Maria Stelmachowska-Banaś, Izabella Czajka-Oraniec
Immune checkpoint inhibitors (ICIs) belong to a new group of anticancer drugs targeting T-cell proteins involved in the activation of immune response toward malignancies. Their introduction into clinical practice was a milestone in modern cancer treatment. However, the significant advantage of ICIs over conventional chemotherapy in terms of therapeutic efficacy is accompanied by new challenges related to specific side effects. ICI-induced immune system activation could lead to the loss of self-tolerance, presenting as autoimmune inflammation and dysfunction of various tissues and organs...
October 2020: Endocrine Connections
Catrin Morgan, Rupen Dattani
Corticosteroid (CS) injections are commonly used both in primary and secondary care in the management of chronic shoulder pain. On March 11 2020, the World Health Organisation (WHO) declared the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the causative virus for COVID-19) outbreak a pandemic and global health emergency. There was initial concern with the use of CS injections during the COVID-19 pandemic due to the increased potential for adrenal insufficiency and altered immune response. This led to the publication of guidelines from societies around the world...
September 9, 2020: JSES international
Efstathios Katharopoulos, Natascia Di Lorgi, Paula Fernandez-Alvarez, Amit V Pandey, Michael Groessl, Shraddha Dubey, Núria Camats, Flavia Napoli, Giuseppa Patti, Marilea Lezzi, Mohamad Maghnie, Christa E Flück
Congenital adrenal hyperplasia (CAH) consists of several autosomal recessive disorders that inhibit steroid biosynthesis. We describe a case report diagnosed with adrenal insufficiency due to low adrenal steroids and adrenocorticotropic hormone excess due to lack of cortisol negative feedback signaling to the pituary gland. Genetic work up revealed two missense variants, p.Thr204Arg and p.Leu260Arg in the STAR gene, inherited by both parents (non-consanguineous). The StAR protein supports CYP11A1 enzyme to cleave the side chain of cholesterol and synthesize pregnenolone which is metabolized to all steroid hormones...
August 27, 2020: International Journal of Molecular Sciences
Victoria Birlutiu, Rares Mircea Birlutiu, Alin Iulian Feiereisz
RATIONALE: Syncope is described as the loss of consciousness and postural muscle tone with a short duration and fast onset. Micturition syncope can be caused by abnormal vasovagal response or by the dysfunction of the blood pressure regulating mechanism, which occurs before, during, or immediately after urination. PATIENT CONCERNS: We present 4 cases of COVID-19 hospitalized in the Department of Infectious Diseases of the Academic Emergency Hospital Sibiu, Romania, cases that presented micturition syncope...
July 31, 2020: Medicine (Baltimore)
Salem A Beshyah, Khawla F Ali, Hussein F Saadi
INTRODUCTION: Appropriate dose adjustments of glucocorticoids replacement therapy for adrenal insufficiency (AI) is vital. OBJECTIVE: We sought to scope physicians' perceptions, and practices regarding Ramadan fasting (RF) impact on the management of AI. METHODS: A web-based survey of a convenience sample of endocrinologists. RESULTS: Nearly two-thirds of 145 respondents (64.1%) were adult endocrinologists and almost half (49%) saw more than 10 hypoadrenal patients per year...
July 1, 2020: Endocrine Connections
Rimesh Pal, Sanjay K Bhadada
BACKGROUND AND AIMS: The novel coronavirus disease (COVID-19) pandemic and the resulting nationwide lockdowns have posed a major challenge to the management of pre-existing and newly diagnosed endocrine disorders. Herein, we have summarized the management approaches of common endocrine disorders amid the ongoing pandemic. METHODS: We have performed an extensive literature search for articles in PubMed, EMBASE and Google Scholar databases till 25 May 2020, with the following keywords: "COVID-19", "diabetes mellitus", "thyroid disorders", "primary adrenal insufficiency", "Cushing's syndrome", "pituitary tumors", "vitamin D″", "osteoporosis", "primary hyperparathyroidism", "hypoparathyroidism", "management", "treatment" and "guidelines" with interposition of the Boolean operator "AND"...
June 4, 2020: Diabetes & Metabolic Syndrome
Nunzia Prencipe, Mirko Parasiliti-Caprino, Filippo Gatti, Federica Penner, Alessandro Maria Berton, Chiara Bona, Marina Caputo, Valentina D'Angelo, Vincenzo Cappiello, Valentina Gasco, Ezio Ghigo, Francesco Zenga, Silvia Grottoli
BACKGROUND: Multiple studies tried to identify cortisol cut-offs after pituitary surgery able to assess accurately hypothalamic-pituitary-adrenal axis function, however there is no consensus nowadays. This study aimed to evaluate the accuracy of morning cortisol after transsphenoidal surgery in predicting long term secondary adrenal insufficiency. METHODS: In our tertiary Center, we prospectively determined first and second day cortisol after transsphenoidal surgery in 92 patients without preoperative adrenal insufficiency and not treated with glucocorticoids perioperative...
