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Säo Paulo med. j ; 139(4): 398-404, Jul.-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1290241


ABSTRACT BACKGROUND: Critical diseases usually cause hypercortisolemia via activation of the hypothalamic-pituitary-adrenal axis. OBJECTIVES: To investigate the relationship between serum total cortisol level and mortality among coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU), at the time of their admission. DESIGN AND SETTING: Prospective study developed in a pandemic hospital in the city of Şırnak, Turkey. METHODS: We compared the serum total cortisol levels of 285 patients (141 COVID-19-negative patients and 144 COVID-19-positive patients) followed up in the ICU. RESULTS: The median cortisol level of COVID-19-positive patients was higher than that of COVID-19 negative patients (21.84 μg/dl versus 16.47 μg/dl; P < 0.001). In multivariate logistic regression analysis, mortality was associated with higher cortisol level (odds ratio: 1.20; 95% confidence interval: 1.08-1.35; P = 0.001). The cortisol cutoff point was 31 μg/dl (855 nmol/l) for predicting mortality among COVID-19-positive patients (area under the curve 0.932; sensitivity 59%; and specificity 95%). Among the COVID-19 positive patients with cortisol level ≤ 31 μg/dl (79%; 114 patients), the median survival was higher than among those with cortisol level > 31 μg/dl (21%; 30 patients) (32 days versus 19 days; log-rank test P < 0.001). CONCLUSION: Very high cortisol levels are associated with severe illness and increased risk of death, among COVID-19 patients in the ICU.

Humans , Hydrocortisone , COVID-19 , Pituitary-Adrenal System , Prospective Studies , SARS-CoV-2 , Hypothalamo-Hypophyseal System , Intensive Care Units
Medicina (B.Aires) ; 81(1): 69-75, mar. 2021. graf
Article in English | LILACS | ID: biblio-1287243


Abstract After a stressful event, adaptative mechanisms are carried out to support vital functions. Hypothalamic-pituitary-adrenal axis plays a key role in stress response regulating metabolism, cardiovascular function and immune system. This review addresses pathophysiological changes of the adrenal axis during critical illness, recognizing limitations of methods applied for its evaluation in this special context and defining indications for corticosteroid replacement in critically ill patients. The concept of relative adrenal insufficiency should be abandoned; cosyntropin stimulation test should not be performed for diagnosis of adrenal insufficiency in critical illness nor for establishing the need of treatment.

Resumen Diversos mecanismos adaptativos se ponen en marcha para sostener las funciones orgánicas vitales en el paciente crítico. El eje hipotálamo-hipófiso-adrenal tiene un papel clave en la respuesta al estrés al regular el metabolismo, la función cardiovascular y la respuesta inmune. Esta revisión tiene por objetivos analizar los cambios fisiopatológicos que se producen en el eje adrenal durante la enfermedad crítica, reconocer las limitaciones de los métodos diagnósticos y definir indicaciones de tratamiento de reemplazo corticoideo en este contexto. El concepto de insuficiencia adrenal relativa debe ser descartado y no se recomienda el test de estímulo con cosintropina para diagnóstico de insuficiencia adrenal durante enfermedad crítica ni para definir la necesidad de tratamiento.

Humans , Critical Illness , Adrenal Insufficiency/diagnosis , Pituitary-Adrenal System , Hydrocortisone , Hypothalamo-Hypophyseal System
Article in English | WPRIM | ID: wpr-880350


BACKGROUND@#The industrial revolution has resulted in increased synthesis and the introduction of a variety of compounds into the environment and their potentially hazardous effects have been observed in the biota. The present study was aimed to evaluate the potential endocrine-disrupting effects of chronic exposure to the low concentrations of bisphenol S (BPS) in male rats.@*METHODS@#Weaning male Sprague-Dawley rats (22 days old) were either exposed to water containing 0.1% ethanol for control or different concentrations of BPS (0.5, 5, and 50 μg/L) in drinking water for 48 weeks in the chronic exposure study. After completion of the experimental period, animals were dissected and different parameters (hormone concentrations, histology of testis and epididymis, oxidative stress and level of antioxidant enzymes in the testis, daily sperm production (DSP), and sperm parameters) were determined.@*RESULTS@#Results of the present study showed a significant alteration in the gonadosomatic index (GSI) and relative reproductive organ weights. Oxidative stress in the testis was significantly elevated while sperm motility, daily sperm production, and the number of sperm in epididymis were reduced. Plasma testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) concentrations were reduced and estradiol levels were high in the 50 μg/L-exposed group. Histological observations involved a significant reduction in the epithelial height of the testis along with disrupted spermatogenesis, an empty lumen of the seminiferous tubules, and the caput region of the epididymis.@*CONCLUSION@#These results suggest that exposure to 5 and 50 μg/L of BPS for the chronic duration started from an early age can induce structural changes in testicular tissue architecture and endocrine alterations in the male reproductive system which may lead to infertility in males.

