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Arch. Clin. Psychiatry (Impr.) ; 47(1): 7-12, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088740


Abstract Objectives This study aimed to explore the effect of antidepressant treatment on the HPA axis, changes in depression score, and serum levels of TNF-α in depressed infertile women. Methods In this randomized controlled trial research, 60 infertile women who had undergone in vitro fertilization (IVF) treatment with depression scores between 16-47 were divided into two groups. The intervention group with fluoxetine capsule was under treatment for two months before the embryo transfer, while the control group was given placebo. Depression score, serum levels of tumor necrosis factor alpha (TNF-α) as well as cortisol hormone levels were measured and recorded both before and after the intervention. The data were analyzed using SPSS version 21 software. Results We analyzed the data related to 55 subjects who had undergone embryo transfer. 7 subjects in the intervention group and 3 in the control group got pregnant. We observed a significant decrease in the depression score (p < 0/001) and serum levels of cortisol (p = 0/001) in the intervention group. There was a significant increase in the serum levels of TNF-α in the intervention group (p < 0/001). There was a significant difference between the two groups in the number of pregnancies (p = 0.04). However, there was no statistical difference between them with regard to the number of harvested oocytes (p = 0.174). Discussion Decrease in depression score and cortisol level, and an increase in the levels of TNF-α in the intervention group caused any changes in the number of oocytes in comparison with the control group. However, the number of pregnancies was larger in the intervention group.

Humans , Female , Adult , Fluoxetine/therapeutic use , Tumor Necrosis Factor-alpha/blood , Depression/drug therapy , Hypothalamo-Hypophyseal System/drug effects , Infertility, Female/psychology , Antidepressive Agents/therapeutic use , Hydrocortisone/blood , Fertilization in Vitro , Tumor Necrosis Factor-alpha/drug effects , Treatment Outcome , Infertility, Female/therapy
Arch. endocrinol. metab. (Online) ; 64(1): 82-88, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088767


ABSTRACT Objective The insulin tolerance test (ITT) has been accepted as the gold standard test for assessing the integrity of the growth hormone (GH) - insulin-like growth factor (IGF-1) axis and the hypothalamic-pituitary-adrenal (HPA) axis. The goal of the test is to achieve clinical and biochemical hypoglycemia at a blood glucose level ≤ 40 mg/dL to effectively and correctly assess the HPA and GH-IGF-1 axes. In this study, the GH and cortisol responses of patients who achieved and failed to achieve biochemical hypoglycemia during an ITT were compared. Subjects and methods One hundred thirty-five patients with pituitary disorders were included in the study. Samples for blood glucose levels were obtained after clear symptoms of clinical hypoglycemia developed. The patients were enrolled in the hypoglycemic and nonhypoglycemic groups according to whether their plasma glucose level ≤ 40 mg/dL or > 40 mg/dL during an ITT, and the groups were compared in terms of their GH and cortisol responses. Results The mean age, body mass index and waist circumference of the two patient groups were found to be similar. The mean blood glucose level was significantly lower in the hypoglycemic group than in the nonhypoglycemic group (19.3 and 52.0 mg/dL, respectively). When the two groups were compared in terms of peak cortisol and GH responses, no statistically significant differences were found. Conclusion The data presented suggest that clinically symptomatic hypoglycemia is as effective as biochemically confirmed hypoglycemia during an ITT. Arch Endocrinol Metab. 2020;64(1):82-8

Humans , Male , Female , Adult , Middle Aged , Insulin-Like Growth Factor I/analysis , Hydrocortisone/blood , Human Growth Hormone/blood , Glucose Tolerance Test/methods , Hypoglycemia/blood , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Pituitary-Adrenal System/metabolism , Blood Glucose Self-Monitoring , Retrospective Studies , Glucose Tolerance Test/adverse effects , Hypoglycemia/diagnosis , Hypoglycemia/metabolism , Hypothalamo-Hypophyseal System/metabolism
Arq. bras. med. vet. zootec. (Online) ; 71(5): 1459-1468, set.-out. 2019. tab, graf
Article in Portuguese | ID: biblio-1038667


O objetivo do presente experimento foi avaliar efeito do estresse e da dificuldade de inseminação (DifIA) sobre a taxa de concepção (TC) de vacas (n=93) e novilhas (n= 72) Nelore submetidas à IATF. No D9, anotou-se nota de temperamento (NTe) e tempo da saída do brete (TSB) de todos os animais e coletou-se sangue das novilhas. No dia da IATF (D11), anotou-se NTe, TSB, DifIA e tempo de IA. A TC foi 36% para vacas e 46% para novilhas (P>0,05). Não foi observado efeito de Nte sobre TC (P>0,05). Porém, houve tendência para maior (P<0,10) TC nos animais que não apresentaram dificuldade de inseminação (DifIA1; TP=42%) em comparação aos animais com moderada ou alta dificuldade (DifIA2+DifIA3; TP=27%). Foi observado menor (P<0,05) tempo de IA para animais DifIA1 (17:31±06:02s) que animais DifIA2-3 (30:10±15:45s). Novilhas com maiores (P<0,05) níveis de cortisol apresentaram maior NTe (P<0,05). Entretanto, TC (59%) das novilhas menos reativas (cortisol=4,12±1,12ng/mL; NTe=3,2±0,6) não diferiu da TC (41%; P>0,05) das mais agitadas (cortisol=7,76±1,33ng/mL; NTe=3,82±0,79). Concluiu-se que avaliações de temperamento se relacionaram com nível de estresse, embora esses parâmetros não tenham afetado a TC deste trabalho. A maior dificuldade e/ou tempo necessário para se completar a IA demonstrou ser um potencial fator para a redução da fertilidade na IATF.(AU)

