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Corticotropin Stimulation Test

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81. Congenital Adrenal Hyperplasia Due to Steroid 21-hydroxylase Deficiency

will discuss only 21-hydroxylase deficiency here. The cortisol synthetic block leads to corticotropin stimulation of the adrenal cortex, with accumulation of cortisol precursors that are diverted to sex hormone biosynthesis ( ). A cardinal feature of classic or severe virilizing CAH in newborn females is genital ambiguity. If the disorder is not recognized and treated, both girls and boys undergo rapid postnatal growth and sexual precocity or, in the case of severe enzyme deficiency, neonatal salt loss (...) for hormonal diagnosis of CAH is a cosyntropin stimulation test ( ), it may be difficult to perform on an urgent basis in many clinical settings. Treatment of infants with positive screens and obvious electrolyte abnormalities or circulatory instability should never be delayed for cosyntropin stimulation testing; in such infants, the adrenal cortex is highly stimulated anyway, and baseline steroids will be markedly elevated. Extant norms are for tests employing a pharmacological dose of 0.125–0.25 mg

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2010 The Endocrine Society

82. Androgen Reduction in Congenital Adrenal Hyperplasia, Phase 1

is a cytochrome P450 enzyme located in the endoplasmic reticulum. It catalyzes conversion of 17-hydroxyprogesterone (17-OHP) to 11-deoxycortisol, a precursor for cortisol, and progesterone to deoxycorticosterone, a precursor for aldosterone. Aldosterone deficiency may lead to salt wasting with consequent failure to thrive, hypovolemia, shock and if untreated, death in the first few weeks of life. Because patients cannot synthesize cortisol efficiently, the adrenal cortex is stimulated by corticotropin (ACTH (...) Concentration (Cmax) [ Time Frame: 7 days ] Sparse PK will be derived from peak and trough abiraterone levels. Number of adverse events [ Time Frame: 7 days ] Safety monitoring in Phase 1 will include liver function tests (AST, ALT, bilirubin) and possible mineralocorticoid effects (blood pressure, plasma renin). Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members

2015 Clinical Trials

83. Androgen Reduction in Congenital Adrenal Hyperplasia

-OHP) to 11-deoxycortisol, a precursor for cortisol, and progesterone to deoxycorticosterone, a precursor for aldosterone. Aldosterone deficiency may lead to salt wasting with consequent failure to thrive, hypovolemia, shock and if untreated, death in the first few weeks of life. Because patients cannot synthesize cortisol efficiently, the adrenal cortex is stimulated by corticotropin (ACTH) and overproduces cortisol precursors. Some of these precursors are diverted to sex hormone biosynthesis (...) . Abnormal liver function tests (transaminases>3X ULN). Abnormal renal function tests (BUN or creatinine >1.5 ULN). Significant anemia (hemoglobin < 12 g/dl). Clinically significant ECG abnormality A history of a malabsorption syndrome. Evidence of active malignancy. Co-existent disease that may interfere with linear growth or that requires concomitant therapy that is likely to interfere with study procedures or results. Treatment with potentially hepatotoxic medications, CYP2D6, strong inhibitors

2015 Clinical Trials

84. Buserelin treatment to rats causes enteric neurodegeneration with moderate effects on CRF-immunoreactive neurons and Enterobacteriaceae in colon, and in acetylcholine-mediated permeability in ileum (PubMed)

Buserelin treatment to rats causes enteric neurodegeneration with moderate effects on CRF-immunoreactive neurons and Enterobacteriaceae in colon, and in acetylcholine-mediated permeability in ileum The gonadotropin-releasing hormone (GnRH) analog buserelin causes enteric neuronal loss. Acute stress or injection of corticotropin-releasing factor (CRF) affects motility, secretion, and barrier function of the gastrointestinal tract. The aim of the study was to characterize the CRF immunoreactivity (...) in Ussing chambers and the reaction to stressful events was measured by behavior tests. Buserelin treatment reduced the number of neurons along the entire gastrointestinal tract, with increased relative numbers of CRF-immunoreactive submucosal and myenteric neurons in colon (p < 0.05 and p < 0.01, respectively). The overall microbial diversity and relative abundance did not differ between groups, but Enterobacteriaceae was decreased in colon in buserelin-treated rats (p = 0.020). Basal intestinal

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2015 BMC research notes

85. CORTICUS: The end of unconditional love for steroid use?

requirement for at least one hour. All patients underwent a corticotropin stimulation test. Somewhat surprisingly, the use of low-dose hydrocortisone had no significant effect on 28-day mortality, regardless of the patients' adrenal responsiveness to corticotropin. The proportion of patients in whom reversal of shock was achieved was similar in the two groups, though this goal was achieved earlier in patients who received hydrocortisone. New infection, hypernatremia and hyperglycemia occurred more (...) in patients with septic shock, even though a survival benefit has been reported only in patients who remained hypotensive after fluid and vasopressor resuscitation and whose plasma cortisol levels did not rise appropriately after the administration of corticotropin. Methods Objective: To evaluate the efficacy and safety of low-dose hydrocortisone therapy in a broad population of patients with septic shock — in particular, patients who had had a response to a corticotropin test, in whom a benefit

