Low and high circulating cortisol levels predict mortality and cognitive dysfunction early after stroke

OBJECTIVE: Elevated cortisol levels are associated with confusion and poor outcome after stroke. Dehydroepiandrosterone sulphate (DS), the most abundant adrenal androgen may act as an anti-glucocorticoid. An altered regulation of these steroids may affect numerous brain functions, including neuronal survival. The purpose of this study was to investigate serum cortisol and DS levels and the cortisol/DS ratio early after stroke and relate our findings to the presence of disorientation and mortality. DESIGN: Patients with acute ischaemic stroke (n = 88, 56 men and 32 women) admitted to a stroke unit were investigated with repeated clinical assessments and scores for degree of confusion, extent of paresis and level of functioning. Serum cortisol (C) and DS were measured on day 1 and/or day 4. Data for 28-day and 1-year mortality are presented. A control group of 65 age-matched healthy individuals was used. Multivariate analyses of mortality rates in the different tertiles or sixtiles of serum cortisol were performed with logistic regression, adjusting for age, sex, diabetes and level of consciousness. RESULTS: There was no difference in serum cortisol levels on day 1 for stroke patients when compared with control group values. Initial cortisol levels were significantly higher in the patients with acute disorientation versus orientated patients (P < 0.05). Cortisol levels on day 1 were an independent predictor of 28-day mortality, and patients with low cortisol levels (<270 nmol L(-1)) and increased levels (>550 nmol L(-1)) both had an increased 1-year mortality. DS levels on day 1 were significantly elevated in stroke patients. CONCLUSION: Hypercortisolism is associated with cognitive dysfunction early after ischaemic stroke. High and low circulating cortisol levels are associated with increased mortality after stroke. DS levels were not associated with clinical outcome.     

原发性高血压合并无功能肾上腺意外瘤患者代谢综合征患病情况分析

目的：探讨原发性高血压合并无功能肾上腺意外瘤（NFAI）患者代谢综合征（MS）发生情况及其与皮质醇分泌水平的相关性。方法：复旦大学附属中山医院内分泌科2014年10月至2015年4月收治的原发性高血压合并NFAI患者56例（NFAI组）,原发性高血压肾上腺形态正常者58例（EH组）。收集身高、体质量、腹围、血压等体格检查参数;测定电解质,血脂谱,空腹及餐后2 h血糖水平,以及隔夜1 mg地塞米松试验（ONDST）后皮质醇水平。根据有无代谢综合征（MS）,分别将NFAI组和EH组患者分为MS组（MS组）和非MS组（NMS组）,比较各组ONDST后皮质醇水平。结果：NFAI组患者舒张压、体质指数（BMI）、腹围、餐后2 h 血糖、三酰甘油、ONDST后皮质醇水平高于EH组患者（P<0.05）。56例NFAI组患者中,22例（39.2%）合并MS,高于EH组患者（14例,24.1%,P<0.05）。NFAI组患者中,MS亚组患者ONDST后皮质醇水平高于NMS亚组患者（P<0.05）。随着NFAI组患者MS组分数量异常增加,ONDST后皮质醇水平逐渐升高。结论：原发性高血压合并NFAI患者MS患病率较高,其MS发生与ONDST后皮质醇水平相关。     

Addisonian Crisis and Relative Adrenal Failure

Reviews in Endocrine and Metabolic Disorders -     

Circadian urinary 6-sulphatoxymelatonin, cortisol excretion and locomotor activity in airline pilots during transmeridian flights

Airline pilots divided into two groups of age (over and under 50 years) were studied before, during and after westbound (Madrid-Mexico City-Madrid, n = 12) and eastbound (Madrid-Tokyo-Madrid, n = 21) flights. A group of 10 age-matched people staying in Madrid were submitted to the same tests and served as a control group. Changes in urinary 6-sulphatoxymelatonin (6-aMTs) and free cortisol excretion (determined in 6-hr intervals) were measured by radioimmunoassay. Using wrist actigraphy, the circadian locomotor activity rhythm (LAR) was also monitored. Maximal baseline excretion of 6-aMTs occurred between 00:00 and 12:00 hr and maximal excretion of cortisol took place between 6:00 and 12:00 hr in the control group. Analysed globally, older pilots exhibited significantly lower values of 6-aMTs than younger ones. In both flight directions, pilots maintained the pattern of excretion of 6-aMTs, corresponding to baseline. The return flight to Madrid from Mexico and Tokyo coincided with a maximum in 6-aMTs excretion. Pilots kept the cortisol pattern found in the control group, with those over 50 years of age exhibiting significantly lower cortisol values than the younger ones. A 7-hr delay in acrophase of LAR after 2 days in Mexico City was found after cosinor analysis, and similar pre-flight values were found after returning to Madrid. An 8-9-hr acrophase advance of LAR was observed after arriving in Tokyo, with acrophase on the post-return flight day still being advanced 3 4 hr as compared to pre-flight values. Decreases in the amplitude of LAR in older pilots were found at Mexico City, as well as at Tokyo stopover and on post-flight day. Data confirm the occurrence of internal desynchronization in airline crewmembers after transmeridian flights.     

