Common Asthma Steroids Linked to Side Effects in Adrenal Glands

Posted on April 25, 2015 by MaryO

(Reuters Health) – After stopping steroids commonly prescribed for asthma and allergies, a significant number of people may experience signs of malfunctioning in the adrenal glands, a European study finds.

So-called adrenal insufficiency can be dangerous, especially if the person’s body has to cope with a stress like surgery, injury or a serious illness, the study authors say.

“The takeaway message of the study is that in corticosteroid use there is a substantial risk of adrenal insufficiency,” senior author Dr. Olaf Dekkers, an endocrinologist at Aarhus University in Denmark, said by email. “Patients should be aware of this risk and be informed about potential symptoms.”

Those symptoms can include fatigue, dizziness, weight loss and salt cravings, the authors write in the Journal of Clinical Endocrinology and Metabolism.

Corticosteroids are man-made drugs designed to mimic the hormone cortisol, which the adrenal glands produce naturally. The drugs are usually used to counter inflammation in a wide range of conditions, including asthma, psoriasis, rheumatoid arthritis, lupus, blood cancers and organ transplants.

People with adrenal insufficiency do not make enough of two hormones, cortisol and aldosterone. Cortisol helps the body respond to stress, recover from infections and regulate blood pressure and metabolism. Aldosterone helps maintain the right amounts of salt, potassium and water in the body.

While on steroids, the body often produces less of these hormones naturally, and after coming off the drugs it can take a while for natural production to ramp back up. The result is adrenal insufficiency, which can be treated with medication to replace cortisol or aldosterone.

Dekkers and colleagues analyzed 74 research articles published from 1975 to 2014, covering a total of 3753 study participants, to see how different doses and types of corticosteroid treatment might impact the likelihood of developing adrenal insufficiency after treatment.

Researchers found the risk of adrenal insufficiency was highest when corticosteroids were taken orally or injected, and lower with inhaled, nasal or topical treatment.

When they looked just at patients using steroids for asthma, the researchers found that the risk of adrenal insufficiency was about 7 percent with inhaled corticosteroids, but about 44 percent with other formulations including oral medication.

Only about 2 percent of asthma patients on the lowest dose of steroids experienced adrenal insufficiency, compared with about 22 percent on the highest doses.

Similarly, slightly more than 1 percent of asthma patients on short-term steroids developed adrenal insufficiency, compared with about 27 percent on long-term treatment.

There is no way to safely halt treatment with corticosteroids that can rule out the potential for adrenal insufficiency, Dekkers said.

The side effect is more likely when patients take higher doses of steroids or remain on treatment for longer than three weeks, said Dr. Roberto Salvatori, medical director of the pituitary center at Johns Hopkins Hospital in Baltimore.

“It’s likely, and it’s often overlooked because most often the people who prescribe corticosteroids aren’t endocrinologists; they are in other specialities and they don’t recognize the symptoms of adrenal insufficiency,” said Salvatori, who wasn’t involved in the study.

He gives his patients on corticosteroids medical identification bracelets or necklaces to wear so they can be identified as at risk for adrenal insufficiency in an emergency. “This is a very important issue that’s not on the radar screen,” he said.

To be sure, more physicians are aware of the risk now than in the 1970s, and the standard doses and durations of corticosteroid treatment have been reduced in part because of this risk, said Dr. Douglas Coursin, a professor at the University of Wisconsin School of Medicine and Public Health in Madison. He, too, advises medical alert bracelets for patients on long-term or high-dose treatment.

“In the past, patients with asthma, certain immune diseases, those receiving some cancer therapies and those who had a solid organ transplant received higher doses for longer periods of time,” Coursin, who wasn’t involved in the study, said by email. “Overall, I think the risk may be lower than outlined in the study because of practice changes.”

SOURCE: bit.ly/1PjRHYw Journal of Clinical Endocrinology and Metabolism, online April 6, 2015.

