HAYATİ DEMİRASLAN, YASİN ŞİMŞEK, FATİH TANRIVERDİ, MEHMET DOĞANAY, HASAN FAHRETTİN KELEŞTEMUR

Prospective investigation of the hypothalamo?pituitary?adrenalaxis in patients with tularemia

Background/aim: To investigate prospectively the hypothalamo-pituitary-adrenal (HPA) axis by adrenocorticotropic hormone (ACTH) stimulation test. Materials and methods: Tularemia was diagnosed according to guidelines. An ACTH stimulation test (1 µg) and a dexamethasone suppression test (DST; 1 mg) were performed in patients in the acute phase of tularemia before antibiotic treatment and in the chronic phase. Results: Nineteen patients (mean age: 41.0 ± 13.2 years; 57.9% female) with tularemia were enrolled in the study in 2011 and 2012. Cortisol response to ACTH stimulation test was sufficient in all patients during the acute phase. After the DST, the cortisol was not suppressed during the acute phase in only one patient. The median control time of 11 patients after acute tularemia was 13 months. During the chronic phase, cortisol response to ACTH stimulation was normal in all patients, and after DST cortisol was suppressed in all patients. The peak cortisol level after the ACTH stimulation test in the acute phase was higher than that in the chronic phase, but the difference was not statistically significant. Conclusion: The HPA axis of patients with tularemia was not significantly affected in the acute and chronic phases.

Anahtar Kelimeler:

Tularemia, adrenal insufficiency, hypothalamo?pituitary?adrenal axis

Prospective investigation of the hypothalamo?pituitary?adrenalaxis in patients with tularemia

Keywords:

Tularemia, adrenal insufficiency, hypothalamo?pituitary?adrenal axis,

PDF

___

Tarnvik A. WHO Guidelines on Tularemia. Geneva, Switzerland: World Health Organization Press; 2007. 2. Ulu-Kilic A, Gulen G, Sezen F, Kilic S, Sencan I. Tularemia in central Anatolia. Infection 2013; 41: 391–399. 3.
Karadenizli A, Gurcan S, Kolayli F, Vahaboglu H. Outbreak of
tularaemia in Golcuk, Turkey in 2005: report of 5 cases and an
overview of the literature from Turkey. Scand J Infect Dis 2005; 37: 712–716.
Yildiz O, Gokce C, Alp E, Durak AC, Aygen B, Kelestimur F, Doganay M. Investigation of the hypothalamo-pituitary- adrenal axis and changes in the size of adrenal glands in acute brucellosis. Endocr J 2005; 52: 183–188.
Maxime V, Siami S, Annane D. Metabolism modulators in sepsis: the abnormal pituitary response. Crit Care Med 2007; 35: S596–601.
Brierre S, Kumari R, Deboisblanc BP. The endocrine system during sepsis. Am J Med Sci 2004; 328: 238–247.
Manglik S, Flores E, Lubarsky L, Fernandez F, Chhibber VL, Tayek JA. Glucocorticoid insufficiency in patients who present to the hospital with severe sepsis: a prospective clinical trial. Crit Care Med 2003; 31: 1668–1675.
Beisel WR, Bruton J, Anderson KD, Sawyer WD. Adrenocortical responses during tularemia in human subjects. J Clin Endocrinol Metab 1967; 27: 61–69.
Perez-Castrillon JL, Bachiller-Luque P, Martin-Luquero M, Mena-Martin FJ, Herreros V. Tularemia epidemic in northwestern Spain: clinical description and therapeutic response. Clin Infect Dis 2001; 33: 573–576.
Karaca Z, Lale A, Tanriverdi F, Kula M, Unluhizarci K, Kelestimur F. The comparison of low and standard dose ACTH and glucagon stimulation tests in the evaluation of hypothalamo-pituitary-adrenal axis in healthy adults. Pituitary 2011; 14: 134–140.
Pinchot GB, Close VP, Long CN. Adrenal changes produced in rats by infection with B. tularense and B. coli. Endocrinology 1949; 45: 135–142.
Lyons CR, Wu TH. Animal models of Francisella tularensis infection. Ann NY Acad Sci 2007; 1105: 238–265.
Tanriverdi F, De Bellis A, Teksahin H, Alp E, Bizzarro A, Sinisi AA, Bellastella G, Paglionico VA, Bellastella A, Unluhizarci K et al. Prospective investigation of pituitary functions in patients with acute infectious meningitis: is acute meningitis induced pituitary dysfunction associated with autoimmunity? Pituitary 2012; 15: 579–588.