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DOI: 10.1055/s-0029-1237698
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York
Assessment of Adrenal Functions in Patients with Autosomal Dominant Polycystic Kidney Disease
Publikationsverlauf
received 11.02.2009
first decision 23.04.2009
accepted 30.07.2009
Publikationsdatum:
09. Februar 2010 (online)

Abstract
Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease and extrarenal manifestations may be observed in many organ systems. Hypothalamus-pituitary-adrenal axis was not evaluated extensively in patients with ADPKD. We aimed to evaluate this axis in these patients.
Methods: Twenty two patients with ADPKD and 27 healthy subjects were enrolled. Basal dehydroepiandrosterone sulfate (DHEAS) levels and cortisol and DHEA responses to low dose short adrenocorticotropin stimulation test were assessed. Correlation analyses of these parameters with glomerular filtration rates (GFR), renal volumes and pain characteristics in patients with ADPKD were performed.
Results: Patients with ADPKD had higher basal cortisol levels (12.1±3.4 vs. 9.6±4.3 μg/dL, p=0.033), and higher basal cortisol/DHEAS ratios (0.073±0.05 vs. 0.045±0.02, p=0.015) compared to controls. None of the subjects had inadequate response to adrenocorticotropin stimulation. Patients with ADPKD had lower delta cortisol (absolute increase between peak and basal) levels (10.3±2.8 vs. 12.6±4.2 μg/dL, p=0.026) compared to controls. Subgroup analysis showed that significant differences existed only between female patients and female controls. There was no significant correlation between cortisol levels and renal volumes or GFR. A significant correlation was found only between delta cortisol and pain frequency in female patients.
Conclusions: Patients with ADPKD had higher basal cortisol levels, higher basal cortisol/DHEAS ratios and lower delta cortisol levels compared to controls, indicating promptly stimulated zona fasciculata function. Further studies are needed to confirm these results and to investigate possible underlying mechanisms.
Key words
adrenal cortex function tests - adrenal functions - autosomal dominant polycystic kidney disease - flank pain - glomerular filtration rate - renal volume
References
- 1
Agwu JC, Spoudeas H, Hindmarsh PC. et al .
Tests of adrenal insufficiency.
Arch Dis Child.
1999;
80
((4))
330-333
MissingFormLabel
- 2
Clodi M, Riedl M, Schmaldienst S. et al .
Adrenal function in patients with chronic renal failure.
Am J Kidney Dis.
1998;
32
((1))
52-55
MissingFormLabel
- 3
Cockcroft DW, Gault MH.
Prediction of creatinine clearance from serum creatinine.
Nephron.
1976;
16
((1))
31-41
MissingFormLabel
- 4
Crofford LJ.
The hypothalamic-pituitary-adrenal axis in the pathogenesis of rheumatic diseases.
Endocrinol Metab Clin North Am.
2002;
31
1-13
MissingFormLabel
- 5
Cutolo M, Foppiani L, Minuto F.
Hypothalamic-pituitary-adrenal axis impairment in the pathogenesis of rheumatoid arthritis
and polymyalgia rheumatica.
J Endocrinol Invest.
2002;
25
((10 Suppl))
19-23
MissingFormLabel
- 6
Danby P, Harris KP, Williams B. et al .
Adrenal dysfunction in patients with renal amyloid.
Q J Med.
1990;
76
((281))
915-922
MissingFormLabel
- 7
Demir H, Tanriverdi F, Ozogul N. et al .
Evaluation of the hypothalamic-pituitary-adrenal axis in untreated patients with polymyalgia
rheumatica and healthy controls.
Scand J Rheumatol.
2006;
35
((3))
217-223
MissingFormLabel
- 8
Dillon JS.
Dehydroepiandrosterone, dehydroepiandrosterone sulfate and related steroids: their
role in inflammatory, allergic and immunological disorders.
Curr Drug Targets Inflamm Allergy.
2005;
4
((3))
377-385
MissingFormLabel
- 9
Dorin RI, Qualls CR, Crapo LM.
Diagnosis of adrenal insufficiency.
Ann Intern Med.
2003;
139
((3))
194-204
MissingFormLabel
- 10 Ecder T, Fick-Brosnahan GM, Schrier RW. Polycyctic kidney disease, in Schrier RW (ed) Disease of the Kidney and Urinary Tract
(ed 8), chapter 18 Philadelphia, PA,: Lippincott Williams & Wilkins; 2007 pp 502-539
MissingFormLabel
- 11
Ecder T, Schrier RW.
Hypertension in autosomal-dominant polycystic kidney disease: Early occurrence and
unique aspects.
J Am Soc Nephrol.
2001;
12
194-200
MissingFormLabel
- 12
Fick GM, Johnson AM, Hammond WS. et al .
Causes of death in autosomal dominant polycystic kidney disease.
J Am Soc Nephrol.
1995;
5
((12))
2048-2056
MissingFormLabel
- 13
Fick-Brosnahan GM, Belz MM, McFann KK. et al .
Relationship Between Renal Volume Growth and Renal Function in Autosomal Dominant
Polycystic Kidney Disease: A Longitudinal Study.
Am J Kidney Dis.
2002;
39
((6))
1127-1134
MissingFormLabel
- 14
Gaillard RC.
Neuroendocrine-immune system interactions The immune-hypothalamo-pituitary-adrenal
axis.
Trends Endocrinol Metab.
1994;
5
((7))
303-309
MissingFormLabel
- 15
Gunduz Z, Kelestimur F, Durak AC. et al .
The hormonal and radiological evaluation of adrenal glands, and the determination
of the usefulness of low dose ACTH test in patients with renal amyloidosis.
Ren Fail.
2001;
23
((2))
239-249
MissingFormLabel
- 16
Jankord R, Turk JR, Schadt JC. et al .