Filed under: adrenal, adrenal crisis, Rare Diseases | Tagged: , , , , , , , , , , , , , , , , , , , , , | Leave a comment »

Time to Recovery of Adrenal Function After Curative Surgery for Cushing’s Syndrome Depends on Etiology

Posted on April 9, 2015 by MaryO
Christina M. Berr, Guido Di Dalmazi, Andrea Osswald, Katrin Ritzel, Martin Bidlingmaier, Lucas L. Geyer, Marcus Treitl, Klaus Hallfeldt, Walter Rachinger,Nicole Reisch, Rainer Blaser, Jochen Schopohl, Felix Beuschlein, and Martin Reincke
Address all correspondence and requests for reprints to: Martin Reincke, MD, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstr. 1, D-80336 Munich, Germany. E-mail: .
DOI: http://dx.doi.org/10.1210/jc.2014-3632
Abstract

Context:

Successful tumor resection in endogenous Cushing’s syndrome (CS) results in tertiary adrenal insufficiency requiring hydrocortisone replacement therapy.

Objective:

The aim was to analyze the postsurgical duration of adrenal insufficiency of patients with Cushing’s disease (CD), adrenal CS, and ectopic CS.

Design:

We performed a retrospective analysis based on the case records of 230 patients with CS in our tertiary referral center treated from 1983–2014. The mean follow-up time was 8 years.

Patients:

We included 91 patients of the three subtypes of CS undergoing curative intended surgery and documented followup after excluding cases with persistent disease, pituitary radiation, concurrent adrenostatic or somatostatin analog treatment, and malignant adrenal disease.

Results:

The probability of recovering adrenal function within a 5 years followup differed significantly between subtypes (P = .001). It was 82% in ectopic CS, 58% in CD and 38% in adrenal CS. In the total cohort with restored adrenal function (n = 52) the median time to recovery differed between subtypes: 0.6 years (interquartile range [IQR], 0.03–1.1 y) in ectopic CS, 1.4 years (IQR, 0.9–3.4 y) in CD, and 2.5 years (IQR, 1.6–5.4 y) in adrenal CS (P = .002). In CD the Cox proportional-hazards model showed that the probability of recovery was associated with younger age (hazard ratio, 0.896; 95% confidence interval, 0.822–0.976; P = .012), independently of sex, body mass index, duration of symptoms, and basal ACTH and cortisol levels. There was no correlation with length and extend of hypercortisolism or postoperative glucocorticoid replacement doses.

Conclusions:

Time to recovery of adrenal function is dependent on the underlying etiology of CS.

Affiliations
  • Medizinische Klinik und Poliklinik IV (C.M.B., G.D.D., A.O., K.R., M.B., N.R., J.S., F.B., M.R.), Institut für Klinische Radiologie (L.L.G., M.T.), Chirurgische Klinik und Poliklinik—Innenstadt (K.H.), 80336 München, Germany; Klinik für Neurochirurgie, Klinikum Grosshadern (W.R.), Ludwig-Maximilians-Universität München, 81377 München, Germany; and Institut für Medizinische Statistik und Epidemiologie (R.B.), Klinikum rechts der Isar der TU München, 81675 München, Germany

Filed under: adrenal, adrenal crisis, Cushing's, Treatments | Tagged: , , , , , , | Leave a comment »

What Is Adrenal Hyperplasia? – Yahoo News UK

Posted on March 31, 2015 by MaryO

Adrenal hyperplasia is a rare genetic condition that involves the adrenal glands, which lie just above the kidneys.

It results in a blockage in the assembly line that makes the stress hormone cortisol from its chemical precursors.

People with the condition have low levels of cortisol, which helps to regulate blood sugar levels. If they fall too low, it can result in a coma.

But in some cases, the blockage can also reduce the production of aldosterone, a hormone involved in the regulation of salt in the bloodstream.

If salt levels fall too low it can lead to dehydration, vomiting and death.

Regular treatment with steroid medicines can help to maintain normal hormone levels and although the condition is lifelong, the outlook is generally good.

via Missing Boy: What Is Adrenal Hyperplasia? – Yahoo News UK.

Filed under: adrenal | Tagged: , , , , , | Leave a comment »

PRKACA mutations in cortisol-producing adenomas and adrenal hyperplasia

Posted on March 31, 2015 by MaryO
Eur J Endocrinol. 2015 Mar 6. pii: EJE-14-1113. [Epub ahead of print]

PRKACA mutations in cortisol-producing adenomas and adrenal hyperplasia – a single-center study of 60 cases.

