Investigation of the Hypothalamo-pituitary-adrenal Axis and Changes in the Size of Adrenal Glands in Acute Brucellosis

Yıldız, Orhan; Gökçe, Cumali; Alp, Emine; Durak, Ahmet Candan; Aygen, Bilgehan; Keleştimur, Fahrettin; Doğanay, Mehmet

doi:10.1507/endocrj.52.183

Cited by 9 publications

(18 citation statements)

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“…The cortisol/DHEA ratio is abnormal under various pathological conditions such as AIDS, rheumatoid arthritis, and tuberculosis (18)(19)(20). In previous studies, significantly higher levels of cortisol in serum were reported in patients with acute brucellosis than in brucellosis patients at the end of antibiotic treatment or than in healthy subjects (21). In addition, adrenal glands are enlarged in patients with acute brucellosis but return to normal size after therapy (21).…”

Section: Tion Most Of Them Secreted By Macrophages (Such As Interleumentioning

confidence: 97%

Adrenal Steroids Modulate the Immune Response during Brucella abortus Infection by a Mechanism That Depends on the Regulation of Cytokine Production

et al. 2015

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bHuman brucellosis is a protean disease with a diversity of clinical signs and symptoms resulting from infection with Brucella species. Recent reports suggest a cross-regulation between adrenal steroids (cortisol and dehydroepiandrosterone [DHEA]) and the immune system. Monocytes and macrophages are the main replication niche for Brucella. Therefore, we investigated the role of adrenal hormones on the modulation of the immune response mediated by macrophages in B. abortus infection. Cortisol treatment during B. abortus infection significantly inhibits cytokine, chemokine, and MMP-9 secretion. In contrast, DHEA treatment had no effect. However, DHEA treatment increases the expression of costimulatory molecules (CD40, CD86), the adhesion molecule CD54, and major histocompatibility complex class I (MHC- Human brucellosis is characterized by a great diversity of clinical manifestations resulting from infection with Brucella species (4). It is chiefly an inflammatory disease. Inflammation is present both in the acute and chronic phases of the disease and in practically all of the organs affected. Clinical signs of such inflammation are undulant fever, endocarditis, arthritis, osteomyelitis, meningitis, pleocytosis, cellular infiltration of the joints, orchitis, nephritis, hepatic granuloma, etc. (5).IBrucella abortus infection elicits a vigorous Th1 immune response, which also activates cytotoxic T lymphocytes (6-9). Despite the recognition that Th1 immunity is crucial for the control of Brucella infection, several aspects of the immune response, i.e., how the innate immune response shapes the adaptive Th1 immune response and why Th1 immunity is not sufficient to completely eradicate the infection, constitute a conundrum. Macrophages/monocytes were recognized to play an important role in resistance to facultative intracellular bacteria such as Brucella, and activation of macrophages by specifically committed T lymphocytes formed the basis for cell-mediated immunity. However, B. abortus is endowed with a panoply of survival stratagems to evade immune responses and survive inside macrophages, creating a safe niche of replication inside the host (10-13).Several cytokines that are produced during B. abortus infec- [18][19][20]. In previous studies, significantly higher levels of cortisol in serum were reported in patients with acute brucellosis than in brucellosis patients at the end of antibiotic treatment or than in healthy subjects (21). In addition, adrenal glands are enlarged in patients with acute brucellosis but return to normal size after therapy (21). Of note, Th1 Citation Gentilini MV, Velásquez LN, Barrionuevo P, Arriola Benitez PC, Giambartolomei GH, Delpino MV. 2015. Adrenal steroids modulate the immune response during Brucella abortus infection by a mechanism that depends on the regulation of cytokine production.

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Section: Tion Most Of Them Secreted By Macrophages (Such As Interleumentioning

confidence: 97%

Adrenal Steroids Modulate the Immune Response during Brucella abortus Infection by a Mechanism That Depends on the Regulation of Cytokine Production

et al. 2015

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“…However, there was no statistical difference between the cortisol levels in the acute and chronic phases. This may be explained by the fact that inflammation in the acute phase of tularemia was not as severe as other infections, such as acute brucellosis (4,10,13). One of the limitations of our study was that we could not include patients with severe forms of tularemia, such as pulmonary and typhoid forms, which have more potential to activate the HPA axis.…”

Section: Discussionmentioning

confidence: 95%

“…However, minimal or no adrenal response was detected in tularemia patients with moderate symptoms (8). Another experimental human study showed a decrease in free T 4 and an increase in 17-ketosteroid levels (12). This study is a clinical observation of adrenal response in humans.…”

