Excesso de Hormônio Tireoidiano em Curto Prazo Afeta o Coração, mas não Afeta a Atividade Adrenal em Ratos / Short-Term Thyroid Hormone Excess Affects the Heart but Does not Affect Adrenal Activity in Rats

Fundamento: O hipertireoidismo (Hi) exerce um amplo leque de influências em diversos parâmetros fisiológicos. Seu efeito perturbador sobre o sistema cardiovascular é um de seus impactos mais importantes. Além disso, o Hi foi clinicamente associado com o estresse induzido pela hiperativação do eixo hipotalâmico-pituitário-adrenal. Objetivo: Avaliar o impacto do Hi de curto prazo sobre o desempenho cardíaco e a atividade adrenal de ratos. Métodos: A indução de Hi em ratos Wistar através de injeções de T3 (150 μg/kg) por 10 dias (grupo com hipertireoidismo - GH) ou veículo (grupo controle). O desempenho cardiovascular foi avaliado por: ecocardiograma (ECO); razão peso do coração/peso corporal (mg/gr); contratilidade de músculos papilares isolados (MPI) e mensuração direta da pressão arterial. A atividade adrenal foi avaliada pela razão peso adrenal/ peso corporal (mg/gr) e níveis de 24 horas de corticosterona fecal (CF) no 1º, 5º e 10º dias de tratamento com T3. Resultados: No GH, o ECO mostrou redução dos Volumes Finais Sistólico e Diastólico, Tempos de Ejeção, Relaxamento Isovolumétrico e Diastólico Total, Áreas Sistólicas e Diastólica e razão E/A. Aumentaram a frequência cardíaca, a fração de ejeção e o débito cardíaco. A razão peso corporal/peso do coração foi maior. Da mesma forma, nos MPI, a taxa máxima de degradação da força durante o relaxamento foi maior em todas as concentrações extracelulares de cálcio. Os níveis de pressão arterial sistólica (PAS) foram maiores. (p ≤ 0,05). Por outro lado, não houve diferença na razão peso das adrenais/peso corporal ou níveis de 24 horas de CF. ...

Background: Hyperthyroidism (Hy) exerts a broad range of influences on a variety of physiological parameters. Its disruptive effect on cardiovascular system is one of its most remarkable impacts. Moreover, Hy has been clinically associated with stress - induced hyperactivation of the hypothalamic-pituitary-adrenal axis. Objective: Evaluate the impact of short-term Hy on cardiac performance and adrenal activity of rats. Methods: Induction of Hy in Wistar rats through injections of T3 (150 µg/kg) for 10 days (hyperthyroid group - HG) or vehicle (control group). The cardiovascular performance was evaluated by: echocardiography (ECHO); heart weight/body weight (mg/gr) ratio; contractility of isolated papillary muscles (IPM) and direct measurement of blood pressures. Adrenal activity was evaluated by adrenal weight/body weight (mg/gr) ratio and 24-hour fecal corticosterone (FC) levels on the, 5th and 10th days of T3 treatment. Results: In HG, the ECHO showed reduction of the End Systolic and End Diastolic Volumes, Ejection, Total Diastolic and Isovolumic Relaxation Times, Diastolic and Systolic Areas and E/A ratio. Heart Rate, Ejection Fraction and Cardiac Output increased. The heart weight/body weight ratio was higher. Similarly, in IPM, the maximum rate of force decay during relaxation was higher in all extracellular calcium concentrations. Systolic blood pressure (SBP) levels were higher. (p ≤ 0.05). On the other hand, there was no difference in the adrenal weight/body weight ratio or in the 24-hour FC levels. Conclusions: Hy induces positive inotropic, chronotropic and lusitropic effects on the heart by direct effects of T3 and increases SBP. Those alterations are not correlated with changes in the adrenal activity. .

Stress modulating antioxidant effect of Nardostachys jatamansi.

