Adrenal Cortex Diseases ; etiology ; Child ; Humans ; Sepsis ; complications ; physiopathology ; Shock, Septic ; complications ; physiopathology

Adrenal Cortex Hormones ; therapeutic use ; Dementia ; etiology ; physiopathology ; Giant Cell Arteritis ; complications ; drug therapy ; physiopathology ; Humans

BACKGROUNDTraumatic brain injury (TBI) is a heterogeneous condition that can lead to critical LLLness-related corticosteroid insufficiency (CIRCI) causing a high mortality and morbidity. Glucocorticoids were widely used in the clinical management of TBI, but their benefit has been challenged in some studies and their efficacy, especially for treating CIRCI in TBI patients, remains unclear.

METHODSWe conducted a meta-analysis of published data to determine if the controversy is related to clinical dosing and timing of glucocorticoids (GCs) application. We analyzed published reports in four databases (MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and CBMdisc). The published data were stratified into not only low- and high-dose GCs group but also short- and long-term GCs group to compare their effectiveness in improving TBI outcomes.

RESULTSWe totally identified 16 reports. For low-dose patients, the pooled relative risks (RRs) for two clinical outcomes of death or a combination of death and severe disability were 0.95 (95% confidence interval (CI): 0.80 to 1.13) and 0.95 (95% CI: 0.83 to 1.09), respectively. The risks for infection and gastrointestinal bleeding were 0.85 (95% CI: 0.50 to 1.45) and 0.64 (95% CI: 0.15 to 2.70), respectively. For high-dose group, the pooled RR of death is 1.14 (95% CI: 1.06 to 1.21). The pooled RRs for infection and gastrointestinal bleeding for the high-dose patients were 1.04 (95% CI: 0.93 to 1.15) and 1.26 (95% CI: 0.92 to 1.75), respectively. For long-term use group, the pooled RRs for two clinical outcomes of death or a combination of death and severe disability were 0.98 (95% CI: 0.87 to 1.12) and 1.00 (95% CI: 0.90 to 1.11), respectively. The risks for infection and gastrointestinal bleeding were 0.88 (95% CI: 0.71 to 1.11) and 0.96 (95% CI: 0.35 to 2.66), respectively. For short-term use group, the pooled RR of death is 1.15 (95% CI: 1.07 to 1.23), and importantly the effects on infections were beneficial in terms of TBI patients suffering from CIRCI.

CONCLUSIONSThis meta-analysis suggests an increased risk of death for TBI patients on a high dose and short term of glucocorticoids compared with those on a low dose and long term, for whom a trend towards clinical improvement is evident. In addition, stress-does of GCs further decrease the pneumonia incidence in TBI patients suffering from CIRCI. A large-scale multicenter randomized controlled trial is warranted for testing (1) the efficacy of stress-dose GCs treatment in the sub-acute phase of TBI (4-21 days after initial trauma), when CIRCI is most likely to occur; (2) the hypothesis that stress-dose GCs could boost patients' stress function and ensure survival.

Adrenal Cortex Hormones ; deficiency ; Brain Injuries ; drug therapy ; mortality ; physiopathology ; Critical Illness ; Glucocorticoids ; therapeutic use ; Humans ; Hypothalamo-Hypophyseal System ; physiopathology ; Pituitary-Adrenal System ; physiopathology ; Time Factors

OBJECTIVETo study the effect of intrahepatic cholestasis of pregnancy (ICP) on the functions of the hypothalamic-pituitary-adrenocortical (HPA) axis and adrenal cortex in normal neonates.

METHODSDemographic characteristics, prenatal anxiety and depression, and perceived stress during delivery were investigated in 32 ICP women and 32 controls. The cord blood levels of cortisal, adrenocorticotropic hormone (ACTH), and dehydroepiandrosterone sulfate (DHEAS) were measured by the radioimmunity technique in normal neonates immediately after birth.

RESULTSThe scores of prenatal anxiety and depression in ICP women were significantly higher than those in controls (p<0.05 and p<0.01, respectively). There were no significant differences in the perceived stress during delivery between the two groups. The cord blood levels of cortisol and ACTH in neonates from ICP women were significantly lower (p<0.01), while the DHEAS level was significantly higher (p<0.01) than in neonates from controls. The DHEAS/ACTH ratio was significantly higher (p<0.01), while the cortisol/DHEAS ratio was significantly lower in the ICP group (p<0.01) than in the control group. The glycocholic acid level in ICP women was positively correlated with the DHEAS level in neonatal cord blood (r=0.47, p<0.01).

