scholarly journals P.089 Recovery from chronic secondary adrenal insufficiency in patients with pituitary disorders

2016 ◽  
Vol 43 (S2) ◽  
pp. S41-S41
Author(s):  
V Munro ◽  
B Tugwell ◽  
S Doucette ◽  
DB Clarke ◽  
A Lacroix ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Tumour Size ◽  
Pituitary Surgery ◽  
Complete Recovery ◽  
Glucocorticoid Therapy ◽  
Hormone Deficiency ◽  
Secondary Adrenal Insufficiency ◽  
Glucocorticoid Treatment ◽  
Acth Secreting

Background: Patients with pituitary disorders may be placed on steroid replacement for secondary adrenal insufficiency (SAI), generally after pituitary surgery; however, data regarding recovery of long-term SAI are lacking. We conducted a study to assess the longer term recovery rate of SAI in patients with pituitary disorders. Methods: We identified all SAI patients from prospectively entered data in the Halifax Neuropituitary Database from November 1, 2005 to September 30, 2014, who had required glucocorticoid therapy for >3 months, and a minimum follow-up of 6 months. Exclusion: ACTH-secreting adenomas; peri-operative glucocorticoid treatment only; glucocorticoids for non-pituitary conditions. Results: 55 patients fulfilled the criteria, 41 (75%) of which had transsphenoidal surgery. Nine (16.4%) patients had complete recovery of SAI over a median of 20 months (range: 8–51). Smaller tumour size and initial cortisol >175 nmol/L had increased likelihood of recovery; those with secondary hypogonadism or growth hormone deficiency were less likely to recover. Conclusions: This is the first study to examine long-term recover of SAI in patients with pituitary disorders: approximately 1 in 6 patients recover adrenal function, up to 5 years after diagnosis. Consequently, patients with SAI should undergo regular testing to prevent unnecessary chronic glucocorticoid therapy.

scholarly journals Secondary Adrenal Insufficiency after Treatment with Budesonide for Autoimmune Hepatitis

2018 ◽  
Vol 12 (3) ◽  
pp. 597-601 ◽  
Author(s):  
Filip De Maeyer ◽  
Bruno Lapauw ◽  
Anne Hoorens ◽  
Anja Geerts ◽  
Hans Van Vlierberghe ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
Adrenal Insufficiency ◽  
Attractive Alternative ◽  
Secondary Adrenal Insufficiency ◽  
Systemic Activity ◽  
Immunosuppressive Medication ◽  
Systemic Corticosteroids ◽  
First Case ◽  
First Pass

Autoimmune hepatitis (AIH) is a rare cause of chronic liver disease. The backbone of treatment is immunosuppressive medication, typically prednisolone as induction therapy and azathioprine as a maintenance therapy. Side effects of the long-term use of systemic corticosteroids are well known and have led to the use of alternative induction regimens. An attractive alternative is budesonide, a nonhalogenated glucocorticosteroid characterized by a high first-pass effect in the liver (90%), resulting in a high topical anti-inflammatory activity and a low systemic activity. It should be stressed that budesonide is contraindicated in patients with established cirrhosis with portal hypertension and portocaval shunting. In this case report, we present the first case of adrenal insufficiency following treatment with budesonide for AIH.

scholarly journals Comparative study of glucagon and insulin tests for diagnostics of secondary adrenal insufficiency and growth hormone deficiency in children and adolescents

2021 ◽  
Vol 66 (6) ◽  
pp. 50-58
Author(s):  
A. V. Vitebskaya ◽  
E. A. Pisareva ◽  
A. V. Popovich
Keyword(s):  
Growth Hormone ◽  
Children And Adolescents ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Early Morning ◽  
Hormone Deficiency ◽  
Secondary Adrenal Insufficiency ◽  
Glucagon Test ◽  
Cortisol Levels ◽  
Glucagon And Insulin

