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- ItemSomente MetadadadosAbsolute and relative adrenal insufficiency in children with septic shock(Lippincott Williams & Wilkins, 2005-04-01) Pizarro, C. F.; Troster, E. J.; Damiani, D.; Carcillo, J. A.; Universidade Federal de São Paulo (UNIFESP)Objective: Corticosteroid replacement improves outcome in adults with relative adrenal insufficiency and catecholamine-resistant septic shock. We evaluated the relationship of absolute and relative adrenal insufficiency to catecholamine-resistant septic shock in children.Design. Prospective cohort study.Setting. University hospital pediatric intensive care unit in Brazil.Patients. Fifty-seven children with septic shock. Children with HIV infection, those with a history of adrenal insufficiency, and those submitted to any steroid therapy or etomidate within the week before diagnosis of septic shock were excluded.Interventions: None.Measurements and Main Results., A short corticotropin test (250 mu g) was performed, and cortisol levels were measured at baseline and 30 and 60 mins posttest. Adrenal insufficiency was defined by a response <= 9 mu g/dL. Absolute adrenal insufficiency was further defined by a baseline cortisol < 20 mu g/dL and relative adrenal insufficiency by a baseline cortisol > 20 mu g/dL. Absolute adrenal insufficiency was observed in 18% of children, all of whom had catecholamine-resistant shock. Relative adrenal insufficiency was observed in 26% of children, of whom 80% had catecholamine-resistant and 20% had dopamine/dobutamine-responsive shock. All children with fluid-responsive shock had a cortisol response > 9 mu g/dL. Children with adrenal insufficiency had an increased risk of catecholamine-resistant shock (relative risk, 1.88; 95% confidence interval, 1.26-2.79). However, mortality was independently predicted by chronic illness or multiple organ failure (p <.05), not adrenal insufficiency.Conclusions: Absolute and relative adrenal insufficiency is common in children with catecholamine-resistant shock and absent in children with fluid-responsive shock. Studies are warranted to determine whether corticosterold therapy has a survival benefit in children with relative adrenal insufficiency and catecholamine-resistant septic shock.
- ItemSomente MetadadadosAdrenal steroids synthesis during acute infectious diseases in infants(Freund Publishing House Ltd, 2002-11-01) Longui, C. A.; Zlochevsky, ERM; Bachega, Tania Aparecida Sartori Sanchez [UNIFESP]; Monte, O.; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)An increase in plasma 17OHP found in infants requiring differential diagnosis between septic shock and adrenal failure led us to look for adrenal steroids pattern during infection. Infants and Methods: 56 infants, 1-6 months old, were studied during infection of different degrees of severity. Plasma cortisol, 17OHP, androstenedione, DHEA, DHEA-S and testosterone were measured.Results: 24 patients showed an expected cortisol elevation. One child had a low cortisol level. The concentration of 17OHP was above 6.0 nmol/l (200 ng/dl) in 41 patients and above 30.2 nmol/l (1,000 ng/dl) in 10. Higher 17OHP levels and more severe diseases correlated positively.Conclusions: During infectious diseases some patients demonstrated not only cortisol elevation but also 17OHP as high as that observed in NC-CAH. We suggest that if 17OHP elevation is not characteristic of SL-CAH, glucocorticoid therapy should be started and an ACTH test should be performed after recovery before ruling out this pathology.