The rhizomes of Nardostachysjatamansi, the plant commonly known as Jatamansi have been described in Ayurveda for their soothing and sedative action on the central nervous system. In the present study, the anti-stress effect of hydroethanolic extract (70%) of N. jatamansi (NJE) was evaluated in reference to its antioxidant property. Wistar rats were divided into four groups: naive, stressed, and T-200 and T-500 stressed with oral pre-treatment of NJE 200 and 500 mg/kg, respectively. Restraint of rats in metallic chambers for 4 h at 4 degreesC was followed by sacrifice and assessment of stress-induced alterations in biochemical parameters, incidence and severity of ulcers. Lipid peroxidation (LPO) and NO levels in stomach and LPO, NO levels and catalase activity in brain, plasma corticosterone level and adrenal ascorbic acid were measured. In vitro antioxidant activity of NJE was studied by measuring the free radical scavenging activity. NJE showed potent antioxidant activity and significantly reversed the stress-induced elevation of LPO and NO levels and decrease in catalase activity in the brain. It inhibited the incidence of gastric ulcerations and reversed the alterations in biochemical parameters/markers of stress-induced gastric ulceration. NJE also significantly altered stress-induced increase in adrenal and spleen weights and decrease in level of ascorbic acid in adrenal gland. Elevation of plasma corticosterone level was negated dose- dependently. The findings suggest that the NJE possesses significant anti-stress activity, which may be due to its antioxidant activity.

Hiperplasia adrenal macronodular independente de ACTH (AIMAH): aspectos clínicos e moleculares / Clinical and molecular aspects of the ACTH: independent bilateral macronodular adrenal hyperplasia

A AIMAH é caracterizada pela presença de macronódulos em ambas as adrenais, na ausência da estimulação do ACTH. Habitualmente, as manifestações clínicas aparecem somente após várias décadas de vida, provavelmente em função da baixa atividade esteroidogênica do tecido hiperplásico. Entretanto, em indivíduos assintomáticos cuja AIMAH foi descoberta acidentalmente, o eixo HHA já se encontra alterado. Estudos têm demonstrado que, na maioria dos casos de AIMAH, a secreção de cortisol é regulada de modo "aberrante" por hormônios como o GIP, AVP, catecolaminas, LH/hCG e serotonina, através de seus respectivos receptores, ectópicos ou eutópicos, porém aberrantemente acoplados à esteroidogênese. Os mecanismos moleculares responsáveis pela expressão ectópica dos receptores hormonais e/ou de seu acoplamento anormal à esteroidogênese adrenal ainda são pouco conhecidos. Embora a expressão aberrante destes receptores hormonais possa desempenhar um papel importante na iniciação da proliferação celular aumentada, bem como na esteroidogênese, é provável que eventos genéticos adicionais ocorram, envolvendo a regulação do ciclo celular, adesão e transcrição. Mutações no gene GNAS1 não associadas à síndrome de McCune-Albright podem ser encontradas em raros casos de AIMAH. Em alguns casos, a presença de receptor hormonal aberrante abre novas possibilidades de tratamento farmacológico específico do hipercortisolismo, seja isolado ou associado à adrenalectomia unilateral.

Papel de la aldosterona y las glándulas suprarrenales en la acción renal de la adrenomedulina administrada centralmente / Paper of the aldosterone and the suprarenal glands inthe renal action of the adrenomedullin administred centrally

La adrenomedulina (AM) es un péptido hipotensor altamente expresado en el sistema nervioso central. La administración central de AM produce: inhibición de la ingesta de sal, agua y de la secreción de arginina-vasopresina, incremento de los niveles plasmáticos de oxitocina, diuresis y natriuresis. En las glándulas suprarrenales la AM inhibe la secreción de aldosterona (ALD) inducida por la angiotensina II, KCL o ACTH. Nosotros evaluamos la hipótesis de la disminución de la actividad mineralocorticoide sobre el riñón como el posible mecanismo responsable del fenómeno natriurético. La AM-IVT incremento el volumen urinario y la excreción y la excreción de sodio durante las 6 horas del período de recolección de la orina. En las ratas controles y las depletadas de sodio, los niveles de ALD plasmática permanecieron sin cambios hasta 15 minutos después de la AM_IVT. La natriuresis inducida por la AM-IVT no fue afectada significativamente en la ausencia (ratas ADX) o el exceso de ALD plasmática (SHAM, ALD), o en ratas ADX, con o sin reemplazo hormonal. Nurestros resultados sugieren que la AM juega un papel en la regulación central del balance de fluidos y electrolitos, y que el efecto natriurético de la AM cerebral no está relacionado con los niveles plasmáticos de mineralocorticoides, ni con la presencia de las glándulas suprarrenales

