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Browsing Medicine- Scholarly Publications by Subject "Adrenocorticotropic hormone"
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- ItemOpen AccessAdrenocortical function in Nigerian Patients with Pulmonary Tuberculosis (PTB)(2011-03) Odeniyi, I.; Fasanmade, O.; Ajala, M.; Ohwovoriole, A.Addison's disease was frequently consequent upon affectation of the glands by tuberculosis. Pulmonary Tuberculosis (PTB) is still very common in Nigeria but no report on the functional status of the adrenal cortex in patients with PTB in Nigeria exists. It is very important to note that subclinical adrenocortical failure in tuberculosis is an entity that should be considered as cortisol deficiency could be responsible for unexpected sudden death in this category of patients. This study sets out to determine the prevalence of subclinical adrenocortical failure in persons with PTB by determining the response to low-dose (1 ìg) ACTH stimulation. Forty four persons with newly diagnosed sputum-positive PTB and treatment naive, (23 males and 21 females, mean age 34.4 +/- 11.3 years, and mean body mass index (BMI) of 18.9 +/- 2.9 kg/m2) completed the study. Of the one hundred healthy volunteers recruited as control subjects, 70 persons (35 males and 35 females, mean age 38.1 +/- 12.5 years, BMI 24.1 +/- 3.7 kg/m2) completed the exercise. There was no statistically significant difference in the basal cortisol of healthy subjects and persons with PTB (239.9 vs. 229.1 nmol/L, p = 0.661). The thirty minute response to ACTH stimulation test and increment were significantly lower in persons with PTB than in healthy subjects. Adrenocortical insufficiency, mostly at the subclinical level, is common in persons with PTB infection, occurring in about 23% of patients. We therefore recommend that basal cortisol levels should not be used to detect adrenocortical insufficiency; rather stimulation tests should be used to exclude or confirm suspected adrenocortical insufficiency in patients with PTB.
- ItemOpen AccessAdrenocortical Function In Nigerians With Human Immunodeficiency Virus (HIV) Infection(2013) Odeniyi, I.A; Fasanmade, O.A; Ajala, M.O; Ohwovoriole, A.EOBJECTIVE: This study sets out to determine the prevalence of adrenocortical insufficiency in persons with HIV infection by determining the response to low-dose (1 µg) ACTH stimulation. DESIGN: An experimental study involving people with HIV infection and healthy people. SETTING: The study group and the controls were recruited from the Lagos University Teaching Hospital (LUTH). PARTICIPANTS: forty-three newly diagnosed and treatment naïve persons with HIV (23 males and 20 females) and 70 (35 males and 35 females) HIV negative subjects completed the study. INTERVENTION: One µg Synacthen was given intravenously to stimulate the adrenal glands. MAIN OUTCOME MEASURES: Blood was collected for basal cortisol levels and 30 minutes after the injection of ACTH. Cortisol was assayed using ELISA. RESULTS: The mean basal cortisol was 154.9 ± 27.2 nmol/L and 239.9 ± 31.6 nmol/L (p<0.001); while the 30-minute post ACTH test cortisol level was 354.8 ± 19.9 nmol/L and 870.9 ± 163.5 nmol/L (p<0.001) and the increment was 100.0 ± 17.2 nmol/L and 588.8 ± 143.4 nmol/L (p<0.001) in HIV and healthy subject group respectively. Using the diagnostic criteria derived for the diagnosis of adrenocortical insufficiency in this study (30 minute cortisol level <380.2 nmol/L and increment from basal to stimulated cortisol level <158.5 nmol/L); fifteen (34.8%) persons with HIV had adrenal insufficiency. CONCLUSION: Adrenocortical insufficiency is common in persons with HIV infection, occurring in about 34.8% of patients studied. Clinically evident adrenocortical insufficiency is uncommon in persons with HIV.