The objective was to evaluate the influence of stress and difficulty of insemination (DifIA) on conception rate (CR) of Nellore cows (n= 93) and heifers (n= 72) in Timed-AI. On D9, temperament (NTe) and time for chute exit (TSB) were recorded for all animals, and blood samples were colected from heifers. On the day of Timed-AI (D11), NTe, TSB, DifIA and time for AI were recorded. For cows, CR was 36% and for heifers 46% (P> 0.05). No effect (P> 0.05) of NTe was observed on CR. However, a tendency (P< 0,10) for higher CR was observed in animals with no difficulty for insemination (DifIA1; CR=42%) compared to animals that presented moderate or high difficulty (DifIA2+DifIA3, CR=27%). Time required for AI was lower (P< 0.05) in animals DifIA1 (17:31±06:02sec) than in animals DifIA2-3 (30:10±15:45sec). Heifers with greater (P< 0.05) cortisol levels presented higher Nte (P< 0.05). However, CR (59%) of less reactive heifers (cortisol=4,12±1,12ng/mL; NTe=3,2±0,6) did not differ from CR (41%; P> 0.05) of stressed animals (cortisol=7,76±1,33ng/mL; NTe=3,82±0,79). It was concluded that assessments of temperament were related to stress level, although these parameters did not affect the CR of this study. However, the higher difficulty and/or time to complete AI showed to be a potential factor for reducing fertility after timed-AI.(AU)

Animals , Female , Cattle , Stress, Physiological , Hydrocortisone/blood , Insemination, Artificial/methods , Insemination, Artificial/veterinary , Fertility
Arch. endocrinol. metab. (Online) ; 63(2): 175-181, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001221


SUMMARY Cushing's syndrome (CS) is an uncommon condition that leads to high morbidity and mortality. The majority of endogenous CS is caused by excessive ACTH secretion, mainly due to a pituitary tumor - the so-called Cushing's disease (CD) - followed by ectopic ACTH syndrome (EAS), an extra-pituitary tumor that produces ACTH; adrenal causes of CS are even rarer. Several methods are used to differentiate the two main etiologies: specific laboratory tests and imaging procedures, and bilateral inferior petrosal sinus sampling (BIPSS) for ACTH determination; however, identification of the source of ACTH overproduction is often a challenge. We report the case of a 28-year-old woman with clinical and laboratory findings consistent with ACTH-dependent CS. All tests were mostly definite, but several confounding factors provoked an extended delay in identifying the origin of ACTH secretion, prompting a worsening of her clinical condition, with difficulty controlling hyperglycemia, hypokalemia, and hypertension. During this period, clinical treatment was decisive, and measurement of morning salivary cortisol was a differential for monitoring cortisol levels. This report shows that clinical reasoning, experience and use of recent methods of nuclear medicine were decisive for the elucidation of the case.

Humans , Female , Adult , ACTH Syndrome, Ectopic/diagnosis , Carcinoma, Neuroendocrine/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Saliva/metabolism , ACTH Syndrome, Ectopic/etiology , Hydrocortisone/blood , Petrosal Sinus Sampling , Carcinoma, Neuroendocrine/complications , Carcinoma, Neuroendocrine/diagnosis , Adrenocorticotropic Hormone/blood , Diagnosis, Differential , Positron Emission Tomography Computed Tomography , Lung Neoplasms/complications , Lung Neoplasms/diagnosis
J. pediatr. (Rio J.) ; 95(1): 18-26, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-984649


Abstract Objective: To perform a systematic review of the literature for scientific evidence of possible differences in cortisol concentrations in adolescents with eating disorders. Source of data: Electronic searches were conducting in the PubMed, Scientific Electronic Library Online, Virtual Health Library, and Science Direct databases for articles published between 2007 and 2017 using the keywords, cortisol, hydrocortisone; eating disorders, bulimia, bulimia nervosa, anorexia, anorexia nervosa; adolescence, adolescent, adolescents. Synthesis of data: A total of 192 articles were found. After the analysis of the eligibility criteria using the PRISMA method, 19 articles were selected for the present review. Most studies were conducted in Europe. Adolescents diagnosed with anorexia nervosa were evaluated in all studies, except one, when other eating disorders were investigated. Blood was the means used for the determination of cortisol. In ten studies, cortisol levels were higher in the group with anorexia than the control group and a reduction in cortisol levels occurred in the adolescents after being submitted to nutritional recovery. Conclusions: Patients with eating disorders may have several clinical consequences, such as changes in body fat distribution, changes in bone mineral density, worsening of neurocognitive ability, and endocrine changes (e.g., hypercortisolemia), which in turn can lead to hyperglycemia, insulin resistance, hypertension, and increased risk of infections. The findings demonstrate that adolescents with eating disorders, especially anorexia nervosa, have increased cortisol levels, which are reduced after the treatment period. Further studies on differences in cortisol concentrations in adolescents with other eating disorders are needed, using different methods.

Resumo Objetivo: Realizar uma análise sistemática da literatura em busca de evidências científicas de possíveis diferenças nas concentrações de cortisol em adolescentes com transtornos alimentares. Fonte de dados: Pesquisas eletrônicas foram realizadas nas bases de dados do Pubmed, da Scientific Electronic Library Online, da Biblioteca Virtual da Saúde e do Science Direct em busca de artigos publicados entre 2007 e 2017 que utilizaram as palavras-chave: cortisol, hidrocortisona, transtornos alimentares, bulimia, bulimia nervosa, anorexia, anorexia nervosa, adolescência, adolescente e adolescentes. Síntese dos dados: Foram encontrados 192 artigos. Após a análise dos critérios de elegibilidade utilizando o método PRISMA, 19 artigos foram selecionados para esta análise. A maioria dos estudos foi realizada na Europa. Os adolescentes diagnosticados com anorexia nervosa foram avaliados em todos os estudos, com exceção de um, em que outros transtornos alimentares foram investigados. A coleta de sangue foi o meio utilizado para a determinação do cortisol. Em dez estudos, os níveis de cortisol estavam mais elevados no grupo com anorexia do que no grupo de controle e ocorreu uma redução nos níveis de cortisol nos adolescentes após serem submetidos a uma recuperação nutricional. Conclusões: Os pacientes com transtornos alimentares podem apresentar diversas consequências clínicas, como alterações na distribuição de gordura corporal, alterações na densidade mineral óssea, piora da capacidade neurocognitiva e alterações endócrinas, como a hipercortisolemia que, por sua vez, pode levar à hiperglicemia, resistência à insulina, hipertensão e ao aumento do risco de infecções. Os achados demonstraram que os adolescentes com transtornos alimentares, principalmente a anorexia nervosa, apresentaram níveis mais elevados de cortisol, que são reduzidos após o período de tratamento. São necessários estudos adicionais sobre as diferenças nas concentrações de cortisol em adolescentes com outros transtornos alimentares, utilizando meios diferentes.

