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[PMID]:28614010
[Au] Autor:Struja T; Briner L; Meier A; Kutz A; Mundwiler E; Huber A; Mueller B; Bernasconi L; Schuetz P
[Ti] Título:DIAGNOSTIC ACCURACY OF BASAL CORTISOL LEVEL TO PREDICT ADRENAL INSUFFICIENCY IN COSYNTROPIN TESTING: RESULTS FROM AN OBSERVATIONAL COHORT STUDY WITH 804 PATIENTS.
[So] Source:Endocr Pract;23(8):949-961, 2017 Aug.
[Is] ISSN:1530-891X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Adrenocorticotrophic hormone (ACTH) stimulation testing is the current standard for assessing primary and secondary adrenal insufficiency (AI). We aimed to investigate the value of basal cortisol level for prediction of AI. METHODS: We retrospectively analyzed 804 consecutive patients who had high-dose (250 µg, HDT) or low-dose (1 µg, LDT) ACTH testing as part of their diagnostic work-up. Site-specific cut-off levels for AI were <550 in and <500 nmol/L in HDT and LDT, respectively. RESULTS: Overall, 70/400 (17.5%) in the LDT group and 118/404 (29.2%) in the HDT group showed an insufficient increase of cortisol and were categorized as AI. The receiver operating characteristic curve analysis showed an overall area under the curve (AUC) for basal cortisol of 0.88, which was comparable in LDT (area under the curve [AUC] 0.88) and HDT (AUC 0.88). If basal cortisol levels were ≥450 nmol/L (n = 234/804, 29.1%), the negative predictive value to rule out AI was 98.7%. If cortisol was ≤100 nmol/L (n = 69/804, 8.6%) the positive predictive value was 93.2% to rule in AI. There was a minimal additional value of the 30-minute cortisol level in HDT as compared to the 60-minute result, as well as for delta values. CONCLUSION: Basal cortisol levels ≤100 and ≥450 nmol/L were found in almost half of patients tested for possible AI and had high diagnostic accuracy, abolishing the need for formal ACTH testing. The 30-minute cortisol value in HDT did not increase diagnostic accuracy. These data may help guide clinicians when testing can safely be omitted, thereby reducing expenses and simplifying test protocols. ABBREVIATIONS: ACTH = adrenocorticotropic hormone AI = adrenal insufficiency AUC = area under the curve CI = confidence interval HDT = high-dose test HPA axis = hypothalamus-pituitary-adrenal axis ITT = insulin tolerance test LDT = low-dose test NR = normal responders LR+/- = positive/negative likelihood ratio NPV = negative predictive value PPV = positive predictive value.
[Mh] Termos MeSH primário: Insuficiência Adrenal/diagnóstico
Hidrocortisona/sangue
[Mh] Termos MeSH secundário: Insuficiência Adrenal/sangue
Hormônio Adrenocorticotrópico
Adulto
Idoso
Área Sob a Curva
Estudos de Coortes
Cosintropina
Feminino
Seres Humanos
Masculino
Meia-Idade
Valor Preditivo dos Testes
Curva ROC
Estudos Retrospectivos
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
16960-16-0 (Cosyntropin); 9002-60-2 (Adrenocorticotropic Hormone); WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE
[do] DOI:10.4158/EP171861.OR


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[PMID]:28420172
[Au] Autor:Buffolo F; Monticone S; Williams TA; Rossato D; Burrello J; Tetti M; Veglio F; Mulatero P
[Ad] Endereço:Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126 Torino, Italy. fabrizio.buffolo@gmail.com.
[Ti] Título:Subtype Diagnosis of Primary Aldosteronism: Is Adrenal Vein Sampling Always Necessary?
[So] Source:Int J Mol Sci;18(4), 2017 Apr 17.
