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The association between the cortisol and cortisone awakening responses. Psychoneuroendocrinology 2023; 152:106075. [PMID: 36933271 DOI: 10.1016/j.psyneuen.2023.106075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 01/29/2023] [Accepted: 03/04/2023] [Indexed: 03/20/2023]
Abstract
The cortisol awakening response (CAR) is often assessed in the saliva and considered to be representative of serum cortisol. However, free cortisol is rapidly converted into cortisone as it passes from the serum into the saliva. Because of this enzymatic conversion, the salivary cortisone awakening response (EAR) may be more closely related to serum cortisol dynamics than the salivary CAR. Therefore, the purpose of this study was to measure the EAR and CAR in saliva and compare it to the serum CAR. METHODS Male participants (n = 12) had an intravenous catheter placed for serial serum sampling and completed two overnight laboratory sessions, wherein participants slept in the laboratory and saliva and serum samples were collected every 15 min after volitional awakening the following morning. Serum was assayed for total cortisol and saliva for cortisol and cortisone. The CAR and EAR was assessed in saliva and the CAR in serum via mixed-effects growth models and common awakening response indices (area under the curve [AUC] relative to the ground [AUCG] and relative to the increase [AUCI], and change scores [Δ]). RESULTS There was a distinct rise in salivary cortisone following awakening demonstrating the presence of a discernable EAR (βQuadratic = -41.18, [95%CI = -68.90 to -13.46], p < 0.004, Conditional R2 = 0.641). Two EAR indices (AUCG: p < 0.001 and AUCI: p = 0.030) were associated with the corresponding serum CAR indices. CONCLUSION We demonstrate for the first time a distinct cortisone awakening response. The results suggest the EAR may be more closely related to serum cortisol dynamics during the post-awakening period, and thus, may be a biomarker of interest in addition to the CAR for assessing hypothalamic-pituitary-adrenal axis functioning.
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Different Types of Glucocorticoids to Evaluate Stress and Welfare in Animals and Humans: General Concepts and Examples of Combined Use. Metabolites 2023; 13:metabo13010106. [PMID: 36677031 PMCID: PMC9865266 DOI: 10.3390/metabo13010106] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
The main glucocorticoids involved in the stress response are cortisol and cortisone in most mammals and corticosterone in birds and rodents. Therefore, these analytes are currently the biomarkers more frequently used to evaluate the physiological response to a stressful situation. In addition, "total glucocorticoids", which refers to the quantification of various glucocorticoids by immunoassays showing cross-reactivity with different types of glucocorticoids or related metabolites, can be measured. In this review, we describe the characteristics of the main glucocorticoids used to assess stress, as well as the main techniques and samples used for their quantification. In addition, we analyse the studies where at least two of the main glucocorticoids were measured in combination. Overall, this review points out the different behaviours of the main glucocorticoids, depending on the animal species and stressful stimuli, and shows the potential advantages that the measurement of at least two different glucocorticoid types can have for evaluating welfare.
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Rozenveld E, Punt N, van Faassen M, van Beek AP, Touw DJ. Pharmacokinetic Modeling of Hydrocortisone by Including Protein Binding to Corticosteroid-Binding Globulin. Pharmaceutics 2022; 14:pharmaceutics14061161. [PMID: 35745734 PMCID: PMC9231005 DOI: 10.3390/pharmaceutics14061161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Patients with adrenal insufficiency are treated with oral hydrocortisone (HC) to compensate for the loss of endogenous cortisol production. Intrinsic imperfections of cortisol replacement strategies in mimicking normal cortisol secretion are the underlying cause of the increased morbidity and mortality of patients suffering from secondary adrenal insufficiency (SAI). To improve oral hydrocortisone substitution therapy, a better understanding of its pharmacokinetics (PK) is necessary. The previous PK model did not include protein binding. It is known that protein binding can impact hydrocortisone pharmacokinetics. The aim of this study is to describe HC pharmacokinetics including the protein-binding state using Edsim++ (Mediware, Prague) pharmacokinetic modeling software, paving the way for an in-silico tool suitable for drug delivery design. Methods: A total of 46 patients with SAI participated in a randomized double-blind crossover study Patients randomly received a low dose of HC (0.2–0.3 mg/kg body weight/day) for 10 weeks, followed by a high dose (0.4–0.6 mg/kg body weight/day) for another 10 weeks, or vice versa. Plasma samples were obtained and analyzed for free and total hydrocortisone. Single compartment population pharmacokinetic analysis was performed using an extended Werumeus-Buning model built in Edsim++. This model includes a mathematical approach for estimating free cortisol by Nguyen et al., taking the protein binding of HC to albumin and hydrocortisone-binding globulin (CBG, transcortin) into consideration, as well as different states of CBG which affect binding kinetics to HC. The goodness of fit for observed versus predicted values was calculated. Results and conclusions: Nguyen’s formula for free cortisol estimation was successfully implemented in a pharmacokinetic model. The model shows high Spearman’s correlation for observed versus predicted hydrocortisone concentrations. Significantly higher correlations (Spearman’s r, 0.901 vs. 0.836) between total and free hydrocortisone AUC24 (area-under the curve over 24 h) are found when comparing new and old models. This new model was used to simulate the plasma concentration–time behavior of a more suitable hydrocortisone formulation.
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Affiliation(s)
- Eric Rozenveld
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.R.); (N.P.)
| | - Nieko Punt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.R.); (N.P.)
- Medimatics, 6229 HR Maastricht, The Netherlands
| | - Martijn van Faassen
- Department of Laboratory Medicine, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - André P. van Beek
- Department of Endocrinology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Daan J. Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.R.); (N.P.)
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, 9713 GZ Groningen, The Netherlands
- Correspondence:
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Adriaansen BPH, Schröder MAM, Span PN, Sweep FCGJ, van Herwaarden AE, Claahsen-van der Grinten HL. Challenges in treatment of patients with non-classic congenital adrenal hyperplasia. Front Endocrinol (Lausanne) 2022; 13:1064024. [PMID: 36578966 PMCID: PMC9791115 DOI: 10.3389/fendo.2022.1064024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) due to 21α-hydroxylase deficiency (21OHD) or 11β-hydroxylase deficiency (11OHD) are congenital conditions with affected adrenal steroidogenesis. Patients with classic 21OHD and 11OHD have a (nearly) complete enzyme deficiency resulting in impaired cortisol synthesis. Elevated precursor steroids are shunted into the unaffected adrenal androgen synthesis pathway leading to elevated adrenal androgen concentrations in these patients. Classic patients are treated with glucocorticoid substitution to compensate for the low cortisol levels and to decrease elevated adrenal androgens levels via negative feedback on the pituitary gland. On the contrary, non-classic CAH (NCCAH) patients have more residual enzymatic activity and do generally not suffer from clinically relevant glucocorticoid deficiency. However, these patients may develop symptoms due to elevated adrenal androgen levels, which are most often less elevated compared to classic patients. Although glucocorticoid treatment can lower adrenal androgen production, the supraphysiological dosages also may have a negative impact on the cardiovascular system and bone health. Therefore, the benefit of glucocorticoid treatment is questionable. An individualized treatment plan is desirable as patients can present with various symptoms or may be asymptomatic. In this review, we discuss the advantages and disadvantages of different treatment options used in patients with NCCAH due to 21OHD and 11OHD.
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Affiliation(s)
- Bas P. H. Adriaansen
- Radboud Institute of Health Sciences, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Pediatric Endocrinology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mariska A. M. Schröder
- Department of Pediatric Endocrinology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Paul N. Span
- Radiotherapy & OncoImmunology Laboratory, Radboud Institute of Molecular Life Sciences, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Fred C. G. J. Sweep
- Radboud Institute of Health Sciences, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Antonius E. van Herwaarden
- Radboud Institute of Health Sciences, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hedi L. Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: Hedi L. Claahsen-van der Grinten,
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de Guia RM. Stress, glucocorticoid signaling pathway, and metabolic disorders. Diabetes Metab Syndr 2020; 14:1273-1280. [PMID: 32755820 DOI: 10.1016/j.dsx.2020.06.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Glucocorticoids and the GR serve as an essential molecular mediator of stress and different physiologic processes. This review summarizes main findings from studies on the role of the GC/GR signaling in the modulation of genes for nutrient processing by the different organs involved in metabolic diseases. METHODS Descriptive review of relevant papers known to the author was conducted. RESULTS Several high-throughput screenings in the past 15 years have identified potential GR DNA-binding regions in different cell types with genes that are annotated to be important for the control of metabolism. Transcriptional regulation of these GC-responsive genes provides links between the hypothalamic-pituitary-adrenal axis (HPA) and systemic energy homeostasis in both physiological and pathophysiological states. Future studies must reconsider the use of agonist, the utilization of animal models of stress and metabolic disorders, and validation in humans. CONCLUSION This review recapitulates the significant role of the GC/GR signaling in molecular metabolic control and metabolic disorders. Potential future research focus and optimizations have also been identified.
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Affiliation(s)
- Roldan M de Guia
- Joint Division Molecular Metabolic Control, DKFZ-ZMBH Alliance and Network Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Keio Global Research Institute (KGRI) and Department of Pharmacology, Keio University School of Medicine, Tokyo, Japan; Czech Centre for Phenogenomics (CCP), Institute of Molecular Genetics of the Czech Academy of Sciences, Vestec, Czech Republic.
