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van Aalen EA, Lurvink JJJ, Vermeulen L, van Gerven B, Ni Y, Arts R, Merkx M. Turning Antibodies into Ratiometric Bioluminescent Sensors for Competition-Based Homogeneous Immunoassays. ACS Sens 2024; 9:1401-1409. [PMID: 38380622 DOI: 10.1021/acssensors.3c02478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Here we present LUCOS (Luminescent Competition Sensor), a modular and broadly applicable bioluminescent diagnostic platform enabling the detection of both small molecules and protein biomarkers. The construction of LUCOS sensors entails the covalent and site-specific coupling of a bioluminescent sensor component to an analyte-specific antibody via protein G-mediated photoconjugation. Target detection is accomplished through intramolecular competition with a tethered analyte competitor for antibody binding. We established two variants of LUCOS: an inherent ratiometric LUCOSR variant and an intensiometric LUCOSI version, which can be used for ratiometric detection upon the addition of a split calibrator luciferase. To demonstrate the versatility of the LUCOS platform, sensors were developed for the detection of the small molecule cortisol and the protein biomarker NT-proBNP. Sensors for both targets displayed analyte-dependent changes in the emission ratio and enabled detection in the micromolar concentration range (KD,app = 16-92 μM). Furthermore, we showed that the response range of the LUCOS sensor can be adjusted by attenuating the affinity of the tethered NT-proBNP competitor, which enabled detection in the nanomolar concentration range (KD,app = 317 ± 26 nM). Overall, the LUCOS platform offers a highly versatile and easy method to convert commercially available monoclonal antibodies into bioluminescent biosensors that provide a homogeneous alternative for the competitive immunoassay.
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Affiliation(s)
- Eva A van Aalen
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
| | - Joep J J Lurvink
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
| | - Leandra Vermeulen
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
| | - Benice van Gerven
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
| | - Yan Ni
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
| | - Remco Arts
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
| | - Maarten Merkx
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O. Box 513, Eindhoven 5600 MB, The Netherlands
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Charoensri S, Auchus RJ. A Contemporary Approach to the Diagnosis and Management of Adrenal Insufficiency. Endocrinol Metab (Seoul) 2024; 39:73-82. [PMID: 38253474 PMCID: PMC10901672 DOI: 10.3803/enm.2024.1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Adrenal insufficiency (AI) can be classified into three distinct categories based on its underlying causes: primary adrenal disorders, secondary deficiencies in adrenocorticotropin, or hypothalamic suppression from external factors, most commonly glucocorticoid medications used for anti-inflammatory therapy. The hallmark clinical features of AI include fatigue, appetite loss, unintentional weight loss, low blood pressure, and hyponatremia. Individuals with primary AI additionally manifest skin hyperpigmentation, hyperkalemia, and salt craving. The diagnosis of AI is frequently delayed due to the non-specific symptoms and signs early in the disease course, which poses a significant challenge to its early detection prior to an adrenal crisis. Despite the widespread availability of lifesaving glucocorticoid medications for decades, notable challenges persist, particularly in the domains of timely diagnosis while simultaneously avoiding misdiagnosis, patient education for averting adrenal crises, and the determination of optimal replacement therapies. This article reviews recent advancements in the contemporary diagnostic strategy and approaches to optimal treatment for AI.
