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Corticotropin Stimulation Test

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21. The Serotonergic Projection from the Median Raphe Nucleus to the Ventral Hippocampus is Involved in the Retrieval of Fear Memory Through the Corticotropin-Releasing Factor Type 2 Receptor. (PubMed)

The Serotonergic Projection from the Median Raphe Nucleus to the Ventral Hippocampus is Involved in the Retrieval of Fear Memory Through the Corticotropin-Releasing Factor Type 2 Receptor. Several different studies have separately established that serotonin, corticotropin-releasing factor (CRF) receptors, and the hippocampus are involved in fear memory retrieval. The main aim of this study is to connect these separate studies. To assess the levels of anxiety/fear, we used the contextual fear (...) -conditioning test and the elevated plus maze test as memory-dependent and memory-independent tasks, respectively. We injected CRF receptor antagonists or vehicle into the median raphe nucleus (MRN) 10 min before behavioral tests. As a result, 1000 ng of astressin 2B (CRF(2) receptor antagonist), but not 250 ng of antalarmin (CRF(1) receptor antagonist), significantly suppressed the expression rate of freezing behavior in the contextual fear-conditioning test. However, in the elevated plus maze test

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2010 Neuropsychopharmacology

22. Adrenal suppression

endogenous glucocorticoid excess (e.g., Cushing's syndrome after treatment). Even locally administered glucocorticoids may result in adrenal suppression. The adrenocorticotropic hormone stimulation test is generally the most useful test to detect adrenal suppression. Treatment consists of augmented corticosteroid therapy plus supportive care for any intercurrent stress or overt signs of adrenal insufficiency. Preventive measures include minimising corticosteroid dose and duration when possible (...) weeks non-physiological scheduling of glucocorticoid dose megestrol use medroxyprogesterone use Diagnostic investigations serum comprehensive chemistry panel serum a.m. cortisol salivary a.m. cortisol adrenocorticotropic hormone (ACTH) stimulation test insulin tolerance test (ITT) overnight metyrapone test urine synthetic glucocorticoids Treatment algorithm INITIAL ACUTE ONGOING Contributors Authors Associate Professor Department of Endocrinology Cleveland Clinic Foundation Cleveland OH Disclosures

2018 BMJ Best Practice

23. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association

to the pharmacological properties of the drug. Most clinical trials report the numbers of patients stopping the study medication because of any adverse event. The difference between the test agent and placebo is a good measure of the overall tolerability of the agent, provided that the blind remains secure throughout the trial. 1.2. Randomized Controlled Trials In the evaluation of the safety of a drug used long term, the most reliable data are derived from properly designed and conducted large, long-term, double (...) -blind, placebo-controlled randomized trials. The great advantage of this form of investigation is that bias is controlled by random allocation to treatment. There can still be random error, and sometimes other issues within the control of the investigator such as inadequate follow-up or ineffective blinding, but in a well-planned and executed RCT, the results are determined solely by allocation to the test treatment or the control. Most statin RCTs, especially the largest of such trials, were

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2019 American Gastroenterological Association Institute

24. Psychiatric Aspects of Infertility

and increase their risk for recurrent episodes of psychiatric illness (Fortin et al. 1972; Harlow et al. 1999; Harlow et al. 2003; Lolak et al. 2005; Singata-Madliki et al. 2016). © Copyright, American Psychiatric Association, all rights reserved. Selective estrogen receptor modulators (SERMs)—such as clomiphene citrate and tamoxifen—and aromatase inhibitors—such as letrozole—are commonly used for ovarian stimulation and for off-label use in men to increase spermatogenesis (Steiner et al. 2005; Rambhatla (...) , examinations, tests, and the prolonged pursuit of parenthood often for years without success (de Klerk et al. 2007). More research is indicated to further elucidate the connection between infertility interventions and psychiatric implications. Psychotropic Medications and Infertility Theoretically, psychotropic medications may influence the reproductive function in both men and women. This may occur by affecting the levels of neurotransmitters, such as dopamine, serotonin and GABA, that are involved

2019 American Psychiatric Association

25. Emergency management of adrenal insufficiency in children: advocating for treatment options in outpatient and field settings

insufficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2016;101:364–89. 27 Haus E. Chronobiology in the endocrine system. Adv Drug Deliv Rev 2007;59(9-10):985–1014. 28 Murphy H, Livesey J, Espiner EA, et al. The low dose ACTH test-a further word of caution. J Clin Endocrinol Metab 1998;83:712–3. 29 Wade M, Baid S, Calis K, et al. Technical details influence the diagnostic accuracy of the 1 microg ACTH stimulation test. Eur J Endocrinol 2010;162:109–13. 30 Cartaya J, Misra M (...) . The low-dose ACTH stimulation test: is 30 minutes long enough? Endocr Pract 2015;21:508–13. 31 Hindmarsh PC. Management of the child with congenital adrenal hyperplasia. Best Pract Res Clin Endocrinol Metab 2009;23:193–208. 32 Mitchell AL, Napier C, Asam M, et al. Saving lives of in-patients with adrenal insufficiency: implementation of an alert scheme within the Newcastle-upon- Tyne Hospitals e-Prescribing platform. Clin Endocrinol 2014;81:937–8. 33 Schweiger B, Zeitler P , Eppley S, et al. Using

2019 Pediatric Endocrine Society

26. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults

-line treatment in the carefully-selected and thoroughly-counseled patient who has been refractory to first- and second-line OAB treatments. The patient must be able and willing to return for frequent post-void residual evaluation and able and willing to perform self-catheterization if necessary. Standard (Evidence Strength Grade B) 19. Clinicians may offer peripheral tibial nerve stimulation (PTNS) as third-line treatment in a carefully selected patient population. Recommendation (Evidence Strength (...) to the database. Given that the AHRQ report included limited information regarding use of neuromodulation therapies, including sacral neuromodulation (SNS) and peripheral tibial nerve stimulation (PTNS) (also known as posterior tibial nerve stimulation) and limited information regarding the use of intravesical onabotulinumtoxinA to treat non-neurogenic OAB patients, additional searches were performed to capture this literature and relevant data were added to the database. The AUA update literature review

2019 American Urological Association

27. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency

) to improve the positive predictive value of congenital adrenal hyperplasia screening. (1|⊕⊕○○) Technical remark: Laboratories utilizing liquid chromatography–tandem mass spectrometry should participate in an appropriate quality assurance program. Additionally, clinicians should realize that immunoassays lead to more false-positive results. Thus, if laboratory resources do not include liquid chromatography–tandem mass spectrometry, a cosyntropin stimulation test should be performed to confirm diagnosis (...) hyperplasia we recommend referral to pediatric endocrinologists (if regionally available) and evaluation by cosyntropin stimulation testing as needed. (1|⊕⊕⊕○) 3.2 In symptomatic individuals past infancy, we recommend screening with an early-morning (before 8 am ) baseline serum 17-hydroxyprogesterone measurement by liquid chromatography–tandem mass spectrometry. (1|⊕⊕⊕○) 3.3 In individuals with borderline 17-hydroxyprogesterone levels, we recommend obtaining a complete adrenocortical profile after

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2018 The Endocrine Society

28. The role of immunotherapy in IVF: a guideline

-CSF; glucocorticoid/s; GM-CSF; granulocyte colony-stimulating factor; harm; HLA; HLA antigens; hu- man leukocyte antigen; Humira; ICSI; IL-10; IL-17; IL-27; immune modulatory; immune therapy; immunoglobulins, intravenous; immunoglobulins/therapeutic use; immu- nologic tests; immunomodulation; immunomodulatory; immunosuppression;immunotherapy;invitrofertilisation; in vitro fertilization; interleukin-10; interleukin-17; interleukin-27; intracytoplasmic sperm injection; intrali- pid; intralipid (...) to improved live-birth outcome. While some of these medica- tions (e.g., aspirin and corticosteroids) have been used for many years and are relatively low cost, others (e.g., intravenous fat emulsions and granu- locyte colony–stimulating factor [G- CSF]) are newer, of higher cost, and with risks that have been poorly char- acterized. It is imperative that physi- cians providing ART treatments have a full understanding of the potential risks and bene?ts associated with adjuvant immunotherapy in order

2018 Society for Assisted Reproductive Technology

29. Evaluation and Management of Testosterone Deficiency

), sex hormone-binding globulin ([SHBG], 44%, tightly-bound), corticotropin- binding globulin (4%, loosely-bound), and approximately 2% circulates as free testosterone. 9 The free and loosely-bound testosterone fractions combined are known as bioavailable testosterone. Testosterone assays are plagued by variability in results. This variability is expressed as a coefficient of variation (CV), which is a measure of precision. 10 In order to express this precision of assay test results, two measures (...) by producing luteinizing hormone (LH), which targets the Leydig cells in the testes stimulating them to produce testosterone. Serum testosterone and the downstream hormone E2 are involved in the feedback mechanism to the hypothalamus and pituitary to suppress LH production. In homeostasis, LH levels are typically low. With worsening Leydig cell function, there is a reduction in the feedback mechanism resulting in elevation of LH levels (hypergonadotropic hypogonadism). In conditions where LH

2018 American Urological Association

30. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency

other methods ( e.g. , genotyping) to improve the positive predictive value of congenital adrenal hyperplasia screening. (1|⊕⊕○○) Technical remark: Laboratories utilizing liquid chromatography–tandem mass spectrometry should participate in an appropriate quality assurance program. Additionally, clinicians should realize that immunoassays lead to more false-positive results. Thus, if laboratory resources do not include liquid chromatography–tandem mass spectrometry, a cosyntropin stimulation test (...) newborn screens for congenital adrenal hyperplasia we recommend referral to pediatric endocrinologists (if regionally available) and evaluation by cosyntropin stimulation testing as needed. (1|⊕⊕⊕○) 3.2 In symptomatic individuals past infancy, we recommend screening with an early-morning (before 8 am ) baseline serum 17-hydroxyprogesterone measurement by liquid chromatography–tandem mass spectrometry. (1|⊕⊕⊕○) 3.3 In individuals with borderline 17-hydroxyprogesterone levels, we recommend obtaining

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2018 Pediatric Endocrine Society

31. Clinical Study Phase III, Randomized, Double-blind, Prospective and Comparative to Evaluate the Efficacy and Tolerability of Using APETIVITON BC Compared to Petivit BC in Appetite Stimulate.

Clinical Study Phase III, Randomized, Double-blind, Prospective and Comparative to Evaluate the Efficacy and Tolerability of Using APETIVITON BC Compared to Petivit BC in Appetite Stimulate. Clinical Study Phase III, Randomized, Double-blind, Prospective and Comparative to Evaluate the Efficacy and Tolerability of Using APETIVITON BC Compared to Petivit BC in Appetite Stimulate. - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting (...) registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Clinical Study Phase III, Randomized, Double-blind, Prospective and Comparative to Evaluate the Efficacy and Tolerability of Using APETIVITON BC Compared to Petivit BC in Appetite Stimulate. (Apetiviton BC) The safety and scientific validity of this study is the responsibility

2010 Clinical Trials

32. Cognitive modulation of endocrine responses to CRH stimulation in healthy subjects. (PubMed)

controlled or examined in psychiatric studies using biological probes of the HPA axis. To test the hypothesis that psychological factors might complicate HPA study results even in direct, pharmacological challenge paradigms, endocrine responses to corticotropin-releasing hormone (CRH) were examined under two different cognitive preparation conditions.Healthy subjects (n=32) received standard instructions or a cognitive intervention (CI) prior to injection with CRH and placebo, given on separate days (...) in pharmacological activation paradigms, including CRH stimulation tests. The factors manipulated by the CI (novelty/familiarity, control and coping) may have particular salience to the HPA axis. Differential sensitivity to such factors could impact results in studies applying biological HPA probes to psychiatric populations.Copyright 2009 Elsevier Ltd. All rights reserved.

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2010 Psychoneuroendocrinology

33. Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I)

profile. Earlier shock resolution has been shown to lead to lower mortality ( ). However, no studies compared the prognostic value of hemodynamic response to hydrocortisone versus the 250-μg ACTH test for the diagnosis of CIRCI. Meta-analyses examined only differences in mortality rates with corticosteroid treatment between those with and without documented CIRCI ( ). Thus, the task force could only recommend the use of the 250-μg ACTH stimulation test to diagnose CIRCI. | 6. Is corticotropin level (...) superior to the 250-μg ACTH stimulation test for the diagnosis of CIRCI? Recommendation: We suggest against using corticotropin levels for the routine diagnosis of CIRCI (conditional recommendation, low quality of evidence). Rationale: The plasma corticotropin level is determined by corticotropin release from the anterior pituitary gland into the systemic circulation. Normally, plasma concentrations of corticotropin and cortisol change in opposite directions. In primary adrenal insufficiency, plasma

2017 Society of Critical Care Medicine

34. Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association

adversity may increase the risk of cardiometabolic (and other) diseases: behavioral, mental health, and biological. Behavioral Factors Evidence suggests that childhood adversity is associated with adverse health behaviors that increase the risk of cardiometabolic disease, including smoking, overeating, consumption of energy-dense foods, and inactivity. , , The association of childhood adversity with these behaviors was first tested by Felitti et al. In their retrospective ACE study, Felitti et al (...) childbirth would also capture intergenerational adversity and perinatal programming. Limited Identification of Mechanisms As discussed, childhood adversity may provoke unhealthy behaviors and poor mental health or produce neurobiological alterations that initiate relevant pathophysiological processes. Few studies have explicitly tested the mechanisms linking childhood adversity and cardiometabolic disease with comprehensive mediation models. Moreover, no study of which we are aware has tested a range

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2017 American Heart Association

35. Hormonal Replacement in Hypopituitarism in Adults

to diagnose AI. (1|⊕⊕⚪⚪) 1.3 We suggest that a cortisol level <3 μg/dL is indicative of AI and a cortisol level >15 μg/dL likely excludes an AI diagnosis. (2|⊕⚪⚪⚪) 1.4 We suggest performing a corticotropin stimulation test when morning cortisol values are between 3 and 15 μg/dL to diagnose AI. Peak cortisol levels <18.1 μg/dL (500 nmol/L) at 30 or 60 minutes indicate AI. (2|⊕⊕⚪⚪) 1.5 We suggest that clinicians perform biochemical testing for the hypothalamic-pituitary-adrenal (HPA) axis at least 18–24 (...) to evaluate central hypothyroidism, a condition where the thyroid gland does not produce enough hormones because it isn’t stimulated by the pituitary gland. People who have central hypothyroidism should be treated with levothyroxine in doses sufficient to raise levels of the thyroid hormone free thyroxine to the upper half of the reference range. Growth hormone stimulation testing should be used to diagnose patients with suspected growth hormone deficiency. People who have proven cases of growth hormone

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2016 The Endocrine Society

36. Diagnosis and Treatment of Primary Adrenal Insufficiency

| ENDO 2017 Essential Points The Endocrine Society recommends that acutely ill patients who have unexplained symptoms undergo diagnostic testing to rule out primary adrenal insufficiency. Those who have severe symptoms of the condition or adrenal crisis should undergo immediate treatment with medication until diagnostic test results are available. Health care providers should conduct a corticotropin stimulation test to confirm the diagnosis when the patient’s condition allows. Patients should undergo (...) corticotropin stimulation (30 or 60 min) test over other existing diagnostics tests to establish the diagnosis of adrenal insufficiency. Peak cortisol levels below 500 nmol/L (18 μg/dL) (assay dependent) at 30 or 60 minutes indicate adrenal insufficiency. (2|⊕⊕⚪⚪) 2.2 We suggest the low-dose (1 μg) corticotropin test for diagnosis of PAI only when the substance itself is in short supply. (2|⊕⊕⚪⚪) 2.3 If a corticotropin stimulation test is not feasible, we suggest using a morning cortisol <140 nmol/L (5 μg

2016 The Endocrine Society

37. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

(as needed based on patient’s presenting symptoms) Basic lab tests ? Complete blood count ? Fasting glucose ? Fasting lipid profile (TC, vLDL, LDL, HDL, TG) ? Thyroid-stimulating hormone ? Electrolytes ? Liver enzymes If warranted ? Urine toxicology for substance use Adapted from references [32,53]. HDL = high density lipoprotein; LDL = low density lipoprotein; TC = total cholesterol; TG = triglyceride; vLDL = very low density lipoprotein. Katzman et al. BMC Psychiatry 2014, 14(Suppl 1):S1 http (...) of the anxiety symptoms, associations with life events or trauma, the nature of the anxiety (i.e., worry, avoidance, or obsession), and the impact they have had on the patient’s current functioning. Table 5 presents suggested screening questions for individual anxiety and related disorders, from various validated screening tools [27-30], some of which are freely available online (e.g., http://www.macanxiety.com/ online-anxiety-screening-test). Conduct differential diagnosis The differential diagnosis

2014 CPG Infobase

38. Guideline on the management of premature ovarian insufficiency

) antibodies should be performed in women with POI of unknown cause or if an immune disorder is suspected. In patients with a positive TPO-Ab test, thyroid stimulating hormone (TSH) should be measured every year. C 10 There is insufficient evidence to recommend routinely screening POI women for diabetes. D There is no indication for infection screening in women with POI. D The possibility of POI being a consequence of a medical or surgical intervention should be discussed with women as part (...) for at least 4 months, and ? an elevated FSH level > 25 IU/l on two occasions > 4 weeks apart. GPP What are the known causes of POI and how should they be investigated? Chromosomal analysis should be performed in all women with non-iatrogenic Premature Ovarian Insufficiency. C Gonadectomy should be recommended for all women with detectable Y chromosomal material. C Fragile-X premutation testing is indicated in POI women. B The implications of the fragile-X premutation should be discussed before the test

2015 European Society of Human Reproduction and Embryology

39. Adjustment to Cancer: Anxiety and Distress (PDQ®): Health Professional Version

is adjusting.[ ] Self-Report Screening Instruments Studies have tested the ability of single-item measures to accurately identify patients in distress.[ - ] In general, these ultrashort screening methods, such as the Distress Thermometer (DT), have demonstrated only modest overall accuracy. They are best for ruling out—but performed poorly at confirming—distress, anxiety, and depression. The Distress Thermometer (DT) The DT, the National Comprehensive Cancer Network (NCCN) single-item and rapid-screening (...) instrument, asks patients to rate their distress on a scale of 0 to 10, with 10 being extreme distress. On an accompanying problem checklist, patients are asked to indicate what has been a problem for them in the past week.[ ] Although many screening instruments have been tested with cancer patients, the DT has been the most widely investigated. The psychometric properties of the DT—a 0-to-10 visual analog scale in the form of a thermometer labeled No distress at 0 and Extreme distress at 10—have been

2018 PDQ - NCI's Comprehensive Cancer Database

40. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

of cardiac, pulmonary, and metabolic late effects.[ - ] Access to risk-based survivor care Most childhood cancer survivors do not receive recommended risk-based care. The CCSS observed the following: 88.8% of survivors reported receiving some form of medical care.[ ] 31.5% reported receiving care that focused on their previous cancer (survivor-focused care).[ ] 17.8% reported receiving survivor-focused care that included advice about risk reduction and discussion or ordering of screening tests (...) .[ - ] Treatment of childhood HL with higher cumulative doses of alkylating agents and ovarian radiation of 5 Gy or higher (exposures predisposing to premature menopause) have been correlated with reductions in breast cancer risk, underscoring the potential contribution of hormonal stimulation on breast carcinogenesis.[ , , ] Most data describing the risk of radiation-associated breast cancer are based on patients treated for HL, with doses ranging from 15 Gy to 50 Gy. However, the risk of breast cancer

2018 PDQ - NCI's Comprehensive Cancer Database

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