Showing posts with label hormone. Show all posts
Showing posts with label hormone. Show all posts

Friday, February 4, 2011

Dr. Ted Friedman will return for his Third Live Voice Interview, February 13, 2011

Theodore C. Friedman, M.D., Ph.D. has opened a private practice, specializing in treating patients with adrenal, pituitary, thyroid and fatigue disorders. Dr. Friedman has privileges at Cedars-Sinai Medical Center and Martin Luther King Medical Center. His practice includes detecting and treating hormone imbalances, including hormone replacement therapy. Dr. Friedman is also an expert in diagnosing and treating pituitary disorders, including Cushings disease and syndrome.

Dr. Friedman's career reflects his ongoing quest to better understand and treat endocrine problems. With both medical and research doctoral degrees, he has conducted studies and cared for patients at some of the country's most prestigious institutions, including the University of Michigan, the National Institutes of Health, Cedars-Sinai Medical Center, and UCLA's Charles Drew University of Medicine and Science.

He's the "Dr House" of endocrinology. He loves complicated cases and is an outstanding diagnostician.

He also has a PhD in pharmacology.
Posted Image The Everything Health Guide to Thyroid Disease: Professional Advice on Getting the Right Diagnosis, Managing Your Symptoms, And Feeling Great (Everything: Health and Fitness) (Paperback)

by Theodore C., M.D., Ph.D. Friedman (Author), Winnie Yu (Author)

If you have a thyroid condition, you are not alone. An estimated 13 million Americans suffer from thyroid disease. The Everything Health Guide to Thyroid Disease, cowritten by acclaimed thyroid specialist, Theodore C. Friedman, is the authoritative handbook you need to help you live with this disease. You'll learn about:

  • How the thyroid functions and dysfunctions
  • Who is at risk for thyroid disease
  • Well-known thyroid disorders-hyper, hypo, and Grave's disease
  • Far-reaching effects (weight loss and gain, anxiety, depression)
  • Treatments and living with the disease

Complete with a glossary, additional resources, and even a section on thyroid disease in children, The Everything Health Guide to Thyroid Disease is the complete guide for everyday healthy living.

Sample chapters (PDF format)


Kate (Fairley) and Dr. Ted Friedman on National Geographic TV, September 2007

Read Dr. Friedman's First Guest Chat, November 11, 2003.
Read Dr. Friedman's Second Guest Chat, March 2, 2004.
Listen to Dr. Friedman First Live Voice Interview, January 29, 2009.
Listen to Dr. Friedman Second Live Voice Interview, March 13, 2009.

Dr Ted Friedman will return for his Third Live Voice Interview, February 13, 2011, 9:00PM eastern. Listen live at http://www.blogtalkradio.com/CushingsHelp

Posted via email from Cushings Podcasts

Thursday, December 30, 2010

Overactive Adrenal Glands

Adrenal glands are small glands located just on top of a person’s kidneys. These glands are just one of the many glands found in the endocrine system. Sometimes, these glands generate excessive amounts of hormones such as androgenic steroids, corticosteroids and aldosterone. They are then referred to as overactive adrenal glands, a condition also called Cushing's syndrome.


Here are some of the most common signs and symptoms of overactive adrenal glands:
1. Weight gain
One of the primary signs of Cushing’s syndrome is weight gain. A common sign of this condition is your face becoming rounder or more moon-shaped. In some cases, there will also be obesity in the upper body, particularly the upper back and the midsection. You may also begin to gain fat around the neck area.


2. Fragility
While you may be generally gaining weight, you will also experience a general thinning in both your arms and legs. Your fragile skin means that you may bruise easily and be more prone to sores and infection. Healing of bites and wounds take longer than usual. Acne breakouts might occur more frequently.


Red or purple stretch marks tend to develop on your buttocks, stomach, breasts, arms and thighs. In response to overactive adrenal glands, you will also probably experience severe fatigue, feeling very weak and tired most of the time. You may also feel muscle and bone weakness.


3. Reproductive system irregularities
Secreting hormones is just one function of the adrenal glands. Cushing’s syndrome can affect the sexual life and reproductive systems of both men and women. There may be a lower sex drive between both genders. Men may feel a drop in libido, as well as a decrease in fertility.  Women, on the other hand, may experience either irregular menstruation periods or may even stop menstruating. Other women may grow excessive amounts of hair on both the legs and face.


4. Psychological signs
Some individuals with overactive adrenal glands display psychological signs and symptoms. Increased irritability, depression and anxiety are common emotions in people with this condition. These emotions may be displayed for no particular reason. This tends to be an effect of a hormonal imbalance that you are probably experiencing.


Treatment for overactive adrenal glands depends on several factors, including the person’s overall health and medical history.


