Addison's Disease Research Today is a free monthly online journal that collates and summarizes the latest research about Addison's Disease, including details on chronic adrenal insufficiency, treatment, causes, medication.

Hydrocortisone effects on cardiovascular variability in septic shock: A spectral analysis approach.

Aboab J, Polito A, Orlikowski D, Sharshar T, Castel M, Annane D

From Réanimation Polyvalente, Hôpital Raymond Poincaré, AP-HP, Université de Versailles Saint Quentin, Garches, France.

RATIONAL:: Septic shock may be associated with a loss in cardiovascular variability and adrenal dysfunction. OBJECTIVES:: To investigate the relationship between cardiovascular autonomic modulation and adrenal function during sepsis. MEASUREMENT AND MAIN RESULTS:: Seventy-five volunteers with septic shock and six healthy volunteers were prospectively included in the study. Cardiovascular variability was assessed by spectral analysis of heart rate and diastolic blood pressure signals, which included computation of normalized low (LFnu) and high frequency (HFnu) components. Cardiovascular variability was investigated in patients and healthy volunteers immediately before and 1 hr after a single bolus of 50 mg of hydrocortisone (study phase I); in patients according to adrenal function (study phase II); and in patients with septic shock and adrenal insufficiency, before and 72 hrs after a treatment with 50 mg every 6 hrs of hydrocortisone and 50 mug daily of fludrocortisone or their placebos (study phase III). As compared to healthy volunteers, patients had decreased LFnu-HR (0.16 +/- 0.05 vs. 0.23 +/- 0.07 p = 0.01) and LFnu-DBP (0.18 +/- 0.11 vs. 0.28 +/- 0.02 p = 0.01) and, after hydrocortisone, they had a greater increase in LFnu-DBP (p = 0.01). As compared to patients with normal adrenal function, those with adrenal failure had decreased LFnu-HR (0.1 +/- 0.01 vs. 0.2 +/- 0.15 p = 0.01) and LFnu-DBP (0.008 +/- 0.01 vs. 0.14 +/- 0.22 p = 0.0003). In patients with adrenal failure, as compared to placebos, hydrocortisone plus fludrocortisone increased significantly LFnu-DBP (p = 0.02) and low frequency/high volume ratio (p = 0.009). CONCLUSION:: In septic shock, the loss in cardiovascular variability is more marked in patients with adrenal insufficiency and is partly restored by exogenous administration of corticosteroids.

Published 24 April 2008 in Crit Care Med.
Full-text of this article is available online (may require subscription).

Articles on Addison's Disease published 22 April 2008:

HETEROGENEITY IN THE MOLECULAR BASIS OF ACTH RESISTANCE SYNDROME.   Eur J Endocrinol.

Objective: Adrenocorticotropin (ACTH) resistance syndromes are rare, autosomal and genetically heterogeneous diseases that include familial glucocorticoid deficiency (FGD) and triple A syndrome. FGD has been shown to segregate with mutations in the ACTH receptor (MC2R) or MRAP gene, whereas mutations in the AAAS gene have been found in segregation with triple A syndrome. We describe the clinical findings and molecular analysis of MC2R, MRAP and AAAS genes in five Brazilian patients with ACTH ... [Abstract] [Full-text]

Articles on Addison's Disease published 17 April 2008:

Sex differences in brain developing in the presence or absence of gonads.   Dev Neurobiol.

Brain sexual differentiation results from the interaction of genetic and hormonal influences. This study used a unique agonadal mouse model to determine relative contributions of genetic and gonadal hormone influences in the differentiation of selected brain regions. SF-1 knockout (SF-1 KO) mice are born without gonads and adrenal glands and are not exposed to endogenous sex steroids during fetal/neonatal development. Consequently, male and female SF-1 KO mice are born with female external ... [Abstract] [Full-text]

Secondary hypoadrenalism.   Pituitary.

