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Stephan Petersenn - One of the best experts on this subject based on the ideXlab platform.

  • diagnosis of Adrenal insufficiency evaluation of the corticotropin releasing hormone test and basal serum cortisol in comparison to the insulin tolerance test in patients with hypothalamic pituitary Adrenal Disease
    The Journal of Clinical Endocrinology and Metabolism, 2003
    Co-Authors: Lopez I Schmidt, H Lahner, K Mann, Stephan Petersenn
    Abstract:

    The aim of the study was to evaluate the diagnostic value of the human CRH test and the basal morning serum cortisol for the diagnosis of Adrenal insufficiency. Putative peak cortisol cut points for the CRH test and basal cortisol cut points were determined by receiver operating characteristic (ROC) analysis with the insulin tolerance test as reference test. Fifty-four patients with suspected hypothalamic-pituitary-Adrenal Disease were tested. In 20 healthy controls, CRH led to a mean peak cortisol of 594.8 ± 21.7 nmol/liter. The lower limit of a normal response was calculated as 400 nmol/liter. ROC analysis of peak cortisol levels during CRH testing of patients with suspected hypothalamic-pituitary-Adrenal Disease suggested an optimal peak cortisol cut point of ≤377 nmol/liter for the diagnosis of Adrenal insufficiency and a 96% specificity but poor sensitivity of 76%. The baseline cortisol in the healthy control group showed a mean of 439.3 ± 24.9 nmol/liter, resulting in a lower limit of 267 nmol/liter...

  • diagnosis of Adrenal insufficiency evaluation of the corticotropin releasing hormone test and basal serum cortisol in comparison to the insulin tolerance test in patients with hypothalamic pituitary Adrenal Disease
    The Journal of Clinical Endocrinology and Metabolism, 2003
    Co-Authors: Lopez I Schmidt, H Lahner, K Mann, Stephan Petersenn
    Abstract:

    The aim of the study was to evaluate the diagnostic value of the human CRH test and the basal morning serum cortisol for the diagnosis of Adrenal insufficiency. Putative peak cortisol cut points for the CRH test and basal cortisol cut points were determined by receiver operating characteristic (ROC) analysis with the insulin tolerance test as reference test. Fifty-four patients with suspected hypothalamic-pituitary-Adrenal Disease were tested. In 20 healthy controls, CRH led to a mean peak cortisol of 594.8 +/- 21.7 nmol/liter. The lower limit of a normal response was calculated as 400 nmol/liter. ROC analysis of peak cortisol levels during CRH testing of patients with suspected hypothalamic-pituitary-Adrenal Disease suggested an optimal peak cortisol cut point of < or 377 nmol/liter for the diagnosis of Adrenal insufficiency and a 96% specificity but poor sensitivity of 76%. The baseline cortisol in the healthy control group showed a mean of 439.3 +/- 24.9 nmol/liter, resulting in a lower limit of 267 nmol/liter. ROC analysis of patients suggested the highest accuracy for basal cortisol levels of 285 nmol/liter or more for the diagnosis of Adrenal insufficiency (100% sensitivity and 61% specificity). Within this patient group, a cortisol of more than 98 nmol/liter excluded Adrenal insufficiency among those without the disorder, yielding 100% specificity. Using these criteria of upper (285 nmol/liter) and lower (98 nmol/liter) cut-off points with high sensitivity and specificity can reduce the number of individuals who need provocative tests. Basal cortisol is less expensive, and we therefore suggest to use it as a first-line test of Adrenal insufficiency. Because of the low sensitivity of the human CRH test, we do not recommend it as a second test.

William E Rainey - One of the best experts on this subject based on the ideXlab platform.