Animals , Biomarkers , Endocrine Disruptors/toxicity , Environmental Exposure/adverse effects , Environmental Pollutants/toxicity , Hypothalamo-Hypophyseal System/physiopathology , Infertility, Male/physiopathology , Male , Phenols/toxicity , Rats , Rats, Sprague-Dawley , Sulfones/toxicity , Testis/physiopathology , Toxicity Tests, Chronic
Article in English | WPRIM | ID: wpr-922111


"Timely, near, and expectation" is the main principle of battlefield rescue for military combat stress reaction (CSR). Post-traumatic stress disorder (PTSD) is the most common form of CSR and a long-term persistent mental disorder that is caused by unusual threatening or catastrophic psychological trauma. Chinese medicine (CM) has abundant resources, is simple, easy to master, with few side effects. This article summarizes the cellular and animal experimental mechanisms of CM treatment on PTSD, suggesting that traditional Chinese herbs and acupuncture can protect brain functional areas, and adjust hypothalamus-pituitary-adrenal axis. Traditional Chinese herbs and acupuncture have shown good anti-stress efficacy and fewer side effects in clinical application, which may improve the CSR in the battlefield.

Animals , Humans , Hypothalamo-Hypophyseal System , Medicine, Chinese Traditional , Military Personnel , Pituitary-Adrenal System , Stress Disorders, Post-Traumatic/therapy
Article in Chinese | WPRIM | ID: wpr-921796


Breast cancer is a major chronic disease threatening women's health. It has topped the global cancers as the diagnosed cases outnumbered lung cancer patients in 2020. Internal damage due to the seven emotions is an important cause of breast cancer and the disorders of hypothalamic-pituitary-adrenal(HPA) axis and endocrine system and the abnormal immune defense mechanism in response to psychological stress all affect the occurrence and development of breast cancer. It is noteworthy that the theory of seven emotions in traditional Chinese medicine and the psychological stress theory of modern medicine have something in common in some aspects. Therefore, this study explored the correlation between internal damage due to the seven emotions and psychological stress and analyzed the molecular biological mechanisms of psychological stress influencing breast cancer from the perspective of modern medicine, which is helpful to reasonably prevent breast cancer and other related tumors and improve the prognosis of breast cancer patients through emotion regulation.

Breast Neoplasms/genetics , Emotions , Female , Humans , Hypothalamo-Hypophyseal System , Medicine, Chinese Traditional , Pituitary-Adrenal System , Stress, Psychological
Journal of Integrative Medicine ; (12): 439-450, 2021.
Article in English | WPRIM | ID: wpr-888766


OBJECTIVE@#To evaluate the synergic effects of a novel oral supplement formulation, containing prebiotics, yeast β-glucans, minerals and silymarin (Silybum marianum), on lipid and glycidic metabolism, inflammatory and mitochondrial proteins of the liver, in control and high-fat diet-induced obese mice.@*METHODS@#After an acclimation period, 32 male C57BL/6 mice were divided into the following groups: nonfat diet (NFD) vehicle, NFD supplemented, high-fat diet (HFD) vehicle and HFD supplemented. The vehicle and experimental formulation were administered orally by gavage once a day during the last four weeks of the diet (28 consecutive days). We then evaluated energy homeostasis, inflammation, and mitochondrial protein expression in these groups of mice.@*RESULTS@#After four weeks of supplementation, study groups experienced reduced glycemia, dyslipidemia, fat, and hepatic fibrosis levels. Additionally, proliferator-activated receptor-α, AMP-activated protein kinase-1α, peroxisome proliferator-activated receptor γ co-activator-1α, and mitochondrial transcription factor A expression levels were augmented; however, levels of inhibitor of nuclear factor-κB kinase subunit α and p65 nuclear factor-κB expression, and oxidative markers were reduced. Notably, the cortisol/C-reactive protein ratio, a well-characterized marker of the hypothalamic-pituitary-adrenal axis immune interface status, was found to be modulated by the supplement.@*CONCLUSION@#We discovered that the novel supplement was able to modify different antioxidant, metabolic and inflammatory pathways, improving the energy homeostasis and inflammatory status, and consequently alleviated hepatic steatosis.

