Adrenocorticotropin-Cortisol Axis Abnormalities in Hemodialysis Patients*

McDonald, Walter J.; Golper, Thomas A.; Mass, R.; Kendall, John W.; Porter, George A.; Girard, Denis; Fischer, Matthew A.

doi:10.1210/jcem-48-1-92

Cited by 69 publications

(40 citation statements)

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“…Baseline cortisol levels in dialysis patients have been noted to be elevated in some studies [4, 7], but normal in others [3, 6, 13, 14, 15]. In our study, we found no significant difference in baseline cortisol levels between the dialysis and control groups regardless of the method utilized to measure cortisol.…”

Section: Discussioncontrasting

confidence: 50%

“…Others [5]have suggested that intravenous dexamethasone may be more effective than oral dexamethasone in patients on hemodialysis. Some investigators [6, 7, 8]have suggested that a higher oral dose of dexamethasone be used for testing in renal failure patients. Abnormalities in dexamethasone absorption have been implicated by some [6], but shown to be normal by others [8].…”

Section: Discussionmentioning

confidence: 99%

“…Dexamethasone suppression tests have been reported to be unchanged by some [3]and blunted by others [4, 5, 6, 7, 8]in patients on chronic hemodialysis. This lack of suppressibility has been attributed to various factors.…”

Section: Introductionmentioning

confidence: 99%

“…Basal plasma cortisol levels in patients with chronic renal failure have been found to be elevated by some [4, 7], but normal by others [3, 6, 13, 14, 15]. Methodological problems with the radioimmunoassay (RIA) of cortisol in dialysis patients leading to overestimation of cortisol levels have been described [16]and could conceivably be a major causative factor.…”

Section: Introductionmentioning

confidence: 99%

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Paper Chromatography prior to Cortisol RIA Allows for Accurate Use of the Dexamethasone Suppression Test in Chronic Renal Failure

Herle

Birnbaum

Slomowitz

et al. 1998

Nephron

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The assessment of the hypothalamic-pituitary-adrenal axis in patients with chronic renal failure (CRF) on hemodialysis is often hampered by abnormal responses to the standard 1-mg dexamethasone suppression test. Various mechanisms have been proposed to explain this lack of suppressibility. The present study was designed to look into the mechanisms possible for these findings in patients with CRF. We studied 6 patients with CRF on hemodialysis and 5 healthy subjects utilizing the 1-mg dexamethasone suppression test as well as the 50-mg hydrocortisone suppression test. Samples were assayed for dexamethasone, adrenocorticotropic hormone, corticosterone, and cortisol by both direct radioimmunoassay (RIA) and RIA after paper chromatography. Utilizing the direct cortisol RIA, 4 of 6 patients with CRF exhibited blunted dexamethasone suppression, while all 6 patients showed normal suppressibility after dexamethasone when cortisol was measured after paper chromatography. In contrast, all controls showed normal suppressibility regardless of the cortisol assay procedure used. The hydrocortisone suppression test was unreliable in the setting of CRF. Mean dexamethasone levels were similar in both groups. Plasma adrenocorticotropic hormone levels were significantly higher in the CRF patients, possibly indicative of an underlying hypothalamic-pituitary-adrenal axis abnormality. Abnormalities in dexamethasone suppression testing in patients with CRF may be explained by the overestimation of cortisol levels by direct RIA rather than by alteration of dexamethasone absorption or metabolism. Measurement of cortisol after paper chromatography is superior to direct RIA of cortisol in patients with CRF.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Paper Chromatography prior to Cortisol RIA Allows for Accurate Use of the Dexamethasone Suppression Test in Chronic Renal Failure

Herle

Birnbaum

Slomowitz

et al. 1998

Nephron

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“…26,27 Moreover, at least half of this peripherally produced estrone is eventually converted to estradiol in extraovarian tissue. 28 Testosterone is the precursor of estradiol produced in the ovary by the cholesterol metabolism pathway. It accumulates after menopause with the loss of the ovarian function.…”

Section: Discussionmentioning

confidence: 99%

Association between CYP19A1 polymorphisms and sex hormones in postmenopausal Japanese women

et al. 2009

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In postmenopausal women, extraovarian sex hormone production plays an important role in hormone-related diseases, such as breast and endometrial cancers. Aromatase, an enzyme encoded by CYP19A1, is a key enzyme involved in estrogen biosynthesis. The impact of CYP19A1 polymorphisms on serum sex hormone levels in the Japanese population has never been investigated. This study enrolled 100 postmenopausal Japanese women found to be without cancer. Twenty-five CYP19A1 loci were identified, and measurements were conducted on serum levels of sex hormones; lifestyle data were collected, namely estrone (E1), estradiol (E2), testosterone and sex hormone-binding globulin (SHBG). We conducted a cross-sectional analysis to evaluate the impact of CYP19A1 haplotype on serum sex hormone levels. We found that subjects with BMIX25 kg/m 2 showed a significant difference in circulating testosterone levels (0.29±0.19, P¼0.050). Neither age nor the amount of physical exercise or drinking habits showed any effect on hormone levels. We identified seven haplotype blocks in CYP19A1 by LD analysis. Estrone levels differed in rs12148604 (SNP 1) and rs11632903 (SNP14). No significant locus for estradiol was observed. SHBG levels were associated with rs4441215 (SNP11). Testosterone levels were strongly associated with rs752760 (SNP24) and rs2445768 (SNP25) and weakly associated with SNP 1, SNP11 and SNP14 as well. We found that polymorphisms in CYP19A1 influence sex hormone levels in Japanese postmenopausal women.

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Evaluation of the Hypothalamic Hypophyseal Adrenal Axis in Patients Receiving Long-term Hemodialysis

Ramírez¹

1982

Arch Intern Med

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Adrenocorticotropin-Cortisol Axis Abnormalities in Hemodialysis Patients*

Cited by 69 publications

References 0 publications

Paper Chromatography prior to Cortisol RIA Allows for Accurate Use of the Dexamethasone Suppression Test in Chronic Renal Failure

Paper Chromatography prior to Cortisol RIA Allows for Accurate Use of the Dexamethasone Suppression Test in Chronic Renal Failure

Association between CYP19A1 polymorphisms and sex hormones in postmenopausal Japanese women

Evaluation of the Hypothalamic Hypophyseal Adrenal Axis in Patients Receiving Long-term Hemodialysis

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