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Adrenal Disease
The Experts below are selected from a list of 291 Experts worldwide ranked by ideXlab platform
Stephan Petersenn – 1st expert on this subject based on the ideXlab platform
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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, 2003Co-Authors: Lopez I Schmidt, H Lahner, K Mann, Stephan PetersennAbstract: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…
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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, 2003Co-Authors: Lopez I Schmidt, H Lahner, K Mann, Stephan PetersennAbstract: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 – 2nd expert on this subject based on the ideXlab platform
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the potential role of aldosterone producing cell clusters in Adrenal Disease
Hormone and Metabolic Research, 2020Co-Authors: William E RaineyAbstract: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, 2019Co-Authors: Juilee Rege, Adina F Turcu, Tobias Else, Richard J Auchus, William E RaineyAbstract: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 – 3rd expert on this subject based on the ideXlab platform
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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, 2003Co-Authors: Lopez I Schmidt, H Lahner, K Mann, Stephan PetersennAbstract: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…
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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, 2003Co-Authors: Lopez I Schmidt, H Lahner, K Mann, Stephan PetersennAbstract: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.