Animals , Antioxidants , Dietary Supplements , Glucans , Hypothalamo-Hypophyseal System , Liver , Mice , Mice, Inbred C57BL , Mice, Obese , Milk Thistle , Minerals , Pituitary-Adrenal System , Prebiotics , Saccharomyces cerevisiae
Rev. Soc. Argent. Diabetes ; 54(3): 132-139, sept.-dic. 2020. tab, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1147406


Introducción: la depresión (DP) tiene una alta prevalencia en pacientes con diabetes mellitus tipo 1 (DM1) y se asocia a repercusiones clínicas negativas como mayor morbimortalidad cardiovascular y complicaciones crónicas. Existen pocos estudios publicados sobre la funcionalidad del eje hipotálamo-hipófiso-adrenal (H-H-A) en DM1 con DP, y la relación entre la DP y el test de respuesta del cortisol al despertar (RCD) con el control glucémico (CG). Objetivos: analizar la funcionalidad del eje H-H-A a través de la evaluación del RCD en pacientes con DM1 (PD1) con y sin DP. Como objetivos secundarios, conocer la prevalencia de DP en PD1 y ver si existe relación entre el RCD y CG, y entre DP y CG. Materiales y métodos: estudio observacional, prospectivo, de corte transversal, multicéntrico, nacional. Se incluyeron PD1 mayores de 18 años; se utilizó cuestionario Patient Health Questionnaire-9 (PHQ-9) para diagnóstico de DP. Se tomaron muestras de cortisol salival al despertar y a los 30 minutos (RCD), y se consideró RCD bloqueado si el valor de cortisol de los 30 minutos no aumentaba más del 50% del basal. Además se tomaron muestras de sangre en ayunas para medir glucemia, fructosamina y HbA1c. Resultados: se incluyeron 79 pacientes, 39% hombres, edad promedio 38±15 años, duración de la diabetes de 16±13 años; 53% casados/en pareja y 87% con ingresos económicos estables. El 68% de los PD1 presentó el RCD bloqueado. En PD1 con DP el 85% presentó el RCD bloqueado vs el 60% en los no deprimidos y dicha diferencia fue marginalmente significativa (p=0,05). La prevalencia de DP fue de 39%. No se encontró ninguna relación significativa entre RCD bloqueado y control glucémico (p>0,05). Los PD1 con DP moderada-severa presentaron un peor control glucémico en relación a los PD1 sin depresión (evaluado por glucemia mayor de 120 mg/dl, fructosamina mayor de 285 umol/l; p<0,05) y la relación no fue significativa para HbA1c aunque mostró una tendencia. Conclusiones: en pacientes con DM1 y DP se halló el RCD bloqueado en un alto porcentaje. Dado que la DP se asocia a mayor morbimortalidad cardiovascular, podría utilizarse el test de RCD como biomarcador de DP, y podría servir para estratificar esta sub-población de alto de riesgo. La depresión moderada-severa se asoció a peor control glucémico, por lo tanto, diagnosticar y tratar adecuadamente la DP en PD1 podría contribuir a prevenir la aparición o progresión de complicaciones crónicas.