Anomalías de la esteroidogénesis suprarrenal en niños chilenos con micropene / Abnormalities in adrenal steroidogenesis in chilean boys with micropenis

Background: Mutations in type II 3ß hydroxysteroid Dehydrogenase (3ßHSD) are found in male children with severe undervirilized genitalia. Mild undervirilization (isolated micropenis or with distal hypospadia) can be associated with a partial deficit in 3ßHSD activity. Aim: To assess the frequency of abnormal adrenal response to ACTH, suggesting a deficit in adrenal enzymatic activity, in children with mild undervirilization. Patients and methods : We studied 26 male children with micropenis, aged one to eight years. Children with evidences of puberal development or in treatment with drugs that affect steroidal metabolism were excluded from the study. Serum levels of androstenedione (A), dehydroepiandrosterone (DHEA), progesterone (P), 17 hydroxyprogesterone (17 P) and the ratios DHEA/A, P/17 P, 17 P/DHEA were measured after an adrenal stimulation with 0.25 mg/m2 intramuscular ACTH. Results: Two children had DHEA y DHEA/A values suggesting a defective 3ßHSD activity. Other two children had high levels of 17 P, suggesting a deficiency of cytochrome p450c21. A CYP 21 gene mutation was found in one of the later children. Conclusions: A low proportion of children with micropenis have a deficient 3ßHSD activity

Adrenal functions in children with adrenoleukodystrophy.

BACKGROUND: Adrenoleukodystrophy refers to an inherited disorder that mainly affects the adrenal gland, and the nervous system. The most common type is X-linked adrenoleukodystrophy (XALD). The main presenting symptoms are behavioral changes. However, endocrinological manifestations are also important and need to be clarified especially adrenal insufficiency which is a lifethreatening condition that can be prevented. OBJECTIVE: To review the endocrinological and the adrenal functions in X-linked ALD. SUBJECTS AND METHOD: The medical records of four patients diagnosed with ALD at the Endocrinology and Metabolic Unit, Department of Pediatrics, King Chulalongkorn Memorial Hospital between 1998 and 2000 were reviewed. The diagnoses were confirmed by elevated very long chain fatty acid (VLCFA) levels and the typical changes seen on magnetic resonance imaging (MRI) of the brain. The adrenal functions in these patients were studied. RESULTS: All patients presented between 7-11 years of age with learning problems and behavioral changes, without symptoms of adrenal insufficiency such as nausea, vomiting and abdominal pain. However, the physical signs of adrenal insufficiency such as generalized hyperpigmentation particularly on the nipples, skin creases and genitalia were present. The laboratory investigations revealed normal blood sugar and serum electrolytes. The adrenal functions were revealed as follows. Basal ACTH levels were high in 2 cases (290, > 1,250 pg/mL). Basal cortisol level was low in 1 case. ACTH stimulation tests revealed subnormal responses in 3 cases. Magnetic Resonance Imaging of the brain showed white matter degeneration in the occipital area in 2 cases and frontal area in 2 cases. CONCLUSION: Adrenal insufficiency can be detected by laboratory evaluation despite the lack of symptoms, therefore, the adrenal function should be evaluated in X-ALD at diagnosis for proper management.

Pituitary-adrenal function in uncomplicated falciparum malaria.

