Three patients with ectopic corticotropin-releasing hormone(CRH)syndrome due to medullary thyroid carcinoma and literature review / 中华内分泌代谢杂志

Objective:To investigate the pathogenesis of Cushing′s syndrome induced by medullary thyroid carcinoma.Methods:Started from April 2011 to present, three medullary thyroid carcinoma patients with Cushing′s syndrome were enrolled in this study. All patients were 40 to 50 years old, one female and two males. The blood pressure, blood glucose, thyroid function and antibodies, calcitonin, and carcinoembryonic antigen(CEA)were detected. The qualitative and localized diagnosis of Cushing′s syndrome was performed by high- and low-dose dexamethasone suppression tests as well as imaging examinations. The biopsies of all patients were taken to test the immunostaining of calcitonin, adrenocorticotropin(ACTH), and corticotropin-releasing hormone(CRH).Results:According to the clinical manifestation and function tests, three patients were diagnosed as medullary thyroid carcinoma accompanied by ACTH-dependent Cushing′s syndrome. All patients showed positive immunohistochemical staining of calcitonin and CRH, with negative immunostaining of ACTH in one and positive immunostaining of ACTH in two patients. Therefore, the diagnosis of ectopic CRH syndrome caused by medullary thyroid carcinoma was definite.Conclusions:Medullary thyroid carcinoma is a rare cause of Cushing′s syndrome. Tumor cells secrete ACTH and CRH, which in turn cause hypercorticoremia. Ectopic CRH syndrome is very rare. Early diagnosis can be made by immunohistochemical staining of biopsy tissues to guide early targeted treatment and improve the prognosis.

Clinical study and literature review of mifepristone in the treatment of the occult ectopic adrenocorticotropin syndrome / 中华内分泌代谢杂志

This is a follow-up study in two patients who were diagnosed with the occult ectopic adrenocorticotropin syndrome ( EAS) and treated with mifepristone in our hospital. The efficacy and adverse reactions of mifepristone in these two patients with EAS were investigated. The patients had significant improvement in clinical manifestations, the plasma adrenocorticotropic hormone ( ACTH) and cortisol levels decreased in patient 1, while patient 2 remained stable during the treatment. Patient 1 with diabetes mellitus stopped hypoglycemic agents, while the dose of antihypertensive drugs decreased in patient 2 with hypertension, and she was treated with surgery and suffered from transient adrenocortical insufficiency after surgical excision of the lesion. Mifepristone is effective and safe in treating EAS. Surgical treatment should be performed once the lesion is found during the follow-up.

Effect of hsa-miR-663 on proliferation and apoptosis of human adrenal cortical cell line SW-13 / 中华泌尿外科杂志

Objective To investigate the effect of has-miR-663 on proliferation and apoptosis of human adrenal cortical cell line SW-13.Methods Based on the first stage study,in adrenocorticotropinindependent macronodular adrenal hyperplasia (AIMAH),hsa-miR-663 was up-regulated.The synthetic hsa-miR-663 mimics and inhibitors were transfected the SW-13 cell line.Real-time quantitative PCR (RT-PCR) tested the effect of the transfection.According to the results of RT-PCR,cell line was divided into five groups,including blank group,mimics NC group,inhibitor NC group,mimics group,inhibitor group.Then proliferating of the cell was tested by MTT and the apoptosis by Annexin V-FITC/PI.Result By RT-PCR,mimics group showed that has-miR-663 was over-expressed,and inhibitor group were knocked down.MTTshowed that,compared with NC group and Blank group,SW-13 cell line proliferated faster in mimics group and slower in inhibitor group.Annexin V-FITC/PI showed that apoptosis of SW-13 cell line was not different in all the five groups.Conclusion Up-regulating has-miR-663 could accelerate proliferation of adrenal cortical cells.The microRNA might play some role in the pathogenesis of AIMAH.

Study of the diurnal rhythm of cortisol secretion and insulin resistance in the type 2 diabetes mellitus patients with depression / 中国综合临床

Objective To explore the changes of the diurnal rhythm of cortisol secretion and insulin resistance of the type 2 diabetes mellitus(T2DM) patients with depression.Methods The 216 cases outpatient and inpatientof Department of Endocrinology of the Second People's Hospital Changshou, Clinical Psychology of City Mental Health Center of Changshou ,were divided into depression without T2DM group(D group,44 cases), T2DM without depression group(DM group, 124 cases) and the T2DM with depression group(DM-D group,48 cases).And 40 healthy people were from the medical center and as the normal control(NC) group.The levels of fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), Fins, fasting C peptide (FC-P), rhythm in cortisol(Cor) secretion at 3 time points (8:00, 16:00,24:00) and plasma adrenocorticotropin(ACTH) were detected for studies.Results Compared with the D group, DM group and NC group, there were increases of FPG,HbA1c,insulin resistance index (HOMA-IR) in the DM-D group ((11.51 ±2.05) vs.(5.18 ±0.22), (9.47±3.46), (5.11±0.25) mmol/L;(10.28±2.12)％ vs.(5.36±0.34)％, (8.89±2.21)％, (5.53 ±0.32) ％;3.78± 1.08 vs.1.58 ± 0.21,2.70 ± 1.54, 1.14 ± 0.24).Plasma cortisol levels and ACTH levels at time points of 8:00,16:00 in the DM-D group were higher than the group D, DM group and NC group, while insulin sensitivity index(ISI) in the DM-D group was lower than the D group,DM group and NC group (-4.41 ±0.27 vs.-3.57±0.13,-3.92±0.60,-3.22±0.22) ,and the differences were significant (P＜0.05).The loss of normal diurnal rhythm of cortisol secretion were significantly more often inDM-D group than in D group and in DM group(77.1％ vs.50.0％ ,47.6％ ,P＜0.05).The multiple stepwise regression analysis showed that 8:00 Cor and ISI were the related factors for the Hamilton Depression Scale (HAMD) score(95％CI:2.355-3.867, -7.903-2.780,P＜0.001).Logistic regression analysis showed that the level of 8:00 Cor was significant risk factor of the T2DM patients with depression(OR=3.024,95％CI: 1.613-5.668,P=0.002).Conclusion The T2DM patients with depression have higher plasma cortisol level, more abnormal rhythm of cortisol secretion and higher level of insulin resistance.The high level of plasma corfisol maybe significantly related to depression in T2DM patients.

The different expressed microRNA in adrenocorticotropin-independent macronodular adrenal hyperplasia / 中华泌尿外科杂志

Objective To investigate the different expressed microRNA in adrenocorticotropinindependent macronodular adrenal hyperplasia (AIMAH).Methods For the screening different expressed microRNA in AIMAH,5 AIMAH fresh tissues and 5 normal adrenal fresh tissues were collected.Total RNA was extracted by using Trizol reagents,then was purified and tested by denaturing agarose gel electrophoresis and NanoDrop 2000.Then the purified RNA was labeled by using Hy3TM fluorescent label and hybridized with miRCURY Array.MicroRNA array was scanned and analyzed by GenePix 4000B microarray scanner and GenePix proV6.0.The ratio acquired by divided AIMAH fluorescent correction value by normal adrenal fluorescent correction value.If the ratio was greater than 3.0,the microRNA was defined as up-regulating,or smaller than 0.3,as down-regulating.For the validation 40 AIMAH samples and 10 normal adrenal samples were used.The miRCURY array result was validated by real-time quantitative PCR.All the data was managed by SPSS 17.0.When P ＜ 0.05,the difference was significant in Student's t test.Results There were 12 different expressed microRNA between normal adrenal gland and AIMAH,including 7 up-regulating and 5 down-regulating microRNAs.Up-regulating microRNAs included hsa-miR-663,hsa-miR-498,hsa-miR-638,hsa-miR-501-5p,hsa-miR-585,hsa-miR-557 and hsa-miR-144.Down-regulating microRNA included hsa-miR-744,hsa-miR-143,hsa-miR-26a,hsa-miR-22,hsa-miR-29a.Four different expressed microRNAs were identified in validation test,including 3 up-regulating and 1 down-regulating microRNA.Upregulating microRNA included has-miR-663,has-miR-498,and has-miR-557.Down-regulating microRNA was has-miR-744.Conclusion Compared with normal adrenal gland,there might be some different expressed microRNAs in AIMAH.

Changing of cortisol and its associated indices in the serum of patients with traumatic brain injury / 中华创伤杂志

Objective To explore the changing rule and clinical significance of the abnormal cortical secretion resulted from traumatic brain injury (TBI). Methods The serums from 55 TBI patients and 13 normal persons were collected to measure the level of secreting total cortisol (Cor) , adrenocorticotropin (ACTH) and corticosteroid-binding-globulin (CBG) by using radioimmunoactive assay and chemiluminescent immunometric assay. In the meantime, the free cortisol (FC) and free cortisol index (CI) were calculated by using Coolen formula. Results CBG maintained stable, while Cor and other hormones were increased significantly with the severity of TBI. Surgical operation could release the stress partially without disturbing the secretion of hormone. The more quickly the serum hormone decreased, the better prognosis the patients would have. The lower level of Cot could result in poorer prognosis. Conclusions TBI can result in a higher level of Cor as well as other hormones in the serum. The prognosis is poor in patients with a persistent high or low level of Cor. It should be cautious to supply large volume of cortisol at the early phase of TBI.

Effects of Exercise on the Action Scores and Plasma Adrenocorticotropin and Corticosterone in Rats under Psychological Stress / 中国运动医学杂志

group C,CORT value in group I was significant higher than in the other two.In group I+S,the CORT and ACTH concentrations were lower than that in group I,but higher than that in group C and C+S.Conclusion Chronic psychological stress could induce stress-related hormone excretion and action alteration.Exercise to some degree could mitigate the psychological stress reactions.