Adrenal cortex function in asthmatic patients following the discontinuation of chronic therapy with systemic glucocorticosteroids.

OBJECTIVE: To estimate the time it takes for adrenal cortex function in asthmatic patients to return to normal after discontinuation of chronic therapy with systemic glucocorticosteroids (GCs) and to assess the relationship between the duration of the disease, chronic therapy, and the return of the normal adrenal cortex functioning. MATERIALS AND METHODS: The study involved 58 asthmatic patients and 31 healthy volunteers (aged 20-69 years). Adrenal cortex function was evaluated with the Synacthen short test, and determining serum and urinary free cortisol levels after 1, 3, 6, 12, 18, and 21 months following the discontinuation of systemic therapy with GCs. RESULTS: A decreased adrenal reserve was observed 1 month after withdrawal of GCs in 50% of the chronically treated patients. Adrenal cortex function returned to normal in 55% of patients within 6 months, in 24% within 12 months, and in 14% within 15 months of discontinuation of systemic GCs administration. A significant positive correlation between the time taken for return to normal adrenal cortex function and duration of the disease and of GCs therapy was found. CONCLUSIONS: Symptoms of adrenal failure may develop in about 50% of asthmatic patients. In the majority of patients treated long term with systemic GCs, adrenal cortex function returns to normal within 6 months following discontinuation of GCs. The time of such return depends on the duration of the disease and of therapy with systemic GCs.

Dynamic pattern of IGF-I and chosen biochemical markers of bone metabolism in a rat model of postmenopausal osteoporosis.

OBJECTIVE: To assess the relationship between the dynamic pattern of IGF-I levels and chosen biochemical markers of bone metabolism in ovariectomized rats - a model of postmenopausal osteoporosis. METHODS: Six-month-old rats were randomized to sham operation (control group) or ovariectomy. Serum levels of insulin-like growth factor (IGF-I) and chosen biochemical markers of bone metabolism (alkaline phosphatase - ALP, carboxyterminal propeptide of type I procollagen - PICP, cross-linked carboxyterminal telopeptide of type I collagen - ICTP in serum as well as urinary excretion of hydroxyproline - HYP and total calcium - Ca) were measured before (group 0) and 1, 2, 3, 4, 6, 8, 12, 16, 20, 24 and 28 weeks after the operation. RESULTS: In a model of experimental osteoporosis induced by ovariectomy in female rats a distinct tendency to decrease the IGF-I concentrations was shown. Differences were significant in relation to the control group in a period from 2 to 28 weeks after operation. Ovariectomy stimulated the values of studied markers of bone metabolism; it was more intensified in regard to resorption markers. Significant ICTP and HYP concentrations' changes, in relation to the control group, were shown in the some period and total calcium - from 2 to 16 weeks after ovariectomy. However, the values of studied markers of bone formation were generally changing to a slight degree. Significant differences of ALP activity, in relation to the control group, were observed only at 8 and 20 weeks, while those of PICP concentrations were found at in 4, 8 and 12 weeks after the operation. The alterations in the levels of IGF-I correlated significantly and negatively with the changes in ALP activity as well as in PICP, ICTP, HYP and Ca concentrations both in ovariectomized and control rats. This relation was more expressed in the ovariectomized group. CONCLUSIONS: Our findings suggest that secondary changes in IGF-I concentration, due to the deficiency of sex hormones, results in altered bone metabolism in ovariectomized rats.

Effects of hormone replacement therapy on endocrine and spirometric parameters in asthmatic postmenopausal women.

The aim of the study was to see if there are any correlations between changes in the endocrine system and clinical condition of asthmatic patients, in particular their lung function, caused by hormone replacement therapy (HRT). Fifty-five asthmatic and 20 healthy postmenopausal women (aged 48-60) were studied before HRT and after 6 months of cyclical transdermal 17 beta-estradiol and medroxyprogesterone acetate treatment. Serum estradiol, cortisol and dehydroepiandrosterone sulfate (DHEAS) concentrations were assessed with the use of RIA, and spirometry parameters were measured. Statistically significant diminution of asthma exacerbations, reduced consumption of inhaled glucocorticosteroids and improvement in all investigated spirometry parameters was shown in patients treated with glucocorticosteroids during HRT. A reduction in mean 24-hour serum estradiol levels in asthmatic women was noted, whereas cortisol and DHEAS serum concentrations were decreased in asthmatic patients treated with glucocorticosteroids compared with the control group, before HRT. HRT produced increases in the concentrations of estradiol, cortisol and DHEAS in serum. Significant positive correlations were noted between estradiol concentrations and small and medium bronchi tests. In conclusion, HRT in postmenopausal asthmatic women has a favorable influence on the course of asthma, reduces daily use of glucocorticosteroids and frequency of asthma exacerbations and normalizes serum concentrations of estradiol, cortisol and DHEAS, which were decreased before HRT.