[Is] ISSN:1422-0067
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:Aldosterone producing adenoma and bilateral adrenal hyperplasia are the two most common subtypes of primary aldosteronism (PA) that require targeted and distinct therapeutic approaches: unilateral adrenalectomy or lifelong medical therapy with mineralocorticoid receptor antagonists. According to the 2016 Endocrine Society Guideline, adrenal venous sampling (AVS) is the gold standard test to distinguish between unilateral and bilateral aldosterone overproduction and therefore, to safely refer patients with PA to surgery. Despite significant advances in the optimization of the AVS procedure and the interpretation of hormonal data, a standardized protocol across centers is still lacking. Alternative methods are sought to either localize an aldosterone producing adenoma or to predict the presence of unilateral disease and thereby substantially reduce the number of patients with PA who proceed to AVS. In this review, we summarize the recent advances in subtyping PA for the diagnosis of unilateral and bilateral disease. We focus on the developments in the AVS procedure, the interpretation criteria, and comparisons of the performance of AVS with the alternative methods that are currently available.
[Mh] Termos MeSH primário: Glândulas Suprarrenais/irrigação sanguínea
Glândulas Suprarrenais/patologia
Hiperaldosteronismo/diagnóstico
Veias/patologia
[Mh] Termos MeSH secundário: Glândulas Suprarrenais/efeitos dos fármacos
Animais
Biópsia/métodos
Cosintropina/farmacologia
Diagnóstico Diferencial
Seres Humanos
Hiperaldosteronismo/etiologia
Hiperaldosteronismo/metabolismo
Imagem por Ressonância Magnética
Reprodutibilidade dos Testes
Sensibilidade e Especificidade
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
16960-16-0 (Cosyntropin)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170629
[Lr] Data última revisão:
170629
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170420
[St] Status:MEDLINE


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[PMID]:28132968
[Au] Autor:Kishino M; Yoshimoto T; Nakadate M; Katada Y; Kanda E; Nakaminato S; Saida Y; Ogawa Y; Tateishi U
[Ad] Endereço:Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
[Ti] Título:Optimization of left adrenal vein sampling in primary aldosteronism: Coping with asymmetrical cortisol secretion.
[So] Source:Endocr J;64(3):347-355, 2017 Mar 31.
[Is] ISSN:1348-4540
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:We evaluated the influence of catheter sampling position and size on left adrenal venous sampling (AVS) in patients with primary aldosteronism (PA) and analyzed their relationship to cortisol secretion. This retrospective study included 111 patients with a diagnosis of primary aldosteronism who underwent tetracosactide-stimulated AVS. Left AVS was obtained from two catheter positions - the central adrenal vein (CAV) and the common trunk. For common trunk sampling, 5-French catheters were used in 51 patients, and microcatheters were used in 60 patients. Autonomous cortisol secretion was evaluated with a low-dose dexamethasone suppression test in 87 patients. The adrenal/inferior vena cava cortisol concentration ratio [selectivity index (SI)] was significantly lower in samples from the left common trunk than those of the left CAV and right adrenal veins, but this difference was reduced when a microcatheter was used for common trunk sampling. Sample dilution in the common trunk of the left adrenal vein can be decreased by limiting sampling speed with the use of a microcatheter. Meanwhile, there was no significant difference in SI between the left CAV and right adrenal veins. Laterality, determined according to aldosterone/cortisol ratio (A/C ratio) based criteria, showed good reproducibility regardless of sampling position, unlike the absolute aldosterone value based criteria. However, in 11 cases with autonomous cortisol co-secretion, the cortisol hypersecreting side tended to be underestimated when using A/C ratio based criteria. Left CAV sampling enables symmetrical sampling, and may be essential when using absolute aldosterone value based criteria in cases where symmetrical cortisol secretion is uncertain.