To investigate pituitary-adrenal function in acute uncomplicated falciparum malaria, we performed an overnight dexamethasone suppression test in 13 Vietnamese adults with acute malaria and 6 healthy controls. After blood samples were taken for serum cortisol and plasma ACTH at 23.00 hours on the admission day, 1 mg dexamethasone was given and further samples were taken at 08.00, 16.00 and 23.00 hours the next day. The patients received conventional antimalarial and supportive treatment. Baseline plasma ACTH concentrations in the patients [3.9 (0.2-41.2) pmol/l] and controls [3.4 (1.1-4.3) pmol/l] were similar (p=0.51), and exhibited a similar fall after dexamethasone to 0.6 (0.2-2.5) and 0.9 (0.7-1.6) pmol/l at 08.00 hours respectively (p<0.03 vs 23.00 hour values). Serum cortisol levels before dexamethasone were higher in the patients than in the controls [456 (102-821) vs 145 (64-183) nmol/l respectively; p=0.007] and the overnight fall was less in the patients [208 (26-340) and 23 (15-46) nmol/l at 08.00 hours respectively; p<0.001 vs 23.00 hour values and between groups]. Between 08.00 and 23.00 hours, plasma ACTH and serum cortisol remained suppressed in the controls. In the patients, the serum cortisol continued to fall progressively towards control values. These data suggest that there is a raised set point for cortisol inhibition of ACTH secretion but normal corticotrophin responsiveness to dexamethasone in uncomplicated malaria. A raised serum cortisol after dexamethasone in the patients might reflect the combination of a prolonged cortisol half-life and the stimulatory effects of cytokines on the adrenal cortex, with a consequent protective effect against complications such as hypoglycemia.

Target gland functional status in patients with non-Cushing's pituitary macroadenomas undergoing transsphenoidal microsurgery.

OBJECTIVES: Hypopituitarism occurring in patients with pituitary macroadenoma may be reversible after pituitary microsurgery, and surgery itself can lead to hypopituitarism. This study was undertaken to evaluate target gland function prospectively in patients of non-Cushing's pituitary macroadenoma undergoing trans-sphenoidal microsurgery. MATERIAL AND METHODS: A prospective study of fifty patients of non-Cushing's pituitary adenoma was carried out to evaluate target gland (thyroid, adrenal and gonadal) undergoing trans-sphenoidal microsurgery. Thirty-two patients completed postoperative evaluation before radiotherapy. Target gland functions were assessed by measurement of T3, T4, TSH, basal and stimulated cortisol, LH, FSH, testosterone and estradiol. GH and PRL were also measured. Tumor size was assessed on CT/MRI scan. RESULTS: Hypothyroidism, hypoadrenalism and hypogonadism were present in 24%, 54% and 52% of patients. Preoperative hypopituitarism correlated with tumour size. Thyroid, adrenal and gonadal function improved in 87%, 50% and 31%; deteriorated in 4%, 29%, and 37%, respectively after trans-sphenoidal microsurgery. CONCLUSIONS: A subset of patients with non-Cushing's pituitary macroadenoma suffers from hypopituitarism, which reverses after surgery. Failure of recovery correlates with preoperative lower serum prolactin levels.

Adrenal contribution to polycystic ovary syndrome

To examine further the dynamics of adrenal steroidogenesis in selected groups of patients with polycystic ovary syndrome [PCOS] compared to normal ovulatory women of the same age. Materials and Serum cortisol, testosterone, dehydroepiandrosterone sulphate [DHEAS], androstenedione [A], luteinizing hormone [LH], follicle-stimulating hormone, prolactin, 17-hydroxyprogesterone [17-OHP] and sex hormone-binding globulin [SHBG] were measured in the early follicular phase of the period. In addition, 2-day dexamethasone suppression and short adrenotropic hormone [ACTH] stimulation tests were performed for the study group and controls. Serum testosterone [4.3 +/- 1.8 nmol/l], LH [7.6 +/- 1.9 IU/l], and 17-OHP [4.7 +/- 2.3 nmol/l] were higher while SHBG [24.7 +/- 14.2 nmol/l] was lower in patients than the control. Testosterone was significantly suppressed after dexamethasone suppression test while the level of 17-OHP increased significantly in patients more than the control after 60 min of ACTH stimulation. In the PCOS, the ratio of 17-OHP/A showed a significant increase after ACTH stimulation while that of DHEAS/A decreased when compared to controls. The study suggests a contribution of adrenal cytochrome P-450C dysregulation in PCOS. This suggestion could lead to another method of treating some PCOS patients when the usual anti-androgens might not be fully effective in controlling most of the symptoms

