危重症新生儿肾上腺皮质功能状态的研究

目的:研究危重症新生儿肾上腺皮质功能状态、肾上腺皮质功能不全(AI)的发生率及其与患儿预后的关系。方法:选择我科收治的日龄2天的危重症新生儿52例(其中早产儿23例,足月儿29例),根据新生儿危重病例评分(NCIS)分为轻度危重组和重度危重组,分别检测其血清基础皮质醇和小剂量促肾上腺皮质激素(ACTH)刺激实验30分钟后的清皮质醇峰值。血清基础皮质醇15μg/dl为合并AI。结果:危重症早产儿基础皮质醇浓度及小剂量ACTH刺激实验前后皮质醇差值均较足月儿组低[(15.08±4.98)μg/dl vs(19.65±9.18)μg/dl,P=0.027;(12.06±3.71)μg/dl vs(19.09±4.75)μg/dl,P=0.000]。危重症新生儿合并AI的发生率为38.5%,其中早产儿组为47.8%,足月儿组为34.5%。AI组新生儿死亡2例,未发现AI与患儿的死亡率有关。结论:危重症早产儿肾上腺皮质功能较足月儿差。危重症新生儿合并AI的发生率较高,但与患儿的死亡率无关。     

Effects of Short-Term Nocturnal Cortisol Replacement on Cognitive Function and Quality of Life in Patients with Primary or Secondary Adrenal Insufficiency: A Pilot Study

Cortisol replacement in patients with adrenal insufficiency usually consists of hydrocortisone (HC) given orally during day time. Due to the short half-life of hydrocortisone, cortisol levels between midnight and early morning are very low in contrast to the physiological rise of cortisol serum levels during this time. We investigated whether short-term cortisol replacement during the night improves cognitive function and well-being in these patients. Fourteen patients with adrenal insufficiency were put on HC infusion between midnight and 8 a.m. They subsequently underwent neurocognitive testing to measure intellectual functioning, concentration, memory and fine motor skills. Quality of life and mood were also evaluated. All tests were repeated after 2–4 weeks during usual oral glucocorticoid replacement therapy. Blood samples were taken for cortisol, epinephrine and norepinephrine measurement. With the exception of the digit symbol test with better scoring in the oral group (p = 0.005) there were no significant differences in neurocognitive testing, vegetative functions and quality of life on the two occasions. However, a higher cortisol level was associated with a worse performance in short-term memory. Plasma epinephrine concentration was subnormal in both groups, but increased only after intravenous hydrocortisone replacement. Mimicking the physiological rise in cortisol secretion during the night in this pilot study did neither significantly affect quality of life nor cognitive performance and vegetative functions. There was no improvement in general well being. Hydrocortisone infusion during night time might improve adrenomedullary reserve in patients with adrenal insufficiency.     

Sex hormones and bone health in males

Sex steroids play a key role in maintaining skeletal integrity lifelong, through a complex variety of endocrine, but also paracrine and possibly autocrine actions. The current knowledge that androgens may act as pro-hormones for estrogens has seriously challenged many traditional views, so that, at least for their skeletal actions, these can no longer be considered exclusively “male” or “female” hormones.     

王氏连朴饮对脾胃湿热证大鼠行为、肾上腺指数及血清Cort 的影响

目的:观察王氏连朴饮对脾胃湿热证大鼠的行为学、肾上腺指数及血清皮质醇(Cort)的调控作用。方法:将45只雄性Wistar大鼠随机分为正常对照组、模型组、王氏连朴饮(高、中、低剂量)组。利用复合因素复制脾胃湿热证动物模型。通过旷场实验观察大鼠行为学改变,称量法计算肾上腺指数,采用放射免疫法检测大鼠血清Cort的水平。结果:造模成功后大鼠行为发生改变,王氏连朴饮各剂量组对大鼠行为均有恢复作用,但各剂量组间无显著性差异;大鼠肾上腺指数增高,血清Cort升高(P<0.05),王氏连朴饮各剂量组对其均有降低作用,以中剂量组效果最好且有显著性差异(P<0.05)。结论:王氏连朴饮对脾胃湿热证大鼠行为、肾上腺指数和血清Cort有干预作用,这可能是王氏连朴饮清热祛湿的机制之一。     

