Acute psychotic stress is associated with decreased adiponectin serum levels.

OBJECTIVE: To determine the effect of acute psychotic stress on adipokine secretion in non-diabetic subjects. RESEARCH DESIGN AND METHODS: Adiponectin, leptin, and cortisol serum levels were determined in 39 non-diabetic patients with acute psychotic stress reaction admitted to a psychiatric ward. The clinical global impression (CGI) score was used to evaluate the level of psychotic stress. Insulin sensitivity (IS) was determined by the homeostasis model assessment (HOMA). Patients were re-assessed 2 weeks after admission. During hospitalization patients were treated for variable times with either phenothiazines or thioxanthenes. RESULTS: The mean CGI score decreased significantly with time: 5.3+/-0.8 and 2.6+/-0.8 on admission and after 2 weeks respectively (p<0.001). On admission, the mean adiponectin level was significantly lower in patients compared to normal controls: 15.3+/-8.2 mug/ml and 26+/-12.8 mug/ml, respectively (p=0.02). It increased significantly after 2 weeks to 18.2+/-10 mug/ml (p=0.003). By contrast, the leptin and cortisol levels did not change significantly. No correlation was found between the changes in individual CGI scores and adiponectin levels. However, female patients with the highest stress on admission demonstrated the lowest adiponectin levels and insulin sensitivity: p=0.002 and 0.03 respectively. CONCLUSIONS: These data suggest a link between acute psychotic stress reaction and decreased serum adiponectin levels. Further studies are recommended to determine the strength of this association.

Economic impact of CT scanning on the evaluation of pituitary adenomas.

The medical and financial records of three cohorts of 20 consecutive patients with pituitary adenomas surgically treated in 1976, 1978, and 1980 were evaluated to assess the impact of changing technology on the cost of preoperative diagnostic evaluation. The average preoperative length of hospital stay decreased from 6.8 days in 1976 to 1.9 days in 1980. The average diagnostic radiologic charge adjusted to 1980 dollars decreased from +1,747 in 1976 to +585 in 1980, while the radiologic bill as a percentage of the total hospital bill changed from 17.3% in 1976 to 11.9% in 1980. The decline in cost parameters coincided with the dramatic increase in the use of cranial computed tomography and the sharp reduction in the use of angiography and pneumoencephalography. These findings suggest that computed tomography is a highly efficacious technique for the evaluation of patients with suspected pituitary adenoma, resulting in significant savings in the costs of diagnostic evaluation.