Overnight dexamethasone suppression test: normal responses and the diagnosis of Cushing's syndrome

Serum cortisol levels were measured the morning after the administration of 1 mg of dexamethasone. Only 5 of 190 subjects had serum cortisol levels greater than 2 micrograms/dL. Thus, the normal value after dexamethasone suppression is less than 2 micrograms/dL rather than less than 5 micrograms/dL as has generally been accepted. The distinction is important because some individuals with Cushing's syndrome partially suppress their cortisol levels to less than 5 but more than 2 micrograms/dL during the test procedure. Thus, the use of 5 micrograms/dL as the normal value may lead to an unnecessary delay in diagnosis.     

The discriminatory value of the low-dose dexamethasone suppression test in the investigation of paediatric Cushing's syndrome

BACKGROUND: Low- and high-dose dexamethasone suppression tests (LDDST, HDDST) are used in the investigation of Cushing's syndrome (CS). In adults with Cushing's disease (CD), cortisol suppression during LDDST predicts suppression during the HDDST. METHODS: We reviewed the results of the LDDST (0.5 mg 6 hourly x 48 h), HDDST (2.0 mg 6 hourly x 48 h) and corticotrophin-releasing hormone (CRH) test in 32 paediatric patients with CS: 24 had CD, 1 ectopic ACTH syndrome, 5 nodular adrenal hyperplasia and 2 adrenocortical tumours. Results: In CD, LDDST suppressed cortisol from 590.7 +/- 168.8 (mean +/- SD) to 333.7 +/- 104.0 nmol/l after 48 h (0 vs. 48 h, p < 0.05; mean suppression, 45.1%; CI (30.8, 59.4%); 16/24 (66%) suppressed >30%; mean suppression 68.1%, CI (58.1, 77.9%)). The HDDST suppressed cortisol from 596.3 +/- 174.5 to 47.1 +/- 94.8 nmol/l after 48 h (0 vs. 48 h, p < 0.05; mean suppression, 93.5%; CI (88.2, 98.8%) with 17/24 (71%) suppressing to <50 nmol/l and 100% to <50% of baseline). In the LDDST, suppression correlated with that during the HDDST (r = +0.45, p < 0.05) with >30% suppression predicting that in the HDDST and hence CD. CRH increased cortisol by +100.3% (CI 62, 138.5%), 22/24 (91.7%) showing a >20% increase. In the other CS pathologies (n = 8) the LDDST induced no significant decrease in cortisol. CONCLUSION: The LDDST was of diagnostic value by discriminating between CD and other CS aetiologies. In our view the HDDST is redundant in the investigation of paediatric CS.     

Timing of medical diagnosis and treatment: clino-circadian quantification of suppression by dexamethasone of the adrenal cortical cycle in healthy men

The inhibitory effect exerted upon the cyclic activity of the adrenal cortex by a synthetic steroid analog (dexamethasone-21-phosphate) administered at different circadian stages, has been studied previously. Reexamination of the same data by microscopic methods herein provides two sets of objective quantitative endpoints for further studies, namely 1. the characteristics of a rhythm isolated from a superimposed trend as well as noise, and 2. the endpoints of the trend itself. These endpoints quantify the effect of dose and, with the appropriate dose, the optimal timing for a given purpose may also be found.     

Alzheimer's disease and Down's syndrome: Sharing of a unique cerebrovascular amyloid fibril protein

The cerebrovascular amyloid protein from a case of adult Down's syndrome was isolated and purified. Amino acid sequence analysis showed it to be homologous to that of the β protein of Alzheimer's disease. This is the first chemical evidence of a relationship between Down's syndrome and Alzheimer's disease. It suggests that Down's syndrome may be a predictable model for Alzheimer's disease. Assuming the β protein is a human gene product, it also suggests that the genetic defect in Alzheimer's disease is localized on chromosome 21.     

