The Experts below are selected from a list of 156 Experts worldwide ranked by ideXlab platform
Riccardo Pofi - One of the best experts on this subject based on the ideXlab platform.
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the short synacthen Corticotropin Test can be used to predict recovery of hypothalamo pituitary adrenal axis function
The Journal of Clinical Endocrinology and Metabolism, 2018Co-Authors: Riccardo Pofi, Chona Feliciano, Emilia Sbardella, Nicola Argese, Conor Woods, Ashley B Grossman, Helena Gleeson, Bahram Jafarmohammadi, Andrea LenziAbstract:Context The 250-μg short Synacthen (Corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but no data to guide clinicians as to the frequency of repeat Testing or likelihood of HPA axis recovery. Objective To use the SST results to predict adrenal recovery. Design A retrospective analysis of 1912 SSTs data. Patients Seven hundred seventy-six patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n = 110). Main Outcome Measures Recovery of HPA axis function. Results SST 30-minute cortisol levels above or below 350 nmol/L (12.7 μg/dL) best predicted HPA axis recovery [area under the curve (AUC) receiver operating curve (ROC) = 0.85; median recovery time: 334 vs 1368 days, P = 8.5 × 10-13]: 99% of patients with a 30-minute cortisol >350 nmol/L recovered adrenal function within 4 years, compared with 49% in those with cortisol levels <350 nmol/L. In the subgroup analysis, delta cortisol (30-minute-basal) best predicted the recovery (AUC ROC = 0.77; median recovery time: 262 vs 974 days, P = 7.0 × 10-6). No patient with a delta cortisol <100 nmol (3.6 μg/dL) and a subsequent 1-year random cortisol <200 nmol/L (7.3 μg/dL) recovered HPA axis function. Conclusions Cortisol levels across an SST can be used to predict recovery of AI and may guide the frequency of repeat Testing and inform both clinicians and patients as to the likelihood of restoration of HPA axis function.
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The Short Synacthen (Corticotropin) Test Can Be Used to Predict Recovery of Hypothalamo-Pituitary-Adrenal Axis Function.
The Journal of clinical endocrinology and metabolism, 2018Co-Authors: Riccardo Pofi, Chona Feliciano, Emilia Sbardella, Nicola Argese, Conor Woods, Ashley B Grossman, Bahram Jafar-mohammadi, Helena Gleeson, Andrea Lenzi, Am IsidoriAbstract:Context The 250-μg short Synacthen (Corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but no data to guide clinicians as to the frequency of repeat Testing or likelihood of HPA axis recovery. Objective To use the SST results to predict adrenal recovery. Design A retrospective analysis of 1912 SSTs data. Patients Seven hundred seventy-six patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n = 110). Main Outcome Measures Recovery of HPA axis function. Results SST 30-minute cortisol levels above or below 350 nmol/L (12.7 μg/dL) best predicted HPA axis recovery [area under the curve (AUC) receiver operating curve (ROC) = 0.85; median recovery time: 334 vs 1368 days, P = 8.5 × 10-13]: 99% of patients with a 30-minute cortisol >350 nmol/L recovered adrenal function within 4 years, compared with 49% in those with cortisol levels
Andrea Lenzi - One of the best experts on this subject based on the ideXlab platform.
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the short synacthen Corticotropin Test can be used to predict recovery of hypothalamo pituitary adrenal axis function
The Journal of Clinical Endocrinology and Metabolism, 2018Co-Authors: Riccardo Pofi, Chona Feliciano, Emilia Sbardella, Nicola Argese, Conor Woods, Ashley B Grossman, Helena Gleeson, Bahram Jafarmohammadi, Andrea LenziAbstract:Context The 250-μg short Synacthen (Corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but no data to guide clinicians as to the frequency of repeat Testing or likelihood of HPA axis recovery. Objective To use the SST results to predict adrenal recovery. Design A retrospective analysis of 1912 SSTs data. Patients Seven hundred seventy-six patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n = 110). Main Outcome Measures Recovery of HPA axis function. Results SST 30-minute cortisol levels above or below 350 nmol/L (12.7 μg/dL) best predicted HPA axis recovery [area under the curve (AUC) receiver operating curve (ROC) = 0.85; median recovery time: 334 vs 1368 days, P = 8.5 × 10-13]: 99% of patients with a 30-minute cortisol >350 nmol/L recovered adrenal function within 4 years, compared with 49% in those with cortisol levels <350 nmol/L. In the subgroup analysis, delta cortisol (30-minute-basal) best predicted the recovery (AUC ROC = 0.77; median recovery time: 262 vs 974 days, P = 7.0 × 10-6). No patient with a delta cortisol <100 nmol (3.6 μg/dL) and a subsequent 1-year random cortisol <200 nmol/L (7.3 μg/dL) recovered HPA axis function. Conclusions Cortisol levels across an SST can be used to predict recovery of AI and may guide the frequency of repeat Testing and inform both clinicians and patients as to the likelihood of restoration of HPA axis function.
