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Adrenal emergencies: Adrenal crisis
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Trimester-specific 250 µg cosyntropin stimulation test cortisol cutoffs of 25 µg/dL in the first trimester, 29 µg/dL in the second trimester, and 32 µg/dL in the third trimester should only be used in nonstressed patients.8,12 In general, cortisol levels must be interpreted with caution, as they are expected to rise dramatically in the setting of infection, illness, or stress.14 It should also be noted that a cosyntropin stimulation test will not rule out acute central adrenal insufficiency due to recent pituitary dysfunction, as otherwise unaffected adrenal glands are expected to retain the ability to respond to cosyntropin for several months.
Disorders of Consciousness
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Blood: basic laboratory tests are not usually helpful: Hemoglobin level may reveal anemia.Blood urea and serum electrolytes and glucose may reveal the most common metabolic causes.Prolonged fast to assess for hypoglycemia.Short tetracosactrin (cosyntropin) stimulation test to assess for adrenal insufficiency.If autoimmune dysautonomia is suspected, consider ganglionic acetylcholine receptor antibodies, antinuclear antibodies, and rheumatoid factor.
Diseases of the adrenal gland
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Cosyntropin stimulation test.30.25 mg cosyntropin IV × 1Check serum cortisol 60 minutes later – if cortisol remains low, then diagnosis of adrenal insufficiency is made.
Flank pain in the third trimester as a clue to diagnose spontaneous adrenal hemorrhage
Published in Baylor University Medical Center Proceedings, 2022
Busara Songtanin, Nicole Welch, Kenneth Nugent, Anupa Patel
The patient was transferred to our care due to concerns of adrenal hemorrhage. Upon arrival, she complained of severe bilateral flank pain. Computed tomography (CT) of the abdomen and pelvis showed enlargement (3.1 × 2.8 cm) and slight hyperattenuation of the left adrenal gland with loss of its adreniform shape. There was thickening of the right adrenal gland possibly due to mild hemorrhage (Figure 1). Laboratory tests reported a random adrenocorticotropic hormone (ACTH) level of 11.3 pg/mL (reference range 7.2–63.3) and a random cortisol of 2.8 mcg/dL (low). The patient was given intravenous fluids and hydrocortisone for 6 days and then switched to prednisolone 20 mg daily before doing an ACTH stimulation test. Cosyntropin stimulation tests were low at baseline (0.8 mcg/dL; reference range 5.0–21.0), at 30 minutes (1.0 mcg/dL; reference range 14.0–36.0), and at 60 minutes (1.3 mcg/dL; reference 14.0–41.0). The diagnosis of adrenal insufficiency was made, and the patient was started on hydrocortisone 20 mg twice daily and fludrocortisone 0.1 mg daily until delivery. At follow-up postpartum, she was mildly hypertensive, and the steroid dose was tapered to hydrocortisone 30 mg daily and fludrocortisone 0.05 mg daily.
Safety of intranasal corticosteroids for allergic rhinitis in children
Published in Expert Opinion on Drug Safety, 2022
Min Zhang, Jing-Zi Ni, Lei Cheng
As AR is a frequent co-morbidity of asthma, INCSs are often used with a controller medication for asthma, such as inhaled corticosteroids (ICSs) [62,63]. Several studies have reported the safety of concurrent INCSs and ICSs. Two studies have reported normal responses to cosyntropin stimulation in the treatment of comorbid rhinitis and asthma [64]. In the first study, patients with asthma aged 12 years or older are randomized to receive orally inhaled FP (either 88 or 220 μg), or placebo twice-daily delivered from a metered-dose inhaler (MDI) for 26 weeks. In the other study, patients are randomized to receive either orally inhaled FP 250 μg or orally inhaled FP 250 μg/salmeterol 50 μg delivered via the Diskus device for 12 weeks. The results of both studies indicate that the concurrent use of intranasal and inhaled FP via MDI or Diskus does not affect HPA-axis function in patients with rhinitis and asthma [64].
Preclinical cardiac disease in women and men with primary aldosteronism
Published in Blood Pressure, 2021
Arleen Aune, Marina Kokorina, Marianne Aa. Grytaas, Helga Midtbø, Kristian Løvås, Eva Gerdts
We recruited consecutively 109 patients diagnosed with PA at Haukeland University hospital between 2013 and 2016. In patients with elevated aldosterone-to-renin ratio, PA was confirmed by recumbent saline infusion testing, with a positive test defined as post-infusion plasma aldosterone level > 140 pmol/L [16]. Adrenal vein sampling, under continuous cosyntropin infusion, was performed for subtype differentiation at time of study inclusion. Unilateral disease was found in 47%, with no difference between sexes. Interfering medication was withdrawn for 2–4 weeks before diagnostic assessments. Controls were identified among patients with EH that participated in the FAT-associated CardiOvasculaR dysfunction (FATCOR study), another study cohort established at the European Society of Hypertension Excellence Centre in Bergen [17]. EH and PA patients were matched for sex, presence of obesity and age within a five-year range. The study was conducted in accordance with the Declaration of Helsinki and approved by the Regional Ethics Committee. All participants signed written informed consent before inclusion.