June 3, 2020: Neuroendocrinology
Wiebke Arlt, Stephanie E Baldeweg, Simon H S Pearce, Helen L Simpson
We provide guidance on prevention of adrenal crisis during the global COVID-19 crisis, which exposes patients with adrenal insufficiency to an increased risk of acute COVID-19 infection while at the same time restricting access to healthcare due to capacity issues. We highlight the need for education (sick day rules, stringent social distancing rules), equipment (sufficient glucocorticoid supplies, steroid emergency self-injection kit) and empowerment (steroid emergency card, COVID-19 guidelines) to prevent adrenal crises...
April 1, 2020: European Journal of Endocrinology
Midori Yatabe, Kanako Bokuda, Kaoru Yamashita, Satoshi Morimoto, Junichi Yatabe, Yasufumi Seki, Daisuke Watanabe, Satoru Morita, Shuji Sakai, Atsuhiro Ichihara
The importance of cosyntropin stimulation during adrenal vein sampling (AVS) is not fully established, partly due to insufficient AVS data relating the presence and absence of cosyntropin stimulation with postoperative outcome. Therefore, we investigated differences in AVS indices before and after cosyntropin stimulation, and determined whether unstimulated or stimulated AVS indices better correlated with treatment outcome. A retrospective study was conducted in two parts: one with 185 patients who underwent AVS and the other with 81 patients who underwent unilateral adrenalectomy for unilateral aldosterone oversecretion...
April 30, 2020: Hypertension Research: Official Journal of the Japanese Society of Hypertension
Mitsuhide Naruse, Koichi Yamamoto, Takuyuki Katabami, Ryo Nakamaru, Masakatsu Sone, Hiroki Kobayashi, Akiyo Tanabe
Although unilateral primary aldosteronism (PA) should be curable by adrenalectomy (ADX), postsurgical outcome is affected by several clinical factors. Herein we reviewe the importance of age, gender, and BMI as determinants of surgical success based on the recent findings including a nation-wide, multicenter study in Japan (JPAS/JRAS). It is important to determine whether ADX for elderly patients with unilateral PA is as beneficial as younger patients. JPAS/JRAS showed that ADX could benefit elderly patients (>65 years) with definitive unilateral PA in curing of disease and improvement of hypertension, although potential adverse outcomes including hyperkalemia and renal insufficiency need to be considered in some elderly patients at high risk...
April 6, 2020: Hormone and Metabolic Research
Alexander D Chesover, Heather Millar, Lusia Sepiashvili, Khosrow Adeli, Mark R Palmert, Jill Hamilton
Context: Screening for and diagnosing non classic congenital adrenal hyperplasia (NCCAH) uses serum 17-hydroxyprogesterone (17OHP) thresholds established from immunoassay data; however, a new liquid-chromatography tandem mass spectrometry (LC-MS/MS) method results in lower 17OHP values. The evolution of immunoassays is also challenging our diagnostic cut-off for glucocorticoid insufficiency and few data re-evaluate the utility of testing for glucocorticoid insufficiency in NCCAH. Objective: (1) Evaluate the 17OHP threshold that predicts NCCAH in children using LC-MS/MS, and (2) determine the prevalence of glucocorticoid insufficiency in NCCAH...
February 1, 2020: Journal of the Endocrine Society
Kyle K VanKoevering, Katayoon Sabetsarvestani, Stephen E Sullivan, Ariel Barkan, Michelle Mierzwa, Erin L McKean
Background  Management of anterior cranial base malignancies requires multidisciplinary care. Radiation therapy remains a mainstay of definitive or adjuvant treatment. Apart from primary hypothyroidism, the effects of radiation on the hypothalamic-pituitary axis after high-dose treatment of head and neck malignancies remain poorly described. We describe a comprehensive screening protocol for surveillance and characterize the incidence of pituitary dysfunction after radiation for anterior cranial base malignancies...
February 2020: Journal of Neurological Surgery. Part B, Skull Base
T Woodcock, P Barker, S Daniel, S Fletcher, J A H Wass, J W Tomlinson, U Misra, M Dattani, W Arlt, A Vercueil
These guidelines aim to ensure that patients with adrenal insufficiency are identified and adequately supplemented with glucocorticoids during the peri-operative period. There are two major categories of adrenal insufficiency. Primary adrenal insufficiency is due to diseases of the adrenal gland (failure of the hormone-producing gland), and secondary adrenal insufficiency is due to deficient adrenocorticotropin hormone secretion by the pituitary gland, or deficient corticotropin-releasing hormone secretion by the hypothalamus (failure of the regulatory centres)...