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The Short Synacthen (Corticotropin) Test Can Be Used to Predict Recovery of Hypothalamo-Pituitary-Adrenal Axis Function.
The Journal of clinical endocrinology and metabolism, 2018Co-Authors: Riccardo Pofi, Chona Feliciano, Emilia Sbardella, Nicola Argese, Conor Woods, Ashley B Grossman, Bahram Jafar-mohammadi, Helena Gleeson, Andrea Lenzi, Am IsidoriAbstract:Context The 250-μg short Synacthen (Corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but no data to guide clinicians as to the frequency of repeat Testing or likelihood of HPA axis recovery. Objective To use the SST results to predict adrenal recovery. Design A retrospective analysis of 1912 SSTs data. Patients Seven hundred seventy-six patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n = 110). Main Outcome Measures Recovery of HPA axis function. Results SST 30-minute cortisol levels above or below 350 nmol/L (12.7 μg/dL) best predicted HPA axis recovery [area under the curve (AUC) receiver operating curve (ROC) = 0.85; median recovery time: 334 vs 1368 days, P = 8.5 × 10-13]: 99% of patients with a 30-minute cortisol >350 nmol/L recovered adrenal function within 4 years, compared with 49% in those with cortisol levels
Am Isidori - One of the best experts on this subject based on the ideXlab platform.
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The short Synacthen (Corticotropin) Test can be used to predict recovery of hypothalamo-pituitary-adrenal axis function
'The Endocrine Society', 2018Co-Authors: Pofi R, Feliciano C, Sbardella E, Argese N, Cp Woods, Ab Grossman, Jafar-mohammadi B, Gleeson H, Lenzi A, Am IsidoriAbstract:The 250μg Short Synacthen (Corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but currently no data to guide clinicians as to the frequency of repeat Testing or likelihood of HPA axis recovery.To use the SST results to predict recovery of adrenal function.A retrospective analysis of data from 1912 SSTs.776 patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n=110).Recovery of HPA axis function.SST 30-minute cortisol levels above or below 350nmol/L (12.7μg/dL) best predicted HPA axis recovery (AUC ROC=0.85; median recovery time 334 vs. 1368 days, p=8.5x10-13): 99% of patients with a 30-minute cortisol >350nmol/L recovered adrenal function within 4-years, compared with 49% in those with cortisol levels
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The Short Synacthen (Corticotropin) Test Can Be Used to Predict Recovery of Hypothalamo-Pituitary-Adrenal Axis Function.
The Journal of clinical endocrinology and metabolism, 2018Co-Authors: Riccardo Pofi, Chona Feliciano, Emilia Sbardella, Nicola Argese, Conor Woods, Ashley B Grossman, Bahram Jafar-mohammadi, Helena Gleeson, Andrea Lenzi, Am IsidoriAbstract:Context The 250-μg short Synacthen (Corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but no data to guide clinicians as to the frequency of repeat Testing or likelihood of HPA axis recovery. Objective To use the SST results to predict adrenal recovery. Design A retrospective analysis of 1912 SSTs data. Patients Seven hundred seventy-six patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n = 110). Main Outcome Measures Recovery of HPA axis function. Results SST 30-minute cortisol levels above or below 350 nmol/L (12.7 μg/dL) best predicted HPA axis recovery [area under the curve (AUC) receiver operating curve (ROC) = 0.85; median recovery time: 334 vs 1368 days, P = 8.5 × 10-13]: 99% of patients with a 30-minute cortisol >350 nmol/L recovered adrenal function within 4 years, compared with 49% in those with cortisol levels
Djillali Annane - One of the best experts on this subject based on the ideXlab platform.
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Glucocorticoids in the treatment of severe sepsis and septic shock.
