Adrenal function, impaired

Pantothenic acid 10-15 mg/day. Deficiency causes apathy, depression, impaired adrenal function, and muscular weakness, co -Methylpantothenic acid is a specific antagonist. The calcium salt, calcium pantothenate, is the usual commercial form. 

From a study of the response to ACTH of the urinary excretion of 17-ketosteroids, Anderson et al. (Al) suggested that impaired adrenal function may be a factor in idiopathic hypercalcemia of infancy. 

Corticosteroids — Beclomethasone dipropionate (17) aerosol has been tested extensively clinically. It is used prophylactically (400 fig per day), not therapeutically, in the treatment of chronic asthma, particularly in children.52 An evaluation of the drug has been published.53 One of the most important clinical advantages is that 1 7 effectively can replace oral corticosteroids in steroid-dependent patients and avoid many of the adverse effects of adrenal suppression.52,54 Most patients with impaired adrenal function due to oral corticosteroids show recovery of adrenal function within 6 months.55 The combination of 17 and disodium cromoglycate (DSCG) showed no additive therapeutic effects.5 Flunisolide (18), when administered as a nasal spray for 4 weeks during the hay fever season in 51 patients, showed significant symptomatic improvement with no systemic steroid effects observed.57... 

In general, the acute oral toxicity of these substances in rats have been found to be of low to moderate order. In humans, a similar low acute toxicity may be expected. Because of the low vapor pressure of these compounds, any exposure risk from inhalation should be considered very low. The toxic symptoms in humans from overdose include abdominal pain, impaired adrenal function, nausea, diarrhea, and vomiting. Vapors are irritant to eye and mucous membrane. Skin contact may cause irritation and dermatitis. 

It appears there are two main reasons for the accumulation of cholesterol esters in rats that are fed HEAR oil or erucic acid containing diets. First, the cholesterol ester hydrolase fails to increase in activity when these rats are stressed, while in control rats, when stressed, the enzyme doubles its activity (Beckett and Boyd, 1975). Second, cholesteryl erucate, which accumulates in the adrenals of rats fed HEAR oil, is only slowly hydrolyzed by the enzyme, i.e., at 25-30% of the rate of cholesteryl oleate. This may be very significant, since there is considerable cholesteryl erucate accumulation in the adrenal glands of rats fed diets high in erucic acid, i.e., this ester may constitute 29-35% of the total (Carroll, 1962 Walker and Carney, 1971). In addition, in these rats there was an accumulation of 8% cholesteryl eicose-noate. In agreement with this evidence of impaired adrenal function, the results indicate that plasma levels of one of the adrenal hormones, corticosterone, are lower in these rats than in control rats when exposed to an environmental stress (Walker and Carney, 1971 Budzynska-Topolowska eta/., 1975). 

In 23 healthy aged subjects (73.0 8.0 years), the impaired hypothalamo-pituitary-adrenal function became apparent in a most significant decline of the plasma levels of dehydroepiandrosterone and dehydroepiandrosterone-sulphate (Martinez-Ta-BOADA et al. 2002). A close correlation between immune changes with ageing and dehydroepiandrosterone response to ACTH stimulation was found. There was an inverse correlation of lymphocyte changes with the plasma levels of steroids, especially dehydroepiandrosterone and its metabolite, dehydroepiandrosterone-sulphate. 

Endocrine In some centers, megestrol acetate is being used to promote weight gain in malnourished elderly patients. The suspicion that this might lead to impaired adrenal function has been incidentally voiced in the past, and a US group has described such a case in detail [80". ... 

Use with caution in the foiiowing Elderly or debilitated severe impairment of hepatic, pulmonary or renal function myxedema or hypothyroidism adrenal cortical insufficiency CNS depression or coma toxic psychoses prostatic hypertrophy or urethral stricture acute alcoholism delirium tremens or kyphoscoliosis. Naloxone may not be effective in reversing respiratory depression. 

Neuropsychological impairments in mood disorders, particularly those of working memory and executive function, are the most convincing and objective demonstrations of an impairment of consciousness. Since these impairments do not correlate with the severity of the mood disturbance and persist upon recovery they are not simply epiphenomena of the mood disturbance but rather may index trait pathology in susceptible individuals. It has previously been argued that mood disturbance and neuropsychological impairment may result from disturbances in two different neurochemical systems, the serotonin (5-HT) system and the hypothalamic-pituitary-adrenal (HPA) axis, between which there is a close interaction (McAllister-Williams et al., 1998). 

Kennedy MJ, Carpenter JM, Lozano RA, Castile RG. Impaired recovery of hypothalamic-pituitary-adrenal axis function and hypoglycemic seizures after high-dose inhaled corticosteroid therapy in a toddler. Ann Allergy Asthma Immunol 2002 88(5) 523-6. 

The adrenal glands are sensitive to the toxic effects of suramin both glucocorticoid and mineralocorticoid functions can be impaired at doses normally used, necessitating replacement therapy (1081). 

Dogs develop severe and potentially fatal hypoglycemia in pantothenic acid deficiency - this responds to the administration of glucocorticoid hormones, suggesting that it is secondary to impairment of adrenal cortical function. 

---