February 3, 2020: Anaesthesia
Trenton Vu, Meghna Vallabh, Greg Laine
Background: Cortisol thresholds defining adrenal insufficiency (AI) in some cirrhosis-specific studies differ from those recommended by the SCCM/ESICM (Society of Critical Care Medicine/European Society of Intensive Care Medicine) guidelines, which may influence treatment decisions. Objective: To determine if stress-dose hydrocortisone (HC) improves outcomes in vasopressor-dependent patients meeting cirrhosis-specific criteria for AI. Methods: In this retrospective study, AI was defined using criteria from 2 studies in critically ill cirrhosis patients showing mortality reduction with HC (random cortisol <20 µg/dL, or if a standard-dose cosyntropin test was performed, baseline cortisol <15 µg/dL or delta cortisol <9 µg/dL if baseline = 15-34 µg/dL)...
January 12, 2020: Annals of Pharmacotherapy
Jian Xie, Zewen Zhang, Shuisheng Zhang, Yajuan Lv, Yantao Mao, Rujun Liu, Yuan Tian
PURPOSE: We designed the study to investigate the incidence risk of Programmed Cell Death-1 (PD-1) or Ligand 1 (PD-L1) inhibitor-related endocrine dysfunction in patients with lung cancer. METHOD: All the data were collected by 1 primary reviewer and then independently reviewed by 2 secondary reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISM) guidelines. Incidence risk of all-grade and grade 3-5 PD-1/PD-L1 inhibitors related endocrine dysfunction in patients with lung cancer were taken into account...
December 2019: Medicine (Baltimore)
Pedro Souteiro, Sara Donato, Cláudia Costa, Catarina A Pereira, Joana Simões-Pereira, Joana Oliveira, Sandra Belo, Ana Paula Santos, Helena Cardoso, Valeriano Leite, Davide Carvalho, Isabel Torres
INTRODUCTION: Current guidelines specify controversial areas in adrenocortical carcinomas (ACC), such as optimal follow-up time after remission and identification of prognostic markers. We aim to address these topics by analyzing four reference centers in our country. METHODS: Cross-sectional multicentric study of 69 patients (mean age: 51.7 ± 16.7 years-old; women, 72.5%). Kaplan-Meier survival curves and Cox regression analysis were used to calculate overall survival and its predictors...
December 10, 2019: Hormones: International Journal of Endocrinology and Metabolism
Liane Eng, Molly O Regelmann
PURPOSE OF REVIEW: Adrenoleukodystrophy (ALD) is a peroxisomal disorder with varying clinical presentations, including adrenal insufficiency, neurologic disease, and testicular dysfunction. The present review is intended to describe the current knowledge of the pathophysiology of ALD and provide an update regarding newborn screening, diagnosis, monitoring, and treatment. RECENT FINDINGS: New York State initiated newborn screening for ALD on December 30, 2013. Successful ALD newborn screening has led to its addition on other state newborn screens and recommendations for universal screening...
February 2020: Current Opinion in Endocrinology, Diabetes, and Obesity
Ben Gibbison, Daniel M Keenan, Ferdinand Roelfsema, Jon Evans, Kirsty Phillips, Chris A Rogers, Gianni D Angelini, Stafford L Lightman
CONTEXT: Patients with critical illness are thought to be at risk of adrenal insufficiency. There are no models of dynamic hypothalamic-pituitary-adrenal (HPA) axis function in this group of patients and thus current methods of diagnosis are based on aggregated, static models. OBJECTIVE: To characterise the secretory dynamics of the HPA axis in the critically ill after cardiac surgery. DESIGN: Mathematical modelling of cohorts. SETTING: Cardiac critical care unit...
November 18, 2019: Journal of Clinical Endocrinology and Metabolism
Alex K Bonnecaze, Patrick Reynolds, Cynthia A Burns
Patients with primary adrenal insufficiency (PAI) require increased doses of glucocorticoids and mineralocorticoids during stressors, such as surgery, trauma, and sepsis. Although current guidelines exist for dose adjustments in these situations, there is no accepted dosing regimen for patients with PAI participating in intensive endurance exercise. Given the extensive physiologic stress of events, such as marathons, triathlons, and similar events, it is likely that a "stress-dose" of adrenal replacement therapy will not only prevent adrenal crisis, but also improve performance...
November 2019: Clinical Journal of Sport Medicine
Anuradha Kwda, Prematilake Gldc, Batuwita Baui, Kannangoda Kasr, Hewagamage Us, Wijeratne S, Lankatilake Kantha, de Silva Ksh
BACKGROUND: Inhaled corticosteroids (ICS) are the most effective treatment for children with persistent asthma. However adverse effects of ICS on Hypothalamo Pituitary Adrenal (HPA) axis, growth and bone metabolism are a concern. Hence the primary objective of this study was to describe the effects of long term inhaled corticosteroid therapy (ICS) on adrenal function, growth and bone health in children with asthma in comparison to an age and sex matched group of children with asthma who were not on long term ICS...
November 5, 2019: BMC Pediatrics
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