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Affiliation(s)
- Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Richard J. Auchus
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
- Endocrinology & Metabolism Section, Medicine Service, LTC Charles S. Kettles VA Medical Center, Ann Arbor, MI, USA
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Ciancia S, van den Berg SAA, van den Akker ELT. The Reliability of Salivary Cortisol Compared to Serum Cortisol for Diagnosing Adrenal Insufficiency with the Gold Standard ACTH Stimulation Test in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1569. [PMID: 37761530 PMCID: PMC10527706 DOI: 10.3390/children10091569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/03/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
The ACTH (adrenocorticotropic hormone) stimulation test is the gold standard for the diagnosis of adrenal insufficiency (AI), performed with ACTH high dose (HDT) or low dose (LDT). As salivary cortisol has been proposed as an alternative to serum cortisol, our aim was to evaluate the reliability of salivary cortisol compared to serum cortisol for diagnosing AI in children. Data were collected retrospectively. Salivary and serum cortisol values derived by 80 ACTH stimulation tests were obtained (39 F, 36 M; median age 11.5 years, IQR 6.9). Sampling was performed at baseline and after 30 and 60 min from ACTH administration during the HDT, and at baseline and 10, 20, 30, 40 and 60 min after the stimulation for the LDT. A serum cortisol level > 420 nmol/L ruled out AI. The correlation coefficients between serum and salivary cortisol for the HDT (n = 24) were 0.80 at t0, 0.48 at t30 and 0.75 at t60. All patients were adrenal sufficient. In 41% of the LDT, peak serum cortisol indicated insufficient adrenal function. The correlation coefficients between serum and salivary cortisol were 0.59 at t0 and 0.33 at the peak. For a cut-off of salivary cortisol < 15 nmol/L, sensitivity was 73.9% and specificity 69.6%. Our data do not support salivary cortisol as a valid alternative to serum cortisol during LDT. Regarding the HDT, results are more encouraging, however, further studies are needed.
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Affiliation(s)
- Silvia Ciancia
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Center, 3015 Rotterdam, The Netherlands
| | - Sjoerd A. A. van den Berg
- Department of Clinical Chemistry, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Erica L. T. van den Akker
- Division of Endocrinology, Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, University Medical Center, 3015 Rotterdam, The Netherlands
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Dong W, Ding Z, Wu X, Wan R, Liu Y, Pei L, Zhu W. The association between neuropeptide oxytocin and neuropsychiatric disorders after orthopedic surgery stress in older patients. BMC Geriatr 2023; 23:416. [PMID: 37420191 PMCID: PMC10329356 DOI: 10.1186/s12877-023-03989-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/22/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The health outcomes of geriatric patients exposed to surgery were found to be enhanced by social support and stress management. The aim of this study was to characterise the relationship between oxytocin and neuropsychiatric disorders after surgery. METHODS A total of 132 geriatric patients aged ≥ 60 years received orthopedic surgery in the First Affiliated Hospital of Harbin Medical University (Harbin, China) were enrolled in the present study. The salivary levels of stress hormone cortisol and oxytocin were measured by enzyme-linked immunosorbent assay for the screening of the stress state and oxytocin function. Moreover, the Depression Anxiety and Stress Scale (DASS), the Geriatric Anxiety Inventory (GAI), the Geriatric Depression Scale (GDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were conducted to identify the severity of anxiety and depression. The association between oxytocin and mental health was performed by linear regression analyses in older patients receiving orthopedic surgery. Finally, the Duke Social Support Index (DSSI) was selected to measure the social support and the potential link to mental outcomes. RESULTS The scores from questionnaires showed that female patients with higher social support and higher levels of oxytocin demonstrated better stress-reducing responses as reflected by lower cortisol and decreased anxiety and depression symptoms. Regression analyses revealed that there was a significant association between oxytocin and scores in DASS, GAI, GDS, MADRS and DSSI, suggesting a potential link between peripheral oxytocin function and mood outcomes after orthopedic surgery. CONCLUSIONS Our findings reveal that oxytocin enhances the stress-protective effects of social support and reduces anxiety and depression states under stressful circumstances, particularly in older women receiving orthopedic surgery.
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Affiliation(s)
- Wanru Dong
- Drug Safety Evaluation Center, Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Zengbo Ding
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China
| | - Xiao Wu
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China
| | - Ran Wan
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Ying Liu
- College of Pharmacy, Hainan Medical College, Haikou, 570100, China
| | - Liubao Pei
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Weili Zhu
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, 100191, China.