BACKGROUND: Diagnostics of growth hormone deficiency (GHD) and secondary adrenal insufficiency (SAI) is based on estimation of peak GH and cortisol concentrations in provocation tests. Russian consensus on diagnostics and treatment of hypopituitarism in children and adolescences recommends to measure GH and cortisol concentrations in every time-point of insulin test (IT). Glucagon test (GT) is discussed in literature as alternative to IT.AIMS: To estimate the possibility to use provocation GT for diagnostics of SAI and GHD in children and adolescents.MATERIALS AND METHODS: We investigated blood and urine cortisol levels, IT, and GT in 20 patients 6.5–17.8 years (Me 13.0 (10.4; 15.3)) after surgery and/or radiology and/or chemical therapy of head and neck tumors; remission for 0.4–7.5 years (Ме 2.1 (1.5; 5.2)).RESULTS: With cut-off point 550 nmol/L sensitivity and specifity of IT was 100% and 60%, GT — 100% and 53% respectively. Minimal cortisol cut-off level for GT with sensitivity 100% was 500 nmol/L, maximal with specifity 100% — 400 nmol/L.Early morning cortisol levels did not exceed 250 nmol/l in 2 patients with SAI; and were above 500 nmol/l in 8 patients without SAI while primary or repeated examination.GHD was reviled by IT in all patients. Maximal GH concentrations in GT and IT did not differ significantly (p>0.05) but GT results of 4 patients exceeded or met cut-off for this test (7 ng/ml).GT was characterized by less severity compared with IT.CONCLUSIONS: For diagnostics of SAI by GT we can advise cut-off points of cortisol level 500 (sensitivity 100%, specifty 53%) and 400 nmol/L (sensitivity 80%, specifity 100%). Measuring of cortisol levels in 2–3 early morning blood samples allows to exclude or to suspect SAI in half of patients before tests. GH peaks in GT can exceed similarly data in IT that needs future investigation. 

scholarly journals Dual-release hydrocortisone improves hepatic steatosis in patients with secondary adrenal insufficiency: a real-life study

2019 ◽  
Vol 10 ◽  
pp. 204201881987116 ◽  
Author(s):  
Valentina Guarnotta ◽  
Mariagrazia Irene Mineo ◽  
Stefano Radellini ◽  
Giuseppe Pizzolanti ◽  
Carla Giordano
Keyword(s):  
Insulin Sensitivity ◽  
Adrenal Insufficiency ◽  
Hepatic Steatosis ◽  
Real Life ◽  
Resistance Index ◽  
Sensitivity Index ◽  
Secondary Adrenal Insufficiency ◽  
Glucocorticoid Treatment ◽  
Number Of Patients ◽  
Dual Release

Background: Conventional glucocorticoid treatment has a significant impact on liver in patients with adrenal insufficiency. Dual-release hydrocortisone (DR-HC) provides physiological cortisol exposure, leading to an improvement in anthropometric and metabolic parameters. We aimed to evaluate the effects of 12-month DR-HC treatment on the hepatic steatosis index (HSI), a validated surrogate index of hepatic steatosis, in patients with secondary adrenal insufficiency (SAI). Methods: A total of 45 patients with hypopituitarism, 22 with hypogonadism, hypothyroidism, ACTH, and GH deficiencies, and 23 with hypogonadism, hypothyroidism, and ACTH deficiency, on replacement therapy for all the pituitary deficiencies, were switched from conventional hydrocortisone to DR-HC. At baseline and after 12 months, glucose and insulin levels, surrogate estimates of insulin sensitivity, and hepatic steatosis were evaluated through ultrasonography and HSI. Results: At diagnosis, ultrasonography documented steatosis in 31 patients (68.8%) while 33 (73.3%) showed high HSI. Hydrocortisone (HC) dose (β = 1.231, p  = 0.010), insulin resistance index (HOMA-IR) (β = 1.431, p = 0.002), and insulin sensitivity index (ISI)-Matsuda (β = −1.389, p = 0.034) were predictors of HSI at baseline. After 12 months of DR-HC, a significant decrease in body mass index (BMI) ( p = 0.008), waist circumference (WC) ( p = 0.010), fasting insulin ( p  = 0.041), HOMA-IR ( p = 0.047), HSI ( p < 0.001) and number of patients with HSI ⩾36 ( p = 0.003), and a significant increase in sodium ( p < 0.001) and ISI-Matsuda ( p = 0.031) were observed. HOMA-IR (β = 1.431, p  = 0.002) and ISI-Matsuda (β = −9.489, p < 0.001) were identified as independent predictors of HSI at 12 months. Conclusions: In adults with SAI, DR-HC is associated with an improvement in HSI, regardless of the dose used, mainly related to an improvement in insulin sensitivity.