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Salivary cortisol response to psychosocial stress in the late evening depends on CRHR1 genotype. Psychoneuroendocrinology 2020; 116:104685. [PMID: 32361186 DOI: 10.1016/j.psyneuen.2020.104685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022]
Abstract
The activation of the hypothalamus-pituitary-adrenal (HPA) axis is induced by stress. Imbalances in this system increase the risk of developing stress related disorders including mental illness. Variants in the single nucleotide polymorphism (SNP) rs110402 of the corticotropin-releasing hormone receptor type I (CRHR1) gene have been shown in interaction with childhood maltreatment to increase the vulnerability to develop depressive symptoms in adulthood. In this study, the direct contribution of polymorphism of the CRHR1 gene (rs110402) to the salivary cortisol response to stress independently from childhood adversity was investigated. Healthy young men between the ages of 18 and 30, free from childhood maltreatment and early trauma, were genotyped (n = 121). To increase the power of the genetic analysis, only homozygous carriers of the common C (n = 31) and of the rare T (n = 21) allele were selected for this study and exposed to a Trier Social Stress Test (TSST) in the late evening (22.30 to 22.40). Salivary samples for the assessment of cortisol and its inactive metabolite cortisone were taken early in the evening (20.00), just before (22.30) and immediately after (22.40) as well as 15 minutes after stress exposure (22.55). Participants with the TT genotype showed higher cortisol levels 15 minutes post stress compared to participants with the CC genotype. No genotype differences were found for cortisone. Interestingly, TT participants reported lower subjective perceived stress levels before the TSST, but not after stress exposure. These results confirm that variants of rs110402 in the CRHR1 gene contribute to an increased stress response. Contrary to previous findings, however, this effect could be observed in subjects reporting no exposure to childhood maltreatment or early trauma.
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Mackenzie SD, Gifford RM, Boyle LD, Crane MS, Strachan MWJ, Gibb FW. Validated criteria for the interpretation of a single measurement of serum cortisol in the investigation of suspected adrenal insufficiency. Clin Endocrinol (Oxf) 2019; 91:608-615. [PMID: 31380575 DOI: 10.1111/cen.14071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The diagnostic value of a single measurement of serum cortisol as a first step in the investigation of suspected adrenal insufficiency remains unclear. Previously proposed criteria have not been validated, and little is known regarding the performance of the test outwith morning samples in outpatients. We aimed to identify and validate criteria for morning and afternoon serum cortisol which could be used to determine which individuals require dynamic testing, in both outpatient and medical inpatient settings. METHODS We performed a retrospective analysis of 2768 patients attending endocrinology clinics and patients admitted to general medical units in two hospitals in Edinburgh, UK. In baseline samples from the short synacthen test, thresholds which identified a subnormal-stimulated serum cortisol (<430 nmol/L using the Abbott Architect assay) with 95% sensitivity were identified. Criteria drawn from data in patients attending outpatient clinics in one hospital were tested in additional outpatient and inpatient validation cohorts. RESULTS A morning (8 am-12 pm) serum cortisol of <275 nmol/L identified subnormal-stimulated cortisol with 96.2% sensitivity. For afternoon (12 pm-6 pm) samples, a cut-off of <250 nmol/L achieved 96.1% sensitivity. Sensitivity was maintained when the criteria were applied to outpatients in the validation cohort for both morning and afternoon samples. For inpatients, the test was sufficiently sensitive in morning samples only. CONCLUSIONS A single measurement of serum cortisol carries the potential to significantly reduce the need for dynamic testing in the investigation of adrenal insufficiency, whether this is taken in morning or afternoon outpatient clinics, or in morning samples from medical inpatients.
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Affiliation(s)
- Scott D Mackenzie
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Robert M Gifford
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - Luke D Boyle
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mike S Crane
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mark W J Strachan
- Edinburgh Centre for Endocrinology and Diabetes, Western General Hospital, Edinburgh, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
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Trends in Analysis of Cortisol and Its Derivatives. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1140:649-664. [DOI: 10.1007/978-3-030-15950-4_39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Miller R, Wojtyniak JG, Weckesser LJ, Alexander NC, Engert V, Lehr T. How to disentangle psychobiological stress reactivity and recovery: A comparison of model-based and non-compartmental analyses of cortisol concentrations. Psychoneuroendocrinology 2018; 90:194-210. [PMID: 29370954 DOI: 10.1016/j.psyneuen.2017.12.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/01/2017] [Accepted: 12/22/2017] [Indexed: 01/12/2023]
Abstract
This article seeks to address the prevailing issue of how to measure specific process components of psychobiological stress responses. Particularly the change of cortisol secretion due to stress exposure has been discussed as an endophenotype of many psychosomatic health outcomes. To assess its process components, a large variety of non-compartmental parameters (i.e., composite measures of substance concentrations at different points in time) like the area under the concentration-time curve (AUC) are commonly utilized. However, a systematic evaluation and validation of these parameters based on a physiologically plausible model of cortisol secretion has not been performed so far. Thus, a population pharmacokinetic (mixed-effects stochastic differential equation) model was developed and fitted to densely sampled salivary cortisol data of 10 males from Montreal, Canada, and sparsely sampled data of 200 mixed-sex participants from Dresden, Germany, who completed the Trier Social Stress Test (TSST). Besides the two major process components representing (1) stress-related cortisol secretion (reactivity) and (2) cortisol elimination (recovery), the model incorporates two additional, often disregarded components: (3) the secretory delay after stress onset, and (4) deviations from the projected steady-state concentration due to stress-unrelated fluctuations of cortisol secretion. The fitted model (R2 = 99%) was thereafter used to investigate the correlation structure of the four individually varying, and readily interpretable model parameters and eleven popular non-compartmental parameters. Based on these analyses, we recommend to use the minimum-maximum cortisol difference and the minimum concentration as proxy measures of reactivity and recovery, respectively. Finally, statistical power analyses of the reactivity-related sex effect illustrate the consequences of using impure non-compartmental measures of the different process components that underlie the cortisol stress response.
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Affiliation(s)
- Robert Miller
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of General Psychology, Biopsychology and Psychological Methods, TU Dresden, Dresden, Germany.
| | - Jan-Georg Wojtyniak
- Department of Clinical Pharmacology, Saarland University, Saarbrücken, Germany
| | - Lisa J Weckesser
- Institute of General Psychology, Biopsychology and Psychological Methods, TU Dresden, Dresden, Germany
| | - Nina C Alexander
- Department of Psychology, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | - Veronika Engert
- Department of Social Neuroscience, Max Planck Institute for Human Cognition, Leipzig, Germany
| | - Thorsten Lehr
- Department of Clinical Pharmacology, Saarland University, Saarbrücken, Germany
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Peeters B, Langouche L, Van den Berghe G. Adrenocortical Stress Response during the Course of Critical Illness. Compr Physiol 2017; 8:283-298. [DOI: 10.1002/cphy.c170022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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11
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Cadegiani FA, Kater CE. Hypothalamic-Pituitary-Adrenal (HPA) Axis Functioning in Overtraining Syndrome: Findings from Endocrine and Metabolic Responses on Overtraining Syndrome (EROS)-EROS-HPA Axis. SPORTS MEDICINE-OPEN 2017; 3:45. [PMID: 29222606 PMCID: PMC5722782 DOI: 10.1186/s40798-017-0113-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Overtraining syndrome (OTS) results from excessive training load without adequate recovery and leads to decreased performance and fatigue. The pathophysiology of OTS in athletes is not fully understood, which makes accurate diagnosis difficult. Previous studies indicate that alterations in the hypothalamus-pituitary-adrenal (HPA) axis may be responsible for OTS; however, the data is not conclusive. This study aimed to compare, through gold standard and exercise-independent tests, the response of the HPA axis in OTS-affected athletes (OTS group) to healthy physically active subjects (ATL group) and healthy non-active subjects (NCS group). METHODS Selected subjects were evaluated for cortisol response to a 250-μg cosyntropin stimulation test (CST), cortisol and adrenocorticotropic hormone (ACTH) responses during an insulin tolerance test (ITT), and salivary cortisol rhythm (SCR). RESULTS A total of 51 subjects were included (OTS, n = 14; ATL, n = 25; and NCS, n = 12). Cortisol response in the CST was similar among the three groups. Conversely, mean cortisol response during an ITT was significantly higher in ATL (21.7 μg/dL; increase = 9.2 μg/dL) compared to OTS (17.9 μg/dL; 6.3 μg/dL) and NCS (16.9 μg/dL; 6.0 μg/dL) (p ≤ 0.001; p = 0.01). Likewise, median ACTH response during an ITT was significantly higher in ATL (91.4 pg/mL; increase = 45.1 pg/mL) compared to OTS (30.3 pg/mL; 9.7 pg/mL) and NCS (51.4 pg/mL; 38.0 pg/mL) (p = 0.006; p = 0.004). For SCR, mean cortisol 30 min after awakening was significantly higher in ATL (500 ng/dL) compared to OTS (323 ng/dL) and NCS (393 ng/dL) (p = 0.004). We identified the following cutoffs that could help exclude or confirm OTS: cortisol level at 30 min after awakening (exclusion = > 530 ng/dL); cortisol response to ITT (exclusion = > 20.5 μg/dL; confirmation = < 17 μg/dL or increase < 9.5 μg/dL); and ACTH response (exclusion = > 106 pg/mL or increase > 70 pg/mL; confirmation = < 35 pg/mL and increase < 14.5 pg/mL). CONCLUSION The findings of the present study showed that healthy athletes disclose adaptions to exercises that helped improve sport-specific performance, whereas this sort of hormonal conditioning was at least partially lost in OTS, which may explain the decrease in performance in OTS.