Influence of pinealectomy and long-term melatonin administration on GH-IGF-I axis function in male rats.

BACKGROUND: A relationship between circadian GH-IGF-I axis activity and pineal gland function in rats is not sufficiently elucidated, particularly in the aspect of melatonin (MEL) participation with relation to a possible mechanism of these dependencies. OBJECTIVE: Influence of pinealectomy and long-term MEL administration on circadian GH-IGF-I axis function in male rats was evaluated. An attempt was also made to determine whether the effect of exogenous MEL is dependent on the pineal gland presence. METHODS: Studies were performed in 192 sexually mature male Wistar rats, which were subjected to pinealectomy or sham operation. In half of the animals from each group MEL (Sigma, USA) in dose of 50 microg/ 100g b.m. was administrated intraperitoneally (daily between 5 and 6 pm during a 4-week period). Blood for RIA assays of MEL, GH and IGF-I concentrations was collected every 3 hours during a day-beginning at 8 am (rats killed by decapitation). RESULTS: Significant influence of pinealectomy and exogenous MEL on a daily profile of endogenous MEL in rats was confirmed. Distinct, dependent on the time of the day anomalies in circadian oscillations of GH and IGF-I showing positive correlation with changes in endogenous MEL concentrations were also shown. GH rhythm was suppressed in a group of rats with removed pineal gland; after pinealectomy distinct decrease and after MEL use - distinct increase of GH and IGF-I concentrations during the day were observed. It had influenced mean daily concentrations and values of amplitude of circadian GH and IGF-I oscillations in all studied groups of animals. In rats with preserved pineal gland the effect of exogenous MEL action was more intensified. CONCLUSIONS: Pineal gland can influence circadian function of GH-IGF-I axis, and in mechanism of this dependence, changes in endogenous MEL concentrations seem to play an important role. Administration of MEL in rats after pinealectomy only partly prevents changes of GH-IGF-I axis function caused by gland removal, which can indicate participation of other pineal gland substances in generating disturbances. Influence of exogenous MEL on GH-IGF-I axis function during the day is dependent on the presence of pineal gland, which can be connected with indirect and/or direct influence of administrated hormone on this gland.

Circadian serum levels of dehydroepiandrosterone sulphate in postmenopausal asthmatic women before and after long-term hormone replacement.

OBJECTIVE: To assess mean 24-h serum concentrations of dehydroepianrosterone (DHEAS) in postmenopausal women with asthma before and after hormone replacement therapy (HRT). METHODS: Studies were performed in 55 asthmatic and 20 healthy postmenopausal women aged 48-60 before HRT and after 6 months of transdermal 17b-estradiol (E2) and medroxyprogesterone acetate treatment (cyclical method). Serum DHEAS concentrations were assessed with the use of RIA method. RESULTS: In the group of postmenopausal asthmatic women treated with glucocorticoids the mean 24 h DHEAS serum levels were lower than in a similar group not treated with glucocorticoids and a control group of healthy postmenopausal women. However, in both groups of asthmatic women (e.g. glucocorticoid treated and untreated) a significant increase of mean daily DHEAS levels after 6 months of HRT was observed. The hormone concentrations did not change in control group. CONCLUSIONS: Postmenopausal asthmatic women show diminished circadian dehydroepiandrosterone sulphate serum concentrations irrespective whether they were treated with glucocorticoids or not. However, after 6 months of hormonal replacement therapy in these groups increased levels of DHEA were found.

Hormone replacement therapy in postmenopausal asthmatic women.

OBJECTIVES: Assessment of mean 24 h oestradiol (E2) and oestrone (E1) concentration and basic FSH secretion in postmenopausal asthmatic women, before and after HRT use, and to identify any connections between changes in hormone concentrations and patients' clinical state. SUBJECTS: Postmenopausal women (55 asthmatic and 20 healthy, aged 48-60 years). METHOD: Serum hormone concentration was assessed by radioimmunoassay before HRT and after 6 months of transdermal 17beta-E2 and medroxyprogesterone acetate treatment (cyclical method). Intensification of menopausal symptoms was assessed by Kupperman's index. RESULTS: Secretion of oestrogens was lower in postmenopausal women asthmatic women than in postmenopausal healthy women. HRT caused an increase in oestrogen concentration. The 24-h fluctuations of E1 and E2 in all studied groups before and after HRT did not differ significantly. A statistically significant decrease in the number of menopausal symptoms was found during the course of HRT. During the period of HRT, there was a reduction in the number of patients in whom it was necessary to use oral glucocorticoid therapy during exacerbation of asthma. CONCLUSION: A greater reduction in oestrogen secretion was found in postmenopausal asthmatic women than in postmenopausal healthy women. HRT resulted in normalization of serum oestrogen concentration in asthmatic women and diminishing psychosomatic symptoms of the menopause and symptoms of asthma.