雄性大熊猫尿中睾酮和皮质醇代谢物水平及其与繁殖、笼养和季节的关系

收集了雄性大熊猫尿样肾上腺皮质激素和雄性激素代谢物年周期变化基础数据。二月份雄性激素水平最高,与繁殖季节的开始相关。繁殖成功与雄性激素水平无相关,与不同的笼养环境也无相关。与其他熊类物种相比,大熊猫交配和雄性激素水平峰值在一年中的较早时候出现。在大熊猫这样一个多配制物种,这个峰值可以看作与挑战假说相关联。在冬季,肾上腺皮质激素水平逐月升高,12月份出现峰值。在繁殖季节来临前,肾上腺皮质激素可能扮演了一个预备的角色。     

Nerve Growth Factor and Dexamethasone Modulate Synthesis and Storage of Catecholamines in Cultured Rat Adrenal Medullary Cells: Dependence on Postnatal Age

Catecholamine content and in vitro activities of tyrosine hydroxylase (TH) and noradrenaline N-methyltransferase (NMT) were measured in cultures of isolated adrenal medullary cells from newborn and young postnatal rats to study the effects of the differentiation factors glucocorticoids and nerve growth factor (NGF). During the 4-day culture period the cellular catecholamine (CA) content and TH activity remained stable, whereas NMT activity dropped to about half of the initial level. In cells from 2- and 10-day-old rats 10 microM dexamethasone specifically prevented this loss in NMT activity. Furthermore, this glucocorticoid treatment increased, in a dose-dependent manner, the total CA content by 50-100% over control levels without changes in the adrenaline (A) proportion or TH activity. In contrast, NGF did not affect NMT activities at all. In cells from 10-day-old rats 100 ng/ml NFG elevated TH activity and total CA content to about 160% of controls and did not change the proportion of A. This increase in total CA content was linear with the NGF dose and required greater than 5 ng/ml NGF. In chromaffin cells from 2-day-old rats 100 ng/ml NGF affected neither TH activity nor the total content, whereas it significantly reduced the proportion of A by about 25%.     

Long bone growth during prolonged intermittent corticosteroid treatment and subsequent rehabilitation

Summary Immature A/J mice were treated for up to 7 weeks with intermittent doses of triamcinolone hexacetonide and were thereafter allowed to recover for 7 weeks. Qualitative and quantitative morphological measurements were performed on the epiphyseal cartilage plate and diaphyseal bone of the humerus. By the third injection significant structural changes were noted in the cartilaginous tissue followed by a complete cessation of bone growth. The hormonal inhibitory effect on long bone growth lasted throughout the experimental period. However, at the end of the recovery period the length of the humerus was 96% of the normal. In contrast, the humeral width at midshaft and the width of its medullary cavity revealed slower recovery, achieving only 80% of the control values. Following rehabilitation, the growth of experimental epiphyseal plates exceeded that of nontreated animals as their width and the number of hypertrophic chondrocytes were 131% and 125% of their controls respectively. Thus, in A/J mice (a highly susceptible inbred strain of mice) intermittent (every four days) administration of a long-acting corticosteroid hormone arrested endochondral and periosteal bone formation; the former, however, underwent full recovery following the termination of the hormonal treatment.Supported in part by the Hy and Ann Natovich Orthopaedic and Rehabilitation Research FoundationPart of this work was presented in abstract form at the Annual Meeting of the American Association of Anatomists, 1979The authors are grateful to Miss Aviva Valensi, Miss Dorit Licht and Mrs. Pessia Shenzer for their excellent technical assistance     