[Mh] Termos MeSH primário: Glândulas Suprarrenais/irrigação sanguínea
Aldosterona/sangue
Cateterismo/instrumentação
Hidrocortisona/sangue
Hiperaldosteronismo/sangue
Flebotomia/instrumentação
[Mh] Termos MeSH secundário: Neoplasias do Córtex Suprarrenal/diagnóstico
Neoplasias do Córtex Suprarrenal/fisiopatologia
Neoplasias do Córtex Suprarrenal/secreção
Glândulas Suprarrenais/efeitos dos fármacos
Glândulas Suprarrenais/secreção
Adenoma Adrenocortical/diagnóstico
Adenoma Adrenocortical/fisiopatologia
Adenoma Adrenocortical/secreção
Aldosterona/agonistas
Aldosterona/secreção
Doenças Assintomáticas
Cosintropina/farmacologia
Síndrome de Cushing/diagnóstico
Síndrome de Cushing/fisiopatologia
Dexametasona/farmacologia
Diagnóstico Diferencial
Feminino
Seres Humanos
Hidrocortisona/antagonistas & inibidores
Hidrocortisona/secreção
Hiperaldosteronismo/etiologia
Hiperaldosteronismo/metabolismo
Hiperaldosteronismo/fisiopatologia
Masculino
Meia-Idade
Reprodutibilidade dos Testes
Estudos Retrospectivos
Índice de Gravidade de Doença
Veias
Veia Cava Inferior
[Pt] Tipo de publicação:COMPARATIVE STUDY; EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
16960-16-0 (Cosyntropin); 4964P6T9RB (Aldosterone); 7S5I7G3JQL (Dexamethasone); WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170131
[St] Status:MEDLINE
[do] DOI:10.1507/endocrj.EJ16-0433


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[PMID]:28124663
[Au] Autor:Perton FT; Mijnhout GS; Kollen BJ; Rondeel JM; Franken AA; Groeneveld PH
[Ad] Endereço:Department of Internal Medicine, Isala, Zwolle, the Netherlands.
[Ti] Título:Validation of the 1 µg short synacthen test: an assessment of morning cortisol cut-off values and other predictors.
[So] Source:Neth J Med;75(1):14-20, 2017 Jan.
[Is] ISSN:1872-9061
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Clinical practice shows that many low-dose short synacthen tests (LD-SSTs) for diagnosing adrenal insufficiency in an outpatient setting have a normal outcome and could be considered superfluous. The objective of this study is to provide a guideline to safely reduce the number of unnecessarily performed LD-SSTs. METHODS: Data of LD-SSTs performed in outpatients were collected. Optimal morning cortisol cut-off values were determined using ROC analysis. Subsequently the predictive value of several variables was tested using univariable and multivariable logistic regression analyses. RESULTS: A morning cortisol lower cut-off value of 145 nmol/l (specificity 89.9%, positive predictive value 90.0%) and an upper cut-off value of 375 nmol/l (sensitivity 100.0%, negative predictive value 100.0%) were found. Chronic fatigue symptoms and symptoms of hypotension or orthostasis as the main reason for performing the test predict a normal outcome. The use of glucocorticosteroids predicts an abnormal outcome of the LD-SST. Oral, topical, nasal and inhaled glucocorticosteroids are each significant predictors when analysed specifically for predicting central adrenal insufficiency. CONCLUSION: By using morning cortisol cut-off values of 145 nmol/l and 375 nmol/l instead of the conventional cut-off values, the number of LD-SSTs performed in an outpatient setting can be reduced by 12%, while maintaining high sensitivity and specificity. Furthermore, the outcome of the LD-SST can be predicted by additional variables such as the indication for performing the test and the use of glucocorticosteroids. Different routes of administration of glucocorticosteroids such as inhalation or topical use should be taken into account when central insufficiency is suspected.
[Mh] Termos MeSH primário: Insuficiência Adrenal/diagnóstico
Cosintropina/administração & dosagem
Hormônios/administração & dosagem
Hidrocortisona/sangue
[Mh] Termos MeSH secundário: Insuficiência Adrenal/sangue
Adulto
Feminino
Glucocorticoides/efeitos adversos
Seres Humanos
Masculino
Meia-Idade
Valor Preditivo dos Testes
Curva ROC
Valores de Referência
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Nm] Nome de substância:
0 (Glucocorticoids); 0 (Hormones); 16960-16-0 (Cosyntropin); WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170127
[St] Status:MEDLINE


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[PMID]:27861246
[Au] Autor:Durivage C; Blanchette R; Soulez G; Chagnon M; Gilbert P; Giroux MF; Bourdeau I; Oliva VL; Lacroix A; Therasse E
[Ad] Endereço:aDepartment of Radiology, Centre hospitalier de l'Université de Montréal [CHUM] bCentre de recherche, CHUM [CRCHUM] cDepartment of Mathematics and Statistic, University of Montreal dDivision of Endocrinology, Department of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada.
[Ti] Título:Adrenal venous sampling in primary aldosteronism: multinomial regression modeling to detect aldosterone secretion lateralization when right adrenal sampling is missing.
[So] Source:J Hypertens;35(2):362-368, 2017 Feb.
