretreated with O,P'-DDT. Treatment of rabbits with 50 mg/kg/day O,P'-DDT orally for one week produced insignificant change in the plasma cortisol level, significant decrease in the plasma aldosterone and sodium levels and significant increase in the plasma potassium level. The plasma cortisol, aldosterone and sodium levels were markedly decreased, while the plasma potassium level was markedly increased after administration of the same dose of O, P'-DDT to rabbits for two and three weeks. Also, the intensity of these effects of O, P'-DDT was directly related to the duration of administration. The administration of ACTH to rabbits pretreated with 50 mg/kg/day O,P'-DDT orally for three weeks, failed to alter the effects of O,P'- DDT on the plasma cortisol aldosterone and electrolyte levels. The histopathological changes were studied and indicated that O,P'-DDT has a definite effect on the adrenal cortex of the rabbits ranging from outer zonal fatty change to diffuse fatty change with hemorrhage and foci of necrosis depending on the duration of administration. It is concluded that O,P' DDT has the ability to produce a disturbance in the cardiovascular effects of catecholamines and a direct impairment in the function and structure of the adrenal cortex

Adreno-cortical reserve in pulmonary tuberculosis.

Serum cortisol in response to ACTH was assessed in 28 patients with moderately severe to far advanced pulmonary tuberculosis. Ten healthy individuals served as controls. Whereas the basal values were comparable in the two groups the mean delta peak, mean and area under the response curve were significantly lower in the tubercular patients (p < 0.05 to 0.001). Six patients had negligible cortisol response to ACTH stimulation while five others exhibited an inadequate response (rise between 200-300 nmol/L0. None of the subjects had any clinical evidence of adrenocortical insufficiency. The data thus revealed a functional impairment of adrenal cortical reserve in patients of pulmonary tuberculosis.

Adrenocortical insufficiency in smear positive pulmonary tuberculosis.

We studied 40 patients with pulmonary tuberculosis. All were positive for acid-fast bacilli (AFB) in the sputum. Their mean age was 30 yrs (range 10-50 yrs) and the duration of illness was 26.3 +/- 2.3 months. Radiologically minimal, moderately advanced and far advanced lesions were present in 7 (17.5%), 9 (22.5%) and 23 (57.5%) patients respectively. One patient with endobronchial lesion had no radiological evidence of pulmonary tuberculosis. Clinically, 14 patients (35%) had one or the other features of adrenocortical insufficiency. Postural hypotension was the commonest feature and was present in 11 patients (27.5%), followed by nausea and vomiting (20%), loss of axillary hair and libido (10%), skin and mucosal pigmentation in 7.5% of the cases. ACTH stimulation revealed incomplete adrenocortical insufficiency (partially responsive adrenal) in 5 patients (12.5%) and complete adrenocortical insufficiency (non-responsive adrenal) in 2 patients (5%). Patients with features of adrenal insufficiency had significantly longer duration of illness (p < 0.001) but there was no correlation with extent or type of lesion.

Salivary cortisol in the assessment of adrenocortical function in patients with pulmonary tuberculosis.

Adrenocortical function was assessed on the basis of changes in salivary cortisol in patients with pulmonary tuberculosis and the findings compared with those in healthy subjects. A method of direct radioimmunoassay of salivary cortisol was standardized and the sensitivity was 0.8 nmol/l. Cortisol levels in saliva were significantly higher in the patients than in the healthy subjects (P less than 0.001). The diurnal rhythm of cortisol secretion was disturbed in the patients with a significant increase in salivary cortisol beyond 1800 h. While dexamethasone caused an appreciable suppression (87%), stimulation with ACTH (tetracosactrin) resulted in a marked increase in salivary cortisol, the increase being significantly higher in the healthy subjects than in the patients (P less than 0.001). Attempts to classify subjects as positive or negative responders to tetracosactrin based on increases in salivary cortisol in relation to plasma cortisol changes were however not successful, as the agreement between the two methods ranged from 73 to 80 per cent with various criteria used.

