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Ekkehard W Zollner - One of the best experts on this subject based on the ideXlab platform.
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hypothalamic pituitary Adrenal axis suppression in asthmatic children on inhaled corticosteroids part 2 the risk as determined by gold standard Adrenal Function tests a systematic review
Pediatric Allergy and Immunology, 2007Co-Authors: Ekkehard W ZollnerAbstract:Zollner EW. Hypothalamic-pituitary-Adrenal axis suppression in asthmatic children on inhaled corticosteroids (Part 2) - the risk as determined by gold standard Adrenal Function tests: A systematic review. Pediatr Allergy Immunol 2007: 18: 469-474. 2007 The Author Journal compilation 2007 Blackwell Munksgaard The evidence for hypothalamic-pituitary-Adrenal axis (HPA) suppres- sion by inhaled corticosteroids (ICS) was found to be conflicting. Reviewers have not distinguished between gold standard and basal Adrenal Function tests. The utility of the latter is limited by physiological and pathological variability as well as by methodological concerns. The risk of HPA suppression in asthmatic children and adolescents treated with ICS, as determined by gold standard Adrenal Function tests, needs to be established. A systematic review of the literature from January 1973 to July 2005 was performed. The Medline and Cochrane databases were searched, the reference lists of retrieved articles were inspected and pharmaceutical companies were approached. Randomized-controlled trials, cohort and case-control studies designed to detect HPA sup- pression caused by ICS, diagnosed by the insulin tolerance test (ITT) or the metyrapone test, performed on asthmatics of all ages not on oral steroids, were included and assessed for methodological quality. Of the 22 identified studies only four met the criteria for inclusion. All of these were published before 1988 and only one was methodologically sound. The cohort study showed that the baseline risk for HPA suppression is 0% while the absolute risk is 100% in asthmatic children treated with a beclomethasone dipropionate metered dose inhaler at a dose of 250- 600 lg/m 2 /day for 6-42 months. As suggested by other observations these results could be generalized to other ICS. They may be of clinical significance especially if children are subjected to stress. Further research is needed to establish the cumulative dose for all ICS at which HPA suppression will be precipitated. Guidelines for future trials are suggested.
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hypothalamic pituitary Adrenal axis suppression in asthmatic children on inhaled corticosteroids part 1 which test should be used
Pediatric Allergy and Immunology, 2007Co-Authors: Ekkehard W ZollnerAbstract:The effect of inhaled corticosteroids (ICS) on the hypothalamic-pituitary-Adrenal axis (HPA) has been regarded as a ‘benign physiological response’. A recent survey suggests that Adrenal crisis might be more common in asthmatic children on ICS than previously thought. The clinical features of Adrenal insufficiency are non-specific and can easily be missed. Accurate biochemical assessment of the axis is therefore mandatory. A review of the literature determined that all basal Adrenal Function tests, including plasma cortisol profiles, cannot identify which children can respond to stress. There is no evidence to suggests that the degree of the physiological adjustment of the HPA to ICS predicts clinically significant HPA suppression. Only gold standard Adrenal Function tests can assess the integrity of the whole axis. Of the two available tests, the correctly performed overnight metyrapone test (with ACTH levels) is safe and better by far. The use of cortisol profiles should only be used to demonstrate differences in systemic activity of various ICS and delivery devices. Regulatory bodies should insist on trials that evaluate the HPA with a gold standard Adrenal Function test before it is declared safe and allowed to be marketed. A re-analysis of studies that have utilized gold standard Adrenal Function tests only might identify the lowest safe dose and duration of ICS.
Bala Venkatesh - One of the best experts on this subject based on the ideXlab platform.
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characterising Adrenal Function using directly measured plasma free cortisol in stable severe liver disease
Journal of Hepatology, 2010Co-Authors: Terrence C. H. Tan, Jeremy Cohen, Linus Chang, A Woodward, Brett Mcwhinney, John Galligan, Graeme A Macdonald, Bala VenkateshAbstract:Background & Aims Adrenal insufficiency (AI) has been reported in patients with advanced liver disease. Diagnosing AI is problematic owing to controversies in using total serum cortisol as a measure of Adrenal Function. No published data exist on directly measured plasma free cortisol (PFC) in patients with liver disease. Methods This prospective study compared serum total and measured plasma free cortisol to evaluate Adrenal Function in clinically stable cirrhotic patients and healthy controls. Cortisol levels were measured at baseline and following 250μg corticotrophin. AI was defined by total cortisol increments (delta cortisol) of less than 250nmol/L, or a peak total cortisol under 500nmol/L after cosyntropin. We used a peak plasma free cortisol concentration of 33nmol/L as the threshold for AI. Results Forty-three consecutive patients and 10 healthy controls were studied. Cirrhotic patients had significantly lower peak (526 vs. 649nmol/L, p =0.004) and delta total cortisol (264 vs. 397nmol/L, p =0.002) responses compared to healthy controls. However, basal plasma free cortisol was higher in patients (10.9 vs. 6.4nmol/L, p =0.03), and there were no differences in peak plasma free cortisol ( p =0.69) between the two groups. The prevalence of AI using total cortisol criteria was 58% compared to 12% using free cortisol ( p Conclusion In patients with stable severe liver disease, a significant discrepancy exists between the rates of diagnosis of AI using the total and free cortisol criteria. We would advise caution in the interpretation of Adrenal Function testing using total cortisol measurements in this group.
