1921
Volume 84, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

This study presents a cross-sectional analysis of the hormonal alterations of patients with visceral leishmaniasis. The diagnosis was established by the bone marrow aspiration and polymerase chain reaction test. Primary adrenal insufficiency was observed in 45.8% of patients; low aldosterone/renin plasma ratio in 69.4%; low daily urinary aldosterone excretion in 61.1%; and low transtubular potassium gradient in 68.0%. All patients had normal plasma antidiuretic hormone (ADH) concentrations, hyponatremia, and high urinary osmolality. Plasma parathyroid hormone was low in 63%; hypomagnesemia was present in 46.4%, and increased Mg in 100%. Primary thyroid insufficiency was observed in 24.6%, and secondary thyroid insufficiency in 14.1%. Normal follicle-stimulating hormone plasma levels were present in 81.4%; high luteinizing hormone and low testosterone plasma levels in 58.2% of men. There are evidences of hypothalamus-pituitary-adrenal axis abnormalities, inappropriate aldosterone and ADH secretions, and presence of hypoparathyroidism, magnesium depletion, thyroid and testicular insufficiencies.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.2011.09-0171
2011-05-05
2019-02-16
Loading full text...

Full text loading...

/deliver/fulltext/14761645/84/5/668.html?itemId=/content/journals/10.4269/ajtmh.2011.09-0171&mimeType=html&fmt=ahah