Sex difference in link between interleukin-6 and stress.
Endocrinology.
2007;
148
((8))
3758-3764
MissingFormLabel
- 17
Kelestimur F, Goktas Z, Gulmez I. et al .
Low dose (1 microg) adrenocorticotropin stimulation test in the evaluation of hypothalamo-pituitary-adrenal
axis in patients with active pulmonary tuberculosis.
J Endocrinol Invest.
2000;
23
((4))
235-239
MissingFormLabel
- 18
Kyrou I, Tsigos C.
Stress mechanisms and metabolic complications.
Horm Metab Res.
2007;
39
((6))
430-438
MissingFormLabel
- 19
Laureti S, Candeloro P, Aglietti MC. et al .
Dehydroepiandrosterone, 17alpha-hydroxyprogesterone and aldosterone responses to the
low-dose (1 microg) ACTH test in subjects with preclinical adrenal autoimmunity.
Clin Endocrinol (Oxf).
2002;
57
((5))
677-683
MissingFormLabel
- 20
Levey AS, Bosch JP, Lewis JB. et al .
A more accurate method to estimate glomerular filtration rate from serum creatinine:
a new prediction equation. Modification of Diet in Renal Disease Study Group.
Ann Intern Med.
1999;
130
((6))
461-470
MissingFormLabel
- 21
Marin TJ, Martin TM, Blackwell E. et al .
Differentiating the impact of episodic and chronic stressors on hypothalamic-pituitary-adrenocortical
axis regulation in young women.
Health Psychol.
2007;
26
((4))
447-455
MissingFormLabel
- 22
McDonald WJ, Golper TA, Mass RD. et al .
Adrenocorticotropin-cortisol axis abnormalities in hemodialysis patients.
J Clin Endocrinol Metab..
1979;
48
((1))
92-95
MissingFormLabel
- 23
McHorney CA, Ware Jr JE, Raczek AE.
The MOS 36-item short-form health survey (SF36): II. Phychometric and clinical tests
of validity in measuring physical and mental health constructs.
Med Care.
1993;
31
((3))
247-263
MissingFormLabel
- 24
Merta M, Tesar V, Zima T. et al .
Cytokine profile in autosomal dominant polycystic kidney disease.
Biochem Mol Biol Int.
1997;
41
((3))
619-624
MissingFormLabel
- 25
Namli S, Oflaz H, Turgut F. et al .
Improvement of endothelial dysfunction with simvastatin in patients with autosomal
dominant polycystic kidney disease.
Ren Fail.
2007;
29
((1))
55-59
MissingFormLabel
- 26
National Kidney Foundation
.
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification,
and stratification.
Am J Kidney Dis.
2002;
39
((Suppl 2))
S1-S266
MissingFormLabel
- 27
Oguz Y, Oktenli C, Ozata M. et al .
The midnight-to-morning urinary cortisol increment method is not reliable for the
assessment of hypothalamic-pituitary-adrenal insufficiency in patients with end-stage
kidney disease.
J Endocrinol Invest.
2003;
26
((7))
609-615
MissingFormLabel
- 28
Ramirez G, Gomez-Sanchez C, Meikle WA. et al .
Evaluation of the hypothalamic hypophyseal adrenal axis in patients receiving long-term
hemodialysis.
Arch Intern Med.
1982;
142
((8))
1448-1452
MissingFormLabel
- 29
Reimondo G, Bovio S, Allasino B. et al .
Secondary hypoadrenalism.
Pituitary.
2008;
11
((2))
147-154
MissingFormLabel
- 30
Salek FS, Bigos KL, Kroboth PD.
The influence of hormones and pharmaceutical agents on DHEA and DHEA-S concentrations:
a review of clinical studies.
J Clin Pharmacol.
2002;
42
((3))
247-266
MissingFormLabel
- 31
Salvatori R.
Adrenal insufficiency.
JAMA.
2005;
294
((19))
2481-2488
MissingFormLabel
- 32
Scott LV, Svec F, Dinan T.
A preliminary study of dehydroepiandrosterone response to low-dose ACTH in chronic
fatigue syndrome and in healthy subjects.
Psychiatry Res.
2000;
97
((1))
21-28
MissingFormLabel
- 33
Siamopoulos KC, Dardamanis M, Kyriaki D. et al .
Pituitary adrenal responsiveness to Corticotrophin-releasing hormone in chronic uremic
patients.
Perit Dial Int.
1990;
10
((2))
153-156
MissingFormLabel
- 34
Straub RH, Lehle K, Herfarth H. et al .
Dehydroepiandrosterone in relation to other adrenal hormones during an acute inflammatory
stressful disease state compared with chronic inflammatory disease: Role of interleukin-6
and tumour necrosis factor.
Eur J Endocrinol.
2002;
146
((3))
365-374
MissingFormLabel
- 35
Tanriverdi F, Karaca Z, Unluhizarci K. et al .
The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia
syndrome.
Stress.
2007;
10
((1))
13-25
MissingFormLabel
- 36
Wang Y, Moss J, Thisted R.
Predictors of body surface area.
J Clin Anesth.
1992;
4
((1))
4-10
MissingFormLabel
- 37
Zietz B, Wengler I, Messmann H. et al .
Early shifts of adrenal steroid synthesis before and after relief of short-term cholestasis.
J Hepatol.
2001;
35
((3))
329-337
MissingFormLabel
Correspondence
Dr. F. Tufan
Istanbul University
Istanbul Medical Faculty
Internal Medicine
Istanbul University Istanbul
Medical Faculty Department of Internal Medicine
34390 Istanbul
Turkey
Telefon: +902124142000
Fax: +902124142220
eMail: fatihtufan@gmail.com