Introduction: depression (DP) has a high prevalence in patients with type 1 diabetes mellitus (DM1) and is associated with negative clinicals consequences like more cardiovascular morbimortality and chronic complications. There are few studies published about the dysregulation of hypothalamopituitary-adrenal axis (H-P-A) in DM1 with DP and the relation between DP and the Cortisol Awakening Response Test (CAR) with the glycemic control (GC). Objectives: examine the functionality of the H-P-A axis using the Cortisol Awakening Response Test (CAR), in patients with DM1 (PD1) with and without DP. Determine the prevalence of DP in PD1 and examine if there is any relation between CAR and GC and DP and poorer GC. Materials and methods: observational, prospective, national, multicenter study. Patients with DM1, older than 18 years old; Patient Health-9 questionnaire (PHQ-9) was used to diagnose DP and 2 samples of salivary cortisol, and blood samples for glycemia, glycated albumin and Hba1c. Results: 79 patients with DM1 (PD1) were included, 39% male, mean age 38± 15 years old, an average of 16±13 years evolution of diabetes; 53 % married/couple and 87 % have a regular incomes. 68% of PD1 presented CAR blunted. In PD1 with DP 85% has CAR blunted versus 60% in those without DP, and this difference was marginally significant (p=0.05). The prevalence of DP was 39%. No significant relation was found between CAR blunted and glycemic control (p>0.05).PD1 with Moderate-severe DP showed worse metabolic control than the PD1 without DP (evaluated by glycemia higher than 120 mg/dl, glycated albumin higher than 285 umol/l); p<0.05) and the relation was not significant with HbA1c but it showed a trend. Conclusions: patients with DM1 and DP presented a high prevalence of CAR blunted. DP is related with higher cardiovascular morbi-mortality, thus CAR would be useful as a biomarker of DP and would be used to stratify this population of high risk. DP moderate-severe was related to worse glycemic control, hence diagnose and treat correctly DP in PD1 would contribute to prevent the onset or the evolution of chronic complications.

Humans , Diabetes Mellitus, Type 1 , Blood Glucose , Hypothalamo-Hypophyseal System , Hypothalamus
Braz. J. Vet. Res. Anim. Sci. (Online) ; 57(2): e167299, mai. 2020. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1122175


The hypothalamus-pituitary-adrenal axis function may be impaired in patients with critical illnesses, especially cases of sepsis, named critical illness-related corticosteroid insufficiency (CIRCI). This study examined the function of the hypothalamic-pituitary-adrenal axis in normal dogs (n = 10) and dogs with critical diseases (n = 16), through determinations of endogenous ACTH (adrenocorticotropic hormone), basal cortisol and cortisol after stimulation in low doses of synthetic ACTH (1.0µg/kg/IV). The stimulation test with ACTH dose tested was verified as effective for evaluation of adrenal function in healthy and sick dogs. Ill dogs differed from healthy dogs by presenting higher basal cortisol values. Eight sick dogs presented a decrease in endogenous ACTH, basal cortisol, or Δ-cortisol. No significant differences were found between the control groups and critically ill dogs for the values of endogenous ACTH, cortisol after stimulation or Δ-cortisol. We concluded that the stimulation test with low-dose ACTH was effective for evaluation of adrenal function, as well as the fact that a considerable portion of critically ill dogs studied here, especially with sepsis, had evidence of inadequate corticosteroid response to stress.(AU)

A função do eixo hipotálamo-hipófise-adrenal pode estar comprometida em pacientes com doenças críticas, em especial casos de sepse, sendo nomeada de Insuficiência Corticosteroide Relacionada à Doença Crítica (ICRDC). O presente trabalho analisou a função do eixo hipotálamo-hipófise-adrenal em cães normais (n=10) e cães portadores de doenças críticas (n=16), por meio de determinações de ACTH (hormônio adrenocorticotrófico) endógeno, de cortisol basal e de cortisol após estímulo com baixa dose de ACTH sintético (1,0µg/kg/IV). Constatou-se que o teste de estimulação com ACTH na dose testada se mostrou eficaz para avaliação da função adrenal em cães sadios e doentes. Os cães doentes diferiram dos sadios ao apresentar valores maiores de cortisol basal. Oito cães doentes apresentaram diminuição do ACTH endógeno, do cortisol basal ou do Δ-cortisol. Não foram encontradas diferenças significativas entre os grupos Controle e Criticamente enfermos para os valores de ACTH endógeno, cortisol após estimulação ou Δ-cortisol. Concluiu-se que o teste de estimulação com baixa dose de ACTH mostrou-se eficaz para avaliação da função adrenal, assim como, uma parcela considerável da população de cães críticos aqui estudados, em especial com sepse, apresentaram evidências de resposta corticosteroide inadequada frente ao estresse.(AU)