- ItemAcesso aberto (Open Access)Avaliação da resposta do eixo hipotálamo-pituitária-adrena ao teste de supressão da prednisolona em vitimas de violência intencional(Universidade Federal de São Paulo (UNIFESP), 2013) Ruiz, Juliana Elena [UNIFESP]; Mello, Marcelo Feijó de [UNIFESP]; http://lattes.cnpq.br/9828693113292175; http://lattes.cnpq.br/5533026202232757; Universidade Federal de São Paulo (UNIFESP)A violencia repercute sobre a Saúde do ser humano, tanto no plano psicologico como no fisico. As consequencias, para quem vivencia essa experiencia, sao sempre singulares. Os individuos que desenvolvem o Transtorno de Estresse Pos-Traumatico desenvolvem uma constelacao de sintomas, na sequencia de um acontecimento emocional muito traumatico. Existem evidencias de que esses sintomas representam uma manifestacao comportamental de mudancas na estrutura e funcoes cerebrais induzidas pelo estresse. O Eixo Hipotalamo Pituitaria Adrenal (HPA) e controlado por um conjunto de neuronios hipofisiotropicos. Esses neuronios sintetizam e secretam hormonio de liberacao de corticotropina, o principal estimulador do adrenocorticotropico. Um grande numero de pesquisas tem sido realizado, para avaliar como ocorrem essas reacoes fisiologicas e patologicas do estresse. Os objetivos deste estudo foram avaliar a sensibilidade dos receptores de glicocorticoides, atraves da avaliacao da concentracao salivar do cortisol, em pacientes com Transtorno de Estresse Pos-Traumatico (TEPT), apos o Teste de Desafio de Supressao da Prednisolona e identificar as vitimas de violencia, que tambem sofreram algum tipo de experiencia traumatica precoce, se quando adultos, apresentam mais disfuncao do Eixo Hipotalamo Pituitaria Adrenal na forma de hipossecrecao de cortisol. Metodo: foram estudados 48 pacientes que passaram por situacoes traumaticas, sendo 34 com o diagnostico de Transtorno de Estresse Pos Traumatico e 14 pacientes que nao desenvolveram o Transtorno de Estresse Pos Traumatico. No inicio do atendimento, eram administradas escalas como The structured Clinical interview I e II, The Clinician administered PTSD Scale, The Beck Depression Inventory, The Early Trauma Inventory e The Peritraumatic Dissociative Experiences Questionnaire. Amostras de saliva foram coletadas antes e depois do TSP. Resultados: 48 individuos, sendo 34 casos (TEPT positivo) e 14 controles (TEPT negativo) foram incluidos. Comparando a concentracao salivar durante instantes, utilizando ANOVA nao parametrico para dados ordinais com medidas repetidas, foram encontradas diferencas, estatisticamente relevantes, em relacao ao tempo e grupos. Individuos com TEPT apresentavam menor concentracao de cortisol, em relacao as vitimas de violencia sem TEPT. No entanto, quando comparamos a curva do cortisol, diferenciando pacientes com ou sem Transtorno depressivo maior, a ultima tinha curvas semelhantes aos do grupo-controle, com maiores concentracoes de cortisol. O modelo de regressao linear mostrou uma correlacao negativa, entre a concentracao de cortisol salivar em relacao ao despertar com as escalas CAPS, BAI, e o escore de abuso sexual na ETI, ou seja, quanto maiores foram os escores, menores foram as concentracoes de cortisol. Conclusoes: nossos achados reforcaram que, pacientes com TEPT tem baixos niveis de cortisol basal e uma hipersensibilidade dos receptores de glicocorticoides. Entretanto, outros fatores devem ser considerados quando se estuda o Eixo HPA, como a presenca de historia de abuso sexual durante a infancia e Transtorno Depressivo Maior como comorbidade, uma vez que tem um impacto significativo sobre a resposta ao estresse
- ItemSomente MetadadadosCognitive-behavioural group therapy improves a psychophysiological marker of stress in caregivers of patients with Alzheimer's disease(Routledge Journals, Taylor & Francis Ltd, 2014-01-01) Aboulafia-Brakha, T.; Suchecki, D. [UNIFESP]; Gouveia-Paulino, F.; Nitrini, R.; Ptak, R.; Univ Hosp Geneva; Universidade Federal de São Paulo (UNIFESP); Pontificia Univ Catolica São Paulo; Universidade de São Paulo (USP)Background: Family caregivers of patients with dementia frequently experience psychological stress, depression and disturbed psychophysiological activity, with increased levels of diurnal cortisol secretion.Objectives: To compare the effects of a cognitive-behavioural group therapy (CBT) to a psychoeducation group programme (EDUC) on cortisol secretion in caregivers of patients with moderate Alzheimer's disease (AD).Method: Caregivers of AD outpatients were semi-randomly allocated to one of two intervention programmes (CBT or EDUC) consisting of eight weekly sessions. Twenty-six participants completed the study. Before and after intervention, salivary cortisol was collected at four different times of the day. Effects of the interventions were evaluated with self-report psychological scales and questionnaires related to functional abilities and neuropsychiatric symptoms of the AD relative.Results: Only in the CBT group did salivary cortisol levels significantly decrease after intervention, with a large effect size and high achieved power. Both groups reported a reduction of neuropsychiatric symptoms of their AD relative after intervention.Conclusion: Psychoeducation for caregivers may contribute to a reduction of neuropsychiatric symptoms of AD patients while CBT additionally attenuates psychophysiological responses to stressful situations in caregivers, by reducing diurnal cortisol levels. This may lead to a positive impact in the general health of the caregiver, eventually resulting in better care of the AD patient.
