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Corticotropin Stimulation Test

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161. Castration-Resistant Prostate Cancer

initiation of apalutamide treatment, and were managed with medical therapy. Particular attention should be paid to monitoring thyroid stimulating hormone (TSH) in individuals with known hypothyroidism given observed changes in thyroid function with apalutamide treatment. Enzalutamide: Enzalutamide is a novel AR signaling inhibitor. It is a competitive inhibitor of androgen binding and also inhibits nuclear translocation of the AR, DNA binding and coactivator recruitment. 18 This drug binds AR with a five (...) deprivation, treatments were administered solely for palliation. Landmark articles by Tannock et al. 4 and Petrylak et al. 5 demonstrated that docetaxel improved survival for these patients with mCRPC. Since the approval of docetaxel, six additional agents that show a survival benefit have been FDA-approved on the basis of randomized clinical trials. These have included enzalutamide, abiraterone and apalutamide, agents designed specifically to affect the androgen axis; 6-8 sipuleucel-T, which stimulates

2018 American Urological Association

162. Evaluation and Treatment of Hirsutism in Premenopausal Women Full Text available with Trip Pro

mild adrenocorticotropic hormone–dependent functional adrenal hyperandrogenism, and in a minority of instances this form of adrenal hyperandrogenism may occur in isolation ( , ). PCOS is frequently associated with a metabolic syndrome that results from insulin resistance and/or central obesity and that requires considerations distinct from those for hirsutism itself. Obesity may worsen or cause features of PCOS ( , , ). Many women have hirsutism without hyperandrogenemia. We term this “idiopathic (...) for hyperandrogenemia in patients with normal variant unwanted hair, for whom hormonal treatment is not contemplated, places a relatively high value on avoiding the risk of false positives and the resulting increase in medical tests and procedures. It places a relatively low value on the potential benefits of early detection of mild hyperandrogenemia that will not affect initial management and outcome. 2.0 Treatment of Hirsutism in Premenopausal Women 2.1. For most women with patient-important hirsutism despite

2018 The Endocrine Society

163. 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 (...) this article with its authors and with other readers at fertility-and-sterility/posts/33034-26277 S uccessful outcomes in assisted reproductive technology (ART) cycles depend on the develop- mental competence of transferred em- bryo(s) and endometrial receptivity. Multiple factors are believed to be involved in endometrial receptivity, including the hormonal preparation of the endometrium, contractility of the myometrium, and the interaction be- tween the embryo

2018 Society for Assisted Reproductive Technology

164. Chronic Pelvic Pain

Impot Res, 1998. 10 Suppl 2: S117. 146. Ambler, N., et al. Sexual difficulties of chronic pain patients. Clin J Pain, 2001. 17: 138. 147. Loving, S., et al. Pelvic floor muscle dysfunctions are prevalent in female chronic pelvic pain: A cross-sectional population-based study. Eur J Pain, 2014. 18: 1259. 148. Chiarioni, G., et al. Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology, 2010. 138: 1321. 149. Rao, S.S., et al. ANMS (...) urinary tract. J Urol, 1998. 159: 2185. 170. Parsons, C.L., et al. Cyto-injury factors in urine: a possible mechanism for the development of interstitial cystitis. J Urol, 2000. 164: 1381. 171. Chelimsky, G., et al. Autonomic Testing in Women with Chronic Pelvic Pain. J Urol, 2016. 196: 429. 172. Charrua, A., et al. Can the adrenergic system be implicated in the pathophysiology of bladder pain syndrome/interstitial cystitis? A clinical and experimental study. Neurourol Urodyn, 2015. 34: 489. 173