Animals , Dogs , Cosyntropin/administration & dosage , Adrenocorticotropic Hormone , Sepsis/complications , Glucocorticoids/therapeutic use , Hypothalamo-Hypophyseal System/physiopathology , Catastrophic Illness
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
Article in Chinese | WPRIM | ID: wpr-879931


OBJECTIVE@#To investigate the effect of Chinese medicine Wubi Shanyao pills on sexual function of kidney-yang-deficiency mice induced by hydrocortisone.@*METHODS@#Male Kunming mice were injected with hydrocortisone for 10 days to prepare the kidney-yang-deficiency model, and administrated with Wubi Shanyao pills (0.91, 1.82, 2.73 g/kg) for 9 weeks. The general behaviors of mice (autonomous activity, grasping power) were observed; sexual behaviors (capture, straddle, ejaculation frequency and incubation period) of mice were detected by mating experiment. The serum levels of cortisol, adrenocorticotropic hormone (ACTH), luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E@*RESULTS@#Wubi Shanyao pills increased the number of independent activities, grasping power, capture frequency of model mice and shortened the capture latency (all @*CONCLUSIONS@#Wubi Shanyao pills can improve the sexual function of mice with kidney-yang-deficiency induced by hydrocortisone, which may be related to regulating the hypothalamus-pituitary-adrenal axis (HPA axis), promoting the proliferation of testicular cells, and inhibiting cell apoptosis.

Animals , Follicle Stimulating Hormone/blood , Hydrocortisone , Hypothalamo-Hypophyseal System , Kidney/drug effects , Kidney Diseases/drug therapy , Male , Mice , Pituitary-Adrenal System/drug effects , Random Allocation , Sexual Behavior, Animal/drug effects , Yang Deficiency/drug therapy
Article in English | WPRIM | ID: wpr-827419


Major depressive disorder (MDD) is a main type of mood disorder, characterized by significant and lasting depressed mood. Until now, the pathogenesis of MDD is not clear, but it is certain that biological, psychological, and social factors are involved. Childhood trauma is considered to be an important factor in the development of this disease. Previous studies have found that nearly half of the patients with MDD have experienced childhood trauma, and different types of childhood trauma, gender, and age show different effects on this disease. In addition, the clinical characteristics of MDD patients with childhood trauma are also different, which often have more severe depressive symptoms, higher risk of suicide, and more severe cognitive impairment. The response to antidepressants is also worse. In terms of biological mechanisms and marker characteristics, the serotonin transporter gene and the FKBP prolyl isomerase 5 have been shown to play an important role in MDD and childhood trauma. Moreover, some brain imaging and biomarkers showed specific features, such as changes in gray matter in the dorsal lateral prefrontal cortex, and abnormal changes in hypothalamic-pituitary-adrenal axis function.

Child , Depressive Disorder, Major , Gray Matter , Humans , Hypothalamo-Hypophyseal System , Pituitary-Adrenal System , Suicide
Article in Chinese | WPRIM | ID: wpr-826652


The effect of acupuncture-moxibustion on respiratory system and systemic immune inflammatory response were reviewed to explore the possible role of neuroimmunomodulation in the control of inflammatory response and the effect mechanism of cholinergic anti-inflammatory pathway on coronavirus disease 2019 (COVID-19). Acupuncture-moxibustion could produce the local and systemic anti-inflammatory effect on COVID-19 through the activation of cholinergic anti-inflammatory pathway. Compared with humoral anti-inflammatory pathway, the neuronal anti-inflammatory pathway has earlier initiation, rapider action, and more localization, which play a more important role in the initial stage of inflammatory response. This may be an important basis for acupuncture-moxibustion intervention in the early stage of COVID-19. In addition to cholinergic anti-inflammatory pathway, acupuncture-moxibustion may also play an anti-inflammatory role in activating sympathetic nerve, hypothalamic-pituitary-adrenal axis and other neural anti-inflammatory pathways. How acupuncture-moxibustion play its role in stimulating the vagus nerve and sympathetic nerve in different periods of inflammatory response, and whether the effect is based on the selection of acupoints and the methods of stimulation, will be the research direction of the transformation from basic research to clinical research for acupuncture-moxibustion.