Humans , Male , Adolescent , Hydrocortisone/blood , Feeding and Eating Disorders/blood , Biomarkers/blood
Arq. bras. cardiol ; 111(5): 656-663, Nov. 2018. tab
Article in English | LILACS | ID: biblio-973786


Abstract Background: Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group. Objective: In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI. Methods: Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant. Results: Left ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups. Conclusion: Our study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.

Resumo Fundamento: A maioria das massas adrenais descobertas incidentalmente, denominadas incidentaloma adrenal (IA), são adenomas adrenais não funcionantes. O manejo adequado da IA ainda é um tema de debate, e por isso é necessário investigar suas morbidades associadas. Entretanto, dados referentes a alterações cardíacas morfológicas e funcionais são limitados nesse grupo. Objetivo: Neste estudo, objetivamos avaliar as características estruturais e funcionais cardíacas e as propriedades de condução atrial em pacientes com IA não funcionante. Métodos: Trinta pacientes com IA não funcionante e 46 controles adequadamente pareados foram incluídos no estudo. Após análise hormonal e bioquímica, todos os participantes foram submetidos a ecocardiograma transtorácico para obtenção de parâmetros sistólicos e diastólicos de ambos os ventrículos, além dos tempos de condução atrial pelo ecocardiograma com Doppler tecidual. Os dados foram analisados com o Statistical Package for the Social Sciences (SPSS, Chicago, IL, Estados Unidos), versão 17.0 para Windows. P < 0,05 foi considerado estatisticamente significativo. Resultados: O índice de massa do ventrículo esquerdo (VE) e o índice de desempenho miocárdico do VE foram significativamente aumentados no grupo IA. Entre os tempos de condução atrial, os atrasos eletromecânicos intra- e interatriais foram significativamente prolongados em pacientes com IA não funcionante. Outros achados laboratoriais e ecocardiográficos foram semelhantes entre os grupos. Conclusão: Nosso estudo revelou que os tempos de condução intra- e interatrial estavam prolongados e o índice de massa do VE estava aumentado em pacientes com IA não funcionante. Esses achados podem ser marcadores de envolvimento cardíaco subclínico e de tendência a complicações cardiovasculares. Um acompanhamento rigoroso é necessário para indivíduos com IA não funcionante, devido ao aumento do risco cardiovascular.

Humans , Male , Female , Adult , Middle Aged , Echocardiography, Doppler/methods , Adenoma/complications , Adrenal Gland Neoplasms/complications , Cardiac Conduction System Disease/complications , Hydrocortisone/blood , Echocardiography/methods , Cross-Sectional Studies , Atrial Function , Hypertrophy, Left Ventricular/diagnostic imaging , Adrenocorticotropic Hormone/blood , Incidental Findings , Ventricular Septum/physiopathology , Ventricular Septum/diagnostic imaging , Cardiac Conduction System Disease/physiopathology , Cardiac Conduction System Disease/diagnostic imaging
Arq. neuropsiquiatr ; 76(9): 622-634, Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973945


ABSTRACT Multiple sclerosis (MS) is a demyelinating, progressive and neurodegenerative disease. A disturbance on the hypothalamic-pituitary-adrenal axis can be observed in patients with MS, showing altered cortisol levels. We aimed to identify basal cortisol levels and verify the relationship with clinical symptoms in patients with MS. A systematic search was conducted in the databases: Pubmed, Web of Science and SCOPUS. Both higher and lower cortisol levels were associated with MS. Higher cortisol levels were associated with depression and anxiety, while lower levels were associated with depression, fatigue and urinary dysfunction. Higher cortisol levels may be associated with the progression and severity of MS.

RESUMO A esclerose múltipla (EM) é uma doença desmielinizante, progressiva e neurodegenerativa. Um distúrbio no eixo hipotálamo-hipófise-adrenal pode ser observado em pacientes com EM, mostrando níveis alterados de cortisol. Nosso objetivo foi identificar os níveis basais de cortisol e verificar a relação com os sintomas clínicos em pacientes com EM. Uma busca sistemática foi realizada nas bases de dados: Pubmed, Web of Science e SCOPUS. Ambos os níveis de cortisol elevado e baixo foram associados com a EM. Níveis mais elevados de cortisol foram associados à depressão e ansiedade, enquanto níveis mais baixos foram associados à depressão, fadiga e disfunção urinária. Níveis altos de cortisol podem estar associados à progressão e gravidade da EM.

Humans , Hydrocortisone/analysis , Multiple Sclerosis/diagnosis , Saliva/chemistry , Stress, Psychological , Hydrocortisone/urine , Hydrocortisone/blood , Disease Progression , Symptom Assessment , Hair/chemistry , Multiple Sclerosis/psychology
Arch. endocrinol. metab. (Online) ; 62(2): 164-171, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-887639