Current opinion in critical care, 2005Co-Authors: Djillali AnnaneAbstract:PURPOSE OF REVIEW Septic shock remains one of the leading causes of death in intensive care units. In recent years, there is general use of low to moderate doses of corticosteroids in the treatment of septic shock. However, there are wide variations in the practical modality of this treatment, mainly with regard to patients' selection, treatment's dose, timing, route of administration, duration, and weaning. This review provides opinion-based guidelines for the use of corticosteroids in severe sepsis and septic shock. RECENT FINDINGS A summary of the laTest understanding of the mechanisms of action of corticosteroids and the most recent observations in the clinical and biologic responses to corticosteroids in severe sepsis and septic shock is presented. SUMMARY In septic shock, intravenous hydrocortisone should be started immediately after a 250 microg Corticotropin Test, at a dose of 200-300 mg per day. When adrenal insufficiency is confirmed, treatment should be continued at full doses for 7 days. Otherwise, hydrocortisone should be stopped. It is worth considering adding enteral fludrocortisone at a dose of 50 microg per day for 7 days. In severe sepsis, despite growing evidence to support the use of a moderate dose of corticosteroids, the efficacy and safety of this treatment needs to be assessed in a large-scale study.
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effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock
JAMA, 2002Co-Authors: Djillali Annane, Veronique Sebille, Claire Charpentier, Pierreedouard Bollaert, Bruno Francois, Jeanmichel Korach, Gilles Capellier, Yves Cohen, Elie Azoulay, Gilles TrocheAbstract:ContextSeptic shock may be associated with relative adrenal insufficiency. Thus, a replacement therapy of low doses of corticosteroids has been proposed to treat septic shock.ObjectiveTo assess whether low doses of corticosteroids improve 28-day survival in patients with septic shock and relative adrenal insufficiency.Design and SettingPlacebo-controlled, randomized, double-blind, parallel-group trial performed in 19 intensive care units in France from October 9, 1995, to February 23, 1999.PatientsThree hundred adult patients who fulfilled usual criteria for septic shock were enrolled after undergoing a short Corticotropin Test.InterventionPatients were randomly assigned to receive either hydrocortisone (50-mg intravenous bolus every 6 hours) and fludrocortisone (50-µg tablet once daily) (n = 151) or matching placebos (n = 149) for 7 days.Main Outcome MeasureTwenty-eight-day survival distribution in patients with relative adrenal insufficiency (nonresponders to the Corticotropin Test).ResultsOne patient from the corticosteroid group was excluded from analyses because of consent withdrawal. There were 229 nonresponders to the Corticotropin Test (placebo, 115; corticosteroids, 114) and 70 responders to the Corticotropin Test (placebo, 34; corticosteroids, 36). In nonresponders, there were 73 deaths (63%) in the placebo group and 60 deaths (53%) in the corticosteroid group (hazard ratio, 0.67; 95% confidence interval, 0.47-0.95; P = .02). Vasopressor therapy was withdrawn within 28 days in 46 patients (40%) in the placebo group and in 65 patients (57%) in the corticosteroid group (hazard ratio, 1.91; 95% confidence interval, 1.29-2.84; P = .001). There was no significant difference between groups in responders. Adverse events rates were similar in the 2 groups.ConclusionIn our trial, a 7-day treatment with low doses of hydrocortisone and fludrocortisone significantly reduced the risk of death in patients with septic shock and relative adrenal insufficiency without increasing adverse events.
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a 3 level prognostic classification in septic shock based on cortisol levels and cortisol response to Corticotropin
JAMA, 2000Co-Authors: Djillali Annane, Veronique Sebille, Gilles Troche, Jeanclaude Raphael, Philippe Gajdos, Eric BellissantAbstract:ContextThe hypothalamic-pituitary-adrenal axis is a major determinant of the host response to stress. The relationship between its activation and patient outcome is not known.ObjectiveTo evaluate the prognostic value of cortisol levels and a short Corticotropin stimulation Test in patients with septic shock.Design and SettingProspective inception cohort study conducted between October 1991 and September 1995 in 2 teaching hospital adult intensive care units in France.ParticipantsA total of 189 consecutive patients who met clinical criteria for septic shock.InterventionA short Corticotropin stimulation Test was performed in all patients by intravenously injecting 0.25 mg of tetracosactrin; blood samples were taken immediately before the Test (T0) and 30 (T30) and 60 (T60) minutes afterward.Main Outcome MeasuresTwenty-eight–day mortality as a function of variables collected at the onset of septic shock, including cortisol levels before the Corticotropin Test and the cortisol response to Corticotropin (Δmax, defined as the difference between T0 and the highest value between T30 and T60).ResultsThe 28-day mortality was 58% (95% confidence interval [CI], 51%-65%) and median time to death was 17 days (95% CI, 14-27 days). In multivariate analysis, independent predictors of death (P≤.001 for all) were McCabe score greater than 0, organ system failure score greater than 2, arterial lactate level greater than 2.8 mmol/L, ratio of PaO2 to fraction of inspired oxygen no more than 160 mm Hg, cortisol level at T0 greater than 34 µg/dL and Δmax no more than 9 µg/dL. Three groups of patient prognoses were identified: good (cortisol level at T0 ≤34 µg/dL and Δmax >9 µg/dL; 28-day mortality rate, 26%), intermediate (cortisol level at T0 34 µg/dL and Δmax ≤9 µg/dL or cortisol level at T0 >34 µg/dL and Δmax >9 µg/dL; 28-day mortality rate, 67%), and poor (cortisol level at T0 >34 µg/dL and Δmax ≤9 µg/dL; 28-day mortality rate, 82%).ConclusionOur data suggest that a short Corticotropin Test has a good prognostic value and could be helpful in identifying patients with septic shock at high risk for death.