P.040 New-onset secondary hormone deficiency in patients with incidental versus clinically manifesting sellar masses

2018 ◽  
Vol 45 (s2) ◽  
pp. S26-S26
Author(s):  
N Vaninetti ◽  
S Mustafa ◽  
S Doucette ◽  
R Glasgow ◽  
L Tramble ◽  
...  
Keyword(s):  
Tumour Size ◽  
Clinical Manifestations ◽  
Hormone Deficiency ◽  
Significant Morbidity ◽  
Hormonal Function ◽  
Nonsurgical Patients ◽  
Incidental Lesions ◽  
New Onset

Background: Secondary hormonal deficiency (SHD) in patients with sellar masses (SM) is associated with significant morbidity. Purpose: to compare long-term risk of new-onset SHD in SM found incidentally (ISM) versus those clinically manifesting (CMSM). Methods: From the Halifax Neuropituitary Program’s database, we identified all patients having non-functioning and non-pituitary SM from January 1, 2006, with ≥ 12 months follow-up. Results: There were 214 CMSM (108 with baseline SHD) and 148 ISM (37 with baseline SHD) patients (mean follow-up: 5.7 and 5.0 years, respectively). In patients who underwent early surgery (<90 days from diagnosis), 3-month post-op hormonal function was considered baseline. Despite unchanged tumour size in over 95%, 129 (35.6%) developed new-onset SHD at up to 120 months. The risk of developing new-onset SHD was similar in CMSM and ISM groups (HR = 1.10; CI= 0.69-1.75; p= 0.7), and in surgical and nonsurgical patients (HR=1.24; CI= 0.59-2.61; p = 0.58). Conclusions: More than one third of patients with non-functioning or non-pituitary SM, presenting either with clinical manifestations or as incidental lesions, will develop new-onset SHD. Furthermore, SHD may develop several years later and despite stability of tumors, highlighting the need for ongoing, long-term hormonal assessment.

TRANSSPHENOIDAL DECOMPRESSION OF THE SELLAR FLOOR FOR CAVERNOUS SINUS MENINGIOMAS

Neurosurgery ◽  
2009 ◽  
Vol 65 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Hiroyoshi Akutsu ◽  
Jürgen Kreutzer ◽  
Rudolf Fahlbusch ◽  
Michael Buchfelder
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Adjuvant Radiotherapy ◽  
Complete Recovery ◽  
Endocrine Function ◽  
Hormone Deficiency ◽  
Tumor Control ◽  
Cranial Nerve Dysfunction ◽  
Cranial Nerve Function

ABSTRACT OBJECTIVE The aim of this study was to assess the outcome of cranial nerve and endocrine function after transsphenoidal decompression for symptomatic cavernous sinus (CS) meningioma. METHODS Between 1991 and 2007, 21 patients (19 women and 2 men; mean age, 51.1 ± 10.6 years) harboring symptomatic CS meningiomas underwent transsphenoidal decompression. Sufficient bone removal, opening of the inferomedial wall of the CS, and tumor debulking were performed. RESULTS Notably, the grading of preoperative optomotoric paresis improved in 15 of the 17 patients who presented with that symptom. Complete recovery could be achieved in 8 patients. Complete recovery rates in patients with preoperative grading of “good,” “fair,” and “poor” were 77.7%, 20%, and 0%, respectively (P = 0.0088). Improvement of cranial nerve dysfunction was found in 32 of 34 deficits. No worsening of cranial nerve function occurred. Endocrinologically, the prolactin level was normalized in 13 of the 17 patients with preoperative hyperprolactinemia. Recovery of growth hormone deficiency and hypogonadism were found in 3 patients (37.5%) and 1 patient (33.3%), respectively. Seventeen patients were followed for more than 3 years. Of these 17 patients, 12 patients received initial postoperative adjuvant radiotherapy. The overall tumor control rate after surgery with initial adjuvant radiotherapy was 100% (median follow-up, 65 months; range, 36–126 months). CONCLUSION Transsphenoidal decompression is a safe and effective treatment to improve cranial nerve and endocrine dysfunction in patients with symptomatic CS meningiomas. The less severe optomotoric nerve palsy before surgery, the better the chance of complete recovery of its function. Combined with adjuvant radiotherapy, this minimally invasive management also provided excellent long-term tumor control.

scholarly journals Significant GH deficiency after long-term cure by surgery in adult patients with Cushing’s disease