ABSTRACT Objective The aim of this study was to determine the frequency of central thyroid dysfunctions in Cushing's syndrome (CS). We also aimed to evaluate the frequency of hyperthyroidism due to the syndrome of the inappropriate secretion of TSH (SITSH), which was recently defined in patients with insufficient hydrocortisone replacement after surgery. Materials and methods We evaluated thyroid functions (TSH and free thyroxine [fT4]) at the time of diagnosis, during the hypothalamo-pituitary-adrenal axis recovery, and after surgery in 35 patients with CS. The patients were separated into two groups: ACTH-dependent CS (group 1, n = 20) and ACTH-independent CS (group 2, n = 15). Patients' clinical and laboratory findings were evaluated in five visits in the outpatient clinic of the endocrinology department. Results The frequency of baseline suppressed TSH levels and central hypothyroidism were determined to be 37% (n = 13) and 26% (n = 9), respectively. A negative correlation was found between baseline cortisol and TSH levels (r = -0.45, p = 0.006). All patients with central hypothyroidism and suppressed TSH levels showed recovery at the first visit without levothyroxine treatment. SITSH was not detected in any of the patients during the postoperative period. No correlation was found between prednisolone replacement after surgery and TSH or fT4 levels on each visit. Conclusion Suppressed TSH levels and central hypothyroidism may be detected in CS, independent of etiology. SITSH was not detected in the early postoperative period due to our adequate prednisolone replacement doses.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Thyroid Gland/physiopathology , Thyroxine/blood , Thyrotropin/blood , Cushing Syndrome/physiopathology , Hyperpituitarism/physiopathology , Hypothalamo-Hypophyseal System/physiopathology , Reference Values , Time Factors , Hydrocortisone/blood , Prednisolone/therapeutic use , Age Factors , Adrenocorticotropic Hormone/blood , Cushing Syndrome/blood , Cushing Syndrome/therapy , Glucocorticoids/therapeutic use , Hyperpituitarism/blood , Hyperthyroidism/blood
Arch. endocrinol. metab. (Online) ; 62(1): 64-71, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-887635


ABSTRACT Objective The present study compares immune and endocrine parameters between HIV-infected patients who underwent the Immune Reconstitution Inflammatory Syndrome (IRIS-P) during antiretroviral therapy (ART) and HIV-patients who did not undergo the syndrome (non-IRIS-P). Materials and methods Blood samples were obtained from 31 HIV-infected patients (15 IRIS-P and 16 non-IRIS-P) before ART (BT) and 48 ± 2 weeks after treatment initiation (AT). Plasma Interleukin-6 (IL-6) and Interleukin-18 (IL-18) were determined by ELISA. Cortisol, dehydroepiandrosterone sulfate (DHEA-S) and thyroxin concentrations were measured using chemiluminescence immune methods. Results Concentrations of IL-6 (7.9 ± 1.9 pg/mL) and IL-18 (951.5 ± 233.0 pg/mL) were significantly higher (p < 0.05) in IRIS-P than in non-IRIS-P (3.9 ± 1.0 pg/mL and 461.0 ± 84.4 pg/mL, respectively) BT. Mean T4 plasma level significantly decreased in both groups of patients after treatment (p < 0.05). In both groups cortisol levels were similar before and after ART (p > 0.05). Levels of DHEA-S in IRIS-P decreased AT (1080.5 ± 124.2 vs. 782.5 ± 123.8 ng/mL, p < 0.05) and they were significantly lower than in non-IRIS-P (782.5 ± 123.8 vs. 1203.7 ± 144.0 ng/mL, p < 0.05). IRIS-P showed higher values of IL-6 and IL-18 BT and lower levels of DHEA-S AT than in non-IRIS-P. Conclusion These parameters could contribute to differentiate IRIS-P from non-IRIS-P. The significant decrease in DHEA-S levels in IRIS-P after ART might suggest a different adrenal response in these patients, which may reflect the severity of the disease.

Humans , Male , Female , Middle Aged , Biomarkers/blood , HIV Infections/blood , Antiretroviral Therapy, Highly Active/adverse effects , Immune Reconstitution Inflammatory Syndrome/blood , Thyroxine/blood , Enzyme-Linked Immunosorbent Assay , Hydrocortisone/blood , HIV Infections/immunology , HIV Infections/metabolism , HIV Infections/drug therapy , Prospective Studies , Interleukin-6/blood , CD4-CD8 Ratio , Dehydroepiandrosterone Sulfate/blood , Viral Load , Interleukin-18/blood , Luminescence , Immune Reconstitution Inflammatory Syndrome/immunology , Immune Reconstitution Inflammatory Syndrome/metabolism
Arch. endocrinol. metab. (Online) ; 61(6): 575-583, Dec. 2017. tab
Article in English | LILACS | ID: biblio-887607


ABSTRACT Objective: The aim of this study was to evaluate the association between insulin resistance and thyroid pathology in obese patients, and compare the results between insulin-resistant and noninsulin-resistant patients. Subjects and methods: Obese/nondiabetic patients, aged 18-70 years, attending the outpatient endocrinology service for 2 years were consecutively included. We evaluated the patients' fasting plasma glucose, insulin, homeostasis model assessment of insulin resistance index (HOMA-IR), thyroid-stimulating hormone (TSH), free thyroxine (FT4), antithyroperoxidase antibodies (TPO-Ab), antithyroglobulin antibodies (Tg-Ab), and thyroid ultrasound. Results: We included 82 patients with a mean age 44.21 ± 12.67 years. The thyroid disorders encountered and their prevalences were: hypothyroidism (14.6%, 95% confidence interval [CI] 8.6-23.8%), hyperthyroidism (1.2%, 95% CI 2.0-6.6%), goiter (28.0%, 95% CI 19.5-3.6%), thyroid nodules (35.4%, 95% CI 25.9-46.2%), and Hashimoto's thyroiditis (32.9%, 95% CI 23.7-43.7%). HOMA-IR correlated positively with TSH levels (r = 0.24, p = 0.028), and this correlation remained after adjustment for body mass index (BMI), waist/hip ratio (WHR), serum cortisol, subcutaneous fat thickness (SFT), visceral fat thickness (VFT), triglycerides, γ-glutamyl transpeptidase (GGT), and alanine aminotransferase (ALT) in multivariate regression analysis (b = 0.207, 95% CI, 0.09-0.385, p = 0.023). TSH levels were significantly higher in patients with HOMA-IR ≥ 2.5 than in those with HOMA-IR < 2.5 (2.03 μIU/mL, interquartile range [IQR] 1.59-2.69 μIU/mL) versus 1.59 μIU/mL, IQR 0.94-2.26 μIU/mL, p = 0.023). Conclusions: The most prevalent thyroid disorder in patients attending our endocrinology clinic for investigation of obesity was thyroid nodules. One in seven patients had hypothyroidism. Our findings suggest that TSH levels correlate with insulin resistance in obese patients.

Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Thyroid Diseases/physiopathology , Thyroid Gland/physiopathology , Insulin Resistance/physiology , Hydrocortisone/blood , Obesity/physiopathology , Thyroid Diseases/blood , Obesity/blood
Rev. Assoc. Med. Bras. (1992) ; 63(10): 899-903, Oct. 2017. tab
Article in English | LILACS | ID: biblio-896302


Summary Introduction: Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Nevertheless, frequent short-term OCS courses could lead to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. Method: Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006). Results: In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. No significant differences were observed among children with or without adrenal suppression, neither in the number of days free of OCS treatment before cortisol evaluation (p=0.29) nor in the last OCS course duration (p=0.20). The number of short-term OCS courses reported in the year preceding the cortisol evaluation was also not different (p=0.89). Conclusion: Short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon exposure to stress during the follow-up of patients with persistent asthma or recurrent wheezing.

Resumo Introdução: A corticoterapia oral (CO) é um dos pilares do tratamento na exacerbação da asma, e cursos de curta duração são geralmente considerados seguros. No entanto, crianças submetidas a repetidos cursos estão sujeitas a disfunção do eixo hipotálamo-hipófise-adrenal (HHA). Objetivo: Investigar a integridade do eixo HHA em crianças com asma persistente ou sibilância recorrente com indicação para corticoterapia inalatória (CI). Método: Avaliação do cortisol sérico basal antes da introdução da CI e 30, 60 e 90 dias após iniciado o tratamento, utilizando-se o imunoensaio ImmuliteÒ Siemens Medical Solutions Diagnostic chemiluminescent (Los Angeles, EUA; 2006). Resultados: Das 140 crianças avaliadas (0,3 a 15 anos de idade) com asma persistente ou sibilância recorrente, 40% relataram ter recebido CO no último mês antes da avaliação. Cerca de 12,5% delas apresentaram supressão adrenal bioquímica e evoluíram com recuperação do eixo HHA durante os primeiros três meses em CI. O número de dias livres de CO e a duração do último curso antes da avaliação do cortisol não foram significativamente diferentes entre as crianças com ou sem supressão adrenal (p=0,29 e p=0,20, respectivamente). O número de cursos de curta duração relatados no ano anterior à avaliação também não esteve associado à supressão adrenal (p=0,89). Conclusão: A utilização dos corticosteroides nas doses convencionais, em cursos de curta duração, pode colocar as crianças em risco de disfunção do eixo HHA. A recuperação desse eixo é possível durante a CI. Profissionais de saúde devem estar atentos para a possibilidade de resposta inadequada ao estresse durante o acompanhamento de crianças com asma persistente ou sibilância recorrente.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Pituitary-Adrenal System/drug effects , Asthma/drug therapy , Adrenal Cortex Hormones/adverse effects , Adrenal Insufficiency/chemically induced , Hypothalamo-Hypophyseal System/drug effects , Pituitary-Adrenal System/physiopathology , Reference Values , Asthma/physiopathology , Time Factors , Administration, Inhalation , Hydrocortisone/blood , Administration, Oral , Prospective Studies , Risk Factors , Adrenal Cortex Hormones/administration & dosage , Adrenal Insufficiency/physiopathology , Statistics, Nonparametric , Disease Progression , Hypothalamo-Hypophyseal System/physiopathology , Luminescent Measurements
Pesqui. vet. bras ; 37(8): 891-896, Aug. 2017. tab
Article in English | ID: biblio-895503


Clinical evaluations of newborns, as well as defining the therapeutic decision, represent significant challenges to the veterinarian. This study aimed to evaluate neonatal vitality using the modified Apgar score and blood glucose, lactate, and cortisol concentrations in newborn equines. Twenty foals of the Paint Horse breed born by normal delivery were evaluated during the first 48 hours of life. The modified Apgar score was determined at birth and 10 minutes later, with values ranging from 0 to 10. Blood samples for the laboratory tests were collected at birth and at 4, 8, 12, 16, 20, 24, 36, and 48 hours. The mean Apgar score was significantly lower at birth than at 10 minutes (p < 0.001). Blood glucose concentrations increased significantly between birth (98.90 ± 35.97 mg/dL) and 8 hours (127.90 ± 27.15 mg/dL), stabilizing after the first 12 hours (148.95 ± 29.59 mg/dL). Serum lactate concentrations showed a significant decrease across the time points tested, with the highest value occurring at birth (5.48 ± 2.17 mmol/L) and stabilizing after 24 hours (2.76 ± 1.31 mmol/L). Cortisol concentrations significantly decreased (p < 0.01) between 4 (10.46 ± 7.46 µg/dL) and 48 hours (5.21 ± 3.35 µg/dL), with the highest value occurring 4 hours after birth. The common occurrence of laboratory abnormalities in healthy newborn foals reinforces the need to conduct regular clinical examinations and to develop laboratory reference values for different breeds and ages.(AU)

A avaliação clínica dos recém-nascidos, bem como a definição da conduta terapêutica adotada representam expressivos desafios ao Médico Veterinário. O objetivo deste estudo foi avaliar a vitalidade neonatal pelo escore de Apgar modificado, glicemia, lactatemia e cortisol em neonatos equinos. Para tal, foram utilizados 20 potros da raça Paint Horse, nascidos em eutocia, durante as primeiras 48 horas de vida. O escore de Apgar modificado foi realizado ao nascimento e 10 minutos após, atribuindo-se notas de 0 a 10. As colheitas das amostras de sangue, para a realização das análises laboratoriais, ocorreram nos momentos ao nascimento, 4, 8, 12, 20 16, 20, 24, 36 e 48 horas de vida. A média do escore de Apgar ao nascimento foi significativamente menor que aos 10 minutos (p<0,001). A glicemia aumentou significativamente entre o nascimento (98,90 ± 35,97 mg/dL) e às 8 horas (127,90 ± 23 27,15 mg/dL), com estabilização após as primeiras 12 horas (148,95 ± 29,59 mg/dL). A concentração sérica de lactato apresentou decréscimo significativo entre os momentos estudados, sendo o maior valor encontrado ao nascimento (5,48 ± 2,17 mmol/L), com estabilização a partir das 24 horas (2,76 ± 1.31 mmol/L). As concentrações de cortisol, reduziram significativamente (p<0,01), entre as 4 (10,46 ± 7,46 µg/dL) e as 48 horas (5,21 ± 3,35 µg/dL), sendo o maior valor encontrado as 4 horas após o nascimento. A ocorrência comum de anormalidades laboratoriais em potros recém-nascidos, aparentemente saudáveis, reforça a necessidade da realização de exames clínicos regulares e o desenvolvimento de valores laboratoriais de referência, em diferentes raças e idades.(AU)