- ItemAcesso aberto (Open Access)Determination of free urinary cortisol in cushing's syndrome using reversed-phase high performance liquid chromatography(Sociedade Brasileira de Química, 2010-01-01) Sugawara, Eduardo Kinio [UNIFESP]; Ribeiro Neto, Luciane Maria [UNIFESP]; Verreschi, Ieda Therezinha do Nascimento [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Determination of free urinary cortisol is a test of choice in the diagnosis of Cushing's syndrome. In this study, cortisol was quantified using reversed-phase high-performance liquid chromatography (RP-HPLC) in urine samples previously extracted with ether and using triamcinolone acetonide as internal standard (IS). A BDS-Hypersil-C18® column, water-acetonitrile (72:28; v/v), with a flow rate of 1.0 mL/min and detection at 243 nm were used. This method showed to be both effective and efficient, with sensitivity and linearity ranging from 2.50 to 150 μg/L, and can be used in substitution to the radioimmunoassay technique within this concentration range.
- ItemAcesso aberto (Open Access)Dyslipidaemia and Undernutrition in Children from Impoverished Areas of Maceio, State of Alagoas, Brazil(Mdpi Ag, 2010-12-01) Veiga, Gabriela R. S.; Ferreira, Haroldo S.; Sawaya, Ana Lydia [UNIFESP]; Calado, Jairo; Florencio, Telma M. M. T.; Univ Fed Alagoas; Universidade Federal de São Paulo (UNIFESP)Chronic undernutrition causes reduced growth and endocrine adaptations in order to maintain basic life processes. in the present study, the biochemical profiles of chronically undernourished children were determined in order to test the hypothesis that chronic undernutrition also causes changes in lipid profile in pre-school children. the study population comprised 80 children aged between 12 and 71 months, including 60 with moderate undernutrition [height-for-age Z (HAZ) scores <= -2 and > -3] and 20 with severe undernutrition (HAZ scores <= -3). Socioeconomic, demographic and environmental data were obtained by application of a questionnaire, and anthropometric measurements and information relating to sex, age and feeding habits were collected by a trained nutritionist. Blood samples were analysed for haemoglobin, vitamin A, insulin-like growth factor 1 (IGF-1) and serum lipids, while cortisol was assayed in the saliva. Faecal samples were submitted to parasitological investigation. Analysis of variance and chi(2) methods were employed in order to select the variables that participated in the multivariate logistic regression analysis. the study population was socioeconomically homogeneous, while the lack of a treated water supply was clearly associated with the degree of malnutrition. Most children were parasitised and anaemia was significantly more prevalent among the severely undernourished. Levels of IGF-1 decreased significantly with increasing severity of undernutrition. Lipid analysis revealed that almost all of the children had dyslipidemia, while low levels of high-density lipoprotein were associated with the degree of undernutrition. It is concluded that chronic malnutrition causes endocrine changes that give rise to alterations in the metabolic profile of pre-school children.
- ItemAcesso aberto (Open Access)Gene Expression Control by Glucocorticoid Receptors during Innate Immune Responses(Frontiers Media Sa, 2016) Xavier, Andre Machado [UNIFESP]; Anunciato, Aparecida Kataryna Olimpio [UNIFESP]; Rosenstock, Tatiana Rosado; Glezer, Isaias [UNIFESP]Glucocorticoids (GCs) are potent anti-inflammatory compounds that have been extensively used in clinical practice for several decades. GC's effects on inflammation are generally mediated through GC receptors (GRs). Signal transduction through these nuclear receptors leads to dramatic changes in gene expression programs in different cell types, typically due to GR binding to DNA or to transcription modulators. During the last decade, the view of GCs as exclusive anti-inflammatory molecules has been challenged. GR negative interference in pro-inflammatory gene expression was a landmark in terms of molecular mechanisms that suppress immune activity. In fact, GR can induce varied inhibitory molecules, including a negative regulator of Toll-like receptors pathway, or subject key transcription factors, such as NF-kappa B and AP-1, to a repressor mechanism. In contrast, the expression of some acute-phase proteins and other players of innate immunity generally requires GR signaling. Consequently, GRs must operate context-dependent inhibitory, permissive, or stimulatory effects on host defense signaling triggered by pathogens or tissue damage. This review aims to disclose how contradictory or comparable effects on inflammatory gene expression can depend on pharmacological approach (including selective GC receptor modulators