Effect of an LH-RH analog on cat testis and adrenal cortex function

The LH-RH analog-LH-RH-A (des-Gly10, [D-Trp6]-LH-RH ethylamide) was administerd in pharmacological doses (20 µg/Kg, sc) to adult male cats for 15 days and its effect on testis and adrenal function was determined. Dayly adminitration of the analog promoted a 3-fold increase in plasma testosterone levels after 7 days, indicating stimulatory effect of LH-RH-A (mean ñ SD for 6 treated cats, 1.88 ñ 0.35 vs 0.51 ñ 0.08ng/ml for 6 control cats). After 15 days the LH-RH-A-treated group exhibited a similar plasma testosterone concentration as the control group (mean ñ SD, 0.96 ñ 0.35 ng/ml vs 0.88 ñ 0.39 ng/ml, respectively), similar testicular and adrenal weights and no significant differences in the spermatogenic process. However, semiquantitative analysis of the zona fasciculata of the adrenals from the LH-RH-A treated group showed a significant accumulation of a substance not stained by hematoxylin-eosin or Schiff periodic acid (mean ñ SD of index of accumulation was 3.50 ñ 0.4 for treated cats vs 2.20 ñ 0.3 for control cats). The present results show that pharmacological doses of LH-RH-A have an effect on the adrenal cortex of cats without modifying spermatogenesis or plasma testosterone levels

study of adrenocortical carcinoma

Adreno - cortical tumours are rare They are classified into functioning and nonfunctioning categories according to their ability to produce excess hormones This study includes 10 cases with adreno - cortical carcinoma The details of their management were discussed The abdominal transperitoneal approach was used in 9 patients The size of the resected tumours ranged between 5 cm to 35 cm diameter and 65 gm to 56 kg weight One patient had liver metastases The ipsilateral kidneys were not involved and were not removed during adrenalectomy Three patients died because of their disease during the first year of follow up The other 7 patients were alive and well with no evidence of recurrence for a period of 9 months to 20 years, although 3 of them have failed to show for follow up after 9, 12 and 18 months There were 3 long term survivors who were followed up for 7 to 20 years The prognostic factors were discussed

Adreno-cortical function in leprosy.

Adreno cortical function was carried out in 43 cases of leprosy. These cases were further divided into tuberculoid, borderline, lepromatous and Lepra reaction. Serum and urinary electrolyte, urinary 17-Ketosteroid and 17-Ketogenic steroid and plasma cortisol levels were measured to assess the adrenocortical status in these different forms of leprosy. It was observed that these parameters were within normal limit in tuberculoid leprosy except low value of urinary 17-Ketogenic steroid. The borderline and Lepromatous leprosy cases revealed low values of urinary sodium, potassium and 17-Ketogenic steroid and high level of serum potassium. However, the cases of lepra reaction revealed low value of serum and urinary sodium and potassium, urinary 17-Ketogenic steroid. The basal plasma cortisol level was high in this group but it was statistically insignificant.

The effect of acute non-fatal haemorrhage on adrenocortical function.

The effect of acute non-fatal haemorrhage on adrenocortical function was assessed in 19 Burmese subjects. The results indicated that acute non-fatal haemorrhage as produced by blood donation stimulated the adrenal cortex to increase its secretion.

Adrenal cortical function and reserve in lepromatous leprosy.

22 chronic Lepromatous Leprosy patients of over 10 years duration, 17 non-reactional and 5 in reactional state who have not taken steroids as part of treatment were selected for the study. Serum cortisol was estimated by Radio-immuno-assay. Samples for basal values were collected at 8.00 A.M. Stimulated values were estimated in samples collected 8 hours after ACTH gel 40 units IM or 2 hours after 0.15 unit/kg BW Plain Insulin I.V. Basal cortisol values are: Normal controls 123.06 +/- 57.33 ng/ml. Non-reactional: 100.47 +/- 30.33 ng/ml; Reactional 141.4 +/- 43.15 ng/ml. Stimulated values are: Normal controls: 207.6 +/- 72.57 ng/ml. Non-reactional: 175.33 +/- 57.07 ng/ml, Reactional: 230 +/- 40.92 ng/ml. Basal serum cortisol in the non-reactional state is slightly lower than in normals but not statistically significant (P greater than 0.1). The basal cortisol in reactional subjects is slightly higher than in normals but not significant statistically (P greater than 0.05). The percentage rise over the basal value after stimulation test is found to be significantly low in both the reactional and non reactional states (P greater than 0.05) and also there is no statistically significant difference between these two groups (p greater than 0.5). Hence it is concluded that the Adrenal cortical reserve is low both in the non-reactional and reactional states of Lepromatous Leprosy.