m-Synephrine: Normal Occurrence in Adrenal Gland

Abstract: Gas chromatography-mass spectrometry-selected ion monitoring has been used to identify m-synephrine (phenylephrine) in bovine adrenal gland. After ion exchange chromatography, m-synephrine was converted to its N-trifluoroacetyl-O-trifluoroacetoxy derivative and identified by retention time and relative intensities of the two characteristic ions at m/e 140 and m/e 455. Deuterated m-synephrine was synthesized and used as an internal standard for quantitative analysis. Bovine adrenal gland contains 83 ng g-¹ (range, 33-131) of endogenous m-synephrine.     

Pre-receptorial regulation of steroid hormones in bone cells: insights on glucocorticoid-induced osteoporosis

In the past decades, concern on glucocorticoid-induced osteoporosis has increased with the widespread use of exogenous glucocorticoids (GC). Mature bone-forming cells (osteoblasts) are considered to be the principal site of action of GC in the skeleton. More likely, it is the entire cellular and molecular network surrounding these cells that is targeted by pharmacological doses of GC. Not only osteoblast and osteocyte metabolism, but the whole differentiation of mesenchymal stem cell toward the osteoblast lineage has been proven to be sensitive to GC. The effects of GC on this process are different according to the stage of differentiation of bone cell precursors. The presence of intact GC signalling is crucial for normal bone development and physiology, as opposed to the detrimental effect of high dose exposure. Both the physiological and pharmacological effects of GC are locally modulated by the activity of the 11β-hydroxysteroid dehydrogenase 1 (HSD1) that acts primarily as a glucocorticoid activator converting the inactive glucocorticoid (cortisone) into the active hormone (cortisol). We reviewed the metabolic and differentiation pathways controlled by GC signalling. These data have been merged with the recent evidences that 11β-HSD1 exert an important role by regulating the vulnerability of bone cells to GC. The different kinetics of 11β-HSD1 at various stage of differentiation and the GC-dependency of enzymatic activity have been presented.     

Review of factors influencing stress hormones in fish and wildlife

Conservation efforts to better understand how wildlife populations respond to environmental change and anthropogenic disturbance has led to a proliferation of research examining physiological indicators of stress response in wildlife. Glucocorticoid stress hormones (GCs), typically cortisol and corticosterone, are among the most frequently measured indicators of the vertebrate stress response. To review the current state of research on stress physiology of free-ranging animals and its application to conservation, we canvassed more than 1000 articles on GC measures in wildlife published since 1969. For 454 studies published since 1990, we assessed the most commonly analysed correlates and disturbances and conducted a meta-analysis on commonly studied species. We noted a prominent divide in the legacies of fish-related analyses and those of higher order vertebrates and the need and opportunity to transfer knowledge between fields. Fish studies most frequently measured physiological indicators, condition, and the relationship between stress and mortality, whereas other vertebrate studies most frequently measured reproduction, condition, and environmental correlates. Correlates that significantly influenced GC levels across all vertebrate groups and are thus important to control for in study design and analyses include density and dispersal of conspecifics, season, reproductive status, and social status. Consistent trends across commonly studied species included positive GC response to capture and handling, reduced GC response related to acclimation, and a lack of correlation between condition and baseline GC levels. Our synthesis within and across diverse taxonomic orders reveals substantial research coverage but a lack of depth in multivariate analyses and a disparity in how correlates are controlled. This paper provides a comprehensive assessment of correlates and disturbances that influence GC measures and, as such, has useful applications to assist conservation physiologists in study design, analysis, and interpretation.     