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Abstract
PURPOSE OF REVIEW Adrenal insufficiency (AI) is the clinical manifestation of deficient production of glucocorticoids with occasionally deficiency also in mineralocorticoids and adrenal androgens and constitutes a fatal disorder if left untreated. The aim of this review is to summarize the new trends in diagnostic methods used for determining the presence of AI. RECENT FINDINGS Novel aetiologies of AI have emerged; severe acute respiratory syndrome coronavirus 2 infection was linked to increased frequency of primary AI (PAI). A new class of drugs, the immune checkpoint inhibitors (ICIs) widely used for the treatment of several malignancies, has been implicated mostly with secondary AI, but also with PAI. Salivary cortisol is considered a noninvasive and patient-friendly tool and has shown promising results in diagnosing AI, although the normal cut-off values remain an issue of debate depending on the technique used. Liquid chromatography-mass spectrometry (LC-MS/MS) is the most reliable technique although not widely available. SUMMARY Our research has shown that little progress has been made regarding our knowledge on AI. Coronavirus disease 2019 and ICIs use constitute new evidence on the pathogenesis of AI. The short synacthen test (SST) remains the 'gold-standard' method for confirmation of AI diagnosis, although salivary cortisol is a promising tool.
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Affiliation(s)
- Vasiliki Siampanopoulou
- Endocrinology Unit, First Department of Internal Medicine, Laiko General Hospital of Athens, National and Kapodistrian University of Athens, Athens
| | - Elisavet Tasouli
- First Department of Internal Medicine, Thriasio General Hospital of Elefsina, Elefsina, Greece
| | - Anna Angelousi
- Endocrinology Unit, First Department of Internal Medicine, Laiko General Hospital of Athens, National and Kapodistrian University of Athens, Athens
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Tan SYT, Tan HC, Zhu L, Loh LM, Lim DST, Swee DS, Chan YL, Lim HB, Ling SL, Ou EJ, Teo WE, Zhang XP, Goh HF, Kek PC. Expanding the use of salivary cortisol as a non-invasive outpatient test in the dynamic evaluation of suspected adrenal insufficiency. Endocr Connect 2023; 12:e230004. [PMID: 36799247 PMCID: PMC10083658 DOI: 10.1530/ec-23-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 02/18/2023]
Abstract
Background Adrenal insufficiency (AI) is potentially life-threatening, and accurate diagnosis is crucial. The first-line diagnostic test, the adrenocorticotrophic hormone (ACTH) stimulation test, measures serum total cortisol. However, this is affected in states of altered albumin or cortisol-binding globulin levels, limiting reliability. Salivary cortisol reflects free bioactive cortisol levels and is a promising alternative. However, few studies are available, and heterogenous methodologies limit applicability. Methods This study prospectively recruited 42 outpatients undergoing evaluation for AI, excluding participants with altered cortisol-binding states. Serum (immunoassay) and salivary (liquid chromatography tandem mass spectrometry) cortisol levels were sampled at baseline, 30 min, and 60 min following 250 µg synacthen administration. AI was defined as a peak serum cortisol level <500 nmol/L in accordance with guidelines. Results The study recruited 21 (50%) participants with AI and 21 without AI. There were no significant differences in baseline characteristics, blood pressure, or sodium levels between groups. Following synacthen stimulation, serum and salivary cortisol levels showed good correlation at all timepoints (R2 = 0.74, P < 0.001), at peak levels (R2 = 0.72, P < 0.001), and at 60 min (R2 = 0.72, P < 0.001). A salivary cortisol cut-off of 16.0 nmol/L had a sensitivity of 90.5% and a specificity of 76.2% for the diagnosis of AI. Conclusion This study demonstrates a good correlation between serum and salivary cortisol levels during the 250 µg synacthen test. A peak salivary cortisol cut-off of 16.0 nmol/L can be used for the diagnosis of AI. It is a less invasive alternative to evaluate patients with suspected AI. Its potential utility in the diagnosis of AI in patients with altered cortisol-binding states should be further studied.