Section: Discussionmentioning

confidence: 99%

“…Because patients were followed for at least 7 months from the onset of tularemia infection, CRP and ESR levels were normal in the chronic phase and were not compared with those in the acute phase. In a previous study on brucellosis, patients were examined after 6 weeks of therapy (4). Long follow-up periods after acute infection are important for the evaluation of pituitary function because acute inflammation may affect the HPA axis.…”

Section: Discussionmentioning

confidence: 99%

“…Variations in adrenal response to tularemia are most prominent in volunteers with typical acute illness, and adrenal response is minimal or absent in those with mild symptoms (4,5). Sepsis-associated abnormal pituitary response may explain some factors, including anatomic damage, acute inflammation, and drug-related cell dysfunction (5).…”

Section: Introductionmentioning

confidence: 99%

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Prospective investigation of the hypothalamo–pituitary–adrenalaxis in patients with tularemia

Demiraslan¹,

Şimşek²,

Tanrıverdi³

et al. 2015

Turk J Med Sci

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IntroductionTularemia is a bacterial zoonotic diseases caused by Francisella tularensis. It exhibits different clinical manifestations depending on bacterial subspecies, such as Francisella subspecies tularensis (type A) or holarctica (type B), and the route of transmission, such as by arthropod bites, inhalation, or the ingestion of contaminated water or food. Tularemia caused by type B is much less severe than tularemia caused by type A, and fatal cases are rare in type B (1). In Turkey, the most common form of tularemia is oropharyngeal, caused by the subspecies holarctica (2,3).The adrenal glands are affected in sepsis, brucellosis, and tuberculosis. Variations in adrenal response to tularemia are most prominent in volunteers with typical acute illness, and adrenal response is minimal or absent in those with mild symptoms (4,5). Sepsis-associated abnormal pituitary response may explain some factors, including anatomic damage, acute inflammation, and drug-related cell dysfunction (5). The hypothalamopituitary-adrenal (HPA) axis may become severely dysfunctional during sepsis (5-7). In the past, the adrenal response of acute tularemia patients has been examined in healthy volunteers ( 8), but it is unclear whether there is a permanent adrenal insufficiency in the postinfectious period. The aim of this study was to investigate the HPA axis by adrenocorticotropic hormone (ACTH) stimulation test in acute tularemia and after therapy in a prospective study. Materials and methodsAdult tularemia patients who attended Erciyes University's Department of Infectious Diseases between 2011 and 2013 were included in this study. The study was approved by the local ethics committee, and informed consent was obtained from each patient. Tularemia was diagnosed in patients who had findings and symptoms compatible with tularemia, such as fever, sore throat, conjunctivitis, lymphadenopathy, cough and malaise, and tularemia microagglutination titer (MAT) of ≥1/128 or a 4-fold increase in titer after 4 weeks. Three of 6 clinical forms of tularemia were defined including oropharyngeal, oculoglandular, and glandular (1,2). Patients who were Background/aim: To investigate prospectively the hypothalamo-pituitary-adrenal (HPA) axis by adrenocorticotropic hormone (ACTH) stimulation test.Materials and methods: Tularemia was diagnosed according to guidelines. An ACTH stimulation test (1 µg) and a dexamethasone suppression test (DST; 1 mg) were performed in patients in the acute phase of tularemia before antibiotic treatment and in the chronic phase.Results: Nineteen patients (mean age: 41.0 ± 13.2 years; 57.9% female) with tularemia were enrolled in the study in 2011 and 2012. Cortisol response to ACTH stimulation test was sufficient in all patients during the acute phase. After the DST, the cortisol was not suppressed during the acute phase in only one patient. The median control time of 11 patients after acute tularemia was 13 months. During the chronic phase, cortisol response to ACTH stimulation was normal in all patients, and after DST ...

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MDCT Linear and Volumetric Analysis of Adrenal Glands: Normative Data and Multiparametric Assessment

et al. 2015

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Investigation of the Hypothalamo-pituitary-adrenal Axis and Changes in the Size of Adrenal Glands in Acute Brucellosis

Cited by 9 publications

References 32 publications

Adrenal Steroids Modulate the Immune Response during Brucella abortus Infection by a Mechanism That Depends on the Regulation of Cytokine Production

Adrenal Steroids Modulate the Immune Response during Brucella abortus Infection by a Mechanism That Depends on the Regulation of Cytokine Production

Prospective investigation of the hypothalamo–pituitary–adrenalaxis in patients with tularemia

MDCT Linear and Volumetric Analysis of Adrenal Glands: Normative Data and Multiparametric Assessment

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