CONCLUSIONSThere may be a dissociation between cortisol and DHEAS in neonates with normal birth outcome from ICP women. ICP may result in a decreased responsiveness of HPA axis and an increased secretion of DHEAS by adrenal cortex in these neonates. This suggests that there might be dysfunction of the fetal zones of the adrenal cortex.

Adrenal Cortex ; physiopathology ; Adrenocorticotropic Hormone ; blood ; Adult ; Cholestasis, Intrahepatic ; physiopathology ; Dehydroepiandrosterone Sulfate ; blood ; Female ; Humans ; Hydrocortisone ; blood ; Hypothalamo-Hypophyseal System ; physiopathology ; Infant, Newborn ; Pituitary-Adrenal System ; physiopathology ; Pregnancy ; Pregnancy Complications ; physiopathology

OBJECTIVETo investigate the effects of obesity on response to therapy and pulmonary function in children with asthma who receive inhaled corticosteroid (ICS) treatment.

METHODSA total of 129 children with asthma were divided into two groups according to their body mass index: normal weight group (n=64) and obese group (n=65). The asthma control status and pulmonary function were compared between the two groups after one year of ICS treatment. The pulmonary function was expressed as percent forced expiratory volume in 1 second (FEV1%), percent predicted forced vital capacity (FVC%), peak expiratory flow (PEF), peak expiratory flow at 25% of vital capacity (PEF25), and peak expiratory flow at 50% of vital capacity (PEF50). The asthma control status was expressed as complete control rate, partial control rate, and uncontrolled rate. Sixty-eight healthy children were selected as the healthy control group.

RESULTSThere were significant differences in the indices of pulmonary function between the three groups before treatment (P<0.01); the healthy control group had the best values of pulmonary function, while the obese group had the worst values. After 1 year of treatment, the normal weight group showed significantly more improvements in FEV1% and FVC% than the obese group (P<0.01). However, there were no significant differences in improvements in PEF, PEF25, and PEF50 between the two groups. The complete control rate, partial control rate, and uncontrolled rate in the normal weight group were 72%, 19%, and 9%, respectively, while the rates in the obese group were 28%, 51%, and 22%, respectively; the normal weight group had a significantly better asthma control status than the obese group (P<0.01).

CONCLUSIONSThe asthmatic children with obesity have a significantly less improvement in large airway function and a poorer asthma control status after ICS treatment than those with the normal weight.

Administration, Inhalation ; Adrenal Cortex Hormones ; administration & dosage ; Asthma ; drug therapy ; physiopathology ; Child ; Child, Preschool ; Female ; Forced Expiratory Volume ; Humans ; Lung ; physiopathology ; Male ; Obesity ; physiopathology

OBJECTIVETo investigate the factors regarding the recovery of postoperative blood pressure of aldosterone producing adenoma (APA) patients.

METHODSSixty-eight patients with APA were recruited and their data including retinal blood vessel by Doppler sonography, urinary trace albumin, pathological changes of renal biopsy and the adrenal tissues around the adenoma were analyzed in order to determine the correlation between these data and postoperative durative hypertension.

RESULTSPostoperative durative hypertension occurred in 14 cases (41.2%) with increased resistance of unilateral or bilateral central artery of retina, in 16 cases (66.7%) with increased level of urinary trace albumin. Fifteen cases underwent renal biopsy and all of them showed different pathological alterations, 11 cases (73.3%) of which presented with postoperative durative hypertension. The pathological changes of the adrenal tissues around the adenoma is either atrophy or non-atrophy (normal or hyperplasia), 8 cases (40%) and 10 cases (22.2%) of which showed postoperative durative hypertension, respectively.

CONCLUSIONThe renal pathological changes and increased resistance of retinal blood vessel are the main reasons leading to postoperative hypertension in patients with APA.