Graeme A Macdonald - One of the best experts on this subject based on the ideXlab platform.
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characterising Adrenal Function using directly measured plasma free cortisol in stable severe liver disease
Journal of Hepatology, 2010Co-Authors: Terrence C. H. Tan, Jeremy Cohen, Linus Chang, A Woodward, Brett Mcwhinney, John Galligan, Graeme A Macdonald, Bala VenkateshAbstract:Background & Aims Adrenal insufficiency (AI) has been reported in patients with advanced liver disease. Diagnosing AI is problematic owing to controversies in using total serum cortisol as a measure of Adrenal Function. No published data exist on directly measured plasma free cortisol (PFC) in patients with liver disease. Methods This prospective study compared serum total and measured plasma free cortisol to evaluate Adrenal Function in clinically stable cirrhotic patients and healthy controls. Cortisol levels were measured at baseline and following 250μg corticotrophin. AI was defined by total cortisol increments (delta cortisol) of less than 250nmol/L, or a peak total cortisol under 500nmol/L after cosyntropin. We used a peak plasma free cortisol concentration of 33nmol/L as the threshold for AI. Results Forty-three consecutive patients and 10 healthy controls were studied. Cirrhotic patients had significantly lower peak (526 vs. 649nmol/L, p =0.004) and delta total cortisol (264 vs. 397nmol/L, p =0.002) responses compared to healthy controls. However, basal plasma free cortisol was higher in patients (10.9 vs. 6.4nmol/L, p =0.03), and there were no differences in peak plasma free cortisol ( p =0.69) between the two groups. The prevalence of AI using total cortisol criteria was 58% compared to 12% using free cortisol ( p Conclusion In patients with stable severe liver disease, a significant discrepancy exists between the rates of diagnosis of AI using the total and free cortisol criteria. We would advise caution in the interpretation of Adrenal Function testing using total cortisol measurements in this group.
E Vidal - One of the best experts on this subject based on the ideXlab platform.
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recovery of Adrenal Function after long term glucocorticoid therapy for giant cell arteritis a cohort study
PLOS ONE, 2013Co-Authors: Yvan Jamilloux, E Liozon, Gregory Pugnet, Sylvie Nadalon, Stephanie Dumonteil, G Gondran, A L Fauchais, E VidalAbstract:Objectives Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer Adrenal insufficiency. We sought to determine the time until recovery of Adrenal Function after long-term GC therapy, and to assess the prevalence and predictors for secondary Adrenal insufficiency. Subjects and Design 150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until Adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared. Results At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of Adrenal Function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, Adrenal Function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05). Conclusion Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians’ vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.
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recovery of Adrenal Function after long term glucocorticoid therapy for giant cell arteritis a cohort study
PLOS ONE, 2013Co-Authors: Yvan Jamilloux, E Liozon, Gregory Pugnet, Sylvie Nadalon, Stephanie Dumonteil, G Gondran, A L Fauchais, E VidalAbstract:The name of the fifth author is incorrectly represented in the Citation. The correct Citation is: Jamilloux Y, Liozon E, Pugnet G, Nadalon S, Ly KH, et al. (2013) Recovery of Adrenal Function after Long-Term Glucocorticoid Therapy for Giant Cell Arteritis: A Cohort Study. PLoS ONE 8(7): e68713. doi:10.1371/journal.pone.0068713.
Terrence C. H. Tan - One of the best experts on this subject based on the ideXlab platform.
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characterising Adrenal Function using directly measured plasma free cortisol in stable severe liver disease
Journal of Hepatology, 2010Co-Authors: Terrence C. H. Tan, Jeremy Cohen, Linus Chang, A Woodward, Brett Mcwhinney, John Galligan, Graeme A Macdonald, Bala VenkateshAbstract:Background & Aims Adrenal insufficiency (AI) has been reported in patients with advanced liver disease. Diagnosing AI is problematic owing to controversies in using total serum cortisol as a measure of Adrenal Function. No published data exist on directly measured plasma free cortisol (PFC) in patients with liver disease. Methods This prospective study compared serum total and measured plasma free cortisol to evaluate Adrenal Function in clinically stable cirrhotic patients and healthy controls. Cortisol levels were measured at baseline and following 250μg corticotrophin. AI was defined by total cortisol increments (delta cortisol) of less than 250nmol/L, or a peak total cortisol under 500nmol/L after cosyntropin. We used a peak plasma free cortisol concentration of 33nmol/L as the threshold for AI. Results Forty-three consecutive patients and 10 healthy controls were studied. Cirrhotic patients had significantly lower peak (526 vs. 649nmol/L, p =0.004) and delta total cortisol (264 vs. 397nmol/L, p =0.002) responses compared to healthy controls. However, basal plasma free cortisol was higher in patients (10.9 vs. 6.4nmol/L, p =0.03), and there were no differences in peak plasma free cortisol ( p =0.69) between the two groups. The prevalence of AI using total cortisol criteria was 58% compared to 12% using free cortisol ( p Conclusion In patients with stable severe liver disease, a significant discrepancy exists between the rates of diagnosis of AI using the total and free cortisol criteria. We would advise caution in the interpretation of Adrenal Function testing using total cortisol measurements in this group.