Animals , Infant, Newborn , Hydrocortisone/blood , Lactic Acid/blood , Glycemic Index , Horses/growth & development , Animals, Newborn/blood , Apgar Score
Arch. argent. pediatr ; 115(3): 262-266, jun. 2017. graf, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-887322


Introducción. Dada la dificultad en la interpretación de los valores de cortisol sérico en recién nacidos (RN), el objetivo de este estudio fue correlacionar los niveles basales de cortisol en el suero y la saliva, y describir las concentraciones de cortisol salival durante el primer mes de vida. Población y métodos. Estudio descriptivo, prospectivo, longitudinal y de correlación. Se seleccionaron RN de término del Servicio de Neonatología del Hospital Nacional Profesor Alejandro Posadas en 2014. En la saliva, se determinó cortisol; en la sangre, cortisol, globulina tansportadora de cortisol y albúmina. Se utilizó la correlación lineal para relacionar cortisol sérico y salival; el test de Friedman para comparar el cortisol durante el primer mes de vida y la diferencia para analizar el comportamiento de valores iguales o inferiores al primer cuartil. Resultados. Se evaluaron 55 RN. Cortisol sérico: 7,65 (1,0-18,1 gg/dl); cortisol salival: 35,88 (5,52107,64 nmol/L); globulina transportadora de cortisol: 22,07 (16,5-33,0 gg/µL), expresados como mediana y rango. El coeficiente de correlación entre el cortisol sérico y salival fue de 0,54; P= 0,001. El comportamiento del cortisol durante el primer mes de vida no mostró diferencias estadísticamente significativas y la diferencia entre la segunda y la primera muestra de valores iguales o inferiores al primer cuartil aumentó en 10 de 12 pacientes. Conclusión. La determinación de cortisol en la saliva refleja la concentración de cortisol sérico en RN normales. Algunos pacientes presentaron niveles bajos de cortisol a las 36 h de vida y mostraron una tendencia a incrementarse espontáneamente durante el primer mes de vida.

Introduction. Given that serum cortisol level interpretation in newborn infants (NBIs) is hard, the objective of this study was to correlate baseline salivary and serum cortisol levels and to describe salivary cortisol levels in the first month of life. Population and Methods. Descriptive, prospective, longitudinal, and correlational study. Term NBIs were selected from the Division of Neonatology of Hospital Nacional Profesor Alejandro Posadas in 2014. Cortisol was measured in saliva specimens while cortisol, cortisol-binding globulin, and albumin were measured in blood specimens. A linear correlation was performed to relate serum and salivary cortisol levels; Friedman test was conducted to compare cortisol levels during the first month of life, and the difference was used to analyze the performance of values equal to or lower than the first quartile. Results. Fifty-five NBIs were studied. Serum cortisol: 7.65 (1.0-18.1 gg/dL); salivary cortisol: 35.88 (5.52-107.64 mmol/L); cortisol-binding globulin: 22.07 (16.5-33.0 gg/µL), expressed as median and range. The correlation coefficient between serum and salivary cortisol was 0.54, P = 0.001. Cortisol performance during the first month of life showed no statistically significant differences, and the difference between the second and the first specimen of values equal to or lower than the first quartile increased in 10 out of 12 patients. Conclusion. The measurement of cortisol in saliva reflects serum cortisol levels in normal NBIs. Some patients had low levels of cortisol at 36 hours of life and showed a trend towards a spontaneous increase during the first month of life.

Humans , Male , Female , Infant, Newborn , Saliva/chemistry , Hydrocortisone/analysis , Hydrocortisone/blood , Prospective Studies , Statistics as Topic , Longitudinal Studies
Arq. bras. med. vet. zootec ; 69(2): 310-316, mar.-abr. 2017. tab
Article in English | ID: biblio-833821


The present study evaluated the impact that orchiectomy, a routine but painful intervention in bovine husbandry, can cause on pulmonary immunity. To identify whether orchiectomy can impair lung defense, analyses of serum cortisol concentration and of alveolar macrophage and their function (phagocytosis and respiratory burst) were evaluated. Sixteen Holstein bulls (7 mo old, 250±50kg of body weight BW) were divided in two homogeneous groups - the castrated group and the sham group - and the sample were collected on Days -7, 1 and 7 relative to the day of the procedure. Serum cortisol concentration statistically increased on Days 1 and 7 (D-7: 4,97±1,28ng/ml; D1: 6,35 ±1,10ng/ml; D7: 8,28±1,94ng/ml) after castration and these variables seem to impact the alveolar macrophage percentage on D1 (D-7: 76,86±3,44%; D1: 60,92±2,44%; D7: 74,17±2,56%) and their respective function of phagocytosis (P) and the oxidative burst (OB) on Days 1 and 7 for the castrated group (P D-7: 56,25±15,63 arbitrary values; D1: 54,75±14,07 arbitrary values; D7: 31,77±8,44 arbitrary values; and OB D-7: 222,34±39,52 arbitrary values; D1: 135,25±37,68 arbitrary values; D7: 117,73±18,17 arbitrary values). These results indicate that surgical castration affected lung defense until seven days after the practice, so the pulmonary cell function was impaired for a period higher than that reported in the literature.(AU)

