Medicine- Scholarly Publications

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Browsing Medicine- Scholarly Publications by Subject "adrenocorticotropic hormone (ACTH)"

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    Open Access
    Adrenocortical function in Nigerians with human immunodeficiency virus infection
    (Ghana Medical Association, 2013-12) Odeniyi, I.; Fasanmade, O.; Ajala, M.O.; Ohwovoriole, A.
    OBJECTIVE: 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.
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    Open Access
    CD4 count as a predictor of adrenocortical insufficiency in persons with human immunodeficiency virus infection: How useful?
    (Medknow publications, 2013-11) Odeniyi, I.; Fasanmade, O.; Ajala, M.O.; Ohwovoriole, A.
    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.
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    Open Access
    Comparison of low dose and standard dose adrenocorticotropin stimulation tests in healthy Nigerians
    (University College Hospital, 2010) Odeniyi, I.A; Fasanmade, O.A; Ajala, M.O; Ohwovoriole, A.E
    Hypothalamo-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.