Hypothalamic‐pituitary‐adrenal axis activity in patients with active rheumatoid arthritis: a controlled study using insulin hypoglycemia stress test

Aim: To study the response of cortisol to insulin‐induced hypoglycemia in patients with active rheumatoid arthritis (RA). Methods: We measured the response of cortisol to insulin‐induced hypoglycemia (0.15 µ/kg) in 10 patients (6 female, 4 male) with active RA and 10 (6 female, 4 male) healthy controls. All patients had never received glucocorticoids before the study. The cortisol concentration was assessed by radioimmunoassay. Results: The mean age was 47.3 years (± 14.2 years) in patients and 43.5 years (± 10.6 years) in control subjects. The mean disease duration was 66.3 months (range 12–120). The basal serum levels of cortisol in patients with RA were not significantly different from those of controls. Although the mean serum cortisol levels after insulin‐induced hypoglycemia were lower in patients with RA than controls in all samples, the significant difference was seen only in the samples 60 min after insulin injection (18.59 vs. 24.28 µg/dL, P = 0.041). Conclusion: Our findings suggest that active RA is associated with dysfunction of the hypothalamic–pituitary‐adrenal axis.     

Maternal depression and infant daytime cortisol

The effect of maternal depressive disorder on infant daytime cortisol production was studied in three groups of infants; one group with mothers with comorbid depression and anxiety (n = 19), a second group with mothers with depression only (n = 7), and a third group with non‐depressed mothers (n = 24). The infants' cortisol production pattern was measured when they were 6, 12, and 18 months old in combination with repeated measures of parenting stress and depression symptoms. Multilevel modeling analyses showed that infants of mothers with comorbid depression and anxiety had relatively higher cortisol production from morning to bedtime and higher bedtime values as compared to infants of non‐depressed mothers and infants of depressed only mothers when they were 6 and 12 months old, but not when 18 months old. The results were interpreted in light of possible changes in the infants' stress regulatory capacities or changes in maternal coping strategies at infant age 18 months. © 2012 Wiley Periodicals, Inc. Dev Psychobiol 55: 334–351, 2013     

Quality of Life,Overweight, and Body Fat Distribution in Middle-Aged Men

Abstract

Measurements of obesity [body mass index (BMI)] and body fat distribution [waist-to-hip ratio (WHR)] were analyzed in 284 51-year-old men in relation to items about social, mental, and physical well-being from the Göteborg Quality of Life Instrument. Overweight participants (BMI ≥ 25) reported a better home-family situation, appetite, and self-esteem, but decreased physical fitness and more pain in the legs compared with their leaner counterparts. Men with abdominal obesity (WHR ≥ 1.0) experienced impaired health and physical fitness and lower self-esteem compared with those with WHR < 1.0. The abdominally obese participants were more often exhausted and experienced depressive symptoms. Abdominal pain was more frequent among those with WHR ≥ 1.0. Overweight and abdominal obesity seem differently associated with social, mental, and physical well-being in men. Impaired quality of life may be causally related to the development of abdominal obesity; the mechanism involved might be increased cortisol secretion, which can redistribute body fat to central adipose tissue depots.     

Daily Life Events Influence the Results of the Dexamethasone Suppression Test in Healthy Women

Although the Dexamethasone Suppression Test (DST) plays an important role in psychosomatic research, confounding factors limit the sensitivity and specificity of the DST. The aim of this study was to investigate the relationship between the intensity of daily life stressors and DST results in healthy participants after controlling the confounding factors. The subjects of this study consisted of 75 healthy volunteers. The intensity of daily life events was assessed using the Taiwanese version of the Recent Life Change Questionnaire (RLCQ). Neuroticism was assessed using the Maudsley Personality Inventory (MPI). The Dexamethasone Suppression Test (DST) was also performed. The regression model showed that daily life events (RLCQ score) were correlated significantly with cortisol level on day 1 and D% only in women. This finding implies that daily life events should be considered as an independent variable in women in further studies when the DST is applied.