Plasma transforming growth factor beta1 in breast cancer patients treated with CMF chemotherapy.

BACKGROUND: In early breast cancer patients the transformed epithelial cells are thought to be sensitive to transforming growth factor beta1 (TGFbeta1)-mediated growth arrest. TGFbeta1 may therefore act as an anti-tumour promoter. However, in advanced breast cancer resistance to such TGFbeta1 action develops. Neoplastic cells produce TGFbeta1, which may enhance tumour invasion and metastasis, mainly by intensifying angiogenesis, which is an immunosuppressive action. In the light of the potential role of TGFbeta1 in breast cancer pathogenesis, an understanding of the effect of applied therapeutic methods on plasma TGFbeta1 concentration is essential. OBJECTIVE: To investigate the effect of adjuvant chemotherapy on plasma transforming growth factor beta1 (TGFbeta1) concentration in breast cancer patients with metastases to axillary lymph nodes. METHOD: Fifteen stage II breast cancer patients on adjuvant chemotherapy with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) were studied along with 15 healthy premenopausal women. RESULTS: Plasma TGFbeta1 concentration (determined by the ELISA method) in the breast cancer patients did not differ significantly from that of the healthy women. Adjuvant CMF chemotherapy significantly decreased plasma TGFbeta1 concentration in those pre-menopausal breast cancer women with metastases to axillary lymph nodes. CONCLUSION: The possible pathogenic action of this growth factor in stage II breast cancer disease warrants further investigation to elucidate whether the induced decrease of blood TGFbeta1 concentration is essential to successful chemotherapy.

Is positive correlation between cortisol and met-enkephalin concentration in blood of women with breast cancer a reaction to stress before chemotherapy administration?

The role of stress in the course of neoplastic diseases has been emphasised over the past few years. Organism defence in form of increased release of hormones, corticosteroids and endogenous opioids should be assessed as a particular form of adaptation. Interactions between stress hormones and others which may influence the growth of breast cancer cells are possible. In this study, the concentration of cortisol and met-enkephalin vis-à-vis growth hormone, insulin-like growth factor-I, prolactin, estradiol, progesterone and melatonin in blood of women with breast cancer before the first cycle of supplementary chemotherapy was compared to that of healthy women. In a group of patients with breast cancer, before the first cycle of chemotherapy, high hypercortisolemia and positive correlation between cortisol and met-enkephalin was observed which may be a result of stress at the beginning of such treatment. A negative correlation between prolactin and met-enkephalin in this group can indirectly testify to essential participation of endogenous opioids in hormonal regulation and can be a response to stress caused by beginning chemotherapy.

[The influence of thyroid diseases and their treatment on the development of osteoporosis]. / Wplyw chorób tarczycy i ich leczenia na rozwój osteoporozy.

Thyroid diseases and their treatment may influence osseous system. This work deals the problem of hyperthyreosis, hypothyreosis and thyroid hormones therapy with osteoporosis. There is reduced bone mass in hyperthyroid patients. Process of restoring lost bone matrix is not reached with euthyroid state, but lasts longer. Changes in bone mass in hypothyreosis are not of such clinical significance as in hyperthyreosis. Other problem is an influence of thyroid hormones therapy on mineral bone density. Data from literature dealing with this problem are divergent. Control thyroxin therapy with TSH level in normal range may diminish unprofitable influence on bone. Early diagnosis of osteoporosis has also substantial importance. Non-invasive methods play an important role.

Diurnal rhythm of serum melatonin, ACTH and cortisol in asthma patients with long term glucocorticoid treatment.

Forty one patients (21 women and 20 men aged 35 to 45 years), with bronchial asthma were divided into two groups: those treated with glucocorticoids (with an equivalent daily dose of 8 mg prednisone) and those receiving no glucocorticoid preparations. The control group consisted of 27 healthy volunteers. The diurnal rhythm of serum melatonin, ACTH and cortisol was evaluated in all subjects. It was found that the dysfunction and reduced reactivity of the pituitary-adrenal axis in asthmatics receiving chronic glucocorticotherapy was accompanied by suppressed melatonin rhythm.

[Glucocorticosteroids in bronchial asthma. I. Mechanism of action and use in therapy]. / Glikokortykosteroidy w astmie oskrzelowej. Czesc. I. Mechanizm dzialania i zastosowanie w leczeniu.

Inflammation plays the main role in the pathogenesis of asthma. Glucocorticosteroids (GS), as the most effective anti-inflammatory drugs are widely used in asthma treatment. So far the mechanism of action, both molecular and on the level of tissues and organs has not been entirely explained. In this work molecular mechanism of glucocorticosteroids action is discussed especially in aspect of therapy. The influence of GS on adrenocortical function is also presented.

