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ABSTRACT. Glucocorticoids (GCs) are key drugs in the treatment of systemic lupus erythematosus (SLE). GC dose reduction during remission is related to disease activity, GC dose used, length of treatment, and individual GC sensitivity. We compared GC receptor α (GRα) isoform and nuclear factor kappaB (NF-κB) messenger RNA quantitation and in vivo GC sensitivity between SLE patients during remission and healthy controls. We performed a cross-sectional study of 19 women aged 22-49 years, including 9 SLE patients in clinical remission taking ≤5 mg prednisone and 10 matched controls. We evaluated GC sensitivity using 2 cortisol suppression tests: a very-low-dose intravenous dexamethasone suppression test (VLD-IV-DST) and a low-dose oral dexamethasone suppression test. GRα and NF-κB mRNA were quantified using real-time polymerase chain reaction. Although basal cortisol and adrenocorticotropic hormone levels were similar between the groups, the percentage of cortisol reduction after the VLD-IV-DST was 56% lower in SLE patients than in controls (P = 0.014). GRα and NF-κB gene expression levels were similar between the groups. The low-dose oral dexamethasone test caused intense cortisol suppression in all individuals, limiting the ability of this test to discriminate individual GC sensitivity. A positive correlation was found between the extent of cortisol suppression in vivo (VLD-IV-DST) and the number of days elapsed since the last flare of lupus activity. Despite clinical remission, SLE patients displayed partial GC resistance recognized by the VLD-IV-DST. The mechanism of this resistance is unrelated to altered GRα and NF-κB mRNA expression.
ABSTRACT. Glucocorticoids (GCs) are key drugs in the treatment of systemic lupus erythematosus (SLE). GC dose reduction during remission is related to disease activity, GC dose used, length of treatment, and individual GC sensitivity. We compared GC receptor α (GRα) isoform and nuclear factor kappaB (NF-κB) messenger RNA quantitation and in vivo GC sensitivity between SLE patients during remission and healthy controls. We performed a cross-sectional study of 19 women aged 22-49 years, including 9 SLE patients in clinical remission taking ≤5 mg prednisone and 10 matched controls. We evaluated GC sensitivity using 2 cortisol suppression tests: a very-low-dose intravenous dexamethasone suppression test (VLD-IV-DST) and a low-dose oral dexamethasone suppression test. GRα and NF-κB mRNA were quantified using real-time polymerase chain reaction. Although basal cortisol and adrenocorticotropic hormone levels were similar between the groups, the percentage of cortisol reduction after the VLD-IV-DST was 56% lower in SLE patients than in controls (P = 0.014). GRα and NF-κB gene expression levels were similar between the groups. The low-dose oral dexamethasone test caused intense cortisol suppression in all individuals, limiting the ability of this test to discriminate individual GC sensitivity. A positive correlation was found between the extent of cortisol suppression in vivo (VLD-IV-DST) and the number of days elapsed since the last flare of lupus activity. Despite clinical remission, SLE patients displayed partial GC resistance recognized by the VLD-IV-DST. The mechanism of this resistance is unrelated to altered GRα and NF-κB mRNA expression.
Pregnancy has a profound effect on the thyroid gland and its function. In iodine-replete countries, the gland size has been found to increase by % during pregnancy, and in areas of iodine deficiency, the gland size increases by %-%. The prevalence of hypothyroidism during pregnancy is estimated to be . -. % for overt hypothyroidism and -% for subclinical hypothyroidism. Worldwide, iodine deficiency remains one of the leading causes of both overt and subclinical hypothyroidism. However, there are many other causes of hypothyroidism during pregnancy, including autoimmune thyroiditis, the most common organic pathology [ ]. Other causes include the following thyroid radioiodine ablation to treat hyperthyroidism or thyroid cancer , hypoplasia and/or agenesis of the thyroid gland, surgery for thyroid tumors and, rarely, central hypothyroidism, including lymphocytic hypophysitis or ectopic thyroid and some drugs, such as rifampin and phenytoin, which can alter thyroid metabolism [ ].It has long been recognized that iodine represents an essential element for fetal growth and development [ ]. In fact, congenital hypothyroidism leads to cretinism, which is characterized by irreversible growth restriction and mental retardation. In mountain areas, such as the Himalayas, "lps and "ndes, iodine depletion can be caused by glaciers and erosion [ ], leading to the presence of cretinism in small sections of the population. Nonetheless, a significant proportion of the population is exposed to mild iodine deficiency, which is responsible for the clinical features of defined goiters, impaired cognition and hypothyroidism [ ]. One way to escape the dangerous and hidden deficiency is to incorporate iodine into the daily diets of people all over the world [ ]. Today, as a result of this strategy, there are no countries with endemic iodine deficiencies, and only approximately countries in the world with a public problem of mild to moderate iodine deficiency [ ]. Some meta-analyses have studied the intelligence quotient IQ reduction in children who suffered from iodine deficiency, but, due to confounding © 2013 Stortoni and Tranquilli; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.factors, it has not been well elucidated whether the IQ reduction depends on an intraor extra-uterine iodine deficiency [ ]. However, some studies have stressed that cognitive disorders that are linked to a mild-moderate iodine deficiency are a reversible clinical phenomenon [ -]. These considerations are interesting because recent data have indicated the recurrence of iodine deficiency in developed countries, such as the United States, "ustralia, New Zealand, United Kingdom and, especially, in Europe [ , ].Given that maternal iodine supplementation has a positive impact on the developmental quotient of children living i...
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