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Affiliation(s)
- Flavio A Cadegiani
- Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), R. Pedro de Toledo 781 - 13th floor, São Paulo, SP, 04039-032, Brazil.
| | - Claudio E Kater
- Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), R. Pedro de Toledo 781 - 13th floor, São Paulo, SP, 04039-032, Brazil
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Werumeus Buning J, Touw DJ, Brummelman P, Dullaart RPF, van den Berg G, van der Klauw MM, Kamp J, Wolffenbuttel BHR, van Beek AP. Pharmacokinetics of oral hydrocortisone - Results and implications from a randomized controlled trial. Metabolism 2017; 71:7-16. [PMID: 28521880 DOI: 10.1016/j.metabol.2017.02.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/11/2017] [Accepted: 02/04/2017] [Indexed: 12/17/2022]
Abstract
CONTEXT AND OBJECTIVE This study aimed at comparing pharmacokinetics of two different doses of hydrocortisone (HC) in patients with secondary adrenal insufficiency (SAI). DESIGN, SETTING AND PATIENTS Forty-six patients with SAI participated in this randomized double-blind crossover study. INTERVENTION Patients received two different doses of HC (0.2-0.3mg HC/kg body weight/day and 0.4-0.6mg HC/kg body weight/day). MAIN OUTCOME MEASURES One- and two-compartment population models for plasma free cortisol, plasma total cortisol and salivary cortisol were parameterized. The individual pharmacokinetic parameters clearance (CL), volume of distribution (Vd), elimination half-life (t1/2), maximum concentration (Cmax), and area under the curve (AUC) were calculated. RESULTS The one-compartment models gave a better description of the data compared to the two-compartment models. Weight-adjusted dosing reduced variability in cortisol exposure with comparable AUCs between weight groups. However, there was large inter-individual variation in CL and Vd of plasma free cortisol, plasma total cortisol and salivary cortisol. As a consequence, AUC24h varied more than 10 fold. Cortisol exposure was increased with the higher dose, but this was dose proportional only for free cortisol concentrations and not for total cortisol. CONCLUSIONS Cortisol concentrations after a doubling of the dose were only dose proportional for free cortisol. HC pharmacokinetics can differ up to 10-fold inter-individually and individual adjustment of treatment doses may be necessary. Doubling of the HC dose in fast metabolizers (patients that showed relative low AUC and thus high clearance compared to other patients), does not result in significantly enhanced exposure during large parts of the day and these patients may need other management strategies.
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Affiliation(s)
- Jorien Werumeus Buning
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Pharmacy, Division of Pharmacokinetics, Toxicology and Targeting, University of Groningen, Groningen, The Netherlands
| | - Pauline Brummelman
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerrit van den Berg
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Melanie M van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jasper Kamp
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Nilubol N, Soldin SJ, Patel D, Rwenji M, Gu J, Masika LS, Chang R, Stratakis CA, Kebebew E. 11-Deoxycortisol may be superior to cortisol in confirming a successful adrenal vein catheterization without cosyntropin: a pilot study. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2017; 4:75-83. [PMID: 28758009 DOI: 10.2217/ije-2016-0020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/07/2017] [Indexed: 01/28/2023] Open
Abstract
AIM We aimed to compare the performance of nine adrenal steroids in confirming the correct catheter position during adrenal venous sampling (AVS) without cosyntropin in patients with primary hyperaldosteronism. MATERIALS & METHODS A successful adrenal vein catheterization without cosyntropin was defined as the ratio of steroids from adrenal to peripheral veins being >3:1. AVS samples from four patients with primary hyperaldosteronism were analyzed. RESULTS Compared with the mean ratio of cortisol without cosyntropin, the ratios of 11-deoxycortisol (p = 0.008), dehydroepiandrosterone (p = 0.01) and androstenedione (p = 0.008) were significantly higher. None of the ratios (n = 8) of cortisol from adrenal to peripheral veins exceeded 3:1, while all ratios of 11-deoxycortisol (p < 0.001) were >3. CONCLUSION Cosyntropin infusion during AVS may not be necessary if 11-deoxycortisol is used to confirm catheter position.
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Affiliation(s)
- Naris Nilubol
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, MD 20892, USA.,Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, MD 20892, USA
| | - Steven J Soldin
- Department of Laboratory Medicine, National Institutes of Health, MD 20892, USA.,Department of Medicine, Division of Endocrinology & Metabolism, Georgetown University, WA 20007, USA.,Department of Laboratory Medicine, National Institutes of Health, MD 20892, USA.,Department of Medicine, Division of Endocrinology & Metabolism, Georgetown University, WA 20007, USA
| | - Dhaval Patel
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, MD 20892, USA.,Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, MD 20892, USA
| | - Muthoni Rwenji
- Department of Laboratory Medicine, National Institutes of Health, MD 20892, USA.,Department of Laboratory Medicine, National Institutes of Health, MD 20892, USA
| | - Jianghong Gu
- Department of Laboratory Medicine, National Institutes of Health, MD 20892, USA.,Department of Laboratory Medicine, National Institutes of Health, MD 20892, USA
| | - Likhona S Masika
- Department of Laboratory Medicine, National Institutes of Health, MD 20892, USA.,Department of Laboratory Medicine, National Institutes of Health, MD 20892, USA
| | - Richard Chang
- Endocrine & Venous Services Section, Interventional Radiology Section, Radiology & Imaging Sciences, National Institutes of Health, MD 20892, USA.,Endocrine & Venous Services Section, Interventional Radiology Section, Radiology & Imaging Sciences, National Institutes of Health, MD 20892, USA
| | - Constantine A Stratakis
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, MD 20892, USA.,Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, MD 20892, USA
| | - Electron Kebebew
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, MD 20892, USA.,Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, MD 20892, USA
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14
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Karunasena N, Margetson DN, Neal G, Whitaker MJ, Ross RJM. Impact of food, alcohol and pH on modified-release hydrocortisone developed to treat congenital adrenal hyperplasia. Eur J Endocrinol 2017; 176:405-411. [PMID: 28100629 PMCID: PMC5425936 DOI: 10.1530/eje-16-0948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND We developed a modified-release hydrocortisone, Chronocort, to replace the cortisol rhythm in patients with congenital adrenal hyperplasia. Food, alcohol and pH affect drug absorption, and it is important to assess their impact when replicating a physiological rhythm. SUBJECTS AND METHODS In vitro dissolution to study impact of alcohol and pH on Chronocort. A phase 1, three-period, cross over study in 18 volunteers to assess the impact of food on Chronocort and to compare bioavailability to immediate-release hydrocortisone. RESULTS In vitro dissolution of Chronocort was not affected by gastrointestinal pH up to 6.0 nor by an alcohol content up to 20% v/v. Food delayed and reduced the rate of absorption of Chronocort as reflected by a longer Tmax (fed vs fasted: 6.75 h vs 4.5 h, P = 0005) and lower Cmax (549.49 nmol/L vs 708.46 nmol/L, ratio 77% with CI 71-85). Cortisol exposure was similar in fed and fasted state: Geo LSmean ratio (CI) AUC0t for fed/fasted was 108.33% (102.30-114.72%). Cortisol exposure was higher for Chronocort compared to immediate-release hydrocortisone: Geo LSmean ratios (CI) 118.83% (111.58-126.54%); however, derived free cortisol showed cortisol exposure CIs were within 80.0-125.0%: Geo LSmean ratio (CI) for AUC0t 112.73% (105.33-120.65%). CONCLUSIONS Gastric pH ≤6.0 and alcohol do not affect hydrocortisone release from Chronocort. Food delays Chronocort absorption, but cortisol exposure is similar in the fasted and fed state and exposure as assessed by free cortisol is similar between Chronocort and immediate-release hydrocortisone.
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Affiliation(s)
| | | | | | | | - Richard JM Ross
- Department of Oncology and MetabolismUniversity of Sheffield, Sheffield, UK
- Correspondence should be addressed to R Ross;
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15
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Mak IYF, Au Yeung BYT, Ng YW, Choi CH, Iu HYP, Shek CC, Tiu SC. Salivary Cortisol and Cortisone After Low-Dose Corticotropin Stimulation in the Diagnosis of Adrenal Insufficiency. J Endocr Soc 2017; 1:96-108. [PMID: 29264470 PMCID: PMC5686556 DOI: 10.1210/js.2016-1056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/29/2016] [Indexed: 12/05/2022] Open
Abstract
Context: Basal and poststimulation salivary cortisol and cortisone levels can be useful in the diagnosis of adrenal insufficiency. However, little is known about the optimal cutoffs and performance characteristics of these tests. Objective: To derive the cutoff values and study the performance characteristics of salivary cortisol and salivary cortisone in the diagnosis of adrenal insufficiency. Design and Setting: Prospective study in a regional hospital in Hong Kong from January 2014 to September 2015. Participants: Fifty-six Chinese healthy volunteers and 171 patients suspected of having adrenal insufficiency. Main Outcome Measures: All participants underwent low-dose short Synacthen test (LDSST) with intravenous injection of 1 μg of tetracosactide (Synacthen 1–24). Serum cortisol, salivary cortisol and cortisone levels were measured at baseline and 30 and 60 minutes afterward. Results: Using the reference cutoff (mean − 2 standard deviations of post-LDSST peak serum cortisol) derived from healthy volunteers as the gold standard, receiver operating characteristic analysis of patients’ data revealed that both post-LDSST peak salivary cortisol and cortisone performed better than basal tests. The most optimal cutoff values for serum cortisol as measured by immunoassay and for salivary cortisol and salivary cortisone as measured by liquid chromatography–tandem mass spectrometry (LC-MS/MS) were 376, 8.6, and 33.5 nmol/L, respectively, for post-LDSST peak values, and 170, 1.7, and 12.5 nmol/L, respectively, for basal values. Conclusions: We established method-specific reference cutoffs for serum cortisol, salivary cortisol, and salivary cortisone during LDSST. Both post-LDSST peak salivary cortisol and cortisone performed well as diagnostic tests for adrenal insufficiency. Their measurements by LC-MS/MS can alleviate problems associated with serum cortisol immunoassays.
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Affiliation(s)
| | | | | | | | - Heidi Yan Ping Iu
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Chi Chung Shek
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
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16
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Weckesser LJ, Alexander NC, Kirschbaum C, Mennigen E, Miller R. Hydrocortisone Counteracts Adverse Stress Effects on Dual-Task Performance by Improving Visual Sensory Processes. J Cogn Neurosci 2016; 28:1784-1803. [PMID: 27378327 DOI: 10.1162/jocn_a_01006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The impact of acute stress on executive processes is commonly attributed to glucocorticoid-induced disruptions of the pFC. However, the occipital cortex seems to express a higher density of glucocorticoid receptors. Consequently, acute stress effects on executive processes could as well be mediated by glucocorticoid (e.g., cortisol)-induced alterations of visual sensory processes. To investigate this alternative route of stress action by demarcating the effects of acute stress and cortisol on executive from those on visual sensory processes, 40 healthy young men completed a standardized stress induction (i.e., the Trier Social Stress Test) and control protocol in two consecutive sessions. In addition, they received either a placebo or hydrocortisone (0.12-mg/kg bodyweight) pill and processed a dual and a partial report task to assess their executive and visual sensory processing abilities, respectively. Hydrocortisone administration improved both partial report and dual-task performance as indicated by increased response accuracies and/or decreased RTs. Intriguingly, the hydrocortisone-induced increase in dual-task performance was completely mediated by its impact on partial report performance (i.e., visual sensory processes). Moreover, RT measures in both tasks shared approximately 26% of variance, which was only in part attributable to hydrocortisone administration (ΔR2 = 8%). By contrast, acute stress selectively impaired dual-task performance (i.e., executive processes), presumably through an alternative route of action. In summary, the present results suggest that cortisol secretion (as mimicked by hydrocortisone administration) may counteract adverse residual stress effects on executive processes by improving visual sensory processes (e.g., the maintenance and amplification of task-relevant sensory information).