[Glucocorticosteroids in bronchial asthma. II. Use of cortisol markers in various biological materials for evaluation of adrenocortical function]. / Glikokortykosteroidy w astmie oskrzelowej Czesc II. Zastosowanie oznaczen kortyzolu w róznych materialach biologicznych do oceny funkcji kory nadnerczy.

Glucocorticosteroids (GS) being widely used in asthma treatment are sometimes applied in high doses and for long period. This treatment is often connected with adrenocortical suppression. Adrenocortical function assessment in GS treated patients with different doses and forms of drug is of great diagnostic and prognostic importance. In the presented work the methods of adrenocortical function assessment are discussed, especially serum cortisol level and non-invasive: saliva and urine cortisol assays.

[Reduced loading of one lower limb as a cause of local osteopenia]. / Zmniejszenie obciazenia jednej konczyny dolnej jako przyczyna osteopenii miejscowej.

An impact of diminished mechanical loading of lower extremity on bone densitometry has been quantitatively assessed with ultrasound. Seventy-three females with lower limb fracture history, coxarthrosis or scoliosis were evaluated. Both heels were submitted to measurements with Achilles densitometer (Lunar, USA). The following parameters were analyzed: Speed of Sound, Broadband Ultrasound Attenuation and Stiffness Index. Decreased values of all parameters were found in unloaded extremities. Speed of Sound was reduced most and in the group with fracture history. To avoid local bone loss short immobilization, early rehabilitation and pharmacotherapy is suggested.

[The influence of patient age on the effectiveness of bronchodilators]. / Wplyw wieku chorych na efektywnosc leków rozkurczajacych oskrzela.

The beta adrenergic receptors are exposed to variety of factors modulating their activity. We analyzed the sensitivity to Salbutamol in asthmatic patients divided into three group (I-30 yr; II-30-50 yr; III-50 yr). The effectiveness of beta adrenergic receptors was assessed by means of estimation of plasma cAMP level before and after Salbutamol infusion. We didn't found any significant differences in plasma cAMP changes between investigated group of patients.

[Activities of certain endocrine glands in bronchial asthma]. / Czynnosc niektórych gruczolów wydzielania wewnetrznego w przebiegu astmy oskrzelowej.

The present reports on the effects of various levels of the endocrine system on the course of bronchial asthma are reviewed. Hypophyseal function in production of certain hormone and functioning of the hypothalamo, hypophyseal-thyroid, -adrenal, and -gonadal axis are discussed. Changes in the functions of endocrine glands may modify the course of allergic diseases.

[Evaluation of selected personality factors in patients with bronchial asthma]. / Ocena wybranych czynników osobowosci u chorych na astme oskrzelowa.

Psychological factors an important role in the development and clinical course of the bronchial asthma. Therefore, an effect of the selected personality features on the course of the bronchial asthma have been studied. The study included 91 asthmatic patients and 30 persons of the control group. Three psychological tests have been used: Wiskad-MMPI. Cattell's Self-Cognition Chart, and Eysenck's Personality Inventory translated by Chojnowski. The study has shown, that asthmatic patients are characterized by the high level of anxiety and marked emotional imbalance, especially female patients. Emotions are suppressed and neglected by the asthmatic patients. These attitude should be considered in psychotherapy of such patients.

[Evaluation of selected personality features in patients with various clinical forms of bronchial asthma]. / Ocena wybranych czynników osobowosci u chorych z róznymi postaciami klinicznymi dychawicy oskrzelowej.

Psychological factors are of importance in the onset and clinical course of the bronchial asthma. Marked emotional disorders are seen in patients with atypical asthma. This study aimed at evaluating selected personality features in patients with various clinical forms of the bronchial asthma. Statistical analysis included 91 asthmatic patients and 30 healthy individuals being a control group. Selected personality features were evaluated with three psychological tests: Eysenck Personality Inventory, Minnesota Multiphasic Personality Inventory, and Cattel's Self cognition Chart. The obtained results have shown that the index of psychopathologies is higher in patients with non-atopic bronchial asthma than in patients with atopic asthma. Therefore, psychotherapy of asthmatic patients, especially with non-atopic form of the disease, should emphasize disturbances of experienced feelings in such patients.

[Assessment of various personality features in patients with bronchial asthma using the Woodworth and Buss-Durke tests]. / Ocena wybranych cech osobowosci chorych na astme oskrzelowa za pomoca testów Woodwortha i Bussa-Durkea.

Certain personality features were assessed in patients with bronchial asthma with particular reference to the aggressiveness and psychic maturity. The aggression level in patients with bronchial asthma was found to be lower than in the control group. It seems that the main effect on the intensity of this emotional disorder group. It seems that the main effect on the intensity of this emotional disorder is exerted by negative environmental factors, while the endogenic factors, among them the health state, seem to be of lower importance.