Testosterone and corticosterone during the breeding cycle of equatorial and European stonechats (Saxicola torquata axillaris and S. t. rubicola)

Northern-temperate male birds show seasonal changes in testosterone concentrations with a peak during the breeding season. Many tropical birds express much lower concentrations of testosterone with slight elevations during breeding. Here we describe testosterone and corticosterone concentrations of male stonechats from equatorial Kenya during different substages of breeding and molt. This tropical species has a short breeding season of approximately 3 months. We compare their hormone concentrations to previously published data of males of a northern-temperate relative, the European stonechat, also a seasonal breeder but with a breeding season of approximately 5 months. Equatorial stonechats show a pronounced peak of testosterone during the nest-building and laying stage. During all other stages, testosterone concentrations are low, similar to other year-round territorial tropical bird species. Corticosterone concentrations peak also during the nest-building and laying stage suggesting that this period of maximum female fecundity is a demanding period for the male. Equatorial stonechats have significantly lower concentrations of testosterone than European stonechats during all stages, except during the nest-building and laying stage. During this stage of maximum female fertility, testosterone levels tend to be higher in equatorial than in European stonechats. Our results suggest that equatorial stonechats belong to a group of tropical bird species that are characterized by a short breeding season and a brief high peak of testosterone during the female's fertile period. Such brief, but substantial peaks of testosterone may be common in tropical birds, but they may easily be missed if the exact breeding stage of individual birds is not known.     

Effects of Adrenal Steroids on Basal Ganglia Neuropeptide mRNA and Tyrosine Hydroxylase Radioimmunoreactive Levels in the Adrenalectomized Rat

Abstract: To investigate the effects of type I (mineralocorticoid) and type II (glucocorticoid) receptor activation on striatal neuropeptide [preproenkephalin (PPE), preprotachykinin (PPT), and preprodynorphin (DYN)] mRNA and midbrain cholecystokinin (CCK) mRNA as well as striatal tyrosine hydroxylase radioimmunoreactivity (TH-RIC) levels, we administered either replacement levels of corticosterone (CORT; 0.5 mg/kg/day, s.c.) or pharmacological levels of deoxycorticosterone acetate (DOCA; a mineralocorticoid steroid with ability to bind to type I and type II receptors; 5 mg/kg, s.c.) to adrenalectomized adult male rats. After 1 week of recovery from adrenalectomy surgery, animals were injected daily with sesame oil or CORT for 1, 3, or 7 days or DOCA for 3 or 7 days and killed 16 h after the last injection. Adrenalectomy resulted in a decrease in all three striatal neuropeptide mRNA levels, compared with sham-operated rats. CORT replacement resulted in recovered PPE and PPT mRNA levels after 1 day and elevated PPE mRNA levels over those in sham-operated controls after 3 days. In contrast, DYN mRNA levels showed recovery after 7 days of CORT replacement. Results after DOCA treatment largely paralleled those after CORT replacement. There were no significant treatment effects on indirect markers of midbrain dopaminergic activity, i.e., CCK mRNA and TH-RIC. From these results we conclude that compared with striatal tachykinin and dynorphinergic neurons, enkephalinergic cells show greater sensitivity, whereas the dopaminergic system, including mesencephalic CCK, demonstrates an insensitivity to physiological CORT and to pharmacological DOCA treatment.     

Bile acids and glucocorticoid metabolism in health and disease

Glucocorticoids are regulators of stress response essential for survival. Liver disease can alter this homeostatic mechanism in patients with liver cirrhosis – a finding that might mirror the controversially discussed condition of critical illness related corticosteroid insufficiency.Underlying mechanisms might be shared molecular pathways in both bile acid as well as glucocorticoid metabolism at the level of synthesis, catabolism or the hypothalamus and the pituitary gland. Molecular links include the farnesoid X receptor FXR or the G protein-coupled bile acid receptor TGR5 expressed in the liver and the adrenals.In this review we sum up knowledge on the regulation of adrenal gland function and steroidogenesis, focussing on bile acids and potential alterations under cholestatic conditions, depict molecular links between glucocorticoid and bile acid metabolism and discuss the difficulties of assessment of adrenal function in humans in general and more specifically in liver diseases.     