- ItemOpen AccessBody mass index and its effect on serum cortisol level(2015) Odeniyi, I.A; Fasanmade, O.A; Ogbera, A.O; Ohwovoriole, A.EINTRODUCTION: Cortisol measurement is indicated in suspected over or under production of cortisol by the adrenal cortex. The finding of low cortisol can create concern and initiate further investigations for the exclusion of adrenal insufficiency. Cushing's syndrome is frequently included in the differential diagnosis of obesity. Some literature describes reduced serum cortisol levels in obesity, however, this is not a well-recognized phenomenon. AIM: The aim of this study was to determine the relationship between body mass index (BMI) and serum cortisol levels. SUBJECTS, MATERIALS AND METHODS: Seventy healthy participants agreed to take part in the study. The anthropometric measurements (weight, height, and waist and hip circumferences) were done. Exclusion criteria include those with a history of adrenal/pituitary disease or medications altering cortisol level. The basal cortisol (BC) sample was taken at 8 a.m. immediately before administration of an intravenous bolus injection of 250 μg adrenocorticotropic hormone (ACTH). BMI categories were defined as normal and high if BMI was 18.5-24.99 kg/m² and ≥ 25 kg/m², respectively. RESULTS: Forty (57.1%) participants had normal BMI while 30 (42.9%) participants had BMI ≥ 25 kg/m² (P0 = 0.053). The mean BC level was lower in participants with BMI ≥ 25 kg/m² but not significant. There was a negative correlation between BMI and BC level ( r = -0.205, P = 0.88) while a positive correlation existed between stimulated cortisol level and BMI (r = 0.009, P = 0.944). CONCLUSION: Persons with BMI above 25 kg/m² had lower BC level though not statistically significant, the trend was noticed. Subjecting people whose BMI is above 25 kg/m² to further stimulation with ACTH because of low BC is not advised because their response to ACTH stimulation was similar to those who have normal BMI.
- ItemOpen AccessCD4 count as a predictor of adrenocortical insufficiency in persons with human immunodeficiency virus infection: How useful?(2013) Odeniyi, I.A.; Fasanmade, O.A.; Ajala, M.O.; Ohwovoriole, A.E.OBJECTIVE: To determine the usefulness of CD4 count in predicting adrenocortical insufficiency (AI) in persons with HIV infection. DESIGN: Experimental study involving people with HIV infection and healthy people. PARTICIPANTS: The participants were recruited from the Lagos University Teaching Hospital. Forty-three newly diagnosed, treatment naive persons with HIV (23 males and 20 females) and 70 (35 males and 35 females) HIV negative subjects completed the study. INTERVENTION: One microgram Synacthen(®) was given intravenously to stimulate the adrenal glands. MAIN OUTCOME MEASURES: Blood was collected for cortisol at 0 and 30 min after the injection of adrenocorticotropic hormone (ACTH) and CD4 count. RESULTS: Mean basal cortisol was 154.9 ± 27.2 nmol/L and 239.9 ± 31.6 nmol/L (P < 0.001); the 30-min post ACTH test, cortisol level was 354.8 ± 19.9 nmol/L and 870.9 ± 163.5 nmol/L (P < 0.001); the increment was 100.0 ± 17.2 nmol/L and 588.8 ± 143.4 nmol/L (P < 0.001) in HIV and healthy subject group; respectively. Using the diagnostic criteria for diagnosis of AI in this study, fifteen (34.8%) persons with HIV had AI. There was no significant correlation between basal cortisol levels and CD4 count in patients with HIV infection (r = -0.2, P = 0.198). There was no significant correlation between stimulated cortisol level and CD4 count in patients with HIV infection (r = -0.09, P = 0.516). CONCLUSION: CD4 count does not predict the presence or absence of AI. ACTH stimulation of the adrenal gland remains the acceptable standard.
- ItemOpen AccessComparison of Low dose and Standard dose Adrenocorticotropin stimulation tests in health Nigerians(2010-06) Odeniyi, I.A; Fasanmade, O.A; Ajala, M; Ohwovoriole, A.EHypothalamo-pituitary-adrenal (HPA) axis dysfunction is a potentially life-threatening condition. It is of paramount importance that safe, reliable diagnostic tests be available to identify patients at risk for adrenal insufficiency. The 250 microg Adrenocorticotropic hormone (ACTH) stimulation test is commonly used to assess adrenocortical function. The 250 microg dose is supraphysiological, therefore several investigators, over the years, have used 1 microg ACTH stimulation test to assess adrenocortical function. The aim of the study was to compare the response of healthy adult Nigerian subjects to the 250 microg and 1 microg ACTH tests. Ten healthy subjects, five males and five females, aged between 20-60 years, (mean, 38.7 years) participated in this study. They all had normal medical histories and physical examinations, were nonsmokers, and had never received any type of glucocorticoid therapy. Serum chemistries, full blood counts, erythrocyte sedimentation rate, were all within normal limits. Both low dose ACTH test and standard dose ACTH test were performed on the 10 subjects in a randomized order on different days.There was no statistically significant difference in mean serum cortisol levels between the two test doses at 30 minutes (928.4 vs 929.8 nmol/L). There was a strong correlation between 30-minute cortisol responses to 1 microg and 250 microg ACTH stimulation tests, r = 0.999; p < 0.001. In agreement with other published data, our study confirms that 1 microg ACTH stimulates adrenocortical secretion in normal subjects in the period 30 minutes post injection comparable to 250 microg ACTH testing.