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Affiliation(s)
| | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Ling Zhu
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Lih Ming Loh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | | | - Du Soon Swee
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Yoke Ling Chan
- Department of Speciality Nursing, Singapore General Hospital, Singapore
| | - Huee Boon Lim
- Department of Speciality Nursing, Singapore General Hospital, Singapore
| | - Shiau Lee Ling
- Department of Speciality Nursing, Singapore General Hospital, Singapore
| | - En Jun Ou
- Department of Speciality Nursing, Singapore General Hospital, Singapore
| | - Wynn Ee Teo
- Department of Speciality Nursing, Singapore General Hospital, Singapore
| | - Xiao Ping Zhang
- Department of Speciality Nursing, Singapore General Hospital, Singapore
| | - Hui Fen Goh
- Department of Speciality Nursing, Singapore General Hospital, Singapore
| | - Peng Chin Kek
- Department of Endocrinology, Singapore General Hospital, Singapore
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van Smeden L, Saris A, Sergelen K, de Jong AM, Yan J, Prins MWJ. Reversible Immunosensor for the Continuous Monitoring of Cortisol in Blood Plasma Sampled with Microdialysis. ACS Sens 2022; 7:3041-3048. [PMID: 36255855 PMCID: PMC9623578 DOI: 10.1021/acssensors.2c01358] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cortisol is a steroid hormone involved in a wide range of medical conditions. The level of the hormone fluctuates over time, but with traditional laboratory-based assays, such dynamics cannot be monitored in real time. Here, a reversible cortisol sensor is reported that allows continuous monitoring of cortisol in blood plasma using sampling by microdialysis. The sensor is based on measuring single-molecule binding and unbinding events of tethered particles. The particles are functionalized with antibodies and the substrate with cortisol-analogues, causing binding and unbinding events to occur between particles and substrate. The frequency of binding events is reduced when cortisol is present in the solution as it blocks the binding sites of the antibodies. The sensor responds to cortisol in the high nanomolar to low micromolar range and can monitor cortisol concentrations over multiple hours. Results are shown for cortisol monitoring in filtered and in microdialysis-sampled human blood plasma.
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Affiliation(s)
- Laura van Smeden
- Department
of Biomedical Engineering, Eindhoven University
of Technology, 5600 MBEindhoven, The Netherlands,Institute
for Complex Molecular Systems (ICMS), Eindhoven
University of Technology, 5600 MBEindhoven, The Netherlands
| | - Annet Saris
- Department
of Biomedical Engineering, Eindhoven University
of Technology, 5600 MBEindhoven, The Netherlands
| | - Khulan Sergelen
- Department
of Biomedical Engineering, Eindhoven University
of Technology, 5600 MBEindhoven, The Netherlands,Institute
for Complex Molecular Systems (ICMS), Eindhoven
University of Technology, 5600 MBEindhoven, The Netherlands
| | - Arthur M. de Jong
- Department
of Applied Physics, Eindhoven University
of Technology, 5600 MBEindhoven, The Netherlands,Institute
for Complex Molecular Systems (ICMS), Eindhoven
University of Technology, 5600 MBEindhoven, The Netherlands
| | - Junhong Yan
- Helia
Biomonitoring, De Lismortel
31, 5612 AREindhoven, The Netherlands
| | - Menno W. J. Prins
- Department
of Biomedical Engineering, Eindhoven University
of Technology, 5600 MBEindhoven, The Netherlands,Department
of Applied Physics, Eindhoven University
of Technology, 5600 MBEindhoven, The Netherlands,Institute
for Complex Molecular Systems (ICMS), Eindhoven
University of Technology, 5600 MBEindhoven, The Netherlands,Helia
Biomonitoring, De Lismortel
31, 5612 AREindhoven, The Netherlands,
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Abstract
Accurate measurement of cortisol is critical in adrenal insufficiency as it reduces the risk associated with misdiagnosis and supports the optimization of stress dose. Comprehensive assays have been developed to determine the levels of bioactive free cortisol and their clinical and analytical efficacies have been extensively discussed because the level of total cortisol is affected by changes in the structure or circulating levels of corticoid-binding globulin and albumin, which are the main reservoirs of cortisol in the human body. Antibody-based immunoassays are routinely used in clinical laboratories; however, the lack of molecular specificity in cortisol assessment limits their applicability to characterize adrenocortical function. Improved specificity and sensitivity can be achieved by mass spectrometry coupled with chromatographic separation methods, which is a cutting-edge technology to measure individual as well as a panel of steroids in a single analytical run. The purpose of this review is to introduce recent advances in free cortisol measurement from the perspectives of clinical specimens and issues associated with prospective analytical technologies.