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Affiliation(s)
| | | | | | - Eva Mennigen
- The University of New Mexico.,University Hospital Carl Gustav Carus
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17
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Watterberg KL. Hydrocortisone Dosing for Hypotension in Newborn Infants: Less Is More. J Pediatr 2016; 174:23-26.e1. [PMID: 27156187 DOI: 10.1016/j.jpeds.2016.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/04/2016] [Accepted: 04/04/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Kristi L Watterberg
- Division of Neonatology, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM.
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18
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Behan LA, Carmody D, Rogers B, Hannon MJ, Davenport C, Tormey W, Smith D, Thompson CJ, Stanton A, Agha A. Low-dose hydrocortisone replacement is associated with improved arterial stiffness index and blood pressure dynamics in severely adrenocorticotrophin-deficient hypopituitary male patients. Eur J Endocrinol 2016; 174:791-9. [PMID: 27025241 DOI: 10.1530/eje-15-1187] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/29/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Increased cardiovascular and cerebrovascular morbidity and mortality in hypopituitary subjects may be linked to inappropriate glucocorticoid exposure; however, the pathophysiology remains unclear. We aimed to examine the effect of three commonly prescribed hydrocortisone (HC) regimens on vascular risk factors. DESIGN An open crossover study randomising ten hypopituitary men with severe adrenocorticotrophic hormone deficiency to three HC dose regimens: dose A (20mg mane and 10mg tarde), dose B (10mg mane and 10mg tarde) and dose C (10mg mane and 5mg tarde). METHODS Following 6 weeks on each regimen, participants underwent 24-h serum cortisol sampling, 24-h ambulatory blood pressure (BP) measurements, calculation of the Ambulatory Arterial Stiffness Index (AASI), oral glucose tolerance testing and fasting serum osteoprotegerin (OPG) sampling. RESULTS There were no differences in 24-h BP between dose regimens and controls; however, low-dose HC replacement (dose C) was associated with the lowest AASI, indicating a less stiff arterial tree (P<0.05) compared with the other dose regimens. Loss of the physiologic nocturnal BP dip was more common in higher HC replacement regimens, although only significant for dose B compared with dose C (P=0.03). Twenty per cent of patients had abnormal glucose tolerance, but this was unrelated to dose regimen. OPG correlated strongly with 24-h BP in those on dose A only (r=0.65, P=0.04). CONCLUSION Currently prescribed HC replacement doses do not result in significant differences in absolute BP levels or improvements in insulin sensitivity. However, lower HC doses may result in lower arterial stiffness and a more physiological nocturnal BP dip. Long-term studies are required to confirm these findings and evaluate their impact on vascular morbidity in this patient group.
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Affiliation(s)
- Lucy-Ann Behan
- Department of EndocrinologyBeaumont Hospital and RCSI Medical School, Dublin, Ireland
| | - David Carmody
- Department of EndocrinologyBeaumont Hospital and RCSI Medical School, Dublin, Ireland
| | - Bairbre Rogers
- Department of EndocrinologyBeaumont Hospital and RCSI Medical School, Dublin, Ireland
| | - Mark J Hannon
- Department of EndocrinologyBeaumont Hospital and RCSI Medical School, Dublin, Ireland
| | - Colin Davenport
- Department of EndocrinologyBeaumont Hospital and RCSI Medical School, Dublin, Ireland
| | - William Tormey
- Department of Chemical PathologyBeaumont Hospital, Dublin, Ireland Biomedical SciencesUlster University, Coleraine, Northern Ireland, UK
| | - Diarmuid Smith
- Department of EndocrinologyBeaumont Hospital and RCSI Medical School, Dublin, Ireland
| | | | - Alice Stanton
- Department of Molecular and Cellular TherapeuticsRCSI Research Institute, Dublin, Ireland
| | - Amar Agha
- Department of EndocrinologyBeaumont Hospital and RCSI Medical School, Dublin, Ireland
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19
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Debono M, Harrison RF, Whitaker MJ, Eckland D, Arlt W, Keevil BG, Ross RJ. Salivary Cortisone Reflects Cortisol Exposure Under Physiological Conditions and After Hydrocortisone. J Clin Endocrinol Metab 2016; 101:1469-77. [PMID: 26812690 DOI: 10.1210/jc.2015-3694] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this study we tested the use of salivary cortisol and cortisone as alternatives to serum cortisol. Salivary cortisol is often undetectable and contaminated by hydrocortisone. Salivary cortisone strongly reflects serum cortisol.
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Affiliation(s)
- Miguel Debono
- The University of Sheffield (M.D., R.F.H., M.J.W., R.J.R.), Sheffield S10 2RX, United Kingdom; Diurnal Limited (D.E.), Cardiff, United Kingdom; Institute of Metabolism and Systems Research (W.A.), University of Birmingham, Birmingham, B15 2TT, United Kingdom; and Department of Clinical Biochemistry (B.G.K.), University Hospital South Manchester, Manchester M23 9LT, United Kingdom
| | - Robert F Harrison
- The University of Sheffield (M.D., R.F.H., M.J.W., R.J.R.), Sheffield S10 2RX, United Kingdom; Diurnal Limited (D.E.), Cardiff, United Kingdom; Institute of Metabolism and Systems Research (W.A.), University of Birmingham, Birmingham, B15 2TT, United Kingdom; and Department of Clinical Biochemistry (B.G.K.), University Hospital South Manchester, Manchester M23 9LT, United Kingdom
| | - Martin J Whitaker
- The University of Sheffield (M.D., R.F.H., M.J.W., R.J.R.), Sheffield S10 2RX, United Kingdom; Diurnal Limited (D.E.), Cardiff, United Kingdom; Institute of Metabolism and Systems Research (W.A.), University of Birmingham, Birmingham, B15 2TT, United Kingdom; and Department of Clinical Biochemistry (B.G.K.), University Hospital South Manchester, Manchester M23 9LT, United Kingdom
| | - David Eckland
- The University of Sheffield (M.D., R.F.H., M.J.W., R.J.R.), Sheffield S10 2RX, United Kingdom; Diurnal Limited (D.E.), Cardiff, United Kingdom; Institute of Metabolism and Systems Research (W.A.), University of Birmingham, Birmingham, B15 2TT, United Kingdom; and Department of Clinical Biochemistry (B.G.K.), University Hospital South Manchester, Manchester M23 9LT, United Kingdom
| | - Wiebke Arlt
- The University of Sheffield (M.D., R.F.H., M.J.W., R.J.R.), Sheffield S10 2RX, United Kingdom; Diurnal Limited (D.E.), Cardiff, United Kingdom; Institute of Metabolism and Systems Research (W.A.), University of Birmingham, Birmingham, B15 2TT, United Kingdom; and Department of Clinical Biochemistry (B.G.K.), University Hospital South Manchester, Manchester M23 9LT, United Kingdom
| | - Brian G Keevil
- The University of Sheffield (M.D., R.F.H., M.J.W., R.J.R.), Sheffield S10 2RX, United Kingdom; Diurnal Limited (D.E.), Cardiff, United Kingdom; Institute of Metabolism and Systems Research (W.A.), University of Birmingham, Birmingham, B15 2TT, United Kingdom; and Department of Clinical Biochemistry (B.G.K.), University Hospital South Manchester, Manchester M23 9LT, United Kingdom
| | - Richard J Ross
- The University of Sheffield (M.D., R.F.H., M.J.W., R.J.R.), Sheffield S10 2RX, United Kingdom; Diurnal Limited (D.E.), Cardiff, United Kingdom; Institute of Metabolism and Systems Research (W.A.), University of Birmingham, Birmingham, B15 2TT, United Kingdom; and Department of Clinical Biochemistry (B.G.K.), University Hospital South Manchester, Manchester M23 9LT, United Kingdom
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20
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Bae YJ, Kratzsch J. Corticosteroid-binding globulin: modulating mechanisms of bioavailability of cortisol and its clinical implications. Best Pract Res Clin Endocrinol Metab 2015; 29:761-72. [PMID: 26522460 DOI: 10.1016/j.beem.2015.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Corticosteroid-binding globulin (CBG) is the principal transport protein of glucocorticoids. Approximately 80-90% of serum cortisol binds to CBG with high affinity and only about 5% of cortisol remain unbound and is considered biologically active. CBG seems to modulate and influence the bioavailability of cortisol to local tissues. In this review, we will discuss physicochemical properties of CBG and structure of CBG in the mechanisms of binding and release of cortisol. This review describes several factors affecting CBG functions, such as genetic factors or temperature. Furthermore, clinical implications of CBG abnormalities and the measurement of CBG and its use for assessment of free cortisol levels are described in this review.