[Is] ISSN:1473-5598
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Difficulty to recognize or canulate the right adrenal vein is the most frequent cause of adrenal venous sampling (AVS) failure. We aimed to assess multinomial regression modeling (MRM) of peripheral and left adrenal vein samplings to detect lateralization of aldosterone secretion when the right AVS is missing. METHODS: Simultaneous bilateral AVS samplings were performed before (basal) and after intravenous cosyntropin injection in 188 consecutive patients between December 1989 and September 2015. Different reference standards for lateralization of aldosterone secretion were defined for basal and for postcosyntropin AVS and according to lateralization index cutoffs at least 2 and at least 4. MRMs were built to detect lateralization of aldosterone secretion according to these reference standards using only peripheral and left adrenal veins samplings (without the right AVS). Detection accuracy was assessed by the area under the receiver operating characteristic (AUROC) curves and detection sensitivities were reported for specificity at least 95%. RESULTS: For basal AVS with lateralization index at least 2, AUROC were respectively 0.931 [95% confidence interval (CI) 0.894-0.968] and 0.922 (95% CI 0.882-0.962) for right and left lateralization of aldosterone secretion detection and MRM could detect respectively 65.5 and 62.7% of the right and left lateralization of aldosterone secretion. For AVS after cosyntropin with lateralization index at least 4, AUROC were respectively 0.964 (95% CI: 0.940-0.987) and 0.955 (95% CI: 0.927-0.983) for right and left lateralization of aldosterone secretion, and MRM could detect respectively 77.2 and 72.9% of the right and left lateralization of aldosterone secretion. CONCLUSION: MRM can detect lateralization of aldosterone secretion without the right AVS in most patients and could eliminate the need for repeat AVS when right adrenal vein canulation is nonselective or impossible.
[Mh] Termos MeSH primário: Glândulas Suprarrenais/irrigação sanguínea
Aldosterona/secreção
Hiperaldosteronismo/sangue
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Área Sob a Curva
Cosintropina/farmacologia
Feminino
Hormônios/farmacologia
Seres Humanos
Hiperaldosteronismo/diagnóstico
Masculino
Meia-Idade
Curva ROC
Análise de Regressão
Estudos Retrospectivos
Veias
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hormones); 16960-16-0 (Cosyntropin); 4964P6T9RB (Aldosterone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161119
[St] Status:MEDLINE
[do] DOI:10.1097/HJH.0000000000001165


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[PMID]:27838190
[Au] Autor:O'Callaghan FJ; Edwards SW; Alber FD; Hancock E; Johnson AL; Kennedy CR; Likeman M; Lux AL; Mackay M; Mallick AA; Newton RW; Nolan M; Pressler R; Rating D; Schmitt B; Verity CM; Osborne JP; participating investigators
[Ad] Endereço:Institute of Child Health, University College London, London, UK; Children's Department, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK. Electronic address: f.o'callaghan@ucl.ac.uk.
[Ti] Título:Safety and effectiveness of hormonal treatment versus hormonal treatment with vigabatrin for infantile spasms (ICISS): a randomised, multicentre, open-label trial.
[So] Source:Lancet Neurol;16(1):33-42, 2017 Jan.