Acupuncture Points , Acupuncture Therapy , Betacoronavirus , Coronavirus Infections , Therapeutics , Humans , Hypothalamo-Hypophyseal System , Moxibustion , Pandemics , Pituitary-Adrenal System , Pneumonia, Viral , Therapeutics
Clinics ; 75: e1554, 2020.
Article in English | LILACS | ID: biblio-1089608


Opioids are the main group of pharmacological agents used during the perioperative period and provide a sedative and analgesic component. The observations of opioid consumption in West Europe indicate that this group of drugs is widely used in chronic noncancer pain therapy. Nearly 20 years ago, the first publications indicating that opioids, as an element of perioperative pharmacotherapy in oncologic patients, increase the risk of tumor recurrence and affect further prognosis were presented. The actual publications suggest that there are multifactorial, complex mechanisms underlying the immunological impact and carcinogenesis promotion of opioids and that the intensity varies depending on the type of opioid. There are also questions about the immunosuppressive effects among patients receiving opioids in the treatment of chronic noncancer pain. The aim of the review article is to present information about the action of opioids on the immune system in carcinogenic settings and to define the clinical usefulness of this pharmacological phenomenon.

Humans , Male , Female , Chronic Pain/drug therapy , Carcinogenesis , Analgesics, Opioid/adverse effects , Pituitary-Adrenal System/drug effects , Retrospective Studies , Drug Tolerance , Analgesics, Opioid/therapeutic use , Hypothalamo-Hypophyseal System/drug effects , Opioid-Related Disorders
Cambios rev. méd ; 18(2): 72-79, 2019/12/27. graf., tab.
Article in Spanish | LILACS | ID: biblio-1099677


INTRODUCCIÓN. En el paciente crítico ha existido un conglomerado de situaciones dadas por alteración de las hormonas acorde al comportamiento del eje hipotalámi-co-hipofisario- gonadal, entender su rol es fundamental. OBJETIVO. Describir las alteraciones de las hormonas sexuales en el paciente críticamente enfermo desde un enfoque fisiológico y clínico. MATERIALES Y MÉTODOS. Estudio observacional, de revisión bibliográfica y análisis sistemático de 84 artículos científicos y selección de muestra de 27 en MedLine, The Cochrane Library Plus, LILACS y Web of Science; en español e inglés y variables: hormonas esteroides gonadales, enfermedad crítica, endocrinología, estrés, gónadas y disfunción, periodo 1998-2017. CONCLUSIÓN. Las alteraciones detectadas fueron un mecanismo para la producción de hormonas esteroideas hacia la síntesis predominante de cortisol y soportar el alto estrés meta-bólico de los pacientes. Las citocinas pro inflamatorias fueron importantes en éstos cambios. La polifarmacia fue un factor adicional poco ponderado de la alteración endocrina sexual.

INTRODUCTION. In the critical patient there has been a conglomerate of situations given by alteration of the hormones according to the behavior of the hypothalamic-pi-tuitary-gonadal axis, understanding their role is fundamental. OBJECTIVE. Describe the alterations of sex hormones in the critically ill patient from a physiological and clinical approach.MATERIALS AND METHODS.Observational, literature review and systematic analysis of 84 scientific articles and sample selection of 27 in MedLine, The Cochrane Library Plus, LILACS and Web of Science; in Spanish and English and variables: gonadal steroid hormones, critical illness, endocrinology, stress, gonads and dysfunction, period 1998-2017. CONCLUSION. The alterations detected were a mechanism for the production of steroid hormones towards the predominant syn-thesis of cortisol and withstand the high metabolic stress of the patients. Pro inflam-matory cytokines were important in these changes. Polypharmacy was an additional unweighted factor of sexual endocrine disruption.