Dexamethasone suppression test in psychiatric diagnosis and psychopathology for Chinese patients

The rate of abnormal dexamethasone suppression test (AbDST, post-dexamethasone cortisol greater than 5.0 micrograms/dl) was analyzed in different psychiatric samples, diagnostic categories and different time points of blood sampling. Differences in the AbDST rate in different samples were largely due to different composition of diagnostic categories and time points of samplings. By standard DST protocol (using 4 PM and 11 PM as sampling time points), melancholics had the highest AbDST rate (58.5%) among all diagnostic groups. DST was not a practical technique for differential diagnosis in psychiatric practice because of low prevalence of melancholia in the total patient population. However, it could be a promising variable for psychopathological study. The rate of AbDST was higher at the sampling time of 4 PM than any others. For one time point sampling, the 4 PM one was suggested. 8 AM and 4 PM sampling times were suggested as a practical 2-time-point sampling for DST. The rate of AbDST in different diagnostic groups had a positive relation with the severity of depressive psychopathology in a global sense. There was not any single item or any cluster of depressive symptomatology consistently related to AbDST among all diagnostic categories. Each diagnostic category had its own specific depressive symptoms in relation to AbDST, either positively or negatively. The severity of hypothalamic-pituitary-adrenal axis dysfunction, as shown in persistent AbDST and a high level of post-dexamethasone cortisol level, showed heterogeneous relation with depressive psychopathology. The relation was positive in schizophrenia and mania, was nill in melancholia, and probably reversed U relation in other psychotics and neurotics. Multiple psychopathological and pathophysiological mechanisms responsible for AbDST were suggested.     

Comparison of the saline infusion test and the fludrocortisone suppression test for the diagnosis of primary aldosteronism

For the diagnosis of primary aldosteronism (PA), confirmatory testing is mandatory and different function tests can be employed. There are, however, sparse data comparing the fludrocortisone suppression test (FST) and the saline infusion test (SIT). Patients with PA (n=90) or essential hypertension (n=65) were studied. They underwent one or the other test or both of them. Using the DPC Siemens aldosterone radioimmunoassay, we found that the SIT led to a stronger suppression of aldosterone than the FST. Post-test aldosterone-to-renin ratios (ARRs) and the percentage of suppression of aldosterone serum concentrations performed worse. The same results were observed in patients who underwent both FST and SIT. Some patients had divergent results in both tests. For the SIT, a lower cutoff value should be used than for the FST for the adequate identification of patients with unilateral PA. Long-term prospective studies are needed to address the question at what cutoff values patients benefit from subtype differentiation of PA. We discuss here possible explanations for divergent results obtained with both tests.     

Coagglutination test and its application to the rapid diagnosis of meningococcal meningitis

Modified technique of slide coagglutination test for detecting meningococcal group-specific antigens in the spinal fluid of patients with meningococcal meningitis has been developed. Precipitating meningococcal sera, groups A, C, X, Y, Z, were conjugated with formalin-treated staphylococcal cells, strain Cowan-I. To prevent nonspecific reactions, 5-minute boiling of the spinal fluid specimens is suggested. 111 specimens of spinal fluid were taken from 75 patients at different periods of the disease. All patients were administered antibiotics, and therefore the etiology of the disease was bacteriologically confirmed only in 31% of patients. Coagglutination test was positive in 56.7% of patients, the frequency of positive results reaching 71% during the first 4 days of the disease. The specimens of spinal fluid taken from the control group of patients yielded not more than 2% of the positive results. Coagglutination test is recommended as a rapid test for diagnosing meningococcal meningitis.     

Studies on the ultraviolet light sensitivity of Bloom's syndrome fibroblasts

The sensitivity of Bloom's syndrome (bl/bl) fibroblasts to ultraviolet light (254 nm) has been estimated by 4 criteria: sister-chromatid exchange (SCE) formation, micronucleus production, cell survival, and host-cell reactivation of UV-irradiated adenovirus 2. In general, bl/bl strains did not differ significantly from the normal (+/+) strains in their response to UV treatment by any of the 4 criteria. One bl/bl strain, GM1492, was exceptional: It was abnormally sensitive to UV light in the SCE, micronucleus, and host-cell reactivation assays, but was not sensitive to UV as estimated by colony-forming ability. Thus, although one of the bl/bl strains studied in the experiments was sensitive to UV light as judged by some criteria, UV sensitivity is not a universal characteristic of Bloom's syndrome cells. It is nuclear whether the UV sensitivity of the GM1492 strain reflects genetic diversity within the syndrome or some unrelated property of this strain.     