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Affiliation(s)
- Yoon Ju Bae
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List Strasse 13-15, D-04103, Leipzig, Germany.
| | - Juergen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List Strasse 13-15, D-04103, Leipzig, Germany
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21
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Sarkar U, Rivera-Burgos D, Large EM, Hughes DJ, Ravindra KC, Dyer RL, Ebrahimkhani MR, Wishnok JS, Griffith LG, Tannenbaum SR. Metabolite profiling and pharmacokinetic evaluation of hydrocortisone in a perfused three-dimensional human liver bioreactor. Drug Metab Dispos 2015; 43:1091-9. [PMID: 25926431 DOI: 10.1124/dmd.115.063495] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/29/2015] [Indexed: 12/12/2022] Open
Abstract
Endotoxin lipopolysaccharide (LPS) is known to cause liver injury primarily involving inflammatory cells such as Kupffer cells, but few in vitro culture models are applicable for investigation of inflammatory effects on drug metabolism. We have developed a three-dimensional human microphysiological hepatocyte-Kupffer cell coculture system and evaluated the anti-inflammatory effect of glucocorticoids on liver cultures. LPS was introduced to the cultures to elicit an inflammatory response and was assessed by the release of proinflammatory cytokines, interleukin 6 and tumor necrosis factor α. A sensitive and specific reversed-phase-ultra high-performance liquid chromatography-quadrupole time of flight-mass spectrometry method was used to evaluate hydrocortisone disappearance and metabolism at near physiologic levels. For this, the systems were dosed with 100 nM hydrocortisone and circulated for 2 days; hydrocortisone was depleted to approximately 30 nM, with first-order kinetics. Phase I metabolites, including tetrahydrocortisone and dihydrocortisol, accounted for 8-10% of the loss, and 45-52% consisted of phase II metabolites, including glucuronides of tetrahydrocortisol and tetrahydrocortisone. Pharmacokinetic parameters, i.e., half-life, rate of elimination, clearance, and area under the curve, were 23.03 hours, 0.03 hour(-1), 6.6 × 10(-5) l⋅hour(-1), and 1.03 (mg/l)*h, respectively. The ability of the bioreactor to predict the in vivo clearance of hydrocortisone was characterized, and the obtained intrinsic clearance values correlated with human data. This system offers a physiologically relevant tool for investigating hepatic function in an inflamed liver.
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Affiliation(s)
- Ujjal Sarkar
- Department of Biological Engineering (U.S., D.R.-B., K.C.R., R.L.D., M.R.E., J.S.W., L.G.G., S.R.T.), Department of Chemistry (S.R.T.), and Department of Mechanical Engineering (L.G.G.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and CN Bio Innovations, Oxford University Begbroke Science Park, Begbroke, Oxfordshire, United Kingdom (E.M.L., D.J.H.)
| | - Dinelia Rivera-Burgos
- Department of Biological Engineering (U.S., D.R.-B., K.C.R., R.L.D., M.R.E., J.S.W., L.G.G., S.R.T.), Department of Chemistry (S.R.T.), and Department of Mechanical Engineering (L.G.G.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and CN Bio Innovations, Oxford University Begbroke Science Park, Begbroke, Oxfordshire, United Kingdom (E.M.L., D.J.H.)
| | - Emma M Large
- Department of Biological Engineering (U.S., D.R.-B., K.C.R., R.L.D., M.R.E., J.S.W., L.G.G., S.R.T.), Department of Chemistry (S.R.T.), and Department of Mechanical Engineering (L.G.G.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and CN Bio Innovations, Oxford University Begbroke Science Park, Begbroke, Oxfordshire, United Kingdom (E.M.L., D.J.H.)
| | - David J Hughes
- Department of Biological Engineering (U.S., D.R.-B., K.C.R., R.L.D., M.R.E., J.S.W., L.G.G., S.R.T.), Department of Chemistry (S.R.T.), and Department of Mechanical Engineering (L.G.G.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and CN Bio Innovations, Oxford University Begbroke Science Park, Begbroke, Oxfordshire, United Kingdom (E.M.L., D.J.H.)
| | - Kodihalli C Ravindra
- Department of Biological Engineering (U.S., D.R.-B., K.C.R., R.L.D., M.R.E., J.S.W., L.G.G., S.R.T.), Department of Chemistry (S.R.T.), and Department of Mechanical Engineering (L.G.G.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and CN Bio Innovations, Oxford University Begbroke Science Park, Begbroke, Oxfordshire, United Kingdom (E.M.L., D.J.H.)
| | - Rachel L Dyer
- Department of Biological Engineering (U.S., D.R.-B., K.C.R., R.L.D., M.R.E., J.S.W., L.G.G., S.R.T.), Department of Chemistry (S.R.T.), and Department of Mechanical Engineering (L.G.G.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and CN Bio Innovations, Oxford University Begbroke Science Park, Begbroke, Oxfordshire, United Kingdom (E.M.L., D.J.H.)
| | - Mohammad R Ebrahimkhani
- Department of Biological Engineering (U.S., D.R.-B., K.C.R., R.L.D., M.R.E., J.S.W., L.G.G., S.R.T.), Department of Chemistry (S.R.T.), and Department of Mechanical Engineering (L.G.G.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and CN Bio Innovations, Oxford University Begbroke Science Park, Begbroke, Oxfordshire, United Kingdom (E.M.L., D.J.H.)
| | - John S Wishnok
- Department of Biological Engineering (U.S., D.R.-B., K.C.R., R.L.D., M.R.E., J.S.W., L.G.G., S.R.T.), Department of Chemistry (S.R.T.), and Department of Mechanical Engineering (L.G.G.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and CN Bio Innovations, Oxford University Begbroke Science Park, Begbroke, Oxfordshire, United Kingdom (E.M.L., D.J.H.)
| | - Linda G Griffith
- Department of Biological Engineering (U.S., D.R.-B., K.C.R., R.L.D., M.R.E., J.S.W., L.G.G., S.R.T.), Department of Chemistry (S.R.T.), and Department of Mechanical Engineering (L.G.G.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and CN Bio Innovations, Oxford University Begbroke Science Park, Begbroke, Oxfordshire, United Kingdom (E.M.L., D.J.H.)
| | - Steven R Tannenbaum
- Department of Biological Engineering (U.S., D.R.-B., K.C.R., R.L.D., M.R.E., J.S.W., L.G.G., S.R.T.), Department of Chemistry (S.R.T.), and Department of Mechanical Engineering (L.G.G.), Massachusetts Institute of Technology, Cambridge, Massachusetts; and CN Bio Innovations, Oxford University Begbroke Science Park, Begbroke, Oxfordshire, United Kingdom (E.M.L., D.J.H.)
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22
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Peitzsch M, Dekkers T, Haase M, Sweep FCGJ, Quack I, Antoch G, Siegert G, Lenders JWM, Deinum J, Willenberg HS, Eisenhofer G. An LC-MS/MS method for steroid profiling during adrenal venous sampling for investigation of primary aldosteronism. J Steroid Biochem Mol Biol 2015; 145:75-84. [PMID: 25312486 DOI: 10.1016/j.jsbmb.2014.10.006] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/28/2014] [Accepted: 10/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Steroid profiling for diagnosis of endocrine disorders featuring disordered production of steroid hormones is now possible from advances in liquid chromatography with tandem mass spectrometry (LC-MS/MS). Adrenal venous (AV) measurements of aldosterone and cortisol are a standard practice in the clinical work-up of primary aldosteronism, but do not yet take advantage of steroid profiling. METHODS A novel LC-MS/MS based method was developed for simultaneous measurement of 15 adrenal steroids: aldosterone, corticosterone, 11-deoxycorticosterone, progesterone, pregnenolone, cortisone, cortisol, 11-deoxycortisol, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone-sulfate, 21-deoxycortisol, 18-oxocortisol and 18-hydroxycortisol. These were compared in peripheral venous (pV) and AV plasma from 70 patients undergoing AV sampling with and without cosyntropin stimulation. Aldosterone and cortisol levels measured by LC-MS/MS were compared with those measured by immunoassay. RESULTS Reproducibility of measurements with coefficients of variation ≤10% as well as analytical sensitivity sufficient to measure low pV levels particularly of aldosterone demonstrate the utility of the assay for profiling adrenal steroids in primary aldosteronism. Method comparisons indicated assay and concentration dependent differences of cortisol and aldosterone concentrations measured by immunoassay and LC-MS/MS. Median AV/pV ratios of 11-deoxycortisol (53.0), 17-hydroxyprogesterone (33.4), pregnenolone (62.4), androstenedione (40.6) and dehydroepiandrosterone (33.3) were 2.9- to, 5.4-fold larger than those for cortisol (11.6), with additionally generally larger increases than for cortisol with than without cosyntropin stimulation. CONCLUSION Our LC-MS/MS assay, in addition to improvements over existing immunoassay measurements of aldosterone and cortisol, offers profiling of 13 other adrenal steroids, providing a potentially useful method for the clinical work-up of patients with primary aldosteronism. In particular, the larger AV/pV ratios of several steroids compared to cortisol suggest more sensitive alternatives to the latter for assessing positioning of AV sampling catheters.
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Affiliation(s)
- Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
| | - Tanja Dekkers
- Department of General Internal Medicine, Radboud University Medical Center, Geert Grooteplein 8, 6525 Nijmegen, The Netherlands
| | - Matthias Haase
- Heinrich-Heine-University of Dusseldorf, Medical Faculty, Division for Specific Endocrinology, Moorenstrasse 5, 40225 Dusseldorf, Germany; Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Fred C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525 Nijmegen, The Netherlands
| | - Ivo Quack
- Heinrich-Heine-University of Dusseldorf, Medical Faculty, Department of Nephrology, Moorenstrasse 5, 40225 Dusseldorf, Germany
| | - Gerald Antoch
- Heinrich-Heine-University of Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstrasse 5, 40225 Dusseldorf, Germany
| | - Gabriele Siegert
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Jacques W M Lenders
- Department of General Internal Medicine, Radboud University Medical Center, Geert Grooteplein 8, 6525 Nijmegen, The Netherlands; Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Jaap Deinum
- Department of General Internal Medicine, Radboud University Medical Center, Geert Grooteplein 8, 6525 Nijmegen, The Netherlands
| | - Holger S Willenberg
- Heinrich-Heine-University of Dusseldorf, Medical Faculty, Division for Specific Endocrinology, Moorenstrasse 5, 40225 Dusseldorf, Germany; Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany; Department of Medicine III, University Hospital Carl Gustav Carus, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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Abstract
Critical illness represents a major challenge for the human body, implicating that an adequate stress response is indispensable for survival. Therefore, for a long time, activation of the hypothalamic pituitary adrenal axis was assumed to be increased to respond to this stressful situation. Recent novel insights, however, provided evidence that the HPA-axis is regulated differently during critical illness. Cortisol metabolism was shown to be reduced which contributed to hypercortisolism in an energy efficient way without increasing cortisol production dramatically. Yet, the concomitant low ACTH levels, explained by negative feedback inhibition, could lead to an understimulation of the adrenal gland and affect adrenal structure and function, given the crucial role of ACTH for adrenal gland maintenance. This side-effect could negatively affect outcome predominantly in the prolonged phase of critical illness and could explain the increased incidence of adrenal failure in these patients. Altogether, novel findings represent a paradigm shift in our current understanding of HPA-axis regulation during critical illness and redirect future research perspectives with an urgent need to well-designed clinical trials to further explore HPA-axis functioning during critical illness.