At times, Cushing’s syndrome can be the result of various medical conditions, such as tumors that have grown on the adrenal or pituitary glands. Remember that the symptoms and signs of overactive adrenal glands vary per person, as well as by the extent to which the glands malfunction. Of course, these signs and symptoms may resemble other medical problems and conditions. It would be best to consult with a medical professional immediately.

 

From http://www.testcountry.org/4-signs-of-overactive-adrenal-glands.htm

Friday, March 19, 2010

Magnetic Resonance Imaging and Pituitary Function in Children with Panhypopituitarism

Free Abstract Article (Fulltext) Article (PDF 148 KB)


Original Paper

Magnetic Resonance Imaging and Pituitary Function in Children with Panhypopituitarism
Guimei Li, Peng Shao, Xiaojun Sun, Qian Wang, Lijuan Zhang
Provincial Hospital Affiliated to Shandong University, Shandong, PR China

Address of Corresponding Author

Horm Res Paediatr 2010;73:205-209 (DOI: 10.1159/000284363)


 Key Words

  • Magnetic resonance imaging
  • Insulin-like growth factor-1
  • Multiple pituitary hormone
  • Panhypopituitarism

 Abstract

Background: To explore the relationship between magnetic resonance imaging (MRI) findings and multiple pituitary-target hormones in patients with panhypopituitarism or multiple pituitary hormone deficiency (MPHD).

Methods: 125 patients with MPHD (102 boys, MPHD group) and 90 age-, sex- and Tanner stage-matched normal children (control group) were enrolled. 96 of the patients with MPHD underwent MRI scans of the hypothalamic-pituitary area. The patients were subdivided into five stages according to their MRI findings. The serum concentrations of GH, IGF-1, FT4, TSH, ACTH, cortisol, FSH, LH, prolactin, testosterone and estradiol were measured in patients and in controls.

Results: MRI stage was significantly positively correlated with the number of pituitary hormone deficiencies (r = 0.9, p < 0.001). MRI stage was negatively correlated with peak GH, IGF-1, FT4, cortisol and anterior pituitary height (r = –0.43, –0.47, –0.67, –0.54, and –0.49, respectively, p < 0.01). Diabetes insipidus patients could be stratified according to their MRI stage; diabetes insipidus was found mainly in patients with absence of the posterior pituitary bright spot or small ectopic posterior pituitary bright spot on MRI.

Conclusion: An abnormal MRI finding is evidence of MPHD and, correspondingly, there is a noteworthy correlation between MRI and pituitary function.

Copyright © 2010 S. Karger AG, Basel

From http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=284363&Ausgabe=253980&ProduktNr=224036

Sunday, February 7, 2010

Environmental Issues and Cushing’s

We’ve had quite a bit of discussion on this topic on the Cushing’s Help message boards lately.  A few samples:

We live in a part of Ontario known as "the Chemical Valley". We are surrounded by Dow Chemical, Imperial Oil, Dupont, British Petroleum, Shell Oil and about 12 other chemical plants.

There has been many people complaining about the high rate of cancer in our area and the government was forced to do a health study in our area but as of yet they haven't figured out how to do the testing. My guess is they don't want us to know how sick we really are.

We are part of the Goiter Belt which I think extends to PA. There are very few people here who do not have thyroid problems.

My 2 brothers and 2 sisters are suffering the same as I am and so are all our children! Both my parents died in their 50's from untreated hypothyroid disease. Probably had adrenal/pituitary damage too when I think about their symptoms.

I see hypothyroid people everywhere I look and have since started checking for the hump and cushing signs.

Holy endocrine system Batman, I think we are all suffering at the hands of the Big Oil Companies. My husband works for British Petroleum!!!!

I hate to even think about it. Growing up in Buffalo - erie county new york, which is nestled between lake ontario & lake erie, I don't believe the water is safe to drink. There are several epa areas of concern around lake ontario & lake erie. AOC's (areas of concern) are highly polluted areas. Specificlly erie canal & buffalo river are awful. I found out some years ago that a playground that I frequented as a child was a landfill for hazardous chemicals. Now I have a pituitary tumor, coincidence? Probably not

I live near Green Bay WI, which is part of Lake Michigan. I believe our drinking water comes from the Bay. The water is polluted from the papermills (PCPs). I also did play on a heavily fertilized and treated lawn from a chemical company for at least 5 years when I was little. I had a thyroid nodule removed, hypothyroidism, and I am still in the testing phase to see if I have a pituitary tumor. My father also has hopothyroid, and seems to have kind of a hump. He has had cancer as well.

I remember the nuclear accident in the 80's. It was really scary. I remember them saying something like it was worse than what they reported.

This is one of my future quests, I live in a town on 10,000 people and there are many cases of brain and pituitary tumors, I hear it all the time, I know of at least 3 definite pituitary cushing's cases in my small town. My future goal when I am feeling better is to put my story in the paper, have people call me if they or someone they know has a funtioning pituitary tumor, also brain tumors and brain cancer has some large numbers too. The state sent me a letter I had to fill out when I first found out about my tumor, it was manditory, if I did not fill it out they where going to have my doctor fill it out so I did. So somewhere someone is keeping track of brain tumors in my town. I want to find out the numbers, if it is as bad as I think it is I am going to calll CDC to find out why. I also want to start a support group. But I need to feel better first because this is going to be a big undertaking.

There are many more postings on this topic.

From Wennersten: There’s something in the water

Scientists now tell us there is something in our waters that we least expected.

That “something” is a class of chemicals called endocrine disruptors, and Dr. Vicki Blazer, a fisheries biologist at the United States Geological Survey, thinks the chemicals are responsible for the high concentrations of intersex fish found in the Potomac, and other rivers in the mid-Atlantic.

The chemicals also prove a threat to human health, but a bit of explanation, first.

Our body’s endocrine system is a complex network of glands and hormones that regulate growth, development, and the operation of various organs. The endocrine glands (for example the thyroid, adrenal, pancreas, testes, ovaries and pituitary glands) release hormones that act as chemical messengers and regulate many life functions.

Endocrine disrupters are chemicals that interfere with this system, by either acting like a hormone, or blocking a hormone’s function. They can be natural, but many are man-made such as PCBs, dioxin, DDT and other pesticides, pharmaceuticals and plasticizers. They are found in many products, including plastic bottles, metal food cans, detergents, flame retardants, food, toys, cosmetics and pesticides. They enter the environment and are now commonly found in our streams, rivers, bays and oceans, where scientists are observing problems.

Then Great Lakes Area of Concerns shows a map of problem areas

Forty-three AOCs have been identified: 26 located entirely within the United States; 12 located wholly within Canada; and five that are shared by both countries. Two Canadian AOCs have been delisted and one U.S. AOC has been delisted leaving 30 AOCs remaining on the U.S. side of the border.

RAPs are being developed for each of these AOCs to address impairments to any one of 14 beneficial uses (e.g., restrictions on fish and wildlife consumption, dredging activities, or drinking water consumption) associated with these areas.  USEPA has assigned RAP Liaisons for AOCs.  Sediments have been identified as serious problems in many AOCs. AOC Principles and Guidelines have been finalized for formally delisting these areas as beneficial uses are restored.

What do YOU think?  Are you in one of these areas? Check out this post on the Cushing’s Help message boards  and be heard!

Wednesday, August 26, 2009

Adrenocorticotropic hormone, cortisol values predicted recurrence of Cushing’s disease in children

Morning adrenocorticotropic hormone and cortisol values or an ovine corticotropin-releasing hormone test were better predictors of recurrence of Cushing’s disease in children following transsphenoidal surgery than low urinary free cortisol values, according to new data.

Researchers at the National Institutes of Health set out to identify which of three routine tests work best at identifying patients with Cushing’s disease who are not cured or for the prediction of relapse of the disease.

The study included 72 children aged 6 to 18 years who underwent transsphenoidal surgery. Following surgery, the researchers obtained plasma adrenocorticotropic hormone and serum cortisol, urinary free cortisol and an ovine corticotropin-releasing hormone stimulation test. Children were followed for two to 10 years.

Ninety-four percent of children with Cushing’s disease achieved sustained remission after transsphenoidal surgery. However, two children had persistent disease following surgery and four children appeared cured, but relapsed later — all four children had low or undetectable urinary free cortisol values that were the same as children with cured disease (P>.01).

When compared with children who relapsed, children who remained in remission had significantly lower morning adrenocorticotropic hormone and cortisol levels after transsphenoidal surgery (P<.001).

A subnormal adrenocorticotropic hormone level of <10.8 pg/ml was the best cutoff value for differentiating between remission and relapse, according to the researchers.

Fifty-seven percent of children who had a normal response to ovine corticotropin-releasing hormone experienced recurrence or disease relapse during the early postoperative period; no delayed relapse was observed among children who did not respond to administration following surgery.

Relapse was also associated with a lack of histological confirmation of an adenoma and glucocorticoid replacement for less than six months after surgery.

Batista DL. J Clin Endocrinol Metab.2009;94:2757-2765.

 

From http://www.endocrinetoday.com/view.aspx?rid=43199

Monday, August 17, 2009

Growth hormone replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Helena Filipsson and Gudmundur Johannsson

H Filipsson, Endocrinology, Göteborg, Sweden
G Johannsson, Endocrinology, Medicin, Gothenburg, SE-413 45, Sweden

Correspondence: Gudmundur Johannsson, Email: gudmundur.johannsson@gu.se

Severe growth hormone deficiency (GHD) in adults has been described as a clinical entity. Some of the features associated with GHD could, however, be due to unphysiological and inadequate replacement of other pituitary hormone deficiencies. This may be true for glucocorticoid replacement that lacks a biomarker making dose titration and monitoring difficult.

Moreover, oral oestrogen replacement therapy decreases insulin growth factor 1 (IGF-I) levels compared to transdermal route, which attenuates the responsiveness to GH replacement therapy in women. In addition, in untreated female hypogonadism, oral oestrogen may augment the features associated with GHD in adult women. Important interactions between the hormones used for replacing pituitary hormone deficiency occur. Introducing GH replacement may unmask both an incipient adrenal insufficiency and central hypothyroidism.

Therefore, awareness and proper monitoring of these hormonal interactions are important in order to reach an optimal replacement therapy. This review will focus on the complex hormonal interactions between GH and other pituitary hormones in GHD and in GH replacement.

From http://www.eje.org/cgi/content/abstract/EJE-09-0319v1

Sunday, August 9, 2009

Now I know what it feels like to have a gun held to my own head: Ameera MacIntyre's battle with a brain tumour

Some husbands come home moaning that the boss doesn't appreciate them or that the train to work was delayed again. My husband Donal returns complaining about a crack dealer who pinned him to the floor, drilled a pistol into his temple and threatened to blow his brains out.

And now I know what it feels like to have a gun held to my own head.

I'm only 34, I work out, I don't smoke and I drink only socially. I normally enjoy excellent health. But suddenly, three years ago, I found myself waking up every day with what felt like a bad hangover.

Ameera with husband Donal MacIntyre

Rolling with the punches: Ameera with husband Donal MacIntyre

As each day progressed, the feeling of grogginess and a dull headache would coalesce into a mind-splitting migraine. Sometimes I would be violently sick.

Perhaps most frightening was the effect on my vision. I felt as if there were daggers behind my eyes. My eyesight seemed to be deteriorating rapidly and I was struggling to focus. By the end of each day I was exhausted.

Donal was working flat-out on various TV programmes at the time and I was struggling to look after our three-year-old daughter, Allegra, on my own. I went to see my GP. 'Most likely a hormone imbalance,' he announced airily, after examining me.

'Your periods are irregular and I would suggest that stress is the most likely explanation.' He sent me for blood tests, to reassure me, and he said that if the headaches got any worse I should try paracetamol.

Oh, and he suggested that I take some exercise. Well, we could all do with more of that but in my bones I knew that that wasn't the cause of the problem. Nor, I suspected, was stress.

Sharing my life with someone whose job involves mixing with violent criminals meant I did know a little something about stress. After all, Donal has moved house 50 times in the past decade to avoid the attentions of the criminals he specialises in exposing.

We have moved seven times since we married just three years ago.

I had also put on about 12lb. For someone whose weight had never changed in ten years, metamorphosing from a size six to a size ten in such a short period of time was profoundly worrying.

Living with danger: Ameera and Donal have made efforts to spend more time together, along with daughters Tiger and Allegra, since her diagnosis

Living with danger: Ameera and Donal have made efforts to spend more time together, along with daughters Tiger and Allegra, since her diagnosis

Then, even though it was nearly three-and-a-half years since I had given birth to Allegra, I started to lactate. My breasts just started leaking. It was difficult to go out without a change of bra or top because I could never tell when or where my breasts would discharge milk. It was uncomfortable and embarrassing.

My sister, Fareeda, is a consultant oncologist in Newcastle. Her first thought, when I described my symptoms, was that it could be a pituitary tumour.

Is there anyone who doesn't find the word 'tumour' terrifying? I knew that a tumour on the brain could be fatal. I was frightened for myself and for my family.

I contacted a consultant neurologist who set up an MRI scan without hesitation. Magnetic resonance imaging (MRI) works by taking a series of magnetic images of the brain and building them up into a 3-D picture.

Submitting to the scan is not a particularly enjoyable process for anyone, but is especially unpleasant for those who suffer from claustrophobia, as I do. It felt like being enclosed in a sterile white coffin. It took three attempts before I was able to stay in the machine for the required 20 minutes.

The radiologist entrusted me with the scan films and his report, in a large sealed envelope addressed to the neurologist. I opened it in the hospital waiting room, which I knew I wasn't supposed to do.

I felt the blood draining from my face as I read the words 'pituitary adenoma'. Despite the advance warning from my sister, I was still unprepared. It was one of those moments when a strange stillness descends. I knