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Corticotropin Stimulation Test

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61. Adrenal Suppression in Infants Treated with Topical Ocular Glucocorticoids. (PubMed)

to collect data on results and timing of a standard corticotropin (adrenocorticotropic hormone [ACTH]) stimulation test and GC dose per kilogram body weight.Incidence of adrenal suppression in children tested on GC treatment. Glucocorticoid dose per kilogram body weight.Among 26 consecutive infants, 15 (58%) were tested while they were still on GC treatment. Ten of these 15 infants (67%) had adrenal suppression, 2 of whom had obvious clinical signs of Cushing's syndrome and 1 of whom had signs (...) of Addisonian crises during general anesthesia. Eleven of the 26 infants (42%) were tested at a median time of 21 days (range, 6-89) after treatment cessation, and they all had normal test results. Children with suppressed adrenal function had received cumulative GC doses per body weight that were significantly higher the last 5 days before testing compared with children with normal test results. Infants with adrenal suppression were treated with hydrocortisone replacement therapy. Adrenal function

2018 Ophthalmology

62. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline

Education and Research, Inc.® 3 AUA/SUFU Guideline Overactive Bladder catheterization if necessary. Standard Option (Evidence Strength Grade B C) 18. Clinicians may offer peripheral tibial nerve stimulation (PTNS) as third line treatment in a carefully selected patient population. Recommendation (Evidence Strength Grade C) 19. Clinicians may offer sacral neuromodulation (SNS) as third line treatment in a carefully selected patient population characterized by severe refractory OAB symptoms or patients (...) 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 process, in which an additional systematic review

2014 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

63. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: AUA/SUFU Guideline

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 Option (Evidence Strength Grade B C ) 18. Clinicians may offer peripheral tibial nerve stimulation (PTNS) as third line treatment in a carefully selected patient population. Recommendation (Evidence Strength Grade C) 19. Clinicians may offer sacral neuromodulation (SNS) as third line treatment in a carefully selected (...) 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 process, in which an additional systematic review is conducted periodically to maintain guideline currency with newly-published relevant

2014 American Urological Association

64. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers

and 24 h later NR NR Mean VPT at 1 mo: Org low: 2.9, Org high: 1.1, PL: 3.7 Mean VPT at 4-12 mo: Org low: 3.6, Org high: 2.0, PL: 4.8 Note: No formal test for significance conducted Mean sum scores for patient reported neurological signs and symptoms at 1 mo: Org low: 6.3, Org high: 0.0, PL: 6.3 Mean sum scores for patient reported neurological signs and symptoms at 4-12 mo: Org low: 4.5, Org high: 3.5, PL: 5.7 Note: No formal test for significance conducted Oxycarbazepine (OXC) Argyriou 2006a (...) by toxicities such as nausea, vomiting, and light-headedness. A phase II trial randomly assigned 117 patients with solid tumors receiving treatment with carboplatin/paclitaxel to low-dose (2 μg/kg) or high-dose (4 μg/kg) recombinant human leukemia inhibitory factor (rhuLIF) or placebo. This study was convincingly negative, with no differences between the groups in standardized composite peripheral nerve electrophysiology (CPNE) scores, the primary end point, or other secondary neurological testing variables

2014 American Society of Clinical Oncology Guidelines

65. Primary Ovarian Insufficiency in Adolescents and Young Women

, it is acceptable to test for thyroid disease every 1–2 years. Patients with primary ovarian insufficiency also have a 50% chance of developing adrenal insufficiency if they have adrenal autoimmunity. Patients should be tested for adrenal anti-bodies and if results are positive, should undergo yearly corticotropin stimulation testing. Data are lacking on the follow-up of patients with negative test results (1). Diabetes mellitus, pernicious anemia, myasthenia gravis, rheumatoid arthritis, systemic lupus (...) insufficiency Menstrual irregularity for at least 3 consecutive months Follicle-stimulating hormone and estradiol levels (two random tests at least 1 month apart) Prolactin and thyroid function test If diagnosis is confirmed: Karyotype FMR1 permutation Adrenal antibodies — 21-hydroxylase (CYP21) by immunoprecipitation or — Indirect immunofluorescence Pelvic ultrasonography Data from Nelson LM. Clinical practice. Primary ovarian insufficiency. . Initial laboratory evaluation for suspected primary ovarian

2014 American College of Obstetricians and Gynecologists

66. Manipulating the sleep-wake cycle and circadian rhythms to improve clinical management of major depression

in mice indicate the extent to which the coordination of key behavioral factors is dis- turbed. For example, mice with a point mutation in the CLOCK gene display: (i) hyperactivity over the light/dark cycle;, (ii) reduced depression-like behavior in rodent testing paradigms;, and, (iii) an increase in reward value in response to self-stimulation tests [73-75]. Alterations of clock genes also increase dopamine release, enhance sensitivity to dopamine receptor agonists, and alter the relative (...) Manipulating the sleep-wake cycle and circadian rhythms to improve clinical management of major depression OPINION Open Access Manipulating the sleep-wake cycle and circadian rhythms to improve clinical management of major depression Ian B Hickie 1* , Sharon L Naismith 1 , Rébecca Robillard 1 , Elizabeth M Scott 1,2 and Daniel F Hermens 1 Abstract Background: Clinical psychiatry has always been limited by the lack of objective tests to substantiate diagnoses and a lack of specific treatments

2013 Clinical Practice Guidelines Portal

67. Best practices of ASRM and ESHRE: a journey through reproductive medicine

stimulation cycle with higher doses of gonad- otrophins leading to a cumulative ongoing pregnancy rate that was not different compared with normal responders (Ferraretti et al., 2010). It was noted that after two consecu- tive cycles with POR, the risk of POR in further cycles was close to 100% with a cumulative ongoing pregnancy rate signi?cantly lower than normal responders. In an attempt to assess ovarian reserve before starting stimulation, several tests have been proposed. Generally, ovarian reserve (...) ). Thepresenceofhydrosalpingesalsohasanegativeeffect ontheARToutcome,andsurgeryhasbeenshowntoimprove pregnancy rates (Johnson et al., 2010). The testing of ovarian reserve performed on Day 2/3, in- cludingFSHandE2levels,shouldbeusedfordeterminingan age-adjusted initial stimulation protocol and not to exclude treatment. Moreover, being aware that the best markers of ovarianreserve,AMHandAFC,havelimitedvalueinpredict- ing ‘non-pregnancy’; these markers therefore should not be used to exclude treatment. New SurgicalTechniques Laparoscopic surgery

2012 Society for Assisted Reproductive Technology

68. Don’t stress about CRF: Assessing the translational failures of CRF1 antagonists (PubMed)

Don’t stress about CRF: Assessing the translational failures of CRF1 antagonists Dr. Athina Markou sought treatments for a common neural substrate shared by depression and drug dependence. Antagonists of corticotropin-releasing factor (CRF) receptors, a target of interest to her, have not reached the clinic despite strong preclinical rationale and sustained translational efforts.We explore potential causes for the failure of CRF1 antagonists and review recent findings concerning CRF-CRF1 (...) systems in psychopathology.Potential causes for negative outcomes include (1) poor safety and efficacy of initial drug candidates due to bad pharmacokinetic and physicochemical properties, (2) specificity problems with preclinical screens, (3) the acute nature of screens vs. late-presenting patients, (4) positive preclinical results limited to certain models and conditions with dynamic CRF-CRF1 activation not homologous to tested patients, (5) repeated CRF1 activation-induced plasticity that reduces

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2017 Psychopharmacology

69. Dehydroepiandrosterone sulfate and dehydroepiandrosterone sulfate/cortisol ratio in cirrhotic patients with septic shock: another sign of hepatoadrenal syndrome? (PubMed)

cirrhosis and septic shock.We recruited 46 cirrhotic patients with septic shock, and 46 noncirrhotic counterparts matched by age and sex. We evaluated adrenal function using the short corticotropin stimulation test and analyzed the relation between DHEAS and cortisol.While the nonsurvivors in the cirrhotic group had significantly lower baseline DHEAS, lower baseline DHEAS/cortisol ratio, and reduced increments of both DHEAS and cortisol upon corticotropin stimulation, the survivors had lower baseline (...) Dehydroepiandrosterone sulfate and dehydroepiandrosterone sulfate/cortisol ratio in cirrhotic patients with septic shock: another sign of hepatoadrenal syndrome? Cirrhotic patients are susceptible to sepsis and critical illness-related corticosteroid insufficiency (CIRCI). Dehydroepiandrosterone sulfate (DHEAS) is a corticotropin-dependent adrenal androgen, which has immunostimulating and antiglucocorticoid effects. Considering the synchronized synthesis of cortisol and DHEAS and their opposing

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2017 Critical Care

70. Methamphetamine Induces TET1- and TET3-Dependent DNA Hydroxymethylation of Crh and Avp Genes in the Rat Nucleus Accumbens (PubMed)

Methamphetamine Induces TET1- and TET3-Dependent DNA Hydroxymethylation of Crh and Avp Genes in the Rat Nucleus Accumbens Methamphetamine (METH) addiction is a biopsychosocial disorder that is accompanied by multiple relapses even after prolonged abstinence, suggesting the possibilities of long-lasting maladaptive epigenetic changes in the brain. Here, we show that METH administration produced time-dependent increases in the expression of corticotropin-releasing hormone (Crh/Crf), arginine (...) and at intragenic Avp sites. In addition, METH increased the protein expression of ten-eleven-translocation enzymes that catalyze DNA hydroxymethylation. Importantly, METH increased TET1 binding at the Crh promoter and increased TET3 binding at Avp intragenic regions. We further tested the role of TET enzymes in METH-induced changes in gene expression by using the TET inhibitor, 1,5-isoquinolinediol (IQD), and found that IQD blocked METH-induced increases in Crh and Avp mRNA expression. Together, these results

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2017 Molecular neurobiology

71. Adaptive Changes in the Sensitivity of the Dorsal Raphe and Hypothalamic Paraventricular Nuclei to Acute Exercise, and Hippocampal Neurogenesis May Contribute to the Antidepressant Effect of Regular Treadmill Running in Rats (PubMed)

-HT) neurons in the central nervous system, and the hypothalamic paraventricular nucleus (PVN), in which corticotropin-releasing factor (CRF) neurons initiate the activation of the HPA axis, during one session of acute treadmill running at different speeds (0, 15, 25 m/min, 30 min) in male Wistar rats, using c-Fos immunohistochemistry. We also examined neurogenesis in the hippocampus using immunohistochemistry for doublecortin (DCX) and assessed depressive-like behavior using the forced swim test (...) including serotonergic transmission, activation of the hypothalamic-pituitary-adrenal (HPA) axis, and hippocampal neurogenesis, but few general concepts regarding the optimal exercise regimen for stimulating neural mechanisms involved in antidepressant properties have been developed. Here, we examined how 4 weeks of treadmill running at different intensities (0, 15, 25 m/min, 60 min/day, 5 times/week) alters neuronal activity in the dorsal raphe nucleus (DRN), which is the major source of serotonin (5

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2017 Frontiers in behavioral neuroscience

72. Hormonal Mechanisms of Sleep Restriction

. This scale will be used to assess changes in sleepiness throughout the day and through 4 nights of sleep restriction. Two card gambling task [ Time Frame: 5 days ] Computerized neurobehavioral testing to determine how 4 nights of sleep restriction affects participants' decision making. The end point is discriminability index, d'. Modified Sternberg working memory test [ Time Frame: 5 days ] Computerized neurobehavioral testing to determine how 4 nights of sleep restriction affects reaction time (...) injury or of learning disability - Vision or hearing impairment unless corrected back to normal Anemia (Hct <38%) History of psychiatric illness Clinically significant abnormalities in blood and urine, and free of traces of drugs Other endocrine abnormalities including hypothyroidism or adrenal failure; primary gonadal disease as indicated by serum LH (luteinizing hormone) or FSH (follicle stimulating hormone) concentration >10 or >15 IU/L, respectively, hyperprolactinemia indicated by prolactin

2017 Clinical Trials

73. Normalized early post-operative cortisol and ACTH values predict nonremission after surgery for Cushing's disease. (PubMed)

Normalized early post-operative cortisol and ACTH values predict nonremission after surgery for Cushing's disease. Perioperative increases in adrenocorticotropic hormone (ACTH) and cortisol mimic results of corticotropin-releasing hormone (CRH) stimulation testing. This phenomenon may help identify patients with residual adenoma after transsphenoidal surgery (TSS) for Cushing disease (CD).To predict nonremission after TSS for CD.Retrospective case-control study of patients treated at a single (...) center from December 2003 until July 2016. Early and medium-term remission were assessed at 10 days and 11 months.Two hundred and ninety-one consecutive TSS cases from 257 patients with biochemical evidence of CD seen at a clinical center.Normalized early postoperative values (NEPVs) for cortisol and ACTH were calculated as immediate postoperative cortisol or ACTH levels minus preoperative post-CRH-stimulation test levels.Prediction of early nonremission was evaluated using logistic regression

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2017 Journal of Clinical Endocrinology and Metabolism

74. Chronic primary adrenal insufficiency after unilateral adrenonephrectomy: A case report. (PubMed)

) and a mildly decreased morning serum cortisol level (6.4 mg/mL, normal: 7-28 mg/mL). In addition to the patient's clinical symptoms and laboratory results, the results from ACTH and corticotropin-releasing hormone stimulation tests were used to make a diagnosis of primary adrenal insufficiency.Treatment was initiated using oral prednisolone (20 mg), which rapidly resolved his symptoms. At the 1-year follow-up, the patient had a markedly decreased serum cortisol level (2.0 mg/mL) with an ACTH level

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2017 Medicine

75. Pituitary Adenoma

if asymptomatic and pituitary mass incidentally found on brain imaging Obtain Brain imaging (MRI preferred) If Pituitary Adenoma is suspected Ophthalmology and Endocrine referrals as below Suspected Pituitary Adenoma Consult ophthalmology for macroadenoma even if no visual changes are readily evident Detailed visual field testing Detailed XII. Management Management directed by endocrinology Consult prior to starting management and in completing evaluation once Pituitary Adenoma is identified Prolactinoma (...) daily (or depot 20 mg every 4 weeks) Lanreotide ( tuline) 90 mg SQ every 4 weeks antagonists (reduce IGF-1 and associated symptoms) Pegvisomant ( vert) 15-20 mg daily Non-Functioning Pituitary Adenoma Obtain ophthalmology for Visual field testing and complete Indicated for Non-functioning Pituitary Macroadenoma (>1 cm) Neurosurgery indications Abnormal ophthalmology examination (especially visual field deficit) Neurologic symptoms (e.g. ) Lesion increasing in size to abut the or growth to >1 cm

2018 FP Notebook

76. Plenadren - hydrocortisone

submitted is composed of administrative information, complete quality data, a clinical study comparing PK and safety with the reference medicinal product Hydrocortone and non-clinical and other clinical data based on the Applicant’s own tests and studies and/or bibliographic literature substituting/supporting certain tests or studies. The chosen reference product is: ¦ Medicinal product which is or has been authorised in accordance with Community provisions in accordance with Community provisions (...) of the Monograph of the European Pharmacopoeia (CEP) has been issued. It was noticed that two additional supplementary tests (Other impurities, particle size and residual solvents) were included in the CEP. Specification Hydrocortisone is described in the European Pharmacopoeia. The Ph.Eur. specifications have been implemented by both active substance and finished product manufacturers, where applicable, to control the quality of the active substance. Additional specifications (other impurities, particle size

2011 European Medicines Agency - EPARs

77. Addison's disease

if adrenal insufficiency is suspected. Admission to hospital may be required depending on the clinical picture and clinical judgement. The diagnosis of Addison's disease is usually confirmed in secondary care. An adrenocorticotrophic hormone stimulation (Synacthen®) test should be done. Treatment for Addison's disease is usually initiated and adjusted by a specialist endocrinologist, but repeat prescriptions may be provided in primary care under a shared care arrangement. Hydrocortisone is usually used (...) to the recommendations on corticosteroid dosing during intercurrent illness, and it is now recommended that an adrenocorticotrophic hormone stimulation (Synacthen®) test should be carried out in secondary care. Previous changes Previous changes May 2014 — minor update. Change to the section on choice of hydrocortisone preparation for the treatment of adrenal crisis. October 2010 — minor update. Text regarding DHEA replacement therapy (unlicensed) reworded to reflect that this may be prescribed by some specialists

2016 NICE Clinical Knowledge Summaries

78. Apparent Hypothalamic-Pituitary-Adrenal Axis Suppression via Reduction of Interleukin-6 by Glucocorticoid Therapy in Systemic Autoimmune Diseases. (PubMed)

(28 women) who were starting prednisolone therapy according to our standard regimens were prospectively observed. Patients were classified into high-dose and low-dose groups depending on the dose of prednisolone administered as indicated for their diseases. Plasma adrenocorticotropic hormone (ACTH) and serum cortisol levels were measured by electrochemiluminescence immunoassay. The corticotropin-releasing hormone (CRH) test was performed at baseline and second and forth weeks after starting (...) glucocorticoid therapy. The increased levels of ACTH (ΔACTH) and cortisol (Δcortisol) were investigated. Serum levels of 10 proinflammatory cytokines were measured simultaneously by a multi-spot assay system.In the high-dose group, both basal and stimulated levels of ACTH and cortisol were significantly decreased by glucocorticoid therapy. In the low-dose group, basal ACTH and cortisol levels were also significantly decreased by glucocorticoid therapy, but ΔACTH and Δcortisol were unchanged. Among 10

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2016 PLoS ONE

79. Reduced cortisol metabolism during critical illness. (PubMed)

Reduced cortisol metabolism during critical illness. Critical illness is often accompanied by hypercortisolemia, which has been attributed to stress-induced activation of the hypothalamic-pituitary-adrenal axis. However, low corticotropin levels have also been reported in critically ill patients, which may be due to reduced cortisol metabolism.In a total of 158 patients in the intensive care unit and 64 matched controls, we tested five aspects of cortisol metabolism: daily levels (...) comparisons). Cortisol production was 83% higher in the patients (P=0.02). There was a reduction of more than 50% in cortisol clearance during tracer infusion and after the administration of 100 mg of hydrocortisone in the patients (P≤0.03 for both comparisons). All these factors accounted for an increase by a factor of 3.5 in plasma cortisol levels in the patients, as compared with controls (P<0.001). Impaired cortisol clearance also correlated with a lower cortisol response to corticotropin stimulation

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2013 NEJM

80. An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing's Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency? (PubMed)

and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormone-dependent Cushing's disease. The combination of adrenocorticotropic hormone-dependent Cushing's disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors' knowledge

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2016 Case reports in orthopedics

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