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Smith MN, Griffith WC, Beresford SAA, Vredevoogd M, Vigoren EM, Faustman EM. Using a biokinetic model to quantify and optimize cortisol measurements for acute and chronic environmental stress exposure during pregnancy. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2014; 24:510-6. [PMID: 24301353 DOI: 10.1038/jes.2013.86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/01/2013] [Indexed: 05/04/2023]
Abstract
To fully understand the potentially harmful effects of prenatal stress exposure impacts, it is necessary to quantify long-term and episodic stress exposure during pregnancy. There is a strong body of research relating psychological stress to elevated cortisol levels in biomarkers. Recently, maternal hair has been used to measure cortisol levels, and provides the unique opportunity to assess stress exposure throughout gestation. Understanding how cortisol in the hair is related to more common biomarkers, such as, blood, saliva and urine is currently lacking. Therefore, we developed a biokinetic model to quantify the relationships between hair, blood, saliva and urine cortisol concentrations using published literature values. Hair concentrations were used to retrospectively predict peaks in blood and saliva concentrations over days and months. Simulations showed realistic values in all compartments when results were compared with published literature. We also showed that the significant variability of cortisol in blood leads to a weak relationship between long-term and episodic measurements of stress. To our knowledge, this is the first integrative biokinetic cortisol model for blood, urine, hair and saliva. As such, it makes an important contribution to our understanding of cortisol as a biomarker and will be useful for future epidemiological studies.
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Affiliation(s)
- Marissa N Smith
- Institute for Risk Analysis and Risk Communication, University of Washington, Seattle, Washington, USA
| | - William C Griffith
- Institute for Risk Analysis and Risk Communication, University of Washington, Seattle, Washington, USA
| | - Shirley A A Beresford
- 1] Department of Epidemiology, University of Washington, Seattle, WA, USA [2] Northwest Center for the National Children's Study, University of Washington, Seattle, Washington, USA [3] Cancer Epidemiology, Prevention and Control, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Melinda Vredevoogd
- 1] Institute for Risk Analysis and Risk Communication, University of Washington, Seattle, Washington, USA [2] Northwest Center for the National Children's Study, University of Washington, Seattle, Washington, USA
| | - Eric M Vigoren
- 1] Institute for Risk Analysis and Risk Communication, University of Washington, Seattle, Washington, USA [2] Northwest Center for the National Children's Study, University of Washington, Seattle, Washington, USA
| | - Elaine M Faustman
- 1] Institute for Risk Analysis and Risk Communication, University of Washington, Seattle, Washington, USA [2] Northwest Center for the National Children's Study, University of Washington, Seattle, Washington, USA
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Population pharmacokinetics of unbound hydrocortisone in critically ill neonates and infants with vasopressor-resistant hypotension. Pediatr Crit Care Med 2014; 15:546-53. [PMID: 24797719 PMCID: PMC4682874 DOI: 10.1097/pcc.0000000000000152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine the population pharmacokinetics of unbound hydrocortisone in critically ill neonates and infants receiving IV hydrocortisone for treatment of vasopressor-resistant hypotension and to identify patient-specific sources of pharmacokinetic variability. DESIGN Prospective observational cohort study. SETTING Level 3 neonatal ICU. PATIENTS Sixty-two critically ill neonates and infants receiving IV hydrocortisone as part of standard of care for the treatment of vasopressor-resistant hypotension: median gestational age 28 weeks (range, 23-41), median weight 1.2 kg (range, 0.5-4.4), and 29 females. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Unbound baseline cortisol and postdose hydrocortisone concentrations measured from blood samples being drawn for routine laboratory tests. A one-compartment model best described the data. Allometric weight and postmenstrual age were significant covariates on unbound hydrocortisone clearance and volume of distribution. Final population estimates for clearance, volume of distribution, and baseline cortisol concentration were 20.2 L/hr, 244 L, and 1.37 ng/mL, respectively. Using the median weight and postmenstrual age of our subjects (i.e., 1.2 kg and 28 wk) in the final model, the typical unbound hydrocortisone clearance and volume of distribution were 1.0 L/hr and 4.2 L, respectively. The typical half-life for unbound hydrocortisone was 2.9 hours. A sharp and continuous increase in unbound hydrocortisone clearance was observed at 35 weeks postmenstrual age. CONCLUSIONS We report the first pharmacokinetic data for unbound hydrocortisone, the pharmacologically active moiety, in critically ill neonates and infants with vasopressor-resistant hypotension. Unbound hydrocortisone clearance increased with body weight and was faster in children with an older postmenstrual age. Unbound hydrocortisone clearance increased sharply at 35 weeks postmenstrual age and continued to mature thereafter. This study lays the groundwork for evaluating unbound hydrocortisone exposure-response relationships and drawing definitive conclusions about the dosing of IV hydrocortisone in critically ill neonates and infants with vasopressor-resistant hypotension.
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del Mar Grasa M, Villarreal L, Granero R, Vilà R, Penelo E, Agüera Z, Jiménez-Murcia S, del Mar Romero M, Menchón JM, Remesar X, Fernández-Aranda F, Alemany M. Purging behavior modulates the relationships of hormonal and behavioral parameters in women with eating disorders. Neuropsychobiology 2014; 67:230-40. [PMID: 23689731 DOI: 10.1159/000350473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 02/17/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS There is ample consensus that there is a neurophysiological basis for eating disorders (ED). Traits of personality translate into behavioral traits, purging being a well-defined transversal example. The direct implication of steroid hormones on ED has seldom been studied, despite their effects on behavior. METHODS After psychological interview analysis, 57 ED female patients (31 purgative and 26 nonpurgative) and 17 female controls were studied. Metabolic parameters and analysis of androgen, estrogen and glucocorticoid hormones were determined in parallel to the psychopathological profile (EDI-2 and SCL-90-R) and anthropometric measurements. RESULTS Psychometric tests showed clear differences between ED and controls, but there were few hormonal-metabolic significant differences. In purgative ED there were repeated (significant) positive correlations with corticosteroid-binding globulin (CBG) and negative correlations with sex hormone-binding globulin (SHBG) versus eating and general psychopathology. In nonpurging ED there were positive correlations for deoxycortisol, free fatty acids and albumin and negative for aspartate aminotransferase and psychopathological traits. CONCLUSION The data suggest that CBG/corticosteroids and sexual hormones/SHBG are involved in purging behavior and its psychopathology and severity scores. Correlations of selected psychometric data and the CBG/SHBG levels in purging may eventually result in clinical markers. This approach may provide additional clues for understanding the pathogenesis of ED.
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Affiliation(s)
- Maria del Mar Grasa
- Department of Nutrition and Food Science, Faculty of Biology, University of Barcelona, Barcelona, Spain
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Behan LA, Kelleher G, Hannon MJ, Brady JJ, Rogers B, Tormey W, Smith D, Thompson CJ, McKenna MJ, Agha A. Low-dose hydrocortisone replacement therapy is associated with improved bone remodelling balance in hypopituitary male patients. Eur J Endocrinol 2014; 170:141-50. [PMID: 24123094 DOI: 10.1530/eje-13-0596] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Glucocorticoid (GC) therapy is associated with adverse effects on bone metabolism, yet the effects of different GC physiological replacement regimens in hypopituitarism are not well characterised. We aimed to assess the effect of three hydrocortisone (HC) replacement dose regimens on bone turnover. STUDY DESIGN An open cross-over study randomising ten hypopituitary men with severe acth deficiency to three commonly used HC dose regimens: dose A (20 mg mane and 10 mg tarde), dose B (10 mg mane and 10 mg tarde) and dose C (10 mg mane and 5 mg tarde). METHODS Following 6 weeks of each regimen, the participants underwent 24-h serum cortisol sampling and measurement of bone turnover markers: bone-specific alkaline phosphatase, procollagen type I N-propeptide (PINP), intact osteocalcin (OC(1-49)), C-terminal cross-linking telopeptide (CTX-I) and tartrate-resistant acid phosphatase 5b (TRACP5b). Bone remodelling balance was estimated as an absolute ratio (PINP:CTX-I) and as an index using standardised scores derived from the matched controls. RESULTS There were significant increases in the concentrations of the formation markers PINP (P=0.045) and OC(1-49) (P=0.006) and in the PINP:CTX-I ratio (P=0.015), and a more positive bone remodelling balance index (P=0.03) was observed in patients on the lowest dose C than in those on the highest dose A. Mean 24-h cortisol concentrations correlated negatively with CTX-I (r=-0.66 and P=0.04) and TRACP5b (r=-0.74 and P=0.01) in patients on dose B and with OC(1-49) (r=-0.66 and P=0.04) and CTX-I (r=-0.81 and P<0.01) in patients on dose C. In patients receiving the lower-dose regimen, trough cortisol concentrations correlated with increased bone formation and resorption. CONCLUSION Low-dose HC replacement (10 mg mane and 5 mg tarde) is associated with increased bone formation and a positive bone remodelling balance. This may have a long-term beneficial effect on bone health.