Humans , Male , Female , Stress, Physiological , Thyroid Hormones , Critical Illness , Endocrinology , Amenorrhea , Gonadal Disorders , Oligospermia , Progesterone , Reproductive and Urinary Physiological Phenomena , Sexual Dysfunction, Physiological , Gonadal Steroid Hormones , Testosterone , Hydrocortisone , Convalescence , Cytokines , Adrenocortical Hyperfunction , Muscle Weakness , Selective Estrogen Receptor Modulators , Deep Sedation , Asexuality , Hypothalamo-Hypophyseal System , Intensive Care Units
Gac. méd. Méx ; 155(2): 184-190, mar.-abr. 2019. graf
Article in Spanish | LILACS | ID: biblio-1286481


Resumen El síndrome de ovarios poliquísticos es la enfermedad endocrina más frecuente en la edad reproductiva; se caracteriza por alteraciones menstruales, hiperandrogenismo clínico o bioquímico e identificación ultrasonográfica de quistes ováricos. Las alteraciones neuroendocrinas y metabólicas que lo acompañan implican desensibilización del eje hipotálamo-hipófisis-ovario, esteroidogénesis e hiperandrogenismo. Recientemente se ha explorado el papel de la resistencia a la insulina. Se ha establecido que la principal causa del síndrome de ovarios poliquísticos es el hiperandrogenismo, debido a alteraciones enzimáticas en la vía esteroidogénica, por lo que existe sobreestimulación por parte de la hormona luteinizante a causa de los pulsos rápidos generados por la hormona liberadora de gonadotropinas. Diversos factores de crecimiento y citocinas inhiben la conversión de andrógenos a estrógenos. En la desregulación característica de este síndrome también están involucradas la activina y las prostaglandinas e, incluso, altos niveles de insulina.

Abstract Polycystic ovary syndrome is the most common endocrine disease in reproductive age, characterized by menstrual alterations, clinical or biochemical hyperandrogenism, and ultrasound-identified ovarian cysts. The neuroendocrine and metabolic alterations that accompany this condition involve the desensitization of the hypothalamus-pituitary-ovary axis, steroidogenesis and hyperandrogenism; recently, the role of insulin resistance has been explored. Hyperandrogenism has been established to be the main cause of polycystic ovary syndrome, due to enzymatic alterations in the steroidogenic pathway that cause luteinizing hormone over-stimulation because of quick pulses generated by gonadotropin-releasing hormones. Various growth factors of and cytokines inhibit the conversion of androgens into estrogens; activin and prostaglandins are also involved, even high levels of insulin participate in the characteristic deregulation of this syndrome.

Humans , Female , Polycystic Ovary Syndrome/physiopathology , Hyperandrogenism/physiopathology , Pituitary-Adrenal System/metabolism , Insulin Resistance , Luteinizing Hormone/metabolism , Gonadotropin-Releasing Hormone/metabolism , Hypothalamo-Hypophyseal System/metabolism
Singapore medical journal ; : 140-144, 2019.
Article in English | WPRIM | ID: wpr-776999


INTRODUCTION@#Epidural steroid injections are an integral part of nonsurgical management of radicular pain from lumbar spine disorders. We studied the effect of dexamethasone 8 mg epidural injections on the hypothalamic-pituitary-adrenal axis and serum glucose control of Asian patients.@*METHODS@#18 patients were recruited: six diabetics and 12 non-diabetics. Each patient received a total of dexamethasone 8 mg mixed with a local anaesthetic solution of lignocaine or bupivacaine, delivered into the epidural space. Levels of plasma cortisol, adrenocorticotropic hormone (ACTH), serum glucose after an overnight fast and two-hour postprandial glucose, as well as weight, body mass index, blood pressure and heart rate were measured within one week prior to the procedure (baseline) and at one, seven and 21 days after the procedure.@*RESULTS@#Median fasting blood glucose levels were significantly higher on post-procedure Day 1 than at baseline. However, there was no significant change in median two-hour postprandial blood glucose from baseline levels. At seven and 21 days, there was no significant difference in fasting or two-hour postprandial glucose levels. Both ACTH and serum cortisol were significantly reduced on Day 1 compared to baseline in all patients. There was no significant difference in ACTH and serum cortisol levels from baseline at Days 7 and 21.@*CONCLUSION@#Our study shows that epidural steroid injections with dexamethasone have a real, albeit limited, side effect on glucose and cortisol homeostasis in an Asian population presenting with lower back pain or sciatica.