References

  1. Badaró R, Duarte MI, Veronesi RF, , 2007. Leishmaniose visceral (Calazar). , ed. Trata-do de Infectologia. Third edition. São Paulo, SP: Atheneum, 15611590. [Google Scholar]
  2. Lima Verde FA, Santos GM, Lima Verde FA, Daher EF, Sabóia Neto A, Lima Verde EM, , 2008. Distúrbios ácido-base na leishmaniose visceral. J Bras Neurol 30: 172179. [Google Scholar]
  3. Meleney HE, , 1925. The histopathology of kala-azar in the hamster, monkey and man. Am J Pathol 1: 147168. [Google Scholar]
  4. Bogliolo L, , 1941. On the pathology of viseral leishmaniasis (Leishmania donovani). Hospital 20: 591610. [Google Scholar]
  5. Aguilera G, , 1994. Regulation of pituitary ACTH secretion during chronic stress. Front Neuroendocrinol 15: 321350.[Crossref] [Google Scholar]
  6. Wartofsky L, Burman KD, , 1982. Alterations in thyroid function in patients with systemic illness: the euthyroid sick syndrome. Endocr Rev 3: 164217.[Crossref] [Google Scholar]
  7. Helmreich DL, Parfitt DB, Lu XY, Akil H, Watson SJ, , 2005. Relation between the hypothalamic-pituitary-thyroid (HPT) axis and the hypotalamic-pituitary-adrenal (HPA) axis during repeated stress. Neuroendocrinology 81: 183192.[Crossref] [Google Scholar]
  8. Gaillard RC, , 2003. Interactions between the immune and neuroendocrine systems: clinical implications. J Soc Biol 197: 8995. [Google Scholar]
  9. Orth DN, Kovacs WJ, Wilson JD, Foster DW, Kronenberg HM, Larsen PR, , 1998. The adrenal cortex. , eds. Williams Textbook of Endocrinology. Ninth edition. Philadelphia, PA: W.B. Saunders, 517664. [Google Scholar]
  10. Stern N, Beck FW, Sowers JR, Tuck M, Hsueh WA, Zipser RD, , 1982. Plasma corticosteroids in hiperreninemic hypoaldosteronism: evidence for diffuse impairment of the zona glomerulosa. J Clin Endocrinol Metab 57: 217220.[Crossref] [Google Scholar]
  11. Zipser RD, Davenport MW, Martin KL, Tuck ML, Warner NE, Swinney RR, Davis CL, Horton R, , 1981. Hiporreninemic hipoaldosteronism in the critically ill: a new entity. J Clin Endocrinol Metab 53: 867873.[Crossref] [Google Scholar]
  12. Zettel RM, West ML, Josse RG, Richardson RM, Marsden PA, Halperin ML, , 1997. Renal potassium handling during states of low aldosterone bioactivity: a method to differentiate renal and non renal causes. Am J Nephrol 7: 360366.[Crossref] [Google Scholar]
  13. Aguirela G, Kiss A, Sunar-Akbasak B, , 1995. Hyperreninemic hypoaldosteronismus after chronic stress in the rat. J Clin Invest 96: 15121519.[Crossref] [Google Scholar]
  14. Rolih CA, Ober KP, , 1995. The endocrine response to critical illness. Med Clin North Am 79: 211224.[Crossref] [Google Scholar]
  15. Lima Verde FA, Lima Verde FAA, Veronese FJV, Sabóia Neto A, Lima Verde EM, , 2010. Hyponatremia in visceral leishmaniasis. Rev Inst Med Trop São Paulo 52: 253258.[Crossref] [Google Scholar]
  16. Halperin ML, Goldstein MB, , 1999. Hyponatremia. Fluid, Electrolyte, and Acid-Base Physio-logy. Third edition. Philadelphia, PA: W.B. Saunders, 283328. [Google Scholar]
  17. Lima Verde FA, Lima Verde FA, Lima Verde I, Silva Junior GB, Daher EF, Lima Verde EM, , 2007. Evaluation of renal function in visceral leishmaniasis (kala-azar): a prospective study on 50 patients from Brazil. J Nephrol 20: 430436. [Google Scholar]
  18. Knight R, Woodruff AW, Pettitt LE, , 1967. The mechanism of anaemia in kala-azar a study of 2 patients. Trans R Soc Trop Med Hyg 61: 701705.[Crossref] [Google Scholar]
  19. Pippard MJ, Moir D, Weatherall DJ, Lenicker HM, , 1986. Mechanism of anemia in resistant visceral leishmaniasis. Ann Trop Med Parasitol 80: 317323.[Crossref] [Google Scholar]
  20. Himathonkan T, Dluhy RG, Williams GH, , 1975. Potassium-aldosteron-renin interrelatioships. J Clin Endocrinol 41: 153159.[Crossref] [Google Scholar]
  21. Williams GH, Braley LM, , 1977. Effects of dietary sodium and potassium dietary intake and acute stimulation on aldosterone output by isolated human adrenal cels. J Clin Endocrinol Metab 45: 5564.[Crossref] [Google Scholar]
  22. Rude RK, Oldham SB, Sharp CF, Singer FR, , 1978. Parathyroid hormone secretion in magnesium deficiency. J Clin Endocrinol Metab 47: 800806.[Crossref] [Google Scholar]
  23. Rude RK, Oldham SB, Singer FR, , 1976. Functional hypoparathyroidism and parathyroid hormone end-organ resistence in human magnesium deficiency. Clin Endocrinol (Oxf) 5: 209224.[Crossref] [Google Scholar]