[Is] ISSN:1474-4465
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Infantile spasms constitutes a severe infantile epilepsy syndrome that is difficult to treat and has a high morbidity. Hormonal therapies or vigabatrin are the most commonly used treatments. We aimed to assess whether combining the treatments would be more effective than hormonal therapy alone. METHODS: In this multicentre, open-label randomised trial, 102 hospitals (Australia [three], Germany [11], New Zealand [two], Switzerland [three], and the UK [83]) enrolled infants who had a clinical diagnosis of infantile spasms and a hypsarrhythmic (or similar) EEG no more than 7 days before enrolment. Participants were randomly assigned (1:1) by a secure website to receive hormonal therapy with vigabatrin or hormonal therapy alone. If parents consented, there was an additional randomisation (1:1) of type of hormonal therapy used (prednisolone or tetracosactide depot). Block randomisation was stratified for hormonal treatment and risk of developmental impairment. Parents and clinicians were not masked to therapy, but investigators assessing electro-clinical outcome were masked to treatment allocation. Minimum doses were prednisolone 10 mg four times a day or intramuscular tetracosactide depot 0·5 mg (40 IU) on alternate days with or without vigabatrin 100 mg/kg per day. The primary outcome was cessation of spasms, which was defined as no witnessed spasms on and between day 14 and day 42 from trial entry, as recorded by parents and carers in a seizure diary. Analysis was by intention to treat. The trial is registered with The International Standard Randomised Controlled Trial Number (ISRCTN), number 54363174, and the European Union Drug Regulating Authorities Clinical Trials (EUDRACT), number 2006-000788-27. FINDINGS: Between March 7, 2007, and May 22, 2014, 766 infants were screened and, of those, 377 were randomly assigned to hormonal therapy with vigabatrin (186) or hormonal therapy alone (191). All 377 infants were assessed for the primary outcome. Between days 14 and 42 inclusive no spasms were witnessed in 133 (72%) of 186 patients on hormonal therapy with vigabatrin compared with 108 (57%) of 191 patients on hormonal therapy alone (difference 15·0%, 95% CI 5·1-24·9, p=0·002). Serious adverse reactions necessitating hospitalisation occurred in 33 infants (16 on hormonal therapy alone and 17 on hormonal therapy with vigabatrin). The most common serious adverse reaction was infection occurring in five infants on hormonal therapy alone and four on hormonal therapy with vigabatrin. There were no deaths attributable to treatment. INTERPRETATION: Hormonal therapy with vigabatrin is significantly more effective at stopping infantile spasms than hormonal therapy alone. The 4 week period of spasm cessation required to achieve a primary clinical response to treatment suggests that the effect seen might be sustained, but this needs to be confirmed at the 18 month follow-up. FUNDING: The Castang Foundation, Bath Unit for Research in Paediatrics, National Institute of Health Research, the Royal United Hospitals Bath NHS Foundation Trust, the BRONNER-BENDUNG Stifung/Gernsbach, and University Children's Hospital Zurich.
[Mh] Termos MeSH primário: Anticonvulsivantes/uso terapêutico
Hormônios/uso terapêutico
Espasmos Infantis/tratamento farmacológico
Resultado do Tratamento
Vigabatrina/uso terapêutico
[Mh] Termos MeSH secundário: Cosintropina/uso terapêutico
Esquema de Medicação
Quimioterapia Combinada
Eletroencefalografia
Feminino
Seguimentos
Seres Humanos
Lactente
Masculino
Prednisolona/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anticonvulsants); 0 (Hormones); 16960-16-0 (Cosyntropin); 9PHQ9Y1OLM (Prednisolone); GR120KRT6K (Vigabatrin)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170526
[Lr] Data última revisão:
170526
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161114
[St] Status:MEDLINE


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[PMID]:27474252
[Au] Autor:Umakoshi H; Xiaomei Y; Ichijo T; Kamemura K; Matsuda Y; Fujii Y; Kai T; Fukuoka T; Sakamoto R; Ogo A; Suzuki T; Ogasawara T; Tsuiki M; Naruse M; WAVES-J Study Group
[Ad] Endereço:Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
[Ti] Título:Reassessment of the cosyntropin stimulation test in the confirmatory diagnosis and subtype classification of primary aldosteronism.
[So] Source:Clin Endocrinol (Oxf);86(2):170-176, 2017 Feb.
[Is] ISSN:1365-2265
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Although corticotropin is a representative secretagogue of aldosterone, the utility of the cosyntropin stimulation test (C-ST) in diagnosing primary aldosteronism (PA) has not been elucidated. Aim of the study was to evaluate the clinical utility of C-ST for confirmatory testing and subtype classification of PA. DESIGN, SETTING AND PATIENTS: In this retrospective study, we identified patients with hypertension and positive case-detection results for PA who underwent C-ST and saline infusion testing (SIT) between 2006 and 2013 at eight referral centres in Japan. PA and essential hypertension (EH) were distinguished based on SIT results. PA subtype classification was determined by adrenal venous sampling (AVS). Plasma aldosterone concentration (PAC) was measured before and 30 and 60 min after intravenous cosyntropin administration. The ability of C-ST to distinguish PA from EH and to distinguish unilateral from bilateral disease was assessed by the area under the receiver operating characteristic curve. RESULTS: Of 205 patients with hypertension and positive case-detection results, 139 (68%) had PA based on SIT results. Eighteen patients in whom AVS was unsuccessful were excluded from analysis. The baseline PAC before C-ST was significantly higher (P < 0·01) in patients with PA than in those with EH. However, the degree of difference in PAC between patients with PA and EH was not enhanced by the administration of cosyntropin. In addition, the administration of cosyntropin did not improve the distinction between bilateral and unilateral PA subtypes. CONCLUSIONS: C-ST has no utility as a confirmatory and subtype testing of PA when the diagnosis of PA is based on the positive results in SIT.