Thiel A1, Reis AC2, Haase M3, Goh G4, Schott M5, Willenberg HS6, Scholl UI7.

Author information

Abstract

Objective: Cortisol excess due to adrenal adenomas or hyperplasia causes Cushing’s syndrome. Recent genetic studies have identified a somatic PRKACAL206R mutation as a cause of cortisol-producing adenomas.

We aimed to compare the clinical features of lesions with PRKACA mutations to those with CTNNB1 mutations and to search for similar mutations in unilateral hyperplasia or tumors co-secreting aldosterone.

Design, patients and methods: 60 patients with cortisol excess who had adrenalectomies at our institution between 1992 and 2013 were assessed, and somatic mutations were determined by Sanger sequencing. 36 patients had overt Cushing’s syndrome, the remainder were subclinical. 59 cases were adenomas (three bilateral), one was classified as hyperplasia. Four tumors had proven co-secretion of aldosterone.

Results: Among cortisol-secreting unilateral lesions without evidence of co-secretion (n=52), we identified somatic mutations in PRKACA (L206R) in 23.1%, CTNNB1 (S45P, S45F) in 23.1%, GNAS (R201C) in 5.8% and CTNNB1 plus GNAS (S45P, R201H) in 1.9%. PRKACA and GNAS mutations were mutually exclusive. Of the co-secreting tumors, two (50%) had mutations in KCNJ5 (G151R and L168R). The hyperplastic gland showed a PRKACAL206R mutation, while patients with bilateral adenomas did not have known somatic mutations. PRKACA-mutant lesions were associated with younger age, overt Cushing’s syndrome and higher cortisol levels versus non-PRKACA-mutant or CTNNB1-mutant lesions. CTNNB1 mutations were more significantly associated with right than left lesions.

Conclusions: PRKACAL206R is present not only in adenomas, but also in unilateral hyperplasia and is associated with more severe autonomous cortisol secretion. Bilateral adenomas may be caused by yet-unknown germline mutations.

PMID:
25750087
[PubMed – as supplied by publisher]

From http://www.ncbi.nlm.nih.gov/pubmed/25750087

Filed under: adrenal, Clinical trials, Cushing's, Treatments | Tagged: , , , , , , , , | 1 Comment »

The 3 Things That Wreck Your Hormones (Part 3) | Alan Christianson

Posted on March 28, 2015 by MaryO

adrenal-glands

When it comes to your hormones, stress is all about the adrenal glands. These are a couple of nickel-sized pieces of tissue that can completely make or break your health. The adrenal glands can be affected by diseases, but this is extremely rare and rather straightforward for doctors to diagnose. It is much more common for the adrenal glands to be free of disease but dysfunctional under a large stress load.

The adrenals are different from your other glands in that they make different amounts of hormones as the day goes on. They release a burst of cortisol to wake us up, and they shut it off at night to let us sleep.

Even when a disease or the aging process is the core problem with your hormones, the adrenals still play a role, and here is why: Hormones don’t really do anything until they go inside of your cells. Each cell has a wall around it that lets in just the right amount of hormones at just the right times.

Think of your cell as a castle wall with a drawbridge that only comes down to those who know the password phrase. The password phrase that lets hormones into your cell is “the cortisol rhythm.” The cortisol rhythm is controlled by the adrenal glands. When adrenal hormones are wrecked, it is important to understand what this means. It doesn’t mean they are unable to make hormones; it means their rhythm is disturbed. This is important because you may read that taking cortisol can help if you have low cortisol. At first, this makes sense and seems to fit the strategy for thyroid disease — if you have too little thyroid hormone, take some to replace what is lacking. The problem is that in the case of adrenal stress, low cortisol is not the result of the adrenals being unable to make cortisol. It is the result of all the parts involved in cortisol production being off in their timing. Putting more cortisol into the system just makes the problem worse.

If taking cortisol is not the answer, then what is?

Read the rest of the article at The 3 Things That Wreck Your Hormones (Part 3) | Alan Christianson.

 

 

Filed under: adrenal, Rare Diseases | Tagged: , , | Leave a comment »

« Previous Page — Next Page »