Adrenocorticotropic Hormone , Blood , Adult , Aged , Blood Glucose , Body Mass Index , Dexamethasone , Therapeutic Uses , Diabetes Mellitus , Therapeutics , Endocrine System , Female , Glucocorticoids , Humans , Hydrocortisone , Blood , Hypothalamo-Hypophyseal System , Injections, Epidural , Methods , Male , Middle Aged , Pituitary-Adrenal System , Postprandial Period , Singapore , Young Adult
Article in Chinese | WPRIM | ID: wpr-772110


Thyroglobulin is the most important and abundant protein in thyroid follicles and has been widely studied as a tumor marker of thyroid cancer recurrence and persistence. Tg is considered the material basis of thyroid hormone synthesis and does not participate in the regulation of thyroid hormone synthesis and secretion. This review summarizes the recent progress in the research of thyroid hormone synthesis and secretion regulation via a negative feedback regulation mechanism by the thyroid-hypothalamus-pituitary axis. Thyroglobulin can negatively regulate the synthesis of thyroid hormone by thyroid follicular cells and antagonize the positive regulation of thyrotropin TSH. The function of thyroid follicular cells is presumably a result of Tg and TSH interaction, and a follicular cycle model is proposed to explain the causes of follicular heterogeneity in glands. We also discuss the prospects and clinical significance of studies into the negative feedback regulation mechanism of the thyroid-hypothalamus-pituitary axis and compare two theories for this mechanism.

Feedback, Physiological , Humans , Hypothalamo-Hypophyseal System , Physiology , Neoplasm Recurrence, Local , Thyroglobulin , Metabolism , Thyroid Gland , Physiology , Thyroid Hormones , Metabolism , Thyrotropin , Metabolism
Pesqui. vet. bras ; 38(10): 1949-1954, out. 2018. tab
Article in English | LILACS, VETINDEX | ID: biblio-976372


In view of the fact that cancer is considered a chronic disease that can interfere with hormonal homeostasis by means of cytokines, we hypothesized that, even at early stages, mammary carcinoma is able to alter the balance of the hypothalamic-pituitary-thyroid and hypothalamic-pituitary-adrenal axes. To test this hypothesis, the serum concentrations of basal cortisol, thyroxine (T4), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were evaluated in 20 unspayed bitches that had a histopathological diagnosis of grade 1 mammary carcinoma at clinical stage I according to the World Health Organization (WHO) classification (T1N0M0). The control animals comprised 10 unspayed bitches in perfect health conditions that were matched with those with mammary carcinoma by age. No significant differences regarding the concentrations of basal cortisol, TSH, t4, and fT4 were found between the bitches carrying early stage mammary carcinoma when compared to the control group. This suggests that, even if malignant, early-stage mammary carcinomas do not exhibit the ability to alter the concentrations of hormones produced by the hypothalamic-pituitary-adrenal or hypothalamic-pituitary-thyroid axes.(AU)

Em vista do fato de neoplasias serem consideradas doenças crônicas que por meio de citocinas podem interferir na homeostase hormonal, hipotetizou-se que o carcinoma mamário, mesmo nos seus estádios iniciais, fosse capaz de alterar o equilíbrio dos eixos hipotalâmico-hipofisário-tireóideo e hipotalâmico-hipofisário-adrenal. Para tal, foram avaliadas as concentrações séricas de cortisol basal, tiroxina (T4), tiroxina livre (fT4) e tireotrofina (TSH) de 20 fêmeas caninas, inteiras, com diagnóstico histopatológico de carcinoma mamário grau 1 e estadiamento clínico I segundo a classificação da Organização Mundial da Saúde - OMS (T1N0M0). Os animais controle constituíram-se por 10 fêmeas caninas inteiras, em perfeitas condições de higidez, as quais foram pareadas, por idade, com aquelas portadoras de carcinoma mamário. Não foram encontradas diferenças significativas nas concentrações de cortisol basal, TSH, T4 e fT4 das cadelas portadoras de carcinoma mamário em estádio inicial quando comparadas às controles sugerindo que, mesmo considerados malignos, ainda não apresentam a capacidade de alterar as concentrações dos hormônios produzidos pelos eixos hipotalâmico-hipofisário-adrenal e tireóideo.(AU)

Animals , Dogs , Pituitary-Adrenal System , Mammary Neoplasms, Animal/diagnosis , Dogs/blood , Hypothalamo-Hypophyseal System