2007 ◽  
Vol 156 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Francesca Pecori Giraldi ◽  
Massimiliano Andrioli ◽  
Laura De Marinis ◽  
Antonio Bianchi ◽  
Antonella Giampietro ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Cushing’S Disease ◽  
Gh Deficiency ◽  
Pituitary Surgery ◽  
Male Gender ◽  
Cushing's Disease ◽  
Gh Secretion ◽  
Wide Variability ◽  
Acth Secreting

Objective: Impaired GH secretion usually accompanies Cushing’s syndrome and a variable proportion of patients reportedly fail to recover normal GH secretion after successful treatment. This wide variability is most probably due to differences in the treatment (i.e. surgery and/or radiotherapy), timing of patient re-evaluation after surgery and dynamic tests employed to challenge GH secretion, and hinders a precise assessment of risk of GH deficiency after cure. The aim of the present study is to evaluate GH secretory status after long-term cure of Cushing’s disease achieved by surgery alone. Design and methods: We studied 34 patients (27 females and 7 males, age range 21–68 years) formerly affected by Cushing’s disease. Patients were studied 2–20 years (median 3.3 years) following remission of hypercortisolism; all patients underwent transsphenoidal surgery with the removal of an ACTH-secreting adenoma; repeat pituitary surgery for relapse was performed in two patients while bilateral adrenalectomy was necessary in two patients. In all subjects, the GH response to GHRH+arginine stimulation was evaluated. At the time of testing, 13 patients were still on steroid replacement therapy. Results: In long-term surgical remission, 22 patients (65.0%) presented subnormal GH secretion; partial GH deficiency (GH peak <16.5 μg/l) was found in 11 patients and severe GH deficiency (GH peak <9 μg/l) in another 11. Male gender and length of hypercortisolism were risk factors for postsurgical GH deficiency. Conclusions: This study demonstrates the presence of GH deficiency in a high percentage of patients with Cushing’s disease after long-term remission of hypercortisolism obtained by surgery alone. Male gender and length of hypercortisolism are the most significant predictors of postsurgical GH deficiency. This finding is significant as it highlights that even the most favourable therapeutical course, i.e. remission achieved by surgery alone, is accompanied by impaired GH secretion. Assessment of GH secretion is therefore recommended for all patients cured from Cushing’s disease, even if not submitted to radiotherapy. Studies on the clinical impact of GH deficiency and the use of GH replacement therapy seem warranted in patients cured from Cushing’s disease.

scholarly journals Sonic Hedgehog and WNT Signaling Promote Adrenal Gland Regeneration in Male Mice

Endocrinology ◽  
2017 ◽  
Vol 159 (2) ◽  
pp. 579-596 ◽  
Author(s):  
Isabella Finco ◽  
Antonio M Lerario ◽  
Gary D Hammer
Keyword(s):  
Wnt Signaling ◽  
Adrenal Cortex ◽  
Sonic Hedgehog ◽  
Molecular Mechanisms ◽  
Zona Glomerulosa ◽  
Glucocorticoid Therapy ◽  
Adrenocortical Function ◽  
Glucocorticoid Treatment ◽  
Major Health Problem

Abstract The atrophy and hypofunction of the adrenal cortex following long-term pharmacologic glucocorticoid therapy is a major health problem necessitating chronic glucocorticoid replacement that often prolongs the ultimate return of endogenous adrenocortical function. Underlying this functional recovery is anatomic regeneration, the cellular and molecular mechanisms of which are poorly understood. Investigating the lineage contribution of cortical Sonic hedgehog (Shh)+ progenitor cells and the SHH–responsive capsular Gli1+ cells to the regenerating adrenal cortex, we observed a spatially and temporally bimodal contribution of both cell types to adrenocortical regeneration following cessation of glucocorticoid treatment. First, an early repopulation of the cortex is defined by a marked delamination and expansion of capsular Gli1+ cells, recapitulating the establishment of the capsular-cortical homeostatic niche during embryonic development. This rapid repopulation is promptly cleared from the cortical compartment only to be supplanted by repopulating cortical cells derived from the resident long-term-retained zona glomerulosa Shh+ progenitors. Pharmacologic and genetic dissection of SHH signaling further defines an SHH-dependent activation of WNT signaling that supports regeneration of the cortex following long-term glucocorticoid therapy. We define the signaling and lineage relationships that underlie the regeneration process.

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