- ItemSomente MetadadadosGH-releasing peptide (GHRP-6)-induced ACTH release in patients with Addison's disease: Effect of glucocorticoid withdrawal(Editrice Kurtis S R L, 2003-02-01) Martins, Manoel Ricardo Alves [UNIFESP]; Pinto, ACAR [UNIFESP]; Brunner, E. [UNIFESP]; Silva, MRD [UNIFESP]; Lengyel, AMJ [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)GH releasing peptide (GHRP-6) is a synthetic hexapeptide with potent GH releasing activity both in man and in animals. This peptide is also able to stimulate ACTH and cortisol (F) release. It has been suggested that the ACTH responsiveness to GHRP-6 is modulated by circulating glucocorticoid levels. To further clarify this hypothesis, we studied the effect of GHRP-6 (1 ug/kg, iv) on ACTH and F release in patients with Addison's disease (no.=6) during replacement therapy and after 72 h of glucocorticoid withdrawal. Seven controls were also submitted to a single GHRP-6 test. In control subjects, ACTH values (pmol/l; mean+/-SE) increased from 2.9+/-0.8 to 4.7+/-1.4 (peak). AUC (pmol.min/l) values were 170.3+/-48.8. F (nmol/l) values increased from 257.0+/-42.9 to 367.0+/-50.8. In patients with Addison's disease there was an increase in ACTH levels from 38.1+/-7.1 to 174.9+/-79.4 after GHRP-6 administration. AUC values were 5490.4+/-2269.1. After 72 h withdrawal of glucocorticoid, there was an increase in basal ACTH values (1191.2+/-97.3), and a trend toward an increase in ACTH levels after GHRP-6 (p=0.053). Patients with Addison's disease on therapy showed a significantly higher ACTH response to GHRP-6 when compared to controls. Our results show that in patients with Addison's disease on replacement there is an increased ACTH release after GHRP-6 administration, compared to controls. After 72 h glucocorticoid withdrawal, this enhanced responsiveness is not maintained. Our data suggest that circulating glucocorticoids modulate GHRP-6-induced ACTH release and that multiple mechanisms may be involved in this process. (C) 2003, Editrice Kurtis.
- ItemSomente MetadadadosHypothalamic involvement in chronic migraine(British Med Journal Publ Group, 2001-12-01) Peres, Mario Fernando Prieto [UNIFESP]; del Rio, M. S.; Seabra, MLV; Tufik, Sergio [UNIFESP]; Abucham, Julio [UNIFESP]; Cipolla-Neto, J.; Silberstein, S. D.; Zukerman, Eliova [UNIFESP]; São Paulo Headache Ctr; Thomas Jefferson Univ Hosp; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Objectives-Chronic migraine (CM), previously called transformed migraine, is a frequent headache disorder that affects 2%-3% of the general population. Analgesic overuse, insomnia, depression, and anxiety are disorders that are often comorbid with CM. Hypothalamic dysfunction has been implicated in its pathogenesis, but it has never been studied in patients with CM. the aim was to analyze hypothalamic involvement in CM by measurement of melatonin, prolactin, growth hormone, and cortisol nocturnal secretion.Methods-A total of 338 blood samples (13/patient) from 17 patients with CM and nine age and sex matched healthy volunteers were taken. Melatonin, prolactin, growth hormone, and cortisol concentrations were determined every hour for 12 hours. the presence of comorbid disorders was also evaluated.Results-An abnormal pattern of hypothalamic hormonal secretion was found in CM. This included: (1) a decreased nocturnal prolactin peak, (2) increased cortisol concentrations, (3) a delayed nocturnal melatonin peak in patients with CM, and (4) lower melatonin concentrations in patients with CM with insomnia. Growth hormone secretion did not differ from controls.Conclusion-These results support hypothalamic involvement in CM, shown by a chronobiologic dysregulation, and a possible hyperdopaminergic state in patients with CM. Insomnia might be an important variable in the study findings.