Endocrine and behavioral changes in male African elephants: linking hormone changes to sexual state and reproductive tactics

Hormones play a crucial role in mediating genetic and environmental effects into morphological and behavioral phenotypes. In systems with alternative reproductive tactics (ART) shifts between tactics are hypothesized to be under proximate hormonal control. Most studies of the underlying endocrine changes behind ART have focused on fish and amphibians rather than mammals and few have investigated the potential interaction between different endocrine axes in regulating shifts between conditional dependent tactics. Using a combination of endocrine and behavioral data from male African elephants we expand on our previously published analysis and show that the initial increase in androgens predates the behavioral shifts associated with reproductively active periods, supporting the role of androgens in activating sexually active periods in males. A strong interactive effect between androgens and glucocorticoids was found to determine the presence or absence of temporal gland secretion and urine dribbling, signals associated with the competitive reproductive tactic of musth, with elevated glucocorticoids levels suppressing the occurrence of musth signals. In addition external environmental conditions affected hormone levels. The presence of receptive females resulted in elevated androgens in dominant musth males but increased glucocorticoids in subordinate non-musth males. The presented data on hormones, behavior and reproductive tactics strongly support an underlying endocrine mechanism for mediating the translation of intrinsic as well as extrinsic local conditions into the conditional dependent reproductive tactics in male elephants via interactions between the hypothalamic-pituitary-gonadal and -adrenal axes.     

Glycogen Metabolism in Bovine Adrenal Medulla

Abstract: Glycogen content was determined both in whole adrenal medullary tissue and in isolated adrenal chromaffin cells, in which it responds to glucose deprivation and restoration. [¹⁴C]glucose incorporation into glycogen in isolated adrenal chromaffin cells is increased by previous glucose deprivation ("fasting"). Total glycogen synthase activities are 452 ± 66 mU/g in whole tissue and 305 ± 108 mU/g in isolated cells. The K _m of glycogen synthase for UDP-glucose is 0.67 mM with 13 m m glucose-6-phosphate and 1 m m without this effector. The in vitro inactivation process of glycogen synthase a has been found to be mainly cyclic AMP-dependent, but it also responds to Ca²⁺. Total glycogen phosphorylase activities are 8.69 ± 1.26 U/g in whole tissue and 2.38 ± 0.30 U/g in isolated cells. The requirements for interconversion in vitro of both glycogen synthase and phosphorylase suggest a system similar to that of other tissues. During incubation of isolated adrenal chromaffin cells with 5 m m -glucose, phosphorylase a activity decreases and synthase a activity increases; these changes are more marked in "fasted" cells. Glycogen content and glycogen synthase and phosphorylase activities are higher in the adrenal medulla than in the brain, suggesting a greater metabolic role of glycogen in the adrenal medulla.     

Central Regulation of Adrenal Tyrosine Hydroxylase: Effect of Induction on Catecholamine Levels in the Adrenal Medulla and Plasma

The effect of induction of adrenal tyrosine hydroxylase (TH) by various centrally acting drugs on catecholamine levels in adrenal and plasma was investigated in rats. All the drugs tested, namely oxotremorine, Piribedil, B-HT 920, and HA-966, produced significant increases in adrenal dopamine content and plasma epinephrine level. Denervation of the adrenal abolished the increase in adrenal dopamine as it did the induction of tyrosine hydroxylase. The results suggest that the induced increase of adrenal TH activity, as mediated by certain drugs, results in an elevation of the plasma epinephrine level and that the adrenal dopamine content is a better indicator of the catecholamine-synthesizing capacity of the adrenal medulla than are the other catecholamines.     