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28
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Boisseau N, Enea C, Diaz V, Dugué B, Corcuff JB, Duclos M. Oral contraception but not menstrual cycle phase is associated with increased free cortisol levels and low hypothalamo-pituitary-adrenal axis reactivity. J Endocrinol Invest 2013; 36:955-64. [PMID: 23698556 DOI: 10.3275/8971] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In females, estrogen is a potential modulator of cortisol response to stressors. The aim of this study was to determine the influence of menstrual cycle phase, oral contraception (OC) use and exercise training on hypothalamo-pituitary-adrenal (HPA) axis activity and reactivity after physical stress. AIM We investigated the effects of the menstrual cycle and OC use on exhaustive exerciseinduced changes in free salivary cortisol concentrations and free urinary cortisol/cortisone excretion in healthy young women. MATERIALS AND SUBJECTS Twenty-eight women were allocated to an untrained group (no.=16) or a trained group (no.=12), depending on their physical training background. The untrained group was composed of nine OC users (UNTOC+) and seven eumenorrheic women (UNT-OC-) tested in the follicular and luteal phases, while the trained group was entirely composed of OC+ subjects (T-OC+). METHODS Three laboratory sessions were conducted in a randomised order: a prolonged exercise test, a short-term exercise test, and a control session. For each session, urine and saliva specimens were collected at rest (09:00 h) and then, 30, 60 and 90 min later. RESULTS Estradiol fluctuation during the menstrual cycle phase did not alter free cortisol baseline values and responses to exercise. OC use was associated with increased free resting salivary concentrations and urinary cortisol excretion with blunted salivary cortisol response to prolonged exercise stimulation. No training effect was noted. CONCLUSIONS OC but not menstrual cycle phase is associated with increased free cortisol levels and low HPA axis reactivity.
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Affiliation(s)
- N Boisseau
- Laboratoire des Adaptations Métaboliques à l'Exercice en Conditions Physiologiques et Pathologiques, BP 10448, Clermont University, University of Blaise Pascal, EA 3533, Clermont-Ferrand, France
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Classification criteria for distinguishing cortisol responders from nonresponders to psychosocial stress: evaluation of salivary cortisol pulse detection in panel designs. Psychosom Med 2013; 75:832-40. [PMID: 24184845 DOI: 10.1097/psy.0000000000000002] [Citation(s) in RCA: 251] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hypothalamic-pituitary-adrenal axis reactivity to acute stimulation is frequently assessed by repeated sampling of salivary cortisol. Researchers often strive to distinguish between individuals who show (responders) and those do not show (nonresponders) cortisol responses. For this, fixed threshold classification criteria, such as a 2.5-nmol/l baseline-to-peak increase, are frequently used. However, the performance of such criteria has not been systematically evaluated. METHODS Repeated salivary cortisol data from 504 participants exposed to either the Trier Social Stress Test (TSST; n = 309) or a placebo protocol (n = 195) were used for analyses. To obtain appropriate classifications of cortisol responders versus nonresponders, a physiologically plausible, autoregressive latent trajectory (ALT) mixture model was fitted to these data. Response classifications according to the ALT model and information on the experimental protocol (TSST versus placebo TSST) were then used to evaluate the performance of different proposed classifier proxies by receiver operating characteristics. RESULTS Moment structure of cortisol time series was adequately accounted for by the proposed ALT model. The commonly used 2.5-nmol/l criterion was found to be overly conservative, resulting in a high rate of 16.5% false-negative classifications. Lowering this criterion to 1.5 nmol/l or using a percentage baseline-to-peak increase of 15.5% as a threshold yielded improved performance (39.3% and 26.7% less misclassifications, respectively). CONCLUSIONS Alternative classification proxies (1.5 nmol/l or 15.5% increase) are able to effectively distinguish between cortisol responders and nonresponders and should be used in future research, whenever statistical response class allocation is not feasible.
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30
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Manetti L, Rossi G, Grasso L, Raffaelli V, Scattina I, Del Sarto S, Cosottini M, Iannelli A, Gasperi M, Bogazzi F, Martino E. Usefulness of salivary cortisol in the diagnosis of hypercortisolism: comparison with serum and urinary cortisol. Eur J Endocrinol 2013; 168:315-21. [PMID: 23211575 DOI: 10.1530/eje-12-0685] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Several tests have been proposed to diagnose patients with Cushing's syndrome (CS). The aims of the study were: i) to evaluate the performance of salivary cortisol (SC) in hypercortisolism and ii) to compare SC with serum cortisol (SeC) and urinary cortisol. DESIGN AND PATIENTS This was a diagnostic study. Twenty-seven patients with untreated Cushing's disease (CD untr), 21 women consuming oral contraceptive pill (OCP), 18 pregnant women, and 89 healthy subjects (controls) were enrolled. METHODS SC and SeC at baseline and after the low-dose dexamethasone suppression test (LDDST) and urinary free cortisol (UFC) were measured. RESULTS Midnight SC had a sensitivity of 100% in the CD untr group and a specificity of 97.7% in the controls. Specificity remained high (95.2%) in women taking OCP, while in pregnant women, it decreased to 83.3%. SC after the LDDST showed a sensitivity of 96.3% in the CD untr group; specificity was 97.7% in the controls and 90.5% in OCP women. Midnight SeC had a sensitivity of 100% in the CD untr group. SeC after the LDDST had a sensitivity of 100% in the CD untr group while specificity was 97.7% in the controls and 61.9% in women taking OCP. For UFC, sensitivity was 92.6% in the CD untr group while specificity was 97.7% in the controls and 100% in the OCP group. CONCLUSIONS SC is a reliable parameter for the diagnosis of severe hypercortisolism, with high sensitivity and specificity. In women during pregnancy or taking OCP, the measurement of SC, identifying the free fraction, could be helpful to exclude CS.
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Affiliation(s)
- Luca Manetti
- Department of Endocrinology and Metabolism, University of Pisa, Ospedale Cisanello, via Paradisa 2, 56124 Pisa, Italy.
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Modulation in Wistar rats of blood corticosterone compartmentation by sex and a cafeteria diet. PLoS One 2013; 8:e57342. [PMID: 23451210 PMCID: PMC3579843 DOI: 10.1371/journal.pone.0057342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/21/2013] [Indexed: 01/21/2023] Open
Abstract
In the metabolic syndrome, glucocorticoid activity is increased, but circulating levels show little change. Most of blood glucocorticoids are bound to corticosteroid-binding globulin (CBG), which liver expression and circulating levels are higher in females than in males. Since blood hormones are also bound to blood cells, and the size of this compartment is considerable for androgens and estrogens, we analyzed whether sex or eating a cafeteria diet altered the compartmentation of corticosterone in rat blood. The main corticosterone compartment in rat blood is that specifically bound to plasma proteins, with smaller compartments bound to blood cells or free. Cafeteria diet increased the expression of liver CBG gene, binding plasma capacity and the proportion of blood cell-bound corticosterone. There were marked sex differences in blood corticosterone compartmentation in rats, which were unrelated to testosterone. The use of a monoclonal antibody ELISA and a polyclonal Western blot for plasma CBG compared with both specific plasma binding of corticosterone and CBG gene expression suggested the existence of different forms of CBG, with varying affinities for corticosterone in males and females, since ELISA data showed higher plasma CBG for males, but binding and Western blot analyses (plus liver gene expression) and higher physiological effectiveness for females. Good cross- reactivity to the antigen for polyclonal CBG antibody suggests that in all cases we were measuring CBG.The different immunoreactivity and binding affinity may help explain the marked sex-related differences in plasma hormone binding as sex-linked different proportions of CBG forms.
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Comparison of salivary cortisol as measured by different immunoassays and tandem mass spectrometry. Psychoneuroendocrinology 2013; 38:50-7. [PMID: 22641005 DOI: 10.1016/j.psyneuen.2012.04.019] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 04/30/2012] [Accepted: 04/30/2012] [Indexed: 11/23/2022]
Abstract
Assessing the amount of bioavailable cortisol in saliva with immunoassays and thus sampling an endocrine marker of hypothalamus-pituitary-adrenal axis activity is of major interest in both research and clinical practice. However, absolute cortisol concentrations obtained with different immunoassays (IAs) are barely comparable precluding direct comparison between studies or individuals whenever cortisol analyses were not based on the same IA. The present technical report aims to solve this problem by evaluating the validity of, as well as agreement between the most commonly used immunoassays in psychoneuroendocrinological research (i.e., IBL, DRG, Salimetrics, DSL, and DELFIA) and a reference method (LC-MS/MS) in a sample of 195 saliva specimen covering the whole range of cortisol concentrations in adults. A structural equation modelling framework is applied to decompose systematic assay variance and estimate cortisol reference values, which are adjusted for measurement error and interference of salivary cortisone. Our findings reveal nonlinear relations between IAs and LC-MS/MS, which are discussed in terms of IA cross-reactivity with saliva matrix components. Finally guidelines for converting cortisol concentrations being obtained by these immunoassays into comparable reference values are proposed by providing conversion functions, a conversion table, and an online conversion tool.
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Perogamvros I, Ray DW, Trainer PJ. Regulation of cortisol bioavailability--effects on hormone measurement and action. Nat Rev Endocrinol 2012; 8:717-27. [PMID: 22890008 DOI: 10.1038/nrendo.2012.134] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Routine assessment of the hypothalamic-pituitary-adrenal axis relies on the measurement of total serum cortisol levels. However, most cortisol in serum is bound to corticosteroid-binding globulin (CBG) and albumin, and changes in the structure or circulating levels of binding proteins markedly affect measured total serum cortisol levels. Furthermore, high-affinity binding to CBG is predicted to affect the availability of cortisol for the glucocorticoid receptor. CBG is a substrate for activated neutrophil elastase, which cleaves the binding protein and results in the release of cortisol at sites of inflammation, enhancing its tissue-specific anti-inflammatory effects. Further tissue-specific modulation of cortisol availability is conferred by corticosteroid 11β-dehydrogenase. Direct assessment of tissue levels of bioavailable cortisol is not clinically practicable and measurement of total serum cortisol levels is of limited value in clinical conditions that alter prereceptor glucocorticoid bioavailability. Bioavailable cortisol can, however, be measured indirectly at systemic, extracellular tissue and cell levels, using novel techniques that have provided new insight into the transport, metabolism and biological action of glucocorticoids. A more physiologically informative approach is, therefore, now possible in the assessment of the hypothalamic-pituitary-adrenal axis, which could prove useful in clinical practice.