  • the potential role of aldosterone producing cell clusters in Adrenal Disease
    Hormone and Metabolic Research, 2020
    Co-Authors: William E Rainey
    Abstract:

    Primary aldosteronism (PA) is the most common cause of secondary hypertension. The hallmark of PA is Adrenal production of aldosterone under suppressed renin conditions. PA subtypes include Adrenal unilateral and bilateral hyperaldosteronism. Considerable progress has been made in defining the role for somatic gene mutations in aldosterone-producing adenomas (APA) as the primary cause of unilateral PA. This includes the use of next-generation sequencing (NGS) to define recurrent somatic mutations in APA that disrupt calcium signaling, increase aldosterone synthase (CYP11B2) expression, and aldosterone production. The use of CYP11B2 immunohistochemistry on Adrenal glands from normal subjects, patients with unilateral and bilateral PA has allowed the identification of CYP11B2-positive cell foci, termed aldosterone-producing cell clusters (APCC). APCC lie beneath the Adrenal capsule and like APA, many APCC harbor somatic gene mutations known to increase aldosterone production. These findings suggest that APCC may play a role in pathologic progression of PA. Herein, we provide an update on recent research directed at characterizing APCC and also discuss the unanswered questions related to the role of APCC in PA.

  • steroid biomarkers in human Adrenal Disease
    The Journal of Steroid Biochemistry and Molecular Biology, 2019
    Co-Authors: Juilee Rege, Adina F Turcu, Tobias Else, Richard J Auchus, William E Rainey
    Abstract:

    Abstract Adrenal steroidogenesis is a robust process, involving a series of enzymatic reactions that facilitate conversion of cholesterol into biologically active steroid hormones under the stimulation of angiotensin II, adrenocorticotropic hormone and other regulators. The biosynthesis of mineralocorticoids, glucocorticoids, and Adrenal-derived androgens occur in separate adrenocortical zones as a result of the segregated expression of steroidogenic enzymes and cofactors. This mini review provides the principles of Adrenal steroidogenesis, including the classic and under-appreciated 11-oxygenated androgen pathways. Several Adrenal Diseases result from dysregulated Adrenal steroid synthesis. Herein, we review growing evidence that Adrenal Diseases exhibit characteristic modifications from normal Adrenal steroid pathways that provide opportunities for the discovery of biomarker steroids that would improve diagnosis and monitoring of Adrenal disorders.

Lopez I Schmidt - One of the best experts on this subject based on the ideXlab platform.

  • diagnosis of Adrenal insufficiency evaluation of the corticotropin releasing hormone test and basal serum cortisol in comparison to the insulin tolerance test in patients with hypothalamic pituitary Adrenal Disease
    The Journal of Clinical Endocrinology and Metabolism, 2003
    Co-Authors: Lopez I Schmidt, H Lahner, K Mann, Stephan Petersenn
    Abstract:

    The aim of the study was to evaluate the diagnostic value of the human CRH test and the basal morning serum cortisol for the diagnosis of Adrenal insufficiency. Putative peak cortisol cut points for the CRH test and basal cortisol cut points were determined by receiver operating characteristic (ROC) analysis with the insulin tolerance test as reference test. Fifty-four patients with suspected hypothalamic-pituitary-Adrenal Disease were tested. In 20 healthy controls, CRH led to a mean peak cortisol of 594.8 ± 21.7 nmol/liter. The lower limit of a normal response was calculated as 400 nmol/liter. ROC analysis of peak cortisol levels during CRH testing of patients with suspected hypothalamic-pituitary-Adrenal Disease suggested an optimal peak cortisol cut point of ≤377 nmol/liter for the diagnosis of Adrenal insufficiency and a 96% specificity but poor sensitivity of 76%. The baseline cortisol in the healthy control group showed a mean of 439.3 ± 24.9 nmol/liter, resulting in a lower limit of 267 nmol/liter...

  • diagnosis of Adrenal insufficiency evaluation of the corticotropin releasing hormone test and basal serum cortisol in comparison to the insulin tolerance test in patients with hypothalamic pituitary Adrenal Disease
    The Journal of Clinical Endocrinology and Metabolism, 2003
    Co-Authors: Lopez I Schmidt, H Lahner, K Mann, Stephan Petersenn
    Abstract:

    The aim of the study was to evaluate the diagnostic value of the human CRH test and the basal morning serum cortisol for the diagnosis of Adrenal insufficiency. Putative peak cortisol cut points for the CRH test and basal cortisol cut points were determined by receiver operating characteristic (ROC) analysis with the insulin tolerance test as reference test. Fifty-four patients with suspected hypothalamic-pituitary-Adrenal Disease were tested. In 20 healthy controls, CRH led to a mean peak cortisol of 594.8 +/- 21.7 nmol/liter. The lower limit of a normal response was calculated as 400 nmol/liter. ROC analysis of peak cortisol levels during CRH testing of patients with suspected hypothalamic-pituitary-Adrenal Disease suggested an optimal peak cortisol cut point of < or 377 nmol/liter for the diagnosis of Adrenal insufficiency and a 96% specificity but poor sensitivity of 76%. The baseline cortisol in the healthy control group showed a mean of 439.3 +/- 24.9 nmol/liter, resulting in a lower limit of 267 nmol/liter. ROC analysis of patients suggested the highest accuracy for basal cortisol levels of 285 nmol/liter or more for the diagnosis of Adrenal insufficiency (100% sensitivity and 61% specificity). Within this patient group, a cortisol of more than 98 nmol/liter excluded Adrenal insufficiency among those without the disorder, yielding 100% specificity. Using these criteria of upper (285 nmol/liter) and lower (98 nmol/liter) cut-off points with high sensitivity and specificity can reduce the number of individuals who need provocative tests. Basal cortisol is less expensive, and we therefore suggest to use it as a first-line test of Adrenal insufficiency. Because of the low sensitivity of the human CRH test, we do not recommend it as a second test.

Steven K Libutti - One of the best experts on this subject based on the ideXlab platform.

  • consequences of Adrenal venous sampling in primary hyperaldosteronism and predictors of unilateral Adrenal Disease
    Journal of The American College of Surgeons, 2010
    Co-Authors: Aarti Mathur, Clinton D Kemp, Utpal Dutta, Smita Baid, Alejandro R Ayala, Richard Chang, Seth M Steinberg, Vasilios Papademetriou, Eileen Lange, Steven K Libutti
    Abstract:

    Background In patients with primary hyperaldosteronism, distinguishing between unilateral and bilateral Adrenal hypersecretion is critical in assessing treatment options. Adrenal venous sampling (AVS) has been advocated by some to be the gold standard for localization of the responsible lesion, but there remains a lack of consensus for the criteria and the standardization of technique. Study Design We performed a retrospective study of 114 patients with a biochemical diagnosis of primary hyperaldosteronism who all underwent CT scan and AVS before and after corticotropin (ACTH) stimulation. Univariate and multivariate analyses were performed to determine what factors were associated with AVS lateralization, and which AVS values were the most accurate criteria for lateralization. Results Eighty-five patients underwent surgery at our institution for unilateral hyperaldosteronism. Of the 57 patients who demonstrated unilateral abnormalities on CT, AVS localized to the contralateral side in 5 patients and revealed bilateral hyperplasia in 6 patients. Of the 52 patients who showed bilateral Disease on CT scan, 43 lateralized with AVS. The most accurate criterion on AVS for lateralization was the post-ACTH stimulation value. Factors associated with AVS lateralization included a low renin value, high plasma aldosterone-to plasma-renin ratio, and Adrenal mass ≥ 3 cm on CT scan. Conclusions Because 50% of patients would have been inappropriately managed based on CT scan findings, patients with biochemical evidence of primary hyperaldosteronism and considering Adrenalectomy should have AVS. The most accurate measurement for AVS lateralization was the post-ACTH stimulation value. Although several factors predict successful AVS lateralization, none are accurate enough to perform AVS selectively.

Oksana Lekarev - One of the best experts on this subject based on the ideXlab platform.

  • Adrenal Disease in pregnancy
    Best Practice & Research Clinical Endocrinology & Metabolism, 2011
    Co-Authors: Oksana Lekarev
    Abstract:

    Adrenal disorders in pregnancy are relatively rare, yet can lead to significant maternal and fetal morbidity. Making a diagnosis is challenging as pregnancy may alter the manifestation of Disease, many signs and symptoms associated with pregnancy are also seen in Adrenal Disease, and the fetal-placental unit alters the maternal endocrine metabolism and hormonal feedback mechanisms. The most common cause of Cushing's syndrome in pregnancy is an Adrenal adenoma, followed by pituitary etiology, Adrenal carcinoma, and other exceedingly rare causes. Medical therapy of Cushing's syndrome includes metyrapone and ketoconazole, but generally surgical treatment is more effective. Exogenous corticosteroid administration is the most common cause of Adrenal insufficiency, followed by the endogenous causes of ACTH or CRH secretion. Primary Adrenal insufficiency is least common. A low early morning cortisol