The neuroimmune-endocrine axis: pathophysiological implications for the central nervous system cytokines and hypothalamus-pituitary-adrenal hormone dynamics

Cytokines are molecules that were initially discovered in the immune system as mediators of communication between various types of immune cells. However, it soon became evident that cytokines exert profound effects on key functions of the central nervous system, such as food intake, fever, neuroendocrine regulation, long-term potentiation, and behavior. In the 80's and 90's our group and others discovered that the genes encoding various cytokines and their receptors are expressed in vascular, glial, and neuronal structures of the adult brain. Most cytokines act through cell surface receptors that have one transmembrane domain and which transduce a signal through the JAK/STAT pathway. Of particular physiological and pathophysiological relevance is the fact that cytokines are potent regulators of hypothalamic neuropeptidergic systems that maintain neuroendocrine homeostasis and which regulate the body's response to stress. The mechanisms by which cytokine signaling affects the function of stress-related neuroendocrine systems are reviewed in this article.

A obesidade estaria relacionada ao aumento do volume das adrenais? / Would the obesity related to the adrenal volume increases?

Vários estudos sugerem que existe uma hiperatividade do eixo hipotálamo-hipofisário-adrenal (HHA) na obesidade, com maior acúmulo de gordura na região abdominal. Estes trabalhos demonstram que, após injeções de hormônio liberador de corticotropina (CRF) ou hormônio adrenocorticotrófico (ACTH) e ainda através de testes de stress, os níveis de cortisol estão aumentados em comparação com pacientes com deposição periférica de gordura. Além do mais, alguns estudos mostram que em pacientes deprimidos, onde a hiperatividade do HHA é uma alteração endócrina importante e conhecida, o volume das adrenais está aumentado quando comparado com normais. Para investigar se o teor de gordura visceral de alguma maneira se relaciona com o volume das adrenais, 52 mulheres com idade entre 19 e 54 anos, com diferentes índices de corpulência, foram estudadas através de medidas antropométricas como peso, índice de massa corporal (IMC), cintura e relação cintura-quadril (RCQ). As áreas de gordura visceral (GV) e sub-cutânea (GSC), além do volume das adrenais, foram medidas através da tomografia computadorizada. Houve uma correlação extremamente significativa entre as medidas de distribuição de gordura (RCQ e cintura) e a GV, sendo que a RCQ não se correlacionou com a GSC. O somatório do volume das adrenais mostrou uma correlação positiva e significativa com a RCQ (r = 0,272, p = 0,02) e uma correlação positiva, mas no limite da significância com a GV (r = 0,228, p = 0,05), não mostrando qualquer correlação com a GSC. Além disso, o somatório do volume das adrenais foi maior naquelas com GV >/= 120 cm 2 quando comparado com pacientes com área de GV < 120 cm 2 (p = 0,05). Portanto, o estudo sugere que o depósito de GV parece interrelacionar-se com a hiperatividade do HHA, aqui estimada anatomicamente através do volume das adrenais, glându-la alvo deste eixo.

Función adrenal y matabolismo lipídico en niños asmáticos tratados con budesonida / Adrenal function and lipid metabolism in asthmatic children with budesonide treatment

Objetivo. Evaluar el efecto de bajas dosis de budesonida inhalado sobre la función adrenal y el metabolismo lipídico en niños asmáticos. Material y métodos. Se estudiaron: 10 niños asmáticos (edad promedio, 8.6 años) tratados con budesonida inhalado (200-300 µg/día) por un lapso mayor a tres meses (grupo A); 15 niños asmáticos (edad promedio, 7.8 años) sin tratamiento esteroideo (grupo B), y 10 niños no asmáticos (grupo C). Se determinaron los niveles de cortisol basal y postestímulo con ACTH, andrógenos adrenalis, lípidos y cortisol urinario. Resultados. Entre los grupos A y B no hubo diferencias significativas en las variables estudiadas. En los niños asmáticos (grupo A-B) el cortisol urinario fue significativamente mayor en relación con el grupo C. Los niveles de triglicéridos, colesterol total, colesterol de la lipoproteína de baja densidad e índices aterogénicos furon mayores en el grupo de niños asmáticos, con y sin budesonida, comparado con el grpo C. Conclusiones. El tratamiento con dosis bajas de budesonida inhalado en niños asmáticos no modificó la función del eje adrenal ni el metabolismo lipídico. Los pacientes asmáticos presentaron un perfil lipídico aterogénico que podría incrementar el riesgo de enfermedad cardiovascular

