Minding the gap between cortisol levels measured with second-generation assays and current diagnostic thresholds for the diagnosis of adrenal insufficiency: a single-center experience.

Minding the gap between cortisol levels measured with second-generation assays and current diagnostic thresholds for the diagnosis of adrenal insufficiency: a single-center experience. Hormones (Athens). 2020 Mar 28;: Authors: Grassi G, Morelli V, Ceriotti F, Polledri E, Fustinoni S, D'Agostino S, Mantovani G, Chiodini I, Arosio M Abstract PURPOSE: The current cut-offs for the diagnosis of adrenal insufficiency (AI) have been established using outdated immunoassays. We compared the cortisol concentrations measured with Roche Cortisol I (R1), the newly available Roche Cortisol II (R2), and liquid chromatography tandem mass spectrometry (LC-MS/MS), the gold standard procedure to measure steroids in patients undergoing the corticotropin (ACTH) test. METHODS: We enrolled 30 patients (age 47 ± 21 years) referred to undergo the ACTH test (1 or 250 μg). Cortisol was measured at 0, 30, and 60 min after stimulation with R1, R2, and LC-MS/MS. AI was diagnosed for R1-stimulated peak cortisol concentrations
Source: Hormones - Category: Endocrinology Tags: Hormones (Athens) Source Type: research

Related Links:

Abstract Adrenal insufficiency (AI) is a potential immune-related adverse event (irAE) of immunotherapy (e.g., checkpoint inhibitor). If not identified and treated promptly, AI can be life-threatening. Unlike other irAEs, AI may be irreversible, requiring long-term glucocorticoid and mineralocorticoid replacement. Provider and patient education are essential in the management of immune checkpoint inhibitor-induced AI. PMID: 32441673 [PubMed - as supplied by publisher]
Source: Clinical Journal of Oncology Nursing - Category: Nursing Authors: Tags: Clin J Oncol Nurs Source Type: research
Conclusion: In this series, 85 % of the patients had life-threatening AI and two patients had hypercalcemia. These results pointed out that potent GCs cause serious side effects especially in infants, and the recovery of the HPA axis in children might take as long as 780 days. The parents should be informed regarding the possibility of containing synthetic glucocorticoids in cosmetic products and their side effects. PMID: 32431136 [PubMed - as supplied by publisher]
Source: JCRPE Journal of Clinical Research in Pediatric Endocrinology - Category: Endocrinology Tags: J Clin Res Pediatr Endocrinol Source Type: research
Emergency medical identification (EMI) comes in many forms, including jewelry, wallet cards, shoelace tags, seatbelt covers, on smart phones and more recently, tattoos. While some forms of EMI are free of cost, others are expensive with annual membership fees to provide comprehensive medical information 24/7 to emergency personnel. EMI is vital for patients with chronic and/or hidden conditions like seizure disorders, cardiac disease, allergies, adrenal insufficiency (AI), and diabetes. Having EMI improves access to life saving medical care in life-threatening situations.
Source: Journal of Pediatric Nursing - Category: Nursing Authors: Source Type: research
Conclusion: This case highlights the importance of pursuing a diagnosis when clinical suspicion remains, and the significance of VLCFA analysis for patients with adrenal insufficiency without adrenal antibodies in prompting an ALD diagnosis. Subsequent brain imaging surveillance can detect early, pre-symptomatic cerebral disease allowing for timely treatment and successful arrest of cerebral disease progression. PMID: 32394691 [PubMed - as supplied by publisher]
Source: JCRPE Journal of Clinical Research in Pediatric Endocrinology - Category: Endocrinology Tags: J Clin Res Pediatr Endocrinol Source Type: research
Discussion of these controversial topics represents an attempt to define the role of partial adrenalectomy in modern adrenal surgery. PMID: 32388629 [PubMed - as supplied by publisher]
Source: Hormones - Category: Endocrinology Tags: Hormones (Athens) Source Type: research
CONCLUSION: Our study represents the largest clinical description and characterization of PAI-irAE. Although ICI-associated PAI is a rare adverse event, early recognition is important to implement corticosteroid treatment. Further studies are required to elucidate risk factors and reversibility of this rare but severe irAE. Clinical trial identification number. NCT03492242 IMPLICATIONS FOR PRACTICE: Immune checkpoint inhibitor (ICI)-associated primary adrenal insufficiency (PAI) is a rare adverse event that is important to recognize because it may be severe and life-threatening, requiring emergent and often lifelong hormon...
Source: The Oncologist - Category: Cancer & Oncology Authors: Tags: Oncologist Source Type: research
This study evaluated the diagnostic performance of serum delta cortisol from ACTH stimulation tests and determined appropriate cut-off levels of serum 30-minute delta cortisol for the diagnosis of AI, allowing a reduction in the number of 60-minute cortisol tests. A 6-year retrospective study in 471 patients was conducted. The performance of the serum delta cortisol in diagnosing AI was assessd using a multivariable logistic regression model and the area under ROC curves (AuROC). Both serum 30-minute and 60-minute delta cortisol demonstrated equally high diagnostic accuracy for AI (AuROC for LDT : 0.91 vs 0.90 ; HDT...
Source: Journal of Medical Investigation - Category: General Medicine Tags: J Med Invest Source Type: research
In conclusion, osilodrostat treatment led to a reduction in mUFC in all nine patients with endogenous CS other than Cushing's disease (CD), regardless of disease type, with>80% reduction seen in 6/7 patients at week 12. The safety profile was consistent with previous reports in CD patients, and the reported AEs were manageable. PMID: 32378529 [PubMed - as supplied by publisher]
Source: Endocrine Journal - Category: Endocrinology Tags: Endocr J Source Type: research
Conclusions: Allgrove syndrome is a rare genetic disease that is characterized by the triad of achalasia, alacrima, and adrenal insufficiency. Early diagnosis, confirmed with genetic testing, is essential to initiate an appropriate follow-up and prevent a life-threatening addisonian crisis. Report of novel mutations is important to further characterize this disease.
Source: Cornea - Category: Opthalmology Tags: Case Report Source Type: research
Authors: Zhu J, Eichler F, Biffi A, Duncan CN, Williams DA, Majzoub JA Abstract Adrenoleukodystrophy (ALD) is a rare X-linked disorder of peroxisomal oxidation due to mutations in ABCD1. It is a progressive condition with a variable clinical spectrum that includes primary adrenal insufficiency, myelopathy, and cerebral ALD. Adrenal insufficiency affects over 80% of ALD patients. Cerebral ALD affects one-third of boys under the age of 12 years and progresses to total disability and death without treatment. Hematopoietic stem cell transplantation (HSCT) remains the only disease-modifying therapy if completed in the e...
Source: Endocrine Reviews - Category: Endocrinology Tags: Endocr Rev Source Type: research
More News: Addison's Disease | Adrenal Insufficiency | Endocrinology | Hormones