O presente estudo avaliou o impacto que a orquiectomia, uma intervenção dolorosa comumente realizada durante a criação de bovinos, pode causar na imunidade pulmonar. Para tanto, foram realizadas dosagens de cortisol sérico, bem como a análise de macrófagos alveolares e suas funções (fagocitose e metabolismo oxidativo) de 16 bovinos da raça Holandesa preto e branco (sete meses de idade, 250±50kg de peso vivo). Esses animais foram divididos aleatoriamente em dois grupos homogêneos - grupo castrado e grupo controle - e foram avaliados nos dias -7, 1 e 7, relativos ao dia do procedimento cirúrgico, que foi realizado no dia 0. A concentração de cortisol sérico aumentou estatisticamente nos dias 1 e 7 em relação ao grupo controle (D-7: 4,97±1,28ng/mL; D1: 6,35 ±1,10ng/mL; D7: 8,28±1,94ng/mL). Notou-se diminuição de macrófagos alveolares no D1 (D-7: 76,86±3,44%; D1: 60,92±2,44%; D7: 74,17±2,56%) e de suas funções de fagocitose (F) e metabolismo oxidativo (MO) nos dias 1 e 7 (F D-7: 56,25±15,63 valores arbitrários; D1: 54,75±14,07 valores arbitrários; D7: 31,77±8,44 valores arbitrários; e MO D-7: 222,34±39,52 valores arbitrários; D1: 135,25±37,68 valores arbitrários, D7: 117,73±18,17 valores arbitrários) para o grupo castrado. Esses resultados demonstram que a orquiectomia afeta as defesas pulmonares por até sete dias após a prática, período superior ao relatado pela literatura.(AU)

Animals , Male , Cattle , Immunity, Innate , Orchiectomy/adverse effects , Orchiectomy/veterinary , Cell Respiration/physiology , Hydrocortisone/blood , Macrophages, Alveolar/physiology , Phagocytosis
PAFMJ-Pakistan Armed Forces Medical Journal. 2017; 67 (3): 453-457
in English | IMEMR | ID: emr-188577


Objective: To assess the prevalence of stress as an etiological factor for aphthous ulcers and temporomandibular disorders

Study Design: Cross sectional descriptive study

Place and Duration of Study: Armed Forces Institute of Dentistry Rawalpindi, from Oct 2015 to May 2016

Material and Methods: Two groups of patients were selected. Group I included 119 patients presenting with Aphthous Ulcers while group II had 64 subjects with complaints of temporomandibular disorders [TMDs]

After a thorough history, Hospital Anxiety and Depression Scale [HADS] was used to assess stress in the patients. A HADS-A score of 7 was taken as significant anxiety while a HADS-D score of 7 depicted significant depression

Both groups were then subjected to laboratory examinations. Serum cortisol levels were assessed for both groups while Serum Folate, Ferritin and Vitamin B12 level for group I only. Data were analyzed using SPSS version 21 to calculate descriptive statistics including mean and standard deviations as well as frequencies and percentages

Relationship between HADS score and serum cortisol levels was assessed using Pearson's correlation coefficient

A p-value<0.05 was considered significant

Results: For TMDs, 53 [82.8%] patients were found positive for stress while for aphthous ulcers, 61 [51.3%] were positive for stress. The correlation between HADS score and serum cortisol levels was found significant for both groups at a p=<0.001

Conclusions: Patients showed a high prevalence of stress as an etiological factor for aphthous ulcers and temporomandibular disorders in a local setting

Humans , Female , Male , Adolescent , Adult , Temporomandibular Joint Disorders/etiology , Stomatitis, Aphthous/etiology , Cross-Sectional Studies , Hydrocortisone/blood , Patient Health Questionnaire , Statistics, Nonparametric
Medicina (B.Aires) ; 76(4): 208-212, Aug. 2016. graf, tab
Article in Spanish | LILACS | ID: biblio-841578


La insuficiencia suprarrenal relativa (ISR) es frecuente en pacientes cirróticos con sepsis grave, asociándose a un pobre pronóstico. Se desconoce su importancia en condiciones de enfermedad estable. El objetivo del trabajo ha sido evaluar la prevalencia de la ISR en una serie de pacientes cirróticos estables y su relación con el deterioro de la función hepática. Se determinó el impacto de la ISR en la supervivencia y se correlacionaron los niveles entre el cortisol basal en plasma y saliva en sujetos controles y cirróticos. Fueron incluidos 47 pacientes ambulatorios y 16 controles. La funcionalidad del eje hipotalámico-pituitario-suprarrenal se valoró mediante la prueba de estimulación con 250 μg de ACTH sintética EV, definiendo la ISR como delta cortisol < 9 μg/dl. Respecto al grado de deterioro de la función hepática, 22 tenían un Child-Pugh ≤ 8 y 25 pacientes = 9. La prevalencia de ISR fue de un 22%, siendo significativamente más elevada en aquellos con mayor deterioro de la función hepática (8/32 vs. 3/13, p < 0.05). Se observó correlación entre el cortisol salival y el plasmático basal (r = 0.6, p < 0.0004). Por último, la supervivencia fue más elevada en los pacientes sin ISR al año (97%) y a los tres años (91%) que aquellos que desarrollaron esta complicación (79 % y 51%, p < 0.05, respectivamente). En resumen, la prevalencia de ISR es elevada en los pacientes con cirrosis estable y se relaciona con un deterioro de la función hepática y una mayor mortalidad.

Relative adrenal insufficiency (RAI) is a common finding in cirrhotic patients with severe sepsis, and increased mortality. Its significance is unknown in stable conditions. The aim of this study was to evaluate the prevalence of RAI in stable cirrhotic patients at different stages of the disease. Also, the impact of RAI on the survival was evaluated and basal cortisol levels between plasma and saliva was correlated in control subjects and cirrhotic patients. Forty seven ambulatory patients and 16 control subjects were studied. RAI was defined as a serum cortisol increase of less than 9 μg/dl from baseline after the stimulation with 250 mg of synthetic ACTH. Twenty two had Child-Pugh ≤ 8 and 25 = 9. The prevalence of RAI in patients with stable cirrhosis was 22%. A higher incidence of RAI was observed in patients with a Child-Pugh = 9 (8/32) than in those with ≤ 8 (3/13, p < 0.05). A correlation between salivary cortisol and basal plasma cortisol (r = 0.6, p < 0.0004) was observed. Finally, survival at 1 year (97%) and 3 years (91%) was significantly higher without RAI than those who developed this complication (79% and 51%, p < 0.05, respectively). In summary, the prevalence of RAI is frequent in patients with stable cirrhosis and that it is related to the severity of liver diseaseand increased mortality.

