BACKGROUND: 17α-Hydroxylase/17,20-lyase deficiency (17OHD) caused by mutations in the CYP17A1 gene is a rare form of congenital adrenal hyperplasia typically characterised by cortisol deficiency, mineralocorticoid excess and sex steroid deficiency.
OBJECTIVE: To examine the phenotypic spectrum of 17OHD by clinical and biochemical assessment and corresponding in silico and in vitro functional analysis.
METHODS: Case series.
RESULTS: We assessed eight patients with 17OHD, including four with extreme 17OHD phenotypes: two siblings presented with failure to thrive in early infancy and two with isolated sex steroid deficiency and normal cortisol reserve. Diagnosis was established by mass spectrometry-based urinary steroid profiling and confirmed by genetic CYP17A1 analysis, revealing homozygous and compound heterozygous sequence variants. We found novel (p.Gly111Val, p.Ala398Glu, p.Ile371Thr) and previously described sequence variants (p.Pro409Leu, p.Arg347His, p.Gly436Arg, p.Phe53/54del, p.Tyr60IlefsLys88X). In vitro functional studies employing an overexpression system in HEK293 cells showed that 17,20-lyase activity was invariably decreased while mutant 17α-hydroxylase activity retained up to 14% of WT activity in the two patients with intact cortisol reserve. A ratio of urinary corticosterone over cortisol metabolites reflective of 17α-hydroxylase activity correlated well with clinical phenotype severity.
CONCLUSIONS: Our findings illustrate the broad phenotypic spectrum of 17OHD. Isolated sex steroid deficiency with normal stimulated cortisol has not been reported before. Attenuation of 17α-hydroxylase activity is readily detected by urinary steroid profiling and predicts phenotype severity.
CONCLUSIONS: Here we report, supported by careful phenotyping, genotyping and functional analysis, a prismatic case series of patients with congenital adrenal hyperplasia due to 17α-hydroxylase (CYP17A1) deficiency (17OHD). These range in severity from the abolition of function, presenting in early infancy, and unusually mild with isolated sex steroid deficiency but normal ACTH-stimulated cortisol in adult patients. These findings will guide improved diagnostic detection of CYP17A1 deficiency.

Family hyperaldosteronism type I (glucocorticoids-remediable hyperaldosteronism) is a rare form of symptomatic arterial hypertension (AH), which often leads to the development of cerebrovascular complications. The disease is caused by the formation of the chimeric gene CYP11B2/CYP11B1.  Expression of the chimeric gene is regulated by adrenocorticotropic hormone, and glucocorticoid therapy leads to a decrease in aldosterone secretion and normalization of blood pressure. The article presents the first clinical case of this monogenic disease diagnosed by us in Russia. The features of clinical course and treatment of the patient have been traced in the dynamics for 40 years of observation. Modern approaches to the diagnosis and treatment of this rare family form of hypertension are discussed.

All currently available general anesthetic agents possess potentially lethal side effects requiring their administration by highly trained clinicians. Among these agents is etomidate, a highly potent imidazole-based intravenous sedative-hypnotic that deleteriously suppresses the synthesis of adrenocortical steroids in a manner that is both potent and persistent. We developed two distinct strategies to design etomidate analogs that retain etomidate\'s potent hypnotic activity, but produce less adrenocortical suppression than etomidate. One strategy seeks to reduce binding to 11β-hydroxylase, a critical enzyme in the steroid biosynthetic pathway, which is potently inhibited by etomidate. The other strategy seeks to reduce the duration of adrenocortical suppression after etomidate administration by modifying the drug\'s structure to render it susceptible to rapid metabolism by esterases. In this chapter, we describe the methods used to evaluate the hypnotic and adrenocortical inhibitory potencies of two lead compounds designed using the aforementioned strategies. Our purpose is to provide a case study for the development of novel analogs of existing drugs with reduced side effects.

The Deepwater Horizon oil spill caused the death of a large number of seabirds in the Gulf of Mexico in 2010. However, the long term consequences of oil exposure on migratory birds overwintering in this area have received limited attention. The present study aimed to investigate the impact of oil contamination (e.g., polycyclic aromatic hydrocarbons (PAHs)) on the circulating status of prolactin and corticosterone, two hormones that influence reproductive success in birds, in Northern gannets (Morus bassanus) breeding on Bonaventure Island, Eastern Canada. Using light-based geolocators, it was found that 23.5% of Northern gannets from Bonaventure Island overwintered in the Gulf of Mexico in 2010-2011; the remainder of this population overwintered along the Atlantic Coast of the United States. PAH concentrations (eight compounds) in gannet blood cells were all found to be under the method limits of quantification, which could be the result of the ability of seabirds to metabolize these compounds and the time elapsed between oil exposure and blood sampling. Corticosterone and prolactin levels as well as body mass did not differ between the two major birds\' wintering sites. Moreover, levels of both these hormones did not vary from early to late incubation period. Present results suggest that if Bonaventure Island-breeding Northern gannets had been exposed to oil in the Gulf of Mexico in the aftermath of this historical spill, this exposure could not be associated with changes in hormonal status and body mass in breeding individuals.