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Affiliation(s)
- Ilias Perogamvros
- Endocrine Sciences Research Group, School of Medicine, University of Manchester, A. V. Hill Building, Oxford Road, Manchester M13 9PT, UK.
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Mormede P, Terenina E. Molecular genetics of the adrenocortical axis and breeding for robustness. Domest Anim Endocrinol 2012; 43:116-31. [PMID: 22672758 DOI: 10.1016/j.domaniend.2012.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/20/2012] [Accepted: 05/14/2012] [Indexed: 11/25/2022]
Abstract
The concept of robustness refers to the combination of a high production potential and a low sensitivity to environmental perturbations. The importance of robustness-related traits in breeding objectives is progressively increasing toward the production of animals with a high production level in a wide range of climatic conditions and production systems, together with a high level of animal welfare. Current strategies to increase robustness include selection for "functional traits," such as skeletal and cardiovascular integrity, disease resistance, and mortality at various stages. It is also possible to use global evaluation of sensitivity to the environment (eg reaction norm analysis or canalization), but these techniques are difficult to implement in practice. The glucocorticoid hormones released by the adrenal cortex exert a wide range of effects on metabolism, the cardiovascular system, inflammatory processes, and brain function, for example. Protein catabolism toward energy production and storage (lipids and glycogen) supports their pivotal role in stress responses aiming at the adaptation and survival of individuals under strong environmental pressure. Large individual variations have been described in adrenocortical axis activity, with important physiopathological consequences. In terms of animal production, higher cortisol levels have negative effects on growth rate and feed efficiency and increase the fat:lean ratio of carcasses. On the contrary, cortisol has positive effects on functional traits and adaptation. Intense selection for lean tissue growth and more generally high protein output during the past decades has concomitantly reduced cortisol production, which may be responsible for the negative effects of selection on functional traits. In this paper, we review experimental evidence suggesting that the balance between production and functional traits was modified in favor of improved robustness by selecting animals with higher adrenocortical axis activity, as well as the molecular genetic tools that can be used to fine-tune this objective.
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Affiliation(s)
- P Mormede
- INRA, UMR 444 Génétique Cellulaire, F-31326 Castanet-Tolosan, France.
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Pawluski JL, Brain UM, Underhill CM, Hammond GL, Oberlander TF. Prenatal SSRI exposure alters neonatal corticosteroid binding globulin, infant cortisol levels, and emerging HPA function. Psychoneuroendocrinology 2012; 37:1019-28. [PMID: 22177580 DOI: 10.1016/j.psyneuen.2011.11.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 11/16/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Serotonin influences the development of the hypothalamic-pituitary-adrenal (HPA) system; therefore prenatal exposure to selective serotonin reuptake inhibitor antidepressants (SSRIs) may alter HPA axis development and function. To address this, prenatal exposure to SSRIs and maternal mood were examined in relation to neonatal and infant levels of cortisol and its binding protein, corticosteroid-binding globulin (CBG). METHODS Serum cortisol and CBG levels were assayed from SSRI-exposed and non-exposed mothers and their neonates at delivery. Maternal mood symptoms were documented at 36 weeks gestation. To determine the long-term implications of changes in CBG, levels of salivary cortisol were assessed in infants at 3 months of age. RESULTS Prenatal SSRI exposure significantly increased serum CBG levels in neonates after vaginal delivery (p ≤ 0.038), even when controlling for maternal depression. Neonatal serum cortisol levels did not vary with SSRI exposure or antenatal maternal mood, but were significantly higher following vaginal delivery (p ≤ 0.003). Neonatal serum CBG levels were associated with infant salivary levels of evening cortisol (p ≤ 0.051). In SSRI-exposed infants, increased levels of neonatal CBG predicted a smaller diurnal change in infant salivary cortisol (p ≤ 0.028), regardless of maternal depression. CONCLUSIONS Prenatal SSRI exposure affects the developing HPA system by altering serum CBG levels in neonates and infant salivary cortisol levels. Further research is warranted on the long-term functional implications of the effect of prenatal SSRI exposure on fetal hepatic CBG gene expression and the developing HPA system.
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Affiliation(s)
- Jodi L Pawluski
- Early Human Experience Unit, Department of Pediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
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Alemany M. Do the interactions between glucocorticoids and sex hormones regulate the development of the metabolic syndrome? Front Endocrinol (Lausanne) 2012; 3:27. [PMID: 22649414 PMCID: PMC3355885 DOI: 10.3389/fendo.2012.00027] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 02/06/2012] [Indexed: 12/14/2022] Open
Abstract
The metabolic syndrome is basically a maturity-onset disease. Typically, its manifestations begin to flourish years after the initial dietary or environmental aggression began. Since most hormonal, metabolic, or defense responses are practically immediate, the procrastinated response do not seem justified. Only in childhood, the damages of the metabolic syndrome appear with minimal delay. Sex affects the incidence of the metabolic syndrome, but this is more an effect of timing than absolute gender differences, females holding better than males up to menopause, when the differences between sexes tend to disappear. The metabolic syndrome is related to an immune response, countered by a permanent increase in glucocorticoids, which keep the immune system at bay but also induce insulin resistance, alter the lipid metabolism, favor fat deposition, mobilize protein, and decrease androgen synthesis. Androgens limit the operation of glucocorticoids, which is also partly blocked by estrogens, since they decrease inflammation (which enhances glucocorticoid release). These facts suggest that the appearance of the metabolic syndrome symptoms depends on the strength (i.e., levels) of androgens and estrogens. The predominance of glucocorticoids and the full manifestation of the syndrome in men are favored by decreased androgen activity. Low androgens can be found in infancy, maturity, advanced age, or because of their inhibition by glucocorticoids (inflammation, stress, medical treatment). Estrogens decrease inflammation and reduce the glucocorticoid response. Low estrogen (infancy, menopause) again allow the predominance of glucocorticoids and the manifestation of the metabolic syndrome. It is postulated that the equilibrium between sex hormones and glucocorticoids may be a critical element in the timing of the manifestation of metabolic syndrome-related pathologies.
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Affiliation(s)
- Marià Alemany
- Faculty of Biology, Department of Nutrition and Food Science, University of Barcelona Barcelona, Spain.
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Verbrugghe E, Boyen F, Van Parys A, Van Deun K, Croubels S, Thompson A, Shearer N, Leyman B, Haesebrouck F, Pasmans F. Stress induced Salmonella Typhimurium recrudescence in pigs coincides with cortisol induced increased intracellular proliferation in macrophages. Vet Res 2011; 42:118. [PMID: 22151081 PMCID: PMC3256119 DOI: 10.1186/1297-9716-42-118] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 12/07/2011] [Indexed: 01/31/2023] Open
Abstract
Salmonella Typhimurium infections in pigs often result in the development of carriers that intermittently excrete Salmonella in very low numbers. During periods of stress, for example transport to the slaughterhouse, recrudescence of Salmonella may occur, but the mechanism of this stress related recrudescence is poorly understood. Therefore, the aim of the present study was to determine the role of the stress hormone cortisol in Salmonella recrudescence by pigs. We showed that a 24 h feed withdrawal increases the intestinal Salmonella Typhimurium load in pigs, which is correlated with increased serum cortisol levels. A second in vivo trial demonstrated that stress related recrudescence of Salmonella Typhimurium in pigs can be induced by intramuscular injection of dexamethasone. Furthermore, we found that cortisol, but not epinephrine, norepinephrine and dopamine, promotes intracellular proliferation of Salmonella Typhimurium in primary porcine alveolar macrophages, but not in intestinal epithelial cells and a transformed cell line of porcine alveolar macrophages. A microarray based transcriptomic analysis revealed that cortisol did not directly affect the growth or the gene expression or Salmonella Typhimurium in a rich medium, which implies that the enhanced intracellular proliferation of the bacterium is probably caused by an indirect effect through the cell. These results highlight the role of cortisol in the recrudescence of Salmonella Typhimurium by pigs and they provide new evidence for the role of microbial endocrinology in host-pathogen interactions.
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Affiliation(s)
- Elin Verbrugghe
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
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Behan LA, Rogers B, Hannon MJ, O'Kelly P, Tormey W, Smith D, Thompson CJ, Agha A. Optimizing glucocorticoid replacement therapy in severely adrenocorticotropin-deficient hypopituitary male patients. Clin Endocrinol (Oxf) 2011; 75:505-13. [PMID: 21521342 DOI: 10.1111/j.1365-2265.2011.04074.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal replacement regimen of hydrocortisone in adults with severe ACTH deficiency remains unknown. Management strategies vary from treatment with 15-30 mg or higher in daily divided doses, reflecting the paucity of prospective data on the adequacy of different glucocorticoid regimens. OBJECTIVE Primarily to define the hydrocortisone regimen which results in a 24 h cortisol profile that most closely resembles that of healthy controls and secondarily to assess the impact on quality of life (QoL). DESIGN Ten male hypopituitary patients with severe ACTH deficiency (basal cortisol <100 nm and peak response to stimulation <400 nm) were enrolled in a prospective, randomized, crossover study of 3 hydrocortisone dose regimens. Following 6 weeks of each regimen patients underwent 24 h serum cortisol sampling and QoL assessment with the Short Form 36 (SF36) and the Nottingham Health Profile (NHP) questionnaires. Free cortisol was calculated using Coolen's equation. All results were compared to those of healthy, matched controls. RESULTS Corticosteroid binding globulin (CBG) was significantly lower across all dose regimens compared to controls (P < 0·05). The lower dose regimen C (10 mg mane/5 mg tarde) produced a 24 h free cortisol profile (FCP) which most closely resembled that of controls. Both regimen A(20 mg mane/10 mg tarde) and B(10 mg mane/10 mg tarde) produced supraphysiological post-absorption peaks. There was no significant difference in QoL in patients between the three regimens, however energy level was significantly lower across all dose regimens compared to controls (P < 0·001). CONCLUSIONS The lower dose of hydrocortisone (10 mg/5 mg) produces a more physiological cortisol profile, without compromising QoL, compared to higher doses still used in clinical practice. This may have important implications in these patients, known to have excess cardiovascular mortality.
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Affiliation(s)
- Lucy-Ann Behan
- Division of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin, Ireland
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