Relationship of adrenocortical function and TCM Syndrome typing in elderly patients with severe sepsis

Objective: To explore the relationship between TCM Syndrome typing and adrenocortical function in elderly patients with severe sepsis, and to see whether TCM Syndrome Differentiation can provide clinical clues in identifying relative adrenal insufficiency (RAI) in patients with severe sepsis. Methods: Six ty-one old patients with severe sepsis were classified into four types according to TCM Syndrome Differentiation: The severe invasion of toxic-heat type (Type SITH, n = 21 ); the Qi stagnation and blood stasis type ( Type QSBS, n = 11); the sudden depletion of Yang-Qi type ( Type SDYQ, n = 16); and the exhaustion of Qi-Yin type (Type EOQY, n = 13). The base-line level of plasma cortisol in patients of different types and their response to corticotropin stimulation were compared, which were also compared with those of 12 healthy elderly persons synchronously. Results: The base-line level of plasma cortisol was not significantly different between patients of different Syndrome types (P＞0.05), but they were all sgnificantly higher than that in the healthy persons ( P＜0.05). Compared with Type QSBS and Type EOQY, Type SITH and Type SDYQ showed less cortisol concentration increment after corticotropin stimulation ( P＜0.05). RAI was more prevalent in patients of Type SITH and Type SDYQ than in patients of Type QSBS and Type EOQY (57% vs 25 %, P＜0.01). Conclusion: In old patients with severe sepsis, different TCM Syndrome types are associated with different adrenocortical function status. TCM Syndrome differentiation can provide clinical clues in identifying old patients with severe sepsis who have also RAI.     

伤湿胶囊抗炎镇痛作用的实验研究

为评价伤湿胶囊的抗炎镇痛功效，采用蛋清致大鼠足跖浮肿法、二甲苯致小鼠耳肿胀法、硫酸组胺致小鼠皮肤毛细血管通透性法、大鼠棉球肉芽肿法、小鼠热板法及醋酸扭体法，观察伤湿胶囊的抗炎、镇痛作用，并与伤湿丸比较；用改良Zak法测定小鼠肾上腺中胆固醇含量，结果显示伤湿胶囊对大鼠足肿胀、小鼠耳肿胀及皮肤毛细血管通透性均有显著抑制作用，可明显提高小鼠热板法致痛的痛闷，减少醋酸致痛小鼠的扭体次数，其效果比伤湿丸好；测得小鼠肾上腺中的胆固醇含量明显降低，对大鼠棉球肉芽肿无明显抑制作用，说明伤湿胶囊对急性炎症有较好的抗炎作用和镇痛作用，疗效优于伤湿丸组；对慢性炎症无明显的抑制作用，其抗炎机理初步认为与兴奋肾上腺皮质有关。     

Concomitant coexistence of ACTH‐dependent and independent Cushing syndrome

We report a case of a patient who presented for ACTH‐dependent Cushing after a confirmed hypercortisolism and an inadequate normal ACTH. A transsphenoidal surgery of a pituitary picoadenoma has been done. After surgery, the patient showed the persistence of hypercortisolism. CT scan revealed adrenal adenomas removed surgically and improved the patient.     

人胎肾上腺髓质细胞原代分离培养

本文介绍了一种较简捷、快速的人胎肾上腺髓质细胞原代分离培养的方法。分离出的人胎肾上腺髓质经胶原酶消化后,用Percoll液密度梯度离心可获得纯度为75～85%的肾上腺髓质细胞,将髓质细胞接种到铺有胶原的培养板上,培养2-7天后髓质细胞胞体增大,长出突起,胞浆含有颗粒,用特异性儿茶酚胺诱发萤光技术进一步确定培养的肾上腺髓质细胞的性质,用HPLC测定培养液中单胺类物质的含量。对培养过程中的某些技巧问题进行了讨论。     

Association of genetic polymorphisms and autoimmune Addison’s disease

Autoimmune Addison’s disease (AAD) is a complex genetic disease that results from the interaction of a predisposing genetic background with as yet unknown environmental factors. The disease is marked by the appearance of circulating autoantibodies against steroid 21-hydroxylase. Mutations of the autoimmune regulator gene are responsible for the so-called autoimmune polyendocrine syndrome type I (APS I), of which AAD is a major disease component. Among genetic factors for isolated AAD and APS II, a major role is played by HLA class II genes: HLA-DRB1^*0301-DQA1^*0501-DQB1^*0201 and DRB1^*04-DQA1^*0301-DQB1^*0302 are positively, and RB1^*0403 is negatively, associated with a genetic risk for AAD. The MHC class I chain-related gene A allele 5.1 is strongly and positively associated with AAD. Other gene polymorphisms contributing to genetic risk for AAD are MHC2TA, the gene coding for class II transactivator, the master regulator of class II expression, cytotoxic T lymphocyte antigen-4, PTPN22 and the vitamin D receptor.     

An Adrenal Incidentaloma Diagnosed as Dopamine-Secreting Pheochromocytoma: A Case Report

BackgroundDopamine-secreting pheochromocytomas are exceedingly rare.Case presentationA 28-year-old woman, who was admitted due to 4 hours of acute-onset abdominal pain, detected an adrenal mass incidentally. She was almost asymptomatic without a known family history. Laboratory assessments showed significant increases in dopamine levels of serum and 24-h urinary. By using preoperative a-adrenergic receptor blockers, she developed orthostatic hypotension and palpitations. When she underwent laparoscopic left adrenalectomy, she experienced rapid cyclic fluctuations in systolic blood pressure from 90 mmHg to 200 mmHg. Postoperatively, she exhibited prolonged hypotension, requiring vasopressor therapy and fluid replacement. According to histopathological diagnosis, it was a pheochromocytoma. Dopamine levels in 24-h urine and serum decreased to normal after operation. Analysis of specific gene SDHB, SDHD, RET, VHL and NF1 detected no pathogenic mutations.ConclusionPatients with dopamine-secreting pheochromocytomas are mostly asymptomatic, leading to a significant delay in diagnosis. There is a large possibility for dopamine-secreting pheochromocytomas to show a malignant tendency than the adrenergic and noradrenergic phenotypes. The a-adrenergic receptor blocker is not indicated for preoperative medical treatment because it can cause hypotension and cardiovascular failure. Calcium channel blockers or metyrosine may be better alternatives. All patients with pheochromocytomas should receive targeted genetic testing based on specific clinical features. SDHB, SDHD, RET, VHL and NF1 mutations are suggested for genetic testing of adrenal dopamine-secreting pheochromocytomas.