[Mh] Termos MeSH primário: Cosintropina/farmacologia
Técnicas de Diagnóstico Endócrino/normas
Hiperaldosteronismo/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Idoso
Diagnóstico Diferencial
Hipertensão Essencial
Feminino
Seres Humanos
Hiperaldosteronismo/classificação
Hipertensão
Masculino
Meia-Idade
Valor Preditivo dos Testes
Curva ROC
Estudos Retrospectivos
Sensibilidade e Especificidade
Cloreto de Sódio/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
16960-16-0 (Cosyntropin); 451W47IQ8X (Sodium Chloride)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160731
[St] Status:MEDLINE
[do] DOI:10.1111/cen.13167


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[PMID]:27537994
[Au] Autor:Lam LH; Sugarman JL
[Ti] Título:Adrenal Suppression With Chronic Topical Corticosteroid Use in Psoriasis Patients.
[So] Source:J Drugs Dermatol;15(8):945-8, 2016 Aug 01.
[Is] ISSN:1545-9616
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Topical corticosteroids (TCS) are typically used for extended periods of time for chronic skin conditions, including psoriasis. Chronic TCS use may result in side effects similar to those of systemic corticosteroids. Patients may have subclinical adrenal suppression and be unaware of their risk in the case of serious trauma.
OBJECTIVE: The objective of this study was to investigate the real world effects of chronic TCS use and its effects on adrenal suppression in a chronic disease such as psoriasis.
MATERIALS: This retrospective study utilized data from screening visits of a psoriasis clinical trial in which subjects had been on chronic TCS.
RESULTS: In this study, subjects with moderate to severe psoriasis affecting 16-20% of total body surface area (BSA) and using high-potency TCS at screening had a lower post-cosyntropin cortisol level (18.83 mcg/dL) compared to those with moderate psoriasis involving 10-15% of total BSA and using lower potency TCS at screening (23.22 mcg/dL; P=0.03). Both subject groups had lower post-cosyntropin cortisol levels compared to normal, healthy adults (P<0.001 for both).
CONCLUSION: This suggests that real world chronic use of high potency TCS over a larger BSA may result in silent adrenal suppression.

J Drugs Dermatol. 2016;15(8):945-948.
[Mh] Termos MeSH primário: Corticosteroides/sangue
Glucocorticoides/administração & dosagem
Psoríase/sangue
Psoríase/tratamento farmacológico
[Mh] Termos MeSH secundário: Administração Cutânea
Corticosteroides/antagonistas & inibidores
Adulto
Idoso
Superfície Corporal
Cosintropina/antagonistas & inibidores
Cosintropina/sangue
Esquema de Medicação
Feminino
Glucocorticoides/efeitos adversos
Seres Humanos
Hidrocortisona/antagonistas & inibidores
Hidrocortisona/sangue
Masculino
Meia-Idade
Psoríase/diagnóstico
Estudos Retrospectivos
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Glucocorticoids); 16960-16-0 (Cosyntropin); WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170425
[Lr] Data última revisão:
170425
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160819
[St] Status:MEDLINE


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[PMID]:27259503
[Au] Autor:Ben-Shlomo A; Guzman J; Mirocha J
[Ad] Endereço:Pituitary Center, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Davis Building, Room 3021, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA. anat.benshlomo@cshs.org.
[Ti] Título:Enhanced cosyntropin stimulation test performance enabled by electronic medical record.
[So] Source:Pituitary;19(5):503-6, 2016 Oct.