2009 Critical Care - EBM Journal Club

86. Prospective analysis of adrenal function in patients with acute exacerbations of COPD: The REDUCE* trial (*Reduction in the Use of Corticosteroids in Exacerbated COPD).

days in a placebo-controlled manner. The HPA axis was longitudinally assessed with the 1 μg corticotropin test and a clinical hypocortisolism score at baseline, on day 6 before blinded treatment, at hospital discharge, and for up to 180 days of follow-up. Prednisone was stopped abruptly, irrespective of the test results. Patients discharged with pathological test results received instructions about emergency hydrocortisone treatment.A total of 311 patients were included in the analysis. Mean basal (...) and stimulated serum total cortisol levels were highest on admission (496±398 and 816±413 nmol/l respectively) and lowest on day 6 (235±174 and 453±178 nmol/l respectively). Pathological stimulation tests were found in 63, 38, 9, 3, and 2% of patients on day 6, at discharge, and on days 30, 90, and 180 respectively, without significant difference between treatment groups. Clinical indicators of hypocortisolism did not correlate with stimulation test results, but cortisol levels were inversely associated

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2015 European journal of endocrinology / European Federation of Endocrine Societies

87. The Effect of Corticotrophin-releasing Hormone (CRH) on Esophageal Sensitivity in Healthy Volunteers

will be performed in cross-over on 15 HV with no prior history of digestive disease. Esophageal sensitivity will be tested by multimodal stimulation on two sessions (placebo and CRH-administration), with an interval at least of one week. The two sessions will be scheduled by randomization for every subject. After blinded administration of CRH 100µg or placebo IV, esophageal sensitivity will be assessed using a multimodal esophageal stimulation probe which allows thermal, mechanical, electrical and chemical (...) on esophageal sensitivity to multimodal stimulation in a group of healthy volunteers. This will be assessed by comparing the Temperature values (°C) of the stimulation tests between the placebo and CRH condition to see if CRH affects the sensitivity to increasing temperature. Measurement of changes in esophageal sensitivity after IV CRH administration [ Time Frame: 2 sessions per HV with at least one week interval, duration of each session: approximately 2 hours and 30 minutes. Mechanical stimulation: 30

2014 Clinical Trials

88. Critical Illness-Related Corticosteroid Insufficiency in Cirrhotic Patients With Acute Gastroesophageal Variceal Bleeding: Risk Factors and Association With Outcome. (PubMed)

Critical Illness-Related Corticosteroid Insufficiency in Cirrhotic Patients With Acute Gastroesophageal Variceal Bleeding: Risk Factors and Association With Outcome. Critical illness-related corticosteroid insufficiency can adversely influence the prognosis of critically ill patients. However, its impact on the outcomes of patients with cirrhosis and acute gastroesophageal variceal bleeding remains unknown. We evaluated adrenal function using short corticotropin stimulation test in patients (...) with cirrhosis and gastroesophageal variceal bleeding. The main outcomes analyzed were 5-day treatment failure and 6-week mortality.Prospective observational study.Ten-bed gastroenterology-specific medical ICU at a 3,613-bed university teaching hospital in Taiwan.Patients with liver cirrhosis and acute gastroesophageal variceal bleeding.None.We evaluated adrenal function using short corticotropin stimulation test in 157 episodes of gastroesophageal variceal bleeding in 143 patients with cirrhosis. Critical

2014 Critical Care Medicine

89. The contribution of serine 194 phosphorylation to steroidogenic acute regulatory protein function. (PubMed)

The contribution of serine 194 phosphorylation to steroidogenic acute regulatory protein function. The steroidogenic acute regulatory protein (StAR) facilitates the delivery of cholesterol to the inner mitochondrial membrane, where the cholesterol side-chain cleavage enzyme catalyzes the initial step of steroid hormone biosynthesis. StAR was initially identified in adrenocortical cells as a phosphoprotein, the expression and phosphorylation of which were stimulated by corticotropin. A number (...) StAR, S194A StAR did not rescue the neonatal lethality and only partially rescued the sex reversal in male mice observed uniformly in StAR KO mice. Like the StAR KO mice, the adrenal cortex and testicular Leydig cells contained abundant lipid deposits when stained with oil red O. Adrenal StAR from S194A rescue animals lacks an acidic species, which appears upon corticotropin stimulation in animals rescued with WT StAR, consistent with defective StAR phosphorylation. These findings demonstrate

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2014 Molecular Endocrinology