2018 European Association of Urology

165. Congenital Adrenal Hyperplasia (Elevated 17-OHP)

Congenital Adrenal Hyperplasia (Elevated 17-OHP) Actions are shown in shaded boxes; results are in the unshaded boxes. Abbreviations/Key 17-OHP = 17-hydroxyprogesterone ‘Lytes = Serum electrolytes ACTH stim = Adrenocorticotropic hormone stimulation test 21-OHD = 21-hydroxylase deficiency Steroid profile = Complete adrenal cortical hormone profile, e.g., by MS/MS Discretionary treatment = Consult pediatric endocrinology to determine if hydrocortisone therapy is necessary Mild elevation Moderate (...) to severe elevation Confirmatory tests for 21-OHD: ACTH, stim, steroid profile, genotype Normal Repeat newborn screen Clinical suspicion: Low Clinical suspicion: Low Clinical suspicion: High High No further action Follow actions for moderate to severe elevation Serum 17-OHP, ‘Lytes, glucose Moderately high 17-OHP; NL ‘Lytes, glucose Normal No further action Nonclassic 21-OHD Discretionary treatment Classic 21-OHD Replacement therapy Other enzyme defect Replacement therapy Severely high 17-OHP; Low Na

2018 American College of Medical Genetics and Genomics

166. Early corticosteroid therapy does not improve the prognosis of paediatric septic shock

treatment; group B, with 32 patients, received the same treatment as group A with the addition of the adrenocorticotropic hormone (ACTH) stimulation test, considered positive if there was an increase in cortisol of more than < 9 µg over the baseline level; group C, with 32 patients, received an intravenous stress dose of hydrocortisone (50 mg/m2/24 h) with continuous infusion for 5 days (intervention group [IG]); and group D, consisting of patients from group A or B that required corticosteroids (...) 6 months or short-term corticosteroids within the past 4 weeks were excluded. Intervention: patients were divided in four groups: group A, with 32 patients, received conventional treatment; group B, with 32 patients, received the same treatment as group A with the addition of the adrenocorticotropic hormone (ACTH) stimulation test, considered positive if there was an increase in cortisol of more than < 9 µg over the baseline level; group C, with 32 patients, received an intravenous stress dose

2017 Evidencias en Pediatría

167. Hypothalamic - Pituitary and Growth Disorders in Survivors of Childhood Cancer Full Text available with Trip Pro

doses of HP radiation [ e.g. , ≥18 Gy following standard fractionation, ≥12 Gy following hyperfractionation in the setting of total body irradiation (TBI)], deficits of the other anterior pituitary hormones [LH/FSH, thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH)] develop almost exclusively in survivors previously exposed to HP doses ≥30 Gy. For the most part, the diagnosis and treatment of anterior pituitary deficits in cancer survivors follow the same general principles (...) in childhood cancer survivors treated for tumors in the region of the hypothalamic–pituitary axis and those exposed to ≥30 Gy hypothalamic–pituitary radiation. (1∣⊕⊕⊕O) 5.2 We advise using the same biochemical tests to screen for thyroid-stimulating hormone deficiency in childhood cancer survivors as are used in the noncancer population. (Ungraded Good Practice Statement) 5.3 We recommend against using serum triiodothyronine, thyroid-stimulating hormone surge analysis, or thyrotropin-releasing hormone

2018 The Endocrine Society

168. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy Full Text available with Trip Pro

that the diagnostic work-up should include the following for grade 2 toxicity: Work-up of blood (CBC, comprehensive metabolic panel, thyroid-stimulating hormone [TSH], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), stool (culture, Clostridium difficile , parasite, cytomegalovirus [CMV] or other viral etiology, ova and parasite) should be performed. May test for lactoferrin for patient stratification to determine who needs urgent endoscopy, and calprotectin may be offered to follow up on disease (...) refractory cases may require infliximab or other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, with the exception of endocrinopathies that have been controlled by hormone replacement. Additional information is available at and . INTRODUCTION Section: Immune checkpoint inhibitors (ICPis) have revolutionized the treatment of many different types of cancers. These inhibitors work by blocking pathways called checkpoints. These checkpoint

