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In pediatric patients hypercortisolemia results mostly from the exogenous administration of glucocorticoid hormones. Endogenous hypercortisolemia or Cushing syndrome is rare in children. Signs and symptoms of this syndrome need to be timely recognized and treated as these patients have increased morbidity and mortality. In this article, it is emphasized need for using appropriate diagnostic tests and clear criteria for Cushing syndrome. In case of confirmed diagnosis of Cushing syndrome or Cushing disease, the patients have to be treated and followed-up by experienced multidisciplinary team. Such an approach enables adequate treatment, insures better prognosis and improve cure rates of the patients. [ABSTRACT FROM AUTHOR]

Introduction: Stress is a process that takes place when the body is exposed to any kind of aggression, which in such a way threatens it, that defense using specific adaptation mechanisms is not possible. The adaptive abilities of each individual are limited and different, depending on a number of factors, such as age, sex, health status and numerous psychological and social characteristics. The precondition for an adequate response to stress is the existence of intactness and functional maturity and the competence of the hypothalamic-pituitary-adrenal axis. Objective: The aim of this paper is to investigate the characteristics of the stress response from the earliest age of life. Material and methods: An overview of current knowledge of the adrenal axis and stress response in newborns. Results: Nowdays it is known that the response of the adrenal axis to stress in newborns at birth is qualitatively present, and in the case of a term newborn, it is quantitatively competent, as it is in the later periods of childhood, when the response to stress does not show a significant age related difference. In premature infants this response is weaker. Knowing the specificity of prematurity, it is clear that premature newborns, especially those very low birth weigh, are actually constantly in a certain state of stress initiated in utero. According to the results of numerous studies, it seems that in stress situations some very premature newborns are unable to adapt their secretion of cortisol, which leads them to a state of relative adrenal insufficiency, which is of a transient character - from the second week of life, the secretion of cortisol begins to adapt. However much of vital importance is an adequate response to stress in the state of intense and long-lasting stress, when this response ceases to be purposeful and may have a negative impact on the health of the newborn. Conclusion: Inadequate stress response is a factor that contributes to the development of a pathological condition in a premature newborn. In addition to immediate, significant late consequences of stress are increasingly reported, which imposes the need to prevent stress in these children, as a way to improve the outcome of this most vulnerable population. [ABSTRACT FROM AUTHOR]

Uvod: Hipotalamo-hipofizno-adrenalna (HPA) osovina je biološki sistem ključan za odgovor na stres, a finalni u nizu hormona HPA osovine jeste glukokortikoid kortizol. Kratkoročno povećanje lučenja kortizola ima zaštitnu ulogu, dok je dugoročno povećanje štetno. Određeni procenat depresivnih pacijenata ima povišene vrednosti bazalnog kortizola izvan ćelije (u krvi), i to zbog poremećaja aktivnosti glukokortikoidnog receptora (GR) u ćeliji (jedru ili citoplazmi). Aktuelno istraživanje je imalo za cilj da utvrdi koliko su negativna afektivna stanja povezana sa vanćelijskim, a koliko sa unutarćelijskim promenama HPA signalizacije. Metod: Trideset pet osoba sa dijagnozom akutne depresije (F32/33, MINI 5.0.0 intervju) i 35 kontrola je uključeno u studiju. Upitnik za samoprocenu depresije, anksioznosti i stresa (DASS), zasnovan na dimenzionalnom pristupu mentalnim poremećajima, korišćen je kao mera negativnih afektivnih stanja. Periferni kortizol je određen pomoću hemiluminiscentne metode, a nivoi intraćelijskih proteina (ukupnog nuklearnog GR-a, ukupnog citosolnog GR-a (tGRc), jedarnog GR-a fosforilisanog na serinu 226 (pGR-226) i serinu 211 (pGR-211) i citosolnog FKBP51) putem Western blot-a. Statistička analiza obuhvatila je studenov Ttest, Mann-Whitney test i Pirsonov koeficijent korelacije. Rezultati: Iako su pacijenti imali veće prosečne vrednosti kortizola (469.38±157.48 nmol/l) u odnosu na kontrole (398.29±144.44), razlika nije dostigla statističku značajnost (t=-1.88; p=0.06). Međutim, pacijenti su imali statistički značajno veće vrednosti tGRc, pGR-226, pGR- 211 i FKBP51 u odnosu na kontrole. Korelaciona analiza, vršena na celom uzorku, pokazala je da sa DASS-om najjače koreliraju pGR-226 (r=0.639; p<0.05), FKBP51 (r=0.486, p<0.05) i pGR-211 (r=0.341, p<0.05). Diskusija: Periferni kortizol, kao parametar vanćelijske signalizacije, nije dovoljno senzitivan marker disfunkcije HPA osovine u depresiji. Unutarćelijski parametri koji utiču na aktivnost samog receptora pokazali su snažniju korelaciju sa negativnim afektivnim stanjima. U literaturi postoje podaci koji ukazuju na značaj FKBP51 u depresiji, ali mi naglašavamo da će uz FKBP51 i ispitivanje dinamike fosforilacije GR-a biti važno na putu identifikacije biomarkera afektivnih poremećaja. [ABSTRACT FROM AUTHOR]