90. Ultraviolet B (UVB) Activates Hypothalamic-Pituitary-Adrenal (HPA) Axis in C57BL/6 Mice. (PubMed)

Ultraviolet B (UVB) Activates Hypothalamic-Pituitary-Adrenal (HPA) Axis in C57BL/6 Mice. To test the hypothesis that UVB can activate the hypothalamic-pituitary-adrenal (HPA) axis, the shaved back skin of C57BL/6 mice was exposed to 400 mJ cm(-2) of UVB or was sham irradiated. After 12 and 24 hours of exposure, plasma, skin, brain, and adrenals were collected and processed to measure corticotropin-releasing hormone (CRH), urocortin (Ucn), β-endorphin (β-END), ACTH, and corticosterone (CORT (...) ) or the brain was fixed for immunohistochemical detection of CRH. UVB stimulated plasma levels of CRH, Ucn, β-END, ACTH, and CORT and increased skin expression of Ucn, β-END, and CORT at the gene and protein/peptide levels. UVB stimulated CRH gene and protein expression in the brain that was localized to the paraventricular nucleus of the hypothalamus. In adrenal glands, it increased mRNAs of melanocortin receptor type 2, steroidogenic acute regulatory protein (StAR), and gene coding of steroid 11β

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2014 Journal of Investigative Dermatology

91. Relative adrenal insufficiency in chronic liver disease: its prevalence and effects on long-term mortality. (PubMed)

hepatitis (n = 17) were evaluated prospectively. A short stimulation test (SST) with 250 μg of corticotrophin was performed to detect RAI. RAI was defined as an increase in serum cortisol of <9 μg/dL in patients with a basal total cortisol of <35 μg/dL.RAI was observed in only 13 (24.1%) of 54 patients with cirrhosis. Compared to those without RAI, cirrhotic patients with RAI had significantly higher Child-Turcotte-Pugh score (10.3 ± 1.7 vs. 7.1 ± 1.8, mean ± s.d., P < 0.001) and Model for End-Stage (...) Liver Disease score (14.5 ± 6.6 vs. 9.4 ± 3.7, P = 0.017). The cortisol response to corticotropin was negatively correlated with the severity of cirrhosis (P < 0.05). In addition, the mortality rate was higher in cirrhotic patients with RAI (69.2%) than in those without RAI (4.9%; P < 0.001) during the follow-up period of 20.1 ± 13.5 months (range, 5.8-51.1 months). The cumulative 1-year survival rates in cirrhotic patients with and without RAI were 69.2% and 95.0%, respectively (P = 0.05), while

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2014 Alimentary Pharmacology & Therapeutics

92. ACTHar in the Treatment of Lupus Nephritis

melanocortin receptors (MCRs). Specifically, ACTH binding to melanocortin 2 receptor subtype (MC2R) on the adrenal cortex stimulates the production of cortisol that reduces inflammation in the kidney. In addition to binding to melanocortin 1-5 receptor subtype (MC1-5R) and acting directly on kidney tissues, ACTH may bind to MCRs on various cell types, such as immune cells, and activate processes to protect the kidney. This study will evaluate the most effective dose of ACTHar gel in proliferative LN (Class (...) , oral, from Week 0-24 CellCept 2 grams daily, oral, from Week 25-144 Other Name: Mycophenolate Mofetil Drug: ACTHar gel Arm 1: 80 U biw, subcutaneous, for 3 months. Optionally additional 3 months of 80 U biw if a patient has partial response. Other Names: ACTHar H.P. ACTHar Gel Repository corticotropin Active Comparator: CellCept daily & ACTHar gel qod Patients will be treated with CellCept 3 grams daily for 3 months, and ACTHar gel 80 U qod for the first month and ACTHar gel 80 U biw

2014 Clinical Trials

93. A Study to Investigate the Efficacy and Safety of Cannabidiol (GWP42003-P; CBD) as Adjunctive Treatment for Seizures Associated With Lennox-Gastaut Syndrome in Children and Adults

-and-wave pattern in an EEG prior to the enrollment into the baseline period. Participant had at least 2 drop seizures each week during the first 28 days of the baseline period. Participant was refractory; that is having documented failures on more than 1 antiepileptic drug (AED). Participant was taking 1 or more AEDs at a dose which had been stable for at least 4 weeks prior to screening. All medications or interventions for epilepsy (including ketogenic diet and vagus nerve stimulation [VNS]) were (...) of the study and for 3 months thereafter. Female participant was pregnant (positive pregnancy test), lactating or planning pregnancy during the course of the study and for 3 months thereafter. Participant had been part of a clinical study involving another IMP in the previous 6 months. Patient had significantly impaired hepatic function at screening (Day -28) or randomization (Day 1), defined as any of the following: alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 5 × upper limit

2014 Clinical Trials

94. Inhaled Corticosteroids and Secondary Adrenal Insufficiency (PubMed)

between ICS and AI particularly in children and patients using high doses. However, there have also been reports of AI in adults as well as in patients using low to moderate doses of ICS. To conclude, we recommend screening for AI in select patient groups with an initial early morning serum cortisol. If results are abnormal, more definitive testing such as the low dose corticotropin stimulation test may be done to confirm the diagnosis.