2018 American Society of Clinical Oncology Guidelines

169. 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

170. Intermittent Inhaled Corticosteroids and Long-Acting Muscarinic Antagonists for Asthma

included outcomes that fell into the categories below, using definitions provided by the study. • Asthma exacerbations o Requiring systemic (oral and/or parenteral) corticosteroids, requiring hospitalization, requiring emergency room (ER) visit, requiring intensive care unit or intubation, or as defined by the study 5 o Asthma-related hospitalizations, ER visits, urgent care and outpatient visits • Death o All-cause, asthma-specific • Asthma control o Composite Measures: Asthma Control Test (ACT (...) outcomes. Peto’s odds ratio (OR) and 95 percent confidence intervals were estimated for binary outcomes with rare events ( 50 percent considered substantial. 25 Publication bias was assessed using funnel plot inspection and Egger’s 7 weighted regression test when 10 or more trials were pooled

2018 Effective Health Care Program (AHRQ)

171. European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas Full Text available with Trip Pro

that all pituitary tumours should undergo histopathological analysis, which should include a minimum immunodetection of pituitary hormones and Ki-67 proliferative index evaluation. The p53 immunodetection and the mitotic count should be evaluated at least, when the Ki-67 index is ≥3% (+000). R 2.2.2 We suggest interpretation of histopathological results in the clinical context of the individual patient (+000). R 2.2.3 In patients with aggressive pituitary tumours, we suggest germline genetic testing (...) -67 proliferative index evaluation. The p53 immunodetection and the mitotic count should be evaluated at least, when the Ki-67 index is ≥3% (+000). Reasoning Based on immunohistochemistry (IHC), pituitary tumours are classified into somatotroph (GH, Pit 1 positive), lactotroph (PRL, Pit1 and ER positive), corticotroph (ACTH, Tpit positive), thyrotroph (TSH, Pit1 positive), gonadotroph (FSH/LH, SF1 positive), null cell (negative for hormones and transcription factors) tumours and plurihormonal

2018 European Society of Endocrinology

172. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency Full Text available with Trip Pro

-deoxycortisol and progesterone to deoxycorticosterone, with these products being precursors for cortisol and aldosterone. The blockage of cortisol synthesis 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 abnormal development of the external genitalia with variable extent of virilization. Evaluation for CAH needs to be considered (...) 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

2018 Pediatric Endocrine Society

173. Rare defects in Adrenal Steroidogenesis Full Text available with Trip Pro

findings, hormonal patterns, diagnosis and treatment of 21-hydroxylase deficiency (21OHD) have been studied and discussed in detail ( ). There are also some adrenal disorders of steroidogenesis in which ACTH is not overproduced and hence there is no adrenal hyperplasia. This review will consider all disorders of adrenal steroidogenesis other than 21OHD, whether or not there is adrenal hyperplasia; these forms of CAH are generally rare, but may be common in certain genetically isolated populations (...) ), with female-appearing external genitalia. However, the Sertoli cells continue to produce Müllerian inhibitory hormone appropriately, so that the phenotypically female 46,XY fetus lacks a cervix, uterus and fallopian tubes. In the adrenal, defective cortisol synthesis results in elevated ACTH secretion and severely impaired synthesis of DHEA, which eliminates feto-placental estriol production. Aldosterone synthesis is severely impaired, causing salt loss, but this may be manifested at almost any time from

2018 Pediatric Endocrine Society

174. The Postoperative Basal Cortisol and CRH Tests for Prediction of Long-Term Remission from Cushing's Disease after Transsphenoidal Surgery. Full Text available with Trip Pro

duration was median 11 yr (range 1-22.8 yr). Fewer patients achieved a cortisol nadir below 2 μg/dl (87%) than below 5 μg/dl (98%), yet recurrence rates were similar (<2 μg/dl, 9.5%; <5 μg/dl, 10.4%; 2-4.9 μg/dl, 20%; not significant). CRH-stimulated cortisol (P < 0.002) and ACTH (P = 0.04) values were higher for the recurrence than the remission group. However, no basal or stimulated ACTH or serum or urine cortisol cutoff value predicted all who later recurred.A postoperative cortisol below 2 μg/dl (...) The Postoperative Basal Cortisol and CRH Tests for Prediction of Long-Term Remission from Cushing's Disease after Transsphenoidal Surgery. Selective adenomectomy via transsphenoidal surgery induces remission of Cushing's disease (CD) in most patients. Although an undetectable postoperative serum cortisol (<2 μg/dl) has been advocated as an index of remission, there is no consensus on predictors of recurrence.We hypothesized that patients with subnormal cortisol (2-4.9 μg/dl) might achieve long

