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Bulan A, Pyle-Eilola AL, Mamilly L, Chaudhari M, Henry RK. The utility of a random cortisol level in determining neonatal central adrenal insufficiency. Clin Endocrinol (Oxf) 2023; 98:779-787. [PMID: 36859827 DOI: 10.1111/cen.14903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVES While it has been established within the first 4 months of life that there is no circadian rhythm, what is unclear is the usefulness of a random serum cortisol (rSC) level in determining neonatal central adrenal insufficiency (CAI). The objective of the study is to determine the utility of using rSC in infants less than 4 months old in the evaluation of CAI. DESIGN AND PATIENTS Retrospective chart review of infants who underwent a low dose cosyntropin stimulation test ≤4 months of life with rSC taken as baseline cortisol before stimulation. Infants were divided into three groups: those diagnosed with CAI, those at risk for CAI (ARF-CAI) and a non-CAI group. Mean rSC for each group was compared, and ROC analysis was used to identify rSC cut-off for the diagnosis of CAI. RESULTS Two hundred and fifty one infants with the mean age of 50.5 ± 38.08 days, and 37% of these were born at term gestation. The mean rSC were lower in the CAI group (1.98 ± 1.88 mcg/dl) as compared to the ARF-CAI (6.27 ± 5.48 mcg/dl, p = .002) and non-CAI (4.6 ± 4.02 mcg/dl, p = .007) groups. ROC analysis identified a cut-off of rSC level of 5.6 mcg/dL is associated with 42.6% sensitivity and 100% specificity for the diagnosis of CAI in term infants. CONCLUSIONS This study demonstrates that though an rSC can be used within the first 4 months of life, its value is best when done ≤30 days of life. Moreover, a diagnostic cut-off for CAI using rSC levels was identified for term infants.
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Affiliation(s)
- Ayse Bulan
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Amy L Pyle-Eilola
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Leena Mamilly
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Monika Chaudhari
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Rohan K Henry
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, Ohio, USA
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Feldman MA, Yardley HL, Bulan A, Kamboj MK. Role of Psychologists in Pediatric Endocrinology. Pediatr Clin North Am 2022; 69:905-916. [PMID: 36207101 DOI: 10.1016/j.pcl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The care of youth managed within pediatric endocrine clinics is complex and requires a multi- or interdisciplinary approach. Psychosocial aspects of chronic health conditions are well-documented. Clinical practice guidelines outline the importance of routine psychosocial screening and support for youth with diabetes and obesity. This article outlines the diverse role of psychologists in pediatric endocrinology, including screening, in-clinic intervention, outpatient psychological services, and inpatient consultation. Although research exists documenting the effectiveness of behavioral interventions to improve adherence and health-related quality of life, cost analysis research is emerging.
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Affiliation(s)
- Marissa A Feldman
- Department of Psychology, Johns Hopkins All Children's Hospital, Saint Petersburg, 880 Sixth Street South, Suite 460, Saint Petersburg, FL 33701, USA.
| | - Heather L Yardley
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Ayse Bulan
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Manmohan K Kamboj
- Section of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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Kintrup J, Perrey K, Weichert K, Bulan A, Weber R, Schmidt T. Carbon dioxide as feedstock for carbon monoxide production. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. Kintrup
- Covestro Deutschland AG Process Technology Geb. R17 Chempark 51373 Leverkusen Germany
| | - K. Perrey
- Covestro Deutschland AG Process Technology Geb. R17 Chempark 51373 Leverkusen Germany
| | - K. Weichert
- Covestro Deutschland AG Process Technology Geb. R17 Chempark 51373 Leverkusen Germany
| | - A. Bulan
- Covestro Deutschland AG Process Technology Geb. R17 Chempark 51373 Leverkusen Germany
| | - R. Weber
- Covestro Deutschland AG Process Technology Geb. R17 Chempark 51373 Leverkusen Germany
| | - T. Schmidt
- Covestro Deutschland AG Process Technology Geb. R17 Chempark 51373 Leverkusen Germany
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Gállego-Suárez C, Bulan A, Hirschfeld E, Wachowiak P, Abrishami S, Griffin C, Sturza J, Tzau A, Hayes T, Woolford SJ, Lumeng CN, Lee JM, Singer K. Enhanced Myeloid Leukocytes in Obese Children and Adolescents at Risk for Metabolic Impairment. Front Endocrinol (Lausanne) 2020; 11:327. [PMID: 32528415 PMCID: PMC7266967 DOI: 10.3389/fendo.2020.00327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/27/2020] [Indexed: 12/26/2022] Open
Abstract
Objective: We aimed to examine if myeloid leukocyte profiles are associated with metabolic impairment in children and adolescents with obesity, and if sex, age, or race influence this relationship. Methods: 282 children ages 8-17 were evaluated. Predictor measures were absolute neutrophil counts (ANC), absolute monocyte count, monocyte subtypes and C reactive protein (CRP). Outcome variables were waist circumference, fasting glucose and insulin, HOMA-IR, HbA1c (%) and lipid profiles. Pearson correlation coefficients were used to determine associations between predictor and outcome variables. Wilcoxon two-sample tests were used to evaluate differences by sex. Results: CRP (p < 0.0001), ANC (p < 0.0018), and classical monocytes (p = 0.05) were significantly higher in children with obesity. CRP, ANC and classical monocytes showed positive correlations with waist circumference, insulin, HOMA-IR and triglycerides. CRP was positively associated with ANC overall (p = 0.05). ANC demonstrated positive correlation with monocytes (p < 0.001). The associations between predictor and outcome variables were influenced by sex, race, and age. Conclusions: CRP and myeloid leukocyte populations, specifically classical monocytes and neutrophils associate with both body composition and metabolic parameters in children with obesity suggesting that these cells may play a critical role in metabolic impairment. Race, gender and age interactions between monocytes and metabolic parameters were significant.
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Affiliation(s)
- Cecilia Gállego-Suárez
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Ayse Bulan
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Emily Hirschfeld
- Department of Pediatrics, Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, United States
| | - Phillip Wachowiak
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Simin Abrishami
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Cameron Griffin
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Julie Sturza
- Woodson Biostatistics Consultation Program, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Abigail Tzau
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Taryn Hayes
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Susan J. Woolford
- Department of Pediatrics, Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, United States
| | - Carey N. Lumeng
- Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
- Graduate Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Joyce M. Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
- Department of Pediatrics, Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, United States
| | - Kanakadurga Singer
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
- Graduate Program in Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
- Graduate Program in Cellular and Molecular Biology, University of Michigan Medical School, Ann Arbor, MI, United States
- *Correspondence: Kanakadurga Singer
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