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Affiliation(s)
- Man Ho Choi
- Center for Advanced Biomolecular Recognition, Korea Institute of Science and Technology, Seoul, Korea
- Corresponding author: Man Ho Choi. Center for Advanced Biomolecular Recognition, Korea Institute of Science and Technology, 5 Hwarang-ro 14-gil, Seongbuk-gu, Seoul 02792, Korea Tel: +82-2-958-5081, Fax: +82-2-958-5059, E-mail:
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Lobato M, Gaspar-Marques J, Carreiro-Martins P, Leiria-Pinto P. Secondary adrenal suppression related to high doses of inhaled corticosteroids in patients with severe asthma. Ann Allergy Asthma Immunol 2022; 128:464-466. [PMID: 35007743 DOI: 10.1016/j.anai.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/26/2021] [Accepted: 01/01/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Mariana Lobato
- Allergy and Clinical Immunology Department of Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central (CHULC) EPE, Lisbon, Portugal.
| | - João Gaspar-Marques
- Allergy and Clinical Immunology Department of Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central (CHULC) EPE, Lisbon, Portugal; NOVA Medical School-Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Pedro Carreiro-Martins
- Allergy and Clinical Immunology Department of Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central (CHULC) EPE, Lisbon, Portugal; NOVA Medical School-Comprehensive Health Research Center (CHRC), Lisbon, Portugal
| | - Paula Leiria-Pinto
- Allergy and Clinical Immunology Department of Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central (CHULC) EPE, Lisbon, Portugal; NOVA Medical School-Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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Mifsud S, Gauci Z, Gruppetta M, Mallia Azzopardi C, Fava S. Adrenal insufficiency in HIV/AIDS: a review. Expert Rev Endocrinol Metab 2021; 16:351-362. [PMID: 34521306 DOI: 10.1080/17446651.2021.1979393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/24/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Adrenal insufficiency (AI) is one of the most common potentially life-threatening endocrine complications in people living with human immunodeficiency virus (PLHIV) infection and acquired immunodeficiency syndrome (AIDS). AREAS COVERED In this review, the authors explore the definitions of relative AI, primary AI, secondary AI and peripheral glucocorticoid resistance in PLHIV. It also focuses on the pathophysiology, etiology, diagnosis and management of this endocrinopathy in PLHIV. A literature review was conducted through Medline and Google Scholar search on the subject. EXPERT OPINION Physicians need to be aware of the endocrinological implications of HIV infection and its treatment, especially CYP3A4 enzyme inhibitors. A high index of clinical suspicion is needed in the detection of AI, especially in PLHIV, as it may present insidiously with nonspecific signs and symptoms and may be potentially life threatening if left untreated. Patients with overt primary and secondary AI require glucocorticoid replacement therapy. Overt primary AI also necessitates mineralocorticoid replacement. On the other hand, the management of relative AI remains controversial. In order to reduce the risk of adrenal crisis during periods of stress, the short-term use of glucocorticoids may be necessary in relative AI.
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Affiliation(s)
- Simon Mifsud
- Department of Diabetes, Endocrinology and General Medicine, Mater Dei Hospital, Msida, Malta
| | - Zachary Gauci
- Department of Diabetes, Endocrinology and General Medicine, Mater Dei Hospital, Msida, Malta
| | - Mark Gruppetta
- Department of Diabetes, Endocrinology and General Medicine, Mater Dei Hospital, Msida, Malta
| | | | - Stephen Fava
- Department of Diabetes, Endocrinology and General Medicine, Mater Dei Hospital, Msida, Malta
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