Ligation of the left renal vein in epm1-Wistar rats: functional and morphologic alterations in the kidneys, testes and suprarenal glands

Objective: The ligation of the left renal vein (LLVR) in man is a contraversial procedure in view of the risks of lesion to the renal parenchyma. With the objective of studying the morphologic and functional alterations caused by these lesions, we conducted experimental research with rats. Material and Methods: 64 male adult EPM1-WISTAR rats were used, divided into 8 groups - 4 for LLRV and four control. Each LLRV group and corresponding control group were sacrificed progressively on the 7th, 15th, 30th and 60th day after the initial surgery. Results: We found morphofunctional alterations only in animals that underwent LLRV in the four periods of sacrifice. The proteinuria creatinine in serum, testosterone in serum and serum corticosterone in serum showed practically no alteration in relation to the normal values for rats. Statistically significant severe histological lesions were found in the kidneys and testes of the LLRV groups. Lesions in the suprarenal glands were also present in these groups, but no sufficient to demonstrate statistical significance Conclusion: Based on these results we can conclude that the ligation of the left renal vein is a procedure of high risk in these animals.

Presença de hipocortisolismo clínico-laboratorial em pacientes com paracoccidioidomicose / Presence of clinic-laboratorial hypocortisolism in patients with paracoccidoidomycosis

Micoses sistêmicas se associam, com frequência, ao acometimento da glândula supra-renal. A revisao de prontuários de 135 pacientes com diagnóstico de paracoccidioidomicose permitiu estimar uma prevalência clínica da doença de Addison em 5,2 por cento dos casos. O diagnóstico de doença de Addison foi feito com base na sintomatologia clássica de insuficiência supra-renal (fadiga, perda de peso, fraqueza, hipotensao, hiperpigmentaçao) ou na vigência de um quadro de insuficiência supra-renal aguda. A investigaçao da funçao supra-renal, na ausência de manifestaçoes clínicas clássicas da doença, foi realizada em 9 pacientes. Nesses casos, mostrou resultados sugestivos de normalidade em relaçao ao eixo dos glicocorticóides. Chamam a atençao os baixos níveis de tensao arterial detectados, sendo a pressao diastólica inferior a 80 mmHg em 89,2 por cento dos casos, bem como o alto percentual de hiponatremia e hipercalemia, respectivamente 13,3 por cento e 7,4 por cento dos pacientes avaliados. Estes dados indicam a necessidade de investigaçao adequada do ponto de vista mineralocorticóide. Enfatiza-se que a utilizaçao de agentes antimicóticos inibidores da esteroidogênese deve ser cuidadosamente monitorizada, num contexto de possível hipofunçao supra-renal.

Análisis del tratamiento quirúrgico del síndrome de Cushing en el hospital de especialidades del Centro Médico Nacional de Occidente / Analysis of surgical treatment of Cushing's syndrome in the Hospital of Medical Center of Especialities of Occident

Se revisa la experiencia del tratamiento quirúrgico del síndrome de Cushing en un periódo de 15 años en un hospital de concentración. Se incluyen 22 casos, 19 de ellos femeninos y 3 masculinos, con edades entre 17 y 49 años. Todos presentaban síndrome de Cushing. El diagnóstico se confirmó en base a determinaciones basales y funcionales anormales de cortisol, 17-hidroxicorticoesteroides y ACTH. Los estudios radiológicos de mayor utilidad fueron TAC y retroneumoperitoneo. Los diagnósticos histopatológicos indicaron 3 casos de hiperplasia simple, 2 de hiperplasia macronodular y 1 de micronodular, 10 casos de adenomas y 6 de carcinomas. De estos últimos, 4 fueron resecables. Se efectuaron 10 suprarrenalectomías bilaterales y 14 unilaterales; 21 fueron por abordaje quirúrgico anterior. No hubo mortalidad quirúrgica. La morbilidad operatoria fue del 18 por ciento. Hubo remisión total del síndrome de Cushing en 13 casos; en 2 casos de hiperplasia manejados con suprarrenalectomía bilateral, se desarrolló síndrome de Nelson. Además 11 pacientes requirieron terapia sustitutiva. De los casos con carcinoma, 5 pacientes recibieron quimioterapia con o'p'DDD por recidiva o progresión; todos fallecieron por enfermedad diseminada antes de 5 años