- ItemSomente MetadadadosLead exposure is related to hypercortisolemic profiles and allostatic load in Brazilian older adults(Academic Press Inc Elsevier Science, 2017) Souza-Talarico, Juliana N.; Suchecki, Deborah [UNIFESP]; Juster, Robert-Paul; Plusquellec, Pierrich; Barbosa Junior, Fernando; Bunscheit, Vinicius; Marcouralcis, Tania; de Matos, Tatiane Martins; Lupien, Sonia J.Lead levels (Pb) have been linked to both hyper-and hypo-reactivity of hypothalamic-pituitary-adrenal axis (HPA) axis to acute stress in animals and humans. Similarly, allostatic load (AL), the 'wear and tear' of chronic stress, is associated with inadequate HPA axis activity. We examined whether Pb levels would be associated with altered diurnal cortisol profile, as a primary mediator of AL, during aging. Pb levels were measured from blood samples (BPb) of 126 Brazilian individuals (105 women), between 50 and 82 years old. Six neuroendocrine, metabolic, and anthropometric biomarkers were analyzed and values were transformed into an AL index using clinical reference cut-offs. Salivary samples were collected at home over 2 days at awakening, 30-min after waking, afternoon, and evening periods to determine cortisol levels. A multiple linear regression model showed a positive association between BPb as the independent continuous variable and cortisol awakening response (R-2=0.128
- ItemSomente MetadadadosNeuroendocrine effects of quetiapine in healthy volunteers(Cambridge Univ Press, 2005-03-01) Guerra, Alexandro de Borja Gonçalves [UNIFESP]; Castel, Saulo [UNIFESP]; Benedito-Silva, Ana Amélia [UNIFESP]; Calil, Helena Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The present study measured prolactin, cortisol, ACTH and growth hormone in healthy male volunteers following an acute oral administration of quetiapine, an atypical antipsychotic with high affinity for H, and moderate affinity for sigma, sigma(1), 5-HT2, alpha(2) and D-2 receptors. Fifteen male volunteers entered this randomized double-blind, cross-over, placebo-controlled study. Blood samples were drawn every 30 min from 09:00 hours to 13:00 hours. the first samples were drawn immediately before the administration of 150 mg quetiapine or placebo. Mean results for each hormone and ANOVA for repeated measures were performed. the area under the curve (AUC) hormonal values were calculated and compared by paired t test. the ANOVA showed an increase of prolactin after quetiapine administration from time 60 min up to the end of the observation period. Cortisol decreased after quetiapine administration from time 150 min to time 240 min. ACTH secretion showed no difference compared to placebo. There was a late increase in growth hormone secretion, significant in comparison with placebo only at time 210 min. the AUC values were statistically different for prolactin and cortisol compared to placebo. A single dose of quetiapine (150 mg) increased prolactin secretion probably due to a transiently high D, receptor occupancy at the anterior pituitary. Cortisol secretion decreased as was expected from quetiapine's pharmacodynamic profile. the lack of response of ACTH might be, at least in part, explained by the low hormonal assay sensitivity. the late growth hormone increase might have been due to quetiapine's antagonism of H, receptors.
- ItemAcesso aberto (Open Access)Plaqueta e leptina em adolescentes com obesidade(Sociedade Brasileira de Pediatria, 2008-12-01) Foschini, Denis [UNIFESP]; Santos, Ronaldo Vagner Thomatieli dos [UNIFESP]; Prado, Wagner Luiz do [UNIFESP]; Piano, Aline de [UNIFESP]; Lofrano, Mara Cristina [UNIFESP]; Martins, Aniela C. [UNIFESP]; Carnier, June; Caranti, Danielle Arisa [UNIFESP]; Sanches, Priscila de Lima [UNIFESP]; Tock, Lian [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Tufik, Sergio [UNIFESP]; Dâmaso, Ana Raimunda [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Metodista de São Paulo Faculdade de Educação Física e Fisioterapia; Universidade de Pernambuco Escola Superior de Educação Física Programa de Mestrado AssociadoOBJECTIVE: To analyze the influence of obesity status on immune cell count and concentration of the hormones cortisol and leptin, in order to establish a relationship among the variables analyzed. METHODS: We recruited 27 obese [body mass index (BMI) ≥ 95th percentile[ and 21 non-obese (BMI ≤ 75th percentile) adolescent boys and girls, aged 15-19 years at the post-pubertal stage. BMI was calculated as body weight divided by height squared, and body composition was estimated by plethysmography in the Bod PodTM system. Blood samples were collected to analyze leukocytes, neutrophils, lymphocytes, monocytes, platelets, cortisol, and leptin. The Kolmogorov-Smirnov test was performed, followed by the independent Student t test in case of normal distribution. Significance values were set at p < 0.05 and expressed as means ± standard deviation. The statistical package SPSS for Windows version 12.0 was used. RESULTS: There was no difference between obese and non-obese adolescents in terms of leukocyte, neutrophil, lymphocyte, monocyte and cortisol serum concentrations. The group of obese adolescents presented higher platelet and leptin concentrations (p < 0.01). The prevalence of hyperleptinemia was 25.92% in the obese adolescents (15.38% in boys and 35.7% in girls). CONCLUSIONS: Obese adolescents have higher platelet and leptin concentrations in comparison with non-obese adolescents. It was also found that obese girls presented a higher prevalence of hyperleptinemia than obese boys.