A Developmental Study of Neuron-Specific Enolase in Rat Adrenal Medulla

Abstract: The levels of neuron-specific enolase (NSE) in rat adrenal medulla increase with age. A sharp increase was observed until the age of 15 days. At this time, the NSE level dropped slightly, followed by a gradual increase until the rats were 1 year old. The adrenal medullary NSE levels in males were higher than those observed in females. The difference was seen from 32 days of age, but was not statistically significant until 1 year. This study indicates that NSE can be used as a marker for differentiation in adrenal medulla, as it is used in the central nervous system and in neuroblastoma and pheochromocytoma cells.     

Adrenal Medullary Tropomyosins: Purification and Biochemical Characterization

Tropomyosins have been isolated from bovine adrenal medulla. Purified from a heat-stable extract, the adrenal medullary tropomyosins show the same chromatographic patterns as platelet tropomyosin components purified under very similar conditions on ion-exchange (DEAE-Sephacel) and hydroxylapatite columns. When analyzed by polyacrylamide gel electrophoresis, the purified fraction, reduced and denatured, yielded three polypeptides with apparent molecular weights of 38,000, 35,500, and 32,000. The molar ratio of the two major polypeptides (38 kd and 32 kd) was 2:1. The predominant form of 38 kd is different from other nonmuscle tropomyosins previously isolated and with which an apparent molecular weight of 30,000 is normally associated. The three adrenal medullary tropomyosins have similar isoelectric points of about 4.7. When adrenal tropomyosins were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis in the presence of 8 M urea, each form showed a shift to a higher molecular weight, which is a characteristic of muscle tropomyosin. The 38,000 adrenal medullary tropomyosin exhibits a stronger affinity for F-actin than the other forms. Peptide profiles obtained after limited proteolytic digestion show some similarity between the two predominant tropomyosins of the bovine adrenal medulla and also between these and the alpha and beta forms of bovine skeletal muscle tropomyosin.     

Processing of Proenkephalin in Adrenal Chromaffin Cells

The processing of proenkephalin was studied using [35S]methionine pulse-chase techniques in primary cultures of bovine adrenal medullary chromaffin cells. Following radiolabeling, proenkephalin-derived peptides were extracted from the cells and separated by reverse-phase HPLC. Fractions containing proenkephalin fragments were digested with trypsin and carboxypeptidase B to liberate Met-enkephalin sequences and subjected to a second HPLC step to demonstrate association of radiolabel with Met-enkephalin. Processing of proenkephalin is complete within 2 h of synthesis, suggesting completion at or soon after incorporation into storage vesicles. Pretreatment of the cells with nicotine, histamine, or vasoactive intestinal peptide to enhance the rate of proenkephalin synthesis failed to alter the time course of processing and had minimal effects on the distribution of products formed. Addition of tetrabenazine, an inhibitor of catecholamine uptake into chromaffin vesicles, during radiolabeling and a 6-h chase period caused enhanced proenkephalin processing. These results suggest that the full range of proenkephalin fragments normally found in the adrenal medulla (up to 23.3 kDa) represents final processing products of the tissue and that termination of processing may depend on the co-storage of catecholamines.     

Androgens and bone

Testosterone is the major gonadal sex steroid produced by the testes in men. Testosterone is also produced in smaller amounts by the ovaries in women. The adrenal glands produce the weaker androgens dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione. These androgens collectively affect skeletal homeostasis throughout life in both men and women, particularly at puberty and during adult life. Because testosterone can be metabolized to estradiol by the aromatase enzyme, there has been controversy as to which gonadal sex steroid has the greater skeletal effect. The current evidence suggests that estradiol plays a greater role in maintenance of skeletal health than testosterone, but that androgens also have direct beneficial effects on bone. Supraphysiological levels of testosterone likely have similar effects on bone as lower levels via direct interaction with androgen receptors, as well as effects mediated by estrogen receptors after aromatization to estradiol. Whether high doses of synthetic, non-aromatizable androgens may, in fact, be detrimental to bone due to suppression of endogenous testosterone (and estrogen) levels is a potential concern that warrants further study.