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2014 The open respiratory medicine journal

95. Late Effects of Treatment for Childhood Cancer

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.[ ] Surveillance for new cases of cancer was very low in survivors at the highest risk of colon, breast, or skin cancer, suggesting that survivors and their physicians need education about the risk of subsequent neoplasms and recommended surveillance (...) ) 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 was also increased in the following studies that used lower radiation doses to treat cancer metastatic to the chest/lung (e.g., Wilms tumor, sarcoma) and exposed

2012 PDQ - NCI's Comprehensive Cancer Database

96. Adjustment to Cancer: Anxiety and Distress

professionals conduct the assessment interview to determine how well a patient 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

2012 PDQ - NCI's Comprehensive Cancer Database

97. Osteoporosis (Overview)

be evident, especially in patients with an altered center of gravity from severe kyphosis. [ ] Patients may have difficulty performing tandem gait and performing single limb stance. See for more detail. Diagnosis Baseline laboratory studies include the following: Complete blood count: May reveal anemia Serum chemistry levels: Usually normal in persons with primary osteoporosis Liver function tests Thyroid-stimulating hormone level: Thyroid dysfunction has been associated with osteoporosis 25 (...) joint test Decreased weight-bearing on the fractured side or an antalgic gait pattern Patients with Colles fractures may have the following: Pain on movement of the wrist Dinner fork (bayonet) deformity Patients with pubic and sacral fractures may have the following: Marked pain with ambulation Tenderness to palpation, percussion, or both With sacral fractures, pain with physical examination techniques used to assess the sacroiliac joint (eg, FABER, Gaenslen, or squish test) Balance difficulties may


98. Adrenal Disease and Pregnancy (Follow-up)

replacement. Patients with previously undiagnosed adrenocortical deficiency may present with an acute addisonian crisis during labor or postpartum. Fetal growth restriction Maternal cortisol deficiency has been suggested as a possible cause of fetal intrauterine growth restriction. Clinical suspicion should arise if fetal growth restriction is associated with abnormally low maternal blood pressure and an unusual increase in skin pigmentation due to maternal corticotropin and melanocyte-stimulating hormone (...) , and interpretation of suppression of 24-hour urine cortisol and plasma cortisol levels seems to yield reliable results. Corticotropin levels Once hypercortisolemia is established, corticotropin levels should be measured. For all forms of Cushing syndrome in pregnancy, corticotropin levels are normal or they are high secondary to placental corticotropin production or owing to placental corticotropin-releasing hormone–stimulated pituitary corticotropin production. Therefore, corticotropin levels are not useful


99. Anxiety Disorders (Overview)

response to psychologic or pharmacologic interventions. Previous Next: Pathophysiology In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved. Peripherally, the autonomic nervous system, especially the sympathetic nervous system, mediates many of the symptoms. [ ] Positron emission (...) , 22q, 4q31-q34, and probably 9q31 may be associated with the heritability of panic disorder phenotype. [ ] The cognitive theory regarding panic is that patients with panic disorder have a heightened sensitivity to internal autonomic cues (eg, tachycardia). Triggers of panic can include the following: Injury (eg, accidents, surgery) Illness Interpersonal conflict or loss Use of cannabis (can be associated with panic attacks, perhaps because of breath-holding) [ ] Use of stimulants, such as caffeine


100. Glucocorticoid Therapy and Cushing Syndrome (Diagnosis)

. Yanovski JA, Cutler GB Jr, Chrousos GP, Nieman LK. Corticotropin-releasing hormone stimulation following low-dose dexamethasone administration. A new test to distinguish Cushing's syndrome from pseudo-Cushing's states. JAMA . 1993 May 5. 269(17):2232-8. . Media Gallery Diagnosis of Cushing syndrome. Etiology of Cushing syndrome. Physical findings in Cushing syndrome. of 3 Tables ] Table 1. Glucocorticoid Equivalencies [ ] Type Drug Dose Relative Glucocorticoid Potency Relative Mineralocorticoid Potency (...) and industry to maximize their beneficial effects while minimizing their adverse effects. Thus, many synthetic compounds with glucocorticoid activity have been manufactured and tested. Alterations of the basic steroid nucleus and its side groups give rise to the pharmacologic differences between these chemicals. Such changes may affect the bioavailability of these steroid compounds, including their GI absorption; parenteral distribution; plasma half-life; their metabolism in the liver, fat, or target

2014 eMedicine Pediatrics

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