  24. Lima Verde FA, Lima Verde FA, Daher EF, Santos GM, Sabóia Neto A, Lima Verde EM, , 2009. Renal tubular dysfunction in human visceral leishmaniasis (kala-azar). Clin Nephrol 71: 492500.[Crossref] [Google Scholar]
  25. Duarte MI, Silva MR, Goto H, , 1983. Interstitial nephritis in human kala-azar. Trans R Soc Trop Med Hyg 77: 531537.[Crossref] [Google Scholar]
  26. Rizos E, Liamis G, Elisaf M, , 2002. Multiple metabolic abnormalities in a patient with the syndrome of inappropriate antidiuresis. Nephron 91: 339340.[Crossref] [Google Scholar]
  27. Burnatowska MA, Harris CA, Sutton RA, Dirks JH, , 1977. Effects of PTH and cAMP on renal handling of calcium, magnesium and phosphate in the hamster. Am J Physiol 233: 514518. [Google Scholar]
  28. Sutton RA, Domrongkitchaiporn S, , 1993. Abnormal renal magnesium handling. Miner Electrolyte Metab 12: 232240. [Google Scholar]
  29. Walton RJ, Bijvoet OL, , 1975. Nomogram for derivation of renal threshold phosphate concentration. Lancet 16: 309310.[Crossref] [Google Scholar]
  30. Krapf R, Jaeger P, Hulter HN, , 1992. Chronic respiratory alkalosis induces renal PTH-resistence, hyperphosphatemia and hypocalcemia in humans. Kidney Int 42: 727734.[Crossref] [Google Scholar]
  31. Reiner NE, Malemud CJ, , 1985. Arachidonic acid metabolism by murine pertitoneal macrophages infected with Leishmania donovani: in vitro evidence for parasite-induced alterations in cyclooxygenase and lipoxygenase pathways. J Immunol 134: 556563. [Google Scholar]
  32. Reiner NE, Schultz LA, Malemud CJ, , 1988. Eicosanoid matabolism by Leishmania donovani-infected macrophages: mouse stein responses in prostanoid syntesis. Am J Trop Med Hyg 38: 5964. [Google Scholar]
  33. Henrich WL, Anderson RJ, Berns AS, McDonald KM, Paulsen PJ, Berl T, Schrier RW, , 1978. The role of renal nerves and prostaglandins in control of renal hemodynamics and plasma renin activity during hypotensive hemorrage in the dog. J Clin Invest 61: 744750.[Crossref] [Google Scholar]
  34. Roman RJ, Skelton M, Lechene C, , 1984. Prostaglandin-vasopressin interactions on the renal handling of calcium, and magnesium. Am Soc Pharm & Exp Therap 230: 295301. [Google Scholar]
  35. Faber J, Kirkegaard C, Rasmussen B, Westh H, Busch-Sorensen M, Iensen IW, , 1987. Pituitary-thyroid axis in critical illness. J Clin Endocrinol Metab 65: 315.[Crossref] [Google Scholar]
  36. Smith SR, Chhetri MK, Johanson AJ, Radfar N, Migeon CJ, , 1975. The pituitary-gonadal axis in men with calorie-protein malnutrition. J Clin Endocrinol Metab 41: 6069.[Crossref] [Google Scholar]
  37. Poll T, Zijlstra EE, Mevissen M, , 1995. Interleukin 6 during active visceral leishmaniasis and after treatment. Clin Immunol Immunopathol 77: 111114.[Crossref] [Google Scholar]
  38. Ansari NA, Saluja S, Salotra P, , 2006. Elevated levels of interferon-gamma, interleukin-10, and interleukin-6 during active disease in Indian kala-azar. Clin Immunol 116: 339345.[Crossref] [Google Scholar]
  39. Gionis D, Ilias I, Moustaki M, Mantzos E, Papasdatos I, Koutras DA, Mastorakos G, , 2003. Hipothalamic-pituitary-adrenal axis and interleukin-6 activity in children with head trauma and syndrome of inappropriate secretion of antidiuretic hormone. J Pediatr Endocrinol Metab 16: 4954.[Crossref] [Google Scholar]
  40. Sweep F, Rijnkels C, Hermus A, , 1991. Activation of the hypothalamus-pituitary-adrenal axis by cytokines. Acta Endocrinol (Copenh) 1: 8491. [Google Scholar]
  41. Jones TH, Kennedy RL, , 1993. Cytoquines and hypothalamic-pituitary function. Cytokine 5: 531538.[Crossref] [Google Scholar]
  42. Hermus AR, Sweep CG, , 1990. Cytokines and the hypothalamic-pituitary-adrenal axis. J Steroid Biochem Mol Biol 37: 867871.[Crossref] [Google Scholar]
  43. Mastorakos G, Weber JS, Magiakou MA, Gunn H, Chrousos GP, , 1994. Hypothalamic-pituitary-adrenal axis activation and stimulation of systemic vasopressin secretion by recombinant interleukin-6 in humans: potential implications for the syndrome of inappropriate vasopressin secretion. J Clin Endocrinol Metab 79: 934939. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2011.09-0171
Loading
/content/journals/10.4269/ajtmh.2011.09-0171
Loading

Data & Media loading...

  • Received : 01 Apr 2009
  • Accepted : 12 Feb 2011

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error