[Is] ISSN:1573-7403
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To improve performance of the cosyntropin stimulation test (CST) used for diagnosis of adrenal-cortisol insufficiency by implementing an electronic medical record (EMR) system protocol. METHODS: We implemented a SmartForm protocol of the validated CST in our EMR system (CS-Link™, EPIC) system and compared medical staff test performance before and after protocol implementation. RESULTS: Correct performance of the CST improved significantly after EMR implementation. The number of correctly performed CSTs increased from 16.1 % before to 53.5 % after implementation (p < 0.0001) while those performed incorrectly and were uninterpretable decreased from 36.2 to 7.1 % (p < 0.0001). This performance improvement result in a calculated cost savings of $50,414 for every 100 tests performed. CONCLUSIONS: The EMR system is useful for guiding medical staff to accurately perform the CST, reduce the number of wasted tests, and maximize staff time and resources.
[Mh] Termos MeSH primário: Testes de Função do Córtex Suprarrenal/normas
Cosintropina
Registros Eletrônicos de Saúde
[Mh] Termos MeSH secundário: Protocolos Clínicos
Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
16960-16-0 (Cosyntropin)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160605
[St] Status:MEDLINE
[do] DOI:10.1007/s11102-016-0731-4


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[PMID]:26995200
[Au] Autor:Dusková M; Simunková K; Vítku J; Sosvorová L; Jandíková H; Pospísilová H; Srámková M; Kosák M; Krsek M; Hána V; Zánová M; Springer D; Stárka L
[Ad] Endereço:Institute of Endocrinology, Prague, Czech Republic. mduskova@endo.cz.
[Ti] Título:A Comparison of Salivary Steroid Levels during Diagnostic Tests for Adrenal Insufficiency.
[So] Source:Prague Med Rep;117(1):18-33, 2016.
[Is] ISSN:1214-6994
[Cp] País de publicação:Czech Republic
[La] Idioma:eng
[Ab] Resumo:Numerous diagnostic tests are used to evaluate the hypothalamic-pituitary-adrenal axis (HPA axis). The gold standard is still considered the insulin tolerance test (ITT), but this test has many limitations. Current guidelines therefore recommend the Synacthen test first when an HPA axis insufficiency is suspected. However, the dose of Synacthen that is diagnostically most accurate and sensitive is still a matter of debate. We investigated 15 healthy men with mean/median age 27.4/26 (SD±4.8) years, and mean/median BMI (body mass index) 25.38/24.82 (SD±3.2) kg/m2. All subjects underwent 4 dynamic tests of the HPA axis, specifically 1 µg, 10 µg, and 250 µg Synacthen (ACTH) tests and an ITT. Salivary cortisol, cortisone, pregnenolone, and DHEA (dehydroepiandrosterone) were analysed using liquid chromatography-tandem mass spectrometry. During the ITT maximum salivary cortisol levels over 12.5 nmol/l were found at 60 minutes. Maximum cortisol levels in all of the Synacthen tests were higher than this; however, demonstrating that sufficient stimulation of the adrenal glands was achieved. Cortisone reacted similarly as cortisol, i.e. we did not find any change in the ratio of cortisol to cortisone. Pregnenolone and DHEA were higher during the ITT, and their peaks preceded the cortisol peak. There was no increase of pregnenolone or DHEA in any of the Synacthen tests. We demonstrate that the 10 µg Synacthen dose is sufficient stimulus for testing the HPA axis and is also a safe and cost-effective alternative. This dose also largely eliminates both false negative and false positive results.
[Mh] Termos MeSH primário: Insuficiência Adrenal/diagnóstico
Cosintropina/farmacologia
Desidroepiandrosterona/análise
Hidrocortisona/análise
Pregnenolona/análise
Saliva/metabolismo
[Mh] Termos MeSH secundário: Insuficiência Adrenal/metabolismo
Adulto
Cromatografia Líquida/métodos
Testes Diagnósticos de Rotina/métodos
Voluntários Saudáveis
Hormônios/farmacologia
Seres Humanos
Sistema Hipotálamo-Hipofisário/metabolismo
Masculino
Sistema Hipófise-Suprarrenal/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Hormones); 16960-16-0 (Cosyntropin); 459AG36T1B (Dehydroepiandrosterone); 73R90F7MQ8 (Pregnenolone); WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1606
[Cu] Atualização por classe:160321
[Lr] Data última revisão:
160321
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160321
[St] Status:MEDLINE
[do] DOI:10.14712/23362936.2016.2



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