2011 Journal of Clinical Endocrinology and Metabolism

175. Chronic pain disorder medical treatment guideline.

of methylprednisolone acetate into the knee has about a 25% probability of suppressing the adrenal gland response to exogenous adrenocortocotrophic hormone (ACTH) for 4 or more weeks after injection, but complete recovery of the adrenal response is seen by week 8 after injection (Design: Randomized clinical trial ). Patients who smoke respond less well to non-operative spine care, and quitting smoking results in greater improvement (Design: Prospective cohort study ). Translaminar steroid injections do not increase (...) the original guideline document for types of complementary medicine, time to produce effect, frequency, and optimum duration. Direct Cortical Stimulation There are several types of cortical stimulation to relieve pain. All of these are undergoing further investigation and are considered experimental at this time. The limited studies available do not allow translation to the workers' compensation chronic pain population. An invasive option is implantation in the epidural motor cortex. Given the invasive

2017 National Guideline Clearinghouse (partial archive)

176. Interventions Targeting Sensory Challenges in Children with Autism Spectrum Disorder - An Update

and high ROB) of interventions with sensory-related components (tactile stimulation exercises, weighted blankets) reported few significant differences between treatment groups. Conclusions. Some interventions targeting sensory challenges may produce modest short-term ( 70), both groups received active treatment that included either SI therapy or eclectic group therapy. 39 Treatment lasted for 8 to 10 months. Participants in the SI group improved significantly more than those in the control group

2017 Effective Health Care Program (AHRQ)

177. CRACKCast E128 – Thyroid and Adrenal Disorders

characteristically have more pronounced clinical manifestations and skin hyperpigmentation. Measurement of cortisol in the ACTH stimulation test is the standard and most convenient method to assist in confirming the diagnosis. Refractory hypotension in the acutely ill patient may be the only clue to adrenal insufficiency and is readily treated with the IV administration of glucocorticoids (dexamethasone, 4 mg, or hydrocortisone, 100 mg). Rosen’s In Perspective Here’s the physiology of thyroid production (...) [12] List 5 causes of chronic primary adrenal insufficiency + 1 acute + 3 secondary The clinical manifestations are the result of primary adrenal failure or secondary adrenal disease from malfunction of the hypothalamic-pituitary-adrenal (HPA) axis in its production of adrenocorticotropic hormone (ACTH). Secondary causes are much more common than primary causes. Primary = high ACTH and low cortisol (get subsequent hyperpigmentation) Mild to moderate hyponatremia, with levels typically above 120

2017 CandiEM

178. Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

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 (...) . Finally, although beyond the scope of this review, behavioral factors such as diet and physical activity as outlined earlier can reflect stress-induced physiological changes. For example, ghrelin is a neurohormone that is upregulated under stress conditions and has mild anxiolytic and antidepressant properties ; however, ghrelin also increases appetite, food-seeking behavior, and food-associated reward. , In addition, maltreated children have been found to be deficient in leptin, a hormone

2017 American Heart Association

179. Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock Full Text available with Trip Pro

update examines and grades new studies performed to test the utility and efficacy of the 2007 recommendations. Second, this 2014 update examines and grades relevant new treatment and outcome studies to determine to what degree, if any, the 2007 guidelines should be modified. | METHODS Clinical investigators and clinicians affiliated with the Society of Critical Care Medicine (SCCM) who had special interest in hemodynamic support of pediatric patients with sepsis volunteered to be members (...) the lead of the previous guidelines making recommendations on hemodynamic support medications which may or may not be approved by the U.S. Food and Drug Administration, but which are approved and used in other nations, such as levosimendan, terlipressin, and enoximone. | RESULTS Evolution of the 2002, 2007, and 2014 Guidelines Many studies have tested the observations and recommendations of the 2002 and 2007 guidelines ( , ). Studies in the resource rich setting, where mechanical ventilators, IV

2017 Society of Critical Care Medicine

180. 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

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