ACTH and cortisol after cigarette smoke exposure during the dexamethasone suppression test in smokers and non-smokers

In this research the effect of nicotine, (smoke of cigarette), was studied in smokers and non smokers during dexamethasone inhibitory test (1 mg h 23.00). ACTH and cortisol plasma levels, physiologically suppressed at 08.00, increased, after 30 min from smoking, only in group of non smokers. These data suggest that nicotine, in non smokers, could induce a maximum stimulus on diencephalic structures, so to overcome the inhibition of dexamethasone.     

Serum cortisol radioimmunoassay values in the normal ferret and response to ACTH stimulation and dexamethasone suppression tests

Cortisol values were obtained from 39 ferrets, Mustela putorius furo, by using a commercial radioimmunoassay. Sera from 25 males (18 intact, 7 neutered) and 14 females (7 intact, 7 spayed) were assayed. Resting serum cortisol values ranged from 0.13 to 2.70 micrograms/dl for males (mean = 0.93 +/- 0.63 micrograms/dl), and 0.55 to 1.84 micrograms/dl for females (mean = 0.86 +/- 0.29 microgram/dl). The resting cortisol values of both males and females were comparable to those of the cat (1.0 to 3.0 micrograms/dl). A 7 year old male ferret with suspected hyperadrenocorticism and an adrenal mass had a cortisol level of 8.1 micrograms/dl. Adrenal cortical carcinoma was the histologic diagnosis. One adult female ferret had a cortisol level of 3.30 micrograms/dl. This animal also had proliferative colitis upon necropsy. An ACTH stimulation test (1 U/kg IM) and a low-dose dexamethasone suppression test (0.1 mg/kg) were performed on 10 ferrets. Post-ACTH serum cortisol levels increased by an average of 89%. Post-dexamethasone serum cortisol values decreased by an average of 18% 6 hours post-injection.     

Comparison between a shortened TRH-TSH test and thyroid suppression test in the diagnosis of hyperthyroidosis]

In a selected group of fifty-one persons suspected to be hyperthyroid the comparison between a shortened variant of TRH-TSH stimulation test and thyroid suppression test was made. In patients whose other functional tests gave no univocal results, the agreement between suppressibility of radioiodine uptake and TSH response in 90,2% of cases could be established. High degree of correlation between both parameters (coefficient V = 0.791) permits to regard these tests as practically equivaluablein giving evidence of dysregulation between pituitary and thyroid gland. In persons with TSH-dependent thyroid function, however, no correlation between numerical values of radioiodine uptake and TSH concentrations after stimulations was found.     

Cdk5 suppression blocks SIRT1 degradation via the ubiquitin-proteasome pathway in Parkinson's disease models

The NAD⁺-dependent protein deacetylase sirtuin 1 (SIRT1), a member of the sirtuin family, may have a neuroprotective effect in multiple neurodegenerative disorders such as Alzheimer's disease (AD), Parkinson's disease (PD) and Amyotrophic lateral sclerosis (ALS). Many studies have suggested that overexpression-induced or resveratrol-treated activation of SIRT1 could significantly ameliorate several neurodegenerative diseases in mouse models. However, the type of SIRT1, protein expression levels and underlying mechanisms remain unclear, especially in PD. In this study, the results demonstrated that SIRT1 knockout markedly worsened the movement function in MPTP-lesioned animal model of PD. SIRT1 expression was found to be markedly decreased not only in environmental factor PD models, neurotoxin MPP⁺-treated primary culture neurons and MPTP-induced mice but also in genetic factor PD models, overexpressed α-synuclein-A30PA53T SH-SY5Y stable cell line and hm²α-SYN-39 transgenic mouse strain. Importantly, the degradation of SIRT1 during MPP⁺ treatment was mediated by the ubiquitin-proteasome pathway. Furthermore, the results indicated that cyclin-dependent kinase 5 (Cdk5) was also involved in the decrease of SIRT1 expression, which could be efficiently blocked by the inhibition of Cdk5. In conclusion, our findings revealed that the Cdk5-dependent ubiquitin-proteasome pathway mediated degradation of SIRT1 plays a vital role in the progression of PD.