Adrenal function & the pattern of glucocorticoid induced eosinopenia in tropical pulmonary eosinophilia.

Plasma cortisol levels were estimated in 16 patients with tropical pulmonary eosinophilia (TPE; group A) by radioimmunoassay using 125I labelled cortisol. The cortisol levels showed diurnal variation, the mean levels were 10.22 +/- 4.5 micrograms/dl for the morning samples and 4.91 +/- 2 micrograms/dl for the night samples respectively and were within normal limits. Another six patients with TPE included in the study (group B) had an initial mean plasma cortisol level of 5.83 +/- 1.33 micrograms/dl. Half an hour after intramuscular administration of 250 micrograms of Synacthen (a synthetic glucocorticoid with corticotrophic activity), the mean cortisol level showed a significant rise up to 14.7 +/- 3.54 micrograms/dl (P < 0.01) thus indicating normal adrenocorticohypophysial functions in TPE. There was no significant alteration of total blood eosinophil counts before and after intramuscular Synacthen. An additional 6 patients with TPE (group C) who were given oral prednisolone 30 mg a day for 5 days which was subsequently tapered off in the next 5 days showed a spectacular mid-treatment fall in blood eosinophil levels with a post-treatment rise. In another 3 patients with TPE (group D) total blood eosinophil counts were estimated 4 h after intramuscular hydrocortisone and a prompt eosinopenic response was observed. This indicated that a dose related response to steroids in TPE is unlikely. The absence of eosinopenic response after Synacthen could have been due to the short (half an hour) interval when the eosinophil counts were repeated.

Nódulo suprarrenal no funcionante / Non functioning suprarenal nodule

Entre los años 1969 y 1991 se han operado en nuestro servicio 62 pacientes por patología de la glándula suprarrenal, 16 (25,3 por ciento) corresponden a lesiones adrenales no funcionantes o silentes desde el punto de vista endocrino. Siete pacientes (43,75 por ciento) se diagnosticaron por un hallazgo de los medios por imagen. Las causas más frecuentes de nódulo SR NF fueron Feocromocitoma no funcionante 25 por ciento, Metástasis 25 por ciento y Cáncer SR 18,7 por ciento. Se analiza la metodología diagnóstica la vía de acceso y la morbilidad quirúrgica

Glándula suprarrenal y SIDA, hallazgos postmortem en 119 casos / Suprarenal gland and AIDS, postmortem findings in 119 cases

Se analizaron 119 protocolos de autopsias de pacientes que fallecieron por SIDA. Todos ellos se encontraron en la etapa IV, de acuerdo a la clasificación del Centers For Disease Control. Del total de casos, 104 fueron hombres (87.4%) y 15 mujeres (12.6%). Todos adultos entre 20 y 50 años, 86 pacientes (72.3%) contrajeron la enfermedad a través de relaciones homo y heterosexuales; 25 pacientes (21%) se infectaron mediante transfusión sanguínea y en ocho (6.7%) se desconoce como adquirieron la enfermedad. La afección de las glandulas suprarenales se encontró en 89 casos (75%); sin embargo, 30 casos (25%) macroscopicamente presentaron glandulas de aspecto normal o con deplección lipoide. Histológicamente la lesión predominante fue una adrenalitis con extensa nicrosis cortico medular producida por gérmenes oportunistas. El citomegalovirus fue el agente oportunista detectada, con mayor frecuencia. No obstante que algunos casos presentaron destrucción casi total de ambas glándulas suprarrenales, en ningún paciente se estableció el diagnóstico premortem de insuficiencia córtico -suprarrenal.