Humans , Male , Female , Middle Aged , Adrenal Insufficiency/epidemiology , Liver Cirrhosis/complications , Pituitary-Adrenal System/metabolism , Prognosis , Saliva/chemistry , Hydrocortisone/analysis , Hydrocortisone/blood , Case-Control Studies , Prevalence , Prospective Studies , Adrenal Insufficiency/mortality , Sepsis , Hypothalamo-Hypophyseal System/metabolism , Liver/physiopathology , Liver Cirrhosis/metabolism , Liver Cirrhosis/mortality
Arch. endocrinol. metab. (Online) ; 60(3): 267-286, tab, graf
Article in English | LILACS | ID: lil-785230


ABSTRACT Although it is a rare condition, the accurate diagnosis and treatment of Cushing’s disease is important due to its higher morbidity and mortality compared to the general population, which is attributed to cardiovascular diseases, diabetes mellitus and infections. Screening for hypercortisolism is recommended for patients who present multiple and progressive clinical signs and symptoms, especially those who are considered to be more specific to Cushing’s syndrome, abnormal findings relative to age (e.g., spinal osteoporosis and high blood pressure in young patients), weight gain associated with reduced growth rate in the pediatric population and for those with adrenal incidentalomas. Routine screening is not recommended for other groups of patients, such as those with obesity or diabetes mellitus. Magnetic resonance imaging (MRI) of the pituitary, the corticotropin-releasing hormone (CRH) test and the high-dose dexamethasone suppression test are the main tests for the differential diagnosis of ACTH-dependent Cushing’s syndrome. Bilateral and simultaneous petrosal sinus sampling is the gold standard method and is performed when the triad of initial tests is inconclusive, doubtful or conflicting. The aim of this article is to provide information on the early detection and establishment of a proper diagnosis of Cushing’s disease, recommending follow-up of these patients at experienced referral centers. Arch Endocrinol Metab. 2016;60(3):267-86.

Humans , Adenoma/diagnosis , Cushing Syndrome/diagnosis , Consensus , ACTH-Secreting Pituitary Adenoma/diagnosis , Brazil , Dexamethasone , Hydrocortisone/blood , Magnetic Resonance Imaging , Adenoma/complications , Chromatography, High Pressure Liquid , Cushing Syndrome/etiology , Diagnosis, Differential , ACTH-Secreting Pituitary Adenoma/complications , Glucocorticoids
Arch. endocrinol. metab. (Online) ; 60(2): 125-129, Apr. 2016. tab
Article in English | LILACS | ID: lil-782156


ABSTRACT Objective The objective of this study was to describe clinical presentation, hormonal profile and imaging characteristics of 21 patients with partial Sheehan’s syndrome. Subjects and methods This prospective study was carried out over a period of six years (2008-2013). The evaluation of patients included clinical assessment, hormone estimations and contrast enhanced magnetic resonance imaging of pituitary. Results We documented preservation of gonadotroph, corticotroph and lactotroph function in 71.4, 61.9, and 9.5% of patients respectively. Conclusion To conclude some of the pituitary functions can be preserved in Sheehan’s syndrome and this has important implications from the treatment and long term morbidity point of view.

Humans , Female , Adult , Middle Aged , Pituitary Gland, Anterior/physiopathology , Pituitary Hormones/blood , Thyroxine/blood , Human Growth Hormone/blood , Hypopituitarism/blood , Hypopituitarism/diagnostic imaging , Pituitary Hormones/deficiency , Reference Values , Thyroxine/deficiency , Hydrocortisone/deficiency , Hydrocortisone/blood , Magnetic Resonance Imaging , Prospective Studies , Human Growth Hormone/deficiency , Postpartum Period , Postpartum Hemorrhage
Rev. Hosp. Ital. B. Aires (2004) ; 36(1): 11-14, mar. 2016.
Article in Spanish | LILACS | ID: biblio-1147657


Los síndromes endocrinológicos con hipofunción o hiperfunción con niveles paradójicos de dosajes hormonales han sido bien caracterizados en los últimos años del siglo XX, a partir del desarrollo de técnicas genéticas y moleculares. Presentamos dos pacientes con pseudohipoaldosteronismo y aparente exceso de mineralocorticoides como síndromes en espejo, con la intención de alertar al médico clínico respecto de su consideración como entidad diagnóstica en niños con alteraciones hidroelectrolíticas. (AU)

Endocrinological syndromes with underactive or overactive hormonal levels with paradoxical dosages have been well characterized over the years of the twentieth century, from the development of genetic and molecular techniques. We present two patients with pseudohypoaldosteronism and apparent mineralocorticoid excess as mirror syndromes, with the aim to alert the clinician regarding their consideration as a diagnostic entity in children with fluid and electrolyte disturbances. (AU)

Humans , Male , Infant , Pseudohypoaldosteronism/diagnosis , Mineralocorticoid Excess Syndrome, Apparent/diagnosis , Weight by Age , Dexamethasone/therapeutic use , Hydrocortisone/physiology , Hydrocortisone/blood , Hydrocortisone/therapeutic use , Pseudohypoaldosteronism/physiopathology , Pseudohypoaldosteronism/genetics , Sodium Chloride/administration & dosage , Mineralocorticoid Excess Syndrome, Apparent/physiopathology , 11-beta-Hydroxysteroid Dehydrogenase Type 2/physiology , Diuretics/therapeutic use , Aldosterone/physiology , Aldosterone/blood , Alkalosis/blood , Hyperkalemia/blood , Hypokalemia/blood , Hyponatremia/blood , Muscle Hypotonia/etiology