In vertebrates, stress experienced by mothers during the early stages of reproduction is an important source of epigenetic modifications in their offspring. Birds represent excellent models to test such effects as their maternal investment can be quantified in terms of egg quality. Recently, it has been demonstrated that corticosterone (CORT) can be transmitted from a female bird into its eggs. However, there is little published evidence about maternal effects that are mediated by acute stress. In this study, we demonstrated that female great tits Parus major facing an aerial predator during egg formation increased CORT concentration in eggs that were laid the morning after the treatment. By presenting a predator model to each experimental nest twice a day, we found that maternal stress influences corticosterone content in eggs during a time period from albumen production in the magnum until the initial phase of shell secretion, when additional water is added to the egg in the shell gland. We also found a positive correlation between the duration of parental alarm calls and CORT concentration in eggs. In conclusion, the response of female passerines to predatory cues brings about a maternal effect that may have negative consequences for offspring performance. We also suggest that the total duration of the behavioral response to a stressor is an important determinant of CORT levels in the albumen of bird eggs.

BACKGROUND: The lack of accepted homogeneous criteria for the definition of some demyelinating diseases makes diagnostic characterization difficult and limits data interpretation and therapeutic recommendations. Recurrent encephalomyelitis (ADE-R) along with borderline cases of neuromyelitis optica (NMO) are especially controversial.
OBJECTIVE: To describe the clinical and radiological evolution of an adult-onset ADE-R versus NMO case throughout 9 years of follow-up.
METHODS: Our patient presented with severe symptoms of rhombencephalomyelitis and the cranial and spinal magnetic resonance imaging (MRI) showed large lesions, with gadolinium enhancement in brainstem and spinal cord, correlating with the clinical picture. Infectious aetiology was excluded, IgG index was normal and NMO antibodies were negative. After treatment with intravenous corticosteroids and plasmapheresis, there was excellent recovery in the acute phase. During follow-up, seven relapses have occurred, mainly in the spinal cord, with good recovery and the same symptomatology, albeit with different severity. Immunosuppressive treatment was introduced since the beginning.
CONCLUSIONS: Our case shares common features of both ADE-R and NMO, illustrating that diagnostic characterization is not easy in spite of current criteria.

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A 12-year-old, intact female beagle exhibited symptoms of polyuria-polydipsia and hyperorexia for two months. Blood tests showed elevated asparate aminotransferase, alanine aminotransferase, alkaline phosphatase and creatine kinase levels, as well as marked hypokalemia. The results of adrenocorticotropic hormone stimulation test showed elevated cortisol, aldosterone and corticosterone concentrations. Abdominal ultrasonography confirmed a mass in the left adrenal gland. Masses were also seen in the liver and caudal vena cava. Diagnosis was a tumor of the adrenal cortex with metastases. Trilostane administration was initiated. The dog initially showed improved demeanor as a result of regulating hormone secretion. However, after 88 days, the dog weakened rapidly, before dying on the 117th day. Pathological findings confirmed a diagnosis of adrenocortical carcinoma.

OBJECTIVE: To evaluate the efficacy of fluconazole as an alternative treatment for controlling hypercortisolism in Cushing\'s syndrome and to determine its effect on glucocorticoid production in vitro.
METHODS: Case report and in vitro study in a University Clinic.
METHODS: An 83 year old patient presented with recurrence of Cushing\'s syndrome due to pulmonary metastases three years after unilateral adrenalectomy. During a near fatal episode of sepsis she was started on fluconazole 200 mg/day intravenously which normalised cortisol excretion. The therapy was continued orally for 18 months. Upon temporary discontinuation and reintroduction of treatment, cortisol levels increased and normalized, respectively. At month 16, fluconazole had to be increased to a dose of 400 mg/day to keep cortisol excretion in the normal range. Disease progression was slow and no side effects occurred. IN VITRO RESULTS: Fluconazole in a concentration of 500 microM nearly abolished corticosterone production over 24 h from the adrenal adenoma cell line Y-1 (8.6 +/- 0.5% compared with control, P < 0.0001) and significantly reduced corticosterone production in concentrations of 50 microM (48.3 +/- 1.9% vs. control, P < 0.0001) and 5 microM (80.5 +/- 8.5% vs. control, P < 0.05).
CONCLUSIONS: These results demonstrate for the first time that fluconazole normalises cortisol concentrations in vivo in a patient with Cushing\'s syndrome with adrenal carcinoma and inhibit glucocorticoid production in vitro in a cell line. Thus, fluconazole might be useful in controlling glucocorticoid excess in Cushing\'s syndrome and because of its lower toxicity might be preferable to ketoconazole.

Research on live vertebrates is regulated by ethics committees, who prohibit ;excessively stressful\' procedures. That judgment is based on intuition - a notoriously unreliable criterion when dealing with animals phylogenetically distant from humans. To objectively evaluate the stress imposed by research practices, we measured plasma corticosterone levels in lizards (Eulamprus heatwolei Wells & Wellington, Scincidae). Some procedures (handling and measuring, toe-clipping for identification, exposure to predator scent) did not induce significant increases in corticosterone levels, suggesting that these stimuli generated relatively little stress. However, other stimuli (testing locomotor speed, microchip implantation, blood sampling, an unfamiliar enclosure, tail autotomy, exposure to a heterospecific lizard) were more stressful, with corticosterone levels increasing only transiently in some treatments (<2 h for tail autotomy), but persisting much longer in others (14 days for microchip implantation). Overall, our data suggest that the levels of stress induced by routine laboratory procedures are no greater than those often experienced by lizards in nature; but that intuition provides a poor basis for evaluating the levels of stress induced by research. For example, toe-clipping is often criticized and sometimes banned; but our data suggest that this method is actually less stressful than the technique frequently recommended to replace it on ethical grounds (microchip implantation). Toe-clipping also was less stressful than superficially trivial manipulations such as housing the animal in an unfamiliar enclosure. More generally, we urge researchers to seek objective information on the effects of their activities on research subjects, rather than relying upon subjectivity and anthropomorphism in making these evaluations.