Adolescent ; Adrenal Cortex Neoplasms ; physiopathology ; surgery ; Adrenal Glands ; pathology ; Adrenocortical Adenoma ; physiopathology ; surgery ; Adult ; Blood Pressure ; physiology ; Female ; Humans ; Hyperaldosteronism ; etiology ; physiopathology ; surgery ; Hypertension ; etiology ; Kidney ; pathology ; Male ; Middle Aged ; Postoperative Period ; Retinal Artery ; physiopathology ; Retrospective Studies ; Vascular Resistance ; physiology

Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality.
Adrenal Cortex Hormones ; administration & dosage ; Exercise Therapy ; methods ; Fasciitis, Plantar ; physiopathology ; therapy ; Humans ; Injections ; Outpatients ; Walking ; physiology

The metabolic alterations caused by hyperaldosteronism are being increasingly recognized and have generated considerable interest among the medical fraternity. Hyperaldosteronism is suspected to have a pivotal role in the patho-physiology of congestive cardiac failure where it has been studied extensively. But its effects on calcium metabolism, parathyroid metabolism and renal handling of calcium are less well described. Recent experimental models have shed light into the roles played by previously unknown mechanisms in causing these metabolic alterations. We hereby report a case of primary hyperaldosteronism due to adrenal adenoma (Conn's syndrome) who presented with a myriad of clinical features including symptomatic hypocalcemia, significant weight loss along with uncontrolled hypertension for a prolonged period before eventually detected to have primary hyperaldosteronism. Surgical removal of the causative tumor resulted in prompt disappearance of all the symptoms and signs and regain of lost weight.
Adrenal Cortex Neoplasms/*complications/diagnosis/pathology/surgery ; Adrenocortical Adenoma/*complications/diagnosis/pathology/surgery ; Adult ; Female ; Humans ; *Hyperaldosteronism/complications/etiology/physiopathology ; Hypocalcemia/*etiology ; Pregnancy ; Treatment Outcome

OBJECTIVETo explore the clinical manifestations, diagnosis, treatment and prognosis of acute panautonomic neuropathy (APN).

METHODSWe reviewed the history, clinical findings, electrophysiological characteristics, laboratory features of CSF and treatment of 4 patients with APN.

RESULTSAll these patients showed acute onset with apparent involvement of the autonomic nervous system. The clinical features of autonomic involvement included fixed dilated pupils, abdominal pain, diarrhea, and anhidrosis. Electromyography showed evidence of peripheral neuropathy. Early treatment with corticosteroid and intravenous immunoglobulins resulted in improved prognosis of the patients.

CONCLUSIONAPN is a rare autonomic nervous system disorder, and understanding of the clinical features may help in early diagnosis and treatment of the patients.

Acute Disease ; Adolescent ; Adrenal Cortex Hormones ; therapeutic use ; Adult ; Autonomic Nervous System Diseases ; diagnosis ; physiopathology ; therapy ; Female ; Humans ; Immunoglobulins, Intravenous ; therapeutic use ; Male ; Young Adult

OBJECTIVETo study the association between body mass index (BMI) and lung function of asthmatic children after inhaling corticosteroids (ICS).

METHODSOne hundred and fifty-seven children with asthma were classified into obese (46 cases), over-weight (50 cases) and normal-weight groups (61 cases) based on BMI. All of the children received ICS for one year. Pulmonary functions were evaluated before and after treatment. Large airway function includes forced expiratory volume in one second (FEV1%) and forced vital capacity (FVC%). Small airway function includes maximal expiratory flow 25 (MEF25%) and maximal expiratory flow 50 (MEF50%).

RESULTSThe bronchial provocation test before treatment showed that the decline rate of pulmonary function (FVC%, FEV1%, MEF25% and MEF50%) in the obese group was higher than the normal-weight group after methacholine inhalation. After salbutamol inhalation, the improvement rate of the large airway (FVC%) and small airway (MEF25% and MEF50%) functions in the obese group was lower than the normal-weight group, and the improvement rate of small airway (MEF25% and MEF50%) function in the over-weight group was lower than in the normal-weight group. After treatment with ICS for one year, large airway function (FVC% and FEV1%) in the normal-weight group was higher than pre-treatment, however only FVC% in the normal-weight and obese groups was higher than pre-treatment. There was no significant difference in small airway function before and after treatment in all three groups.

CONCLUSIONSObesity can increase the sensitivity to methacholine and restrain the sensitivity to tosalbutamol in children with asthma. ICS can improve the large airway function in asthmatic children with normal body weight, but has no effect on small airway function. Obesity can restrain the effect of ICS on asthmatic children.

Administration, Inhalation ; Adrenal Cortex Hormones ; administration & dosage ; Asthma ; drug therapy ; physiopathology ; Body Mass Index ; Child ; Female ; Forced Expiratory Volume ; Humans ; Male ; Vital Capacity