Secondary adrenal insufficiency (SAI) is a clinical disorder that results from hypothalamic or hypophyseal damage or from prolonged administration of supraphysiological doses of glucocorticoids. Since glucocorticoids are widely used for a variety of diseases, the prevalence of SAI is by far exceeding that of primary adrenal insufficiency. Although the presentation of adrenal insufficiency may be insidious and difficult to recognize, an appropriate adrenocortical hormone replacement could lead ... [Abstract] [Full-text]

Articles on Addison's Disease published 16 April 2008:

Evaluation of adrenal function using the human corticotrophin-releasing hormone test, low dose Synacthen test and 9am cortisol level in children and adolescents with central adrenal insufficiency.   Clin Endocrinol (Oxf), 68(5): 683-91.

BACKGROUND: The insulin tolerance test (ITT) has become less popular in paediatrics because of the risks associated with hypoglycaemia. Human corticotrophin-releasing hormone (hCRH) test results correlate with the ITT and may be an acceptable method to test for central adrenal insufficiency (CAI). Simpler tests, such as the low dose Synacthen test (LDST) and 9am cortisol, have also been proposed. OBJECTIVE: To compare the ability of the hCRH test, LDST, 9am cortisol level and 24-h cortisol ... [Abstract] [Full-text]

Mechanisms of an autoimmunity syndrome in mice caused by a dominant mutation in Aire.   J Clin Invest.

Homozygous loss-of-function mutations in AIRE cause autoimmune polyglandular syndrome type 1 (APS 1), which manifests in a classic triad of hypoparathyroidism, adrenal insufficiency, and candidiasis. Interestingly, a kindred with a specific G228W AIRE variant presented with an autosomal dominant autoimmune phenotype distinct from APS 1. We utilized a novel G228W-knockin mouse model to show that this variant acted in a dominant-negative manner to cause a unique autoimmunity syndrome. In ... [Abstract] [Full-text]

Articles on Addison's Disease published 14 April 2008:

Severe acute copper sulphate poisoning: a case report.   Arh Hig Rada Toksikol, 59(1): 31-5.

As copper sulphate pentahydrate (CSP) is a common compound used in agriculture and industry, chronic occupational exposures to CSP are well known, but acute poisoning is rare in the Western world. This case report describes acute poisoning of a 33-year-old woman who attempted suicide by ingesting an unknown amount of CSP. On admission to the hospital, she had symptoms and signs of severe hemorrhagic gastroenteritis, dehydration, renal dysfunction and methaemoglobinaemia with normal serum copper ... [Abstract] [Full-text]

Articles on Addison's Disease published 8 April 2008:

Two-stage operation for hepatocellular carcinoma with synchronous bilateral adrenal gland metastasis.   J Hepatobiliary Pancreat Surg, 15(2): 232-6.

Hepatocellular carcinoma (HCC) frequently metastasizes to the adrenal glands. The surgical strategy for HCC associated with bilateral adrenal gland metastasis is complicated because of the possibility of both postoperative hepatic failure and adrenal insufficiency. We herein report a patient with HCC with synchronous bilateral adrenal gland metastasis that was treated successfully with a two-stage operation. A 58-year-old man with HCC (12 cm in diameter) in the right lobe of the liver and ... [Abstract] [Full-text]

Articles on Addison's Disease published 4 April 2008:

Management of sepsis in patients with liver failure.   Curr Opin Crit Care, 14(2): 189-97.

PURPOSE OF REVIEW: Sepsis constitutes the most common cause of death in the ICU. Liver dysfunction is manifested among previously normal subjects with sepsis but even more so in populations with preexisting liver disease. Managing these patients is more challenging. We will review recent literature in sepsis and liver disease, and their bedside application. RECENT FINDINGS: At the cellular-chemical level, studies showed that platelet aggregation and neutrophil activation occur before and are ... [Abstract] [Full-text]

© 2005-2008 Addison's Disease Research Today. All Rights Reserved.