Ashley B Grossman - One of the best experts on this subject based on the ideXlab platform.
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the short synacthen Corticotropin Test can be used to predict recovery of hypothalamo pituitary adrenal axis function
The Journal of Clinical Endocrinology and Metabolism, 2018Co-Authors: Riccardo Pofi, Chona Feliciano, Emilia Sbardella, Nicola Argese, Conor Woods, Ashley B Grossman, Helena Gleeson, Bahram Jafarmohammadi, Andrea LenziAbstract:Context The 250-μg short Synacthen (Corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but no data to guide clinicians as to the frequency of repeat Testing or likelihood of HPA axis recovery. Objective To use the SST results to predict adrenal recovery. Design A retrospective analysis of 1912 SSTs data. Patients Seven hundred seventy-six patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n = 110). Main Outcome Measures Recovery of HPA axis function. Results SST 30-minute cortisol levels above or below 350 nmol/L (12.7 μg/dL) best predicted HPA axis recovery [area under the curve (AUC) receiver operating curve (ROC) = 0.85; median recovery time: 334 vs 1368 days, P = 8.5 × 10-13]: 99% of patients with a 30-minute cortisol >350 nmol/L recovered adrenal function within 4 years, compared with 49% in those with cortisol levels <350 nmol/L. In the subgroup analysis, delta cortisol (30-minute-basal) best predicted the recovery (AUC ROC = 0.77; median recovery time: 262 vs 974 days, P = 7.0 × 10-6). No patient with a delta cortisol <100 nmol (3.6 μg/dL) and a subsequent 1-year random cortisol <200 nmol/L (7.3 μg/dL) recovered HPA axis function. Conclusions Cortisol levels across an SST can be used to predict recovery of AI and may guide the frequency of repeat Testing and inform both clinicians and patients as to the likelihood of restoration of HPA axis function.
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The Short Synacthen (Corticotropin) Test Can Be Used to Predict Recovery of Hypothalamo-Pituitary-Adrenal Axis Function.
The Journal of clinical endocrinology and metabolism, 2018Co-Authors: Riccardo Pofi, Chona Feliciano, Emilia Sbardella, Nicola Argese, Conor Woods, Ashley B Grossman, Bahram Jafar-mohammadi, Helena Gleeson, Andrea Lenzi, Am IsidoriAbstract:Context The 250-μg short Synacthen (Corticotropin) Test (SST) is the most commonly used tool to assess hypothalamo-pituitary-adrenal (HPA) axis function. There are many potentially reversible causes of adrenal insufficiency (AI), but no data to guide clinicians as to the frequency of repeat Testing or likelihood of HPA axis recovery. Objective To use the SST results to predict adrenal recovery. Design A retrospective analysis of 1912 SSTs data. Patients Seven hundred seventy-six patients with reversible causes of AI were identified who had at least two SSTs performed. A subgroup analysis was performed on individuals previously treated with suppressive doses of glucocorticoids (n = 110). Main Outcome Measures Recovery of HPA axis function. Results SST 30-minute cortisol levels above or below 350 nmol/L (12.7 μg/dL) best predicted HPA axis recovery [area under the curve (AUC) receiver operating curve (ROC) = 0.85; median recovery time: 334 vs 1368 days, P = 8.5 × 10-13]: 99% of patients with a 30-minute cortisol >350 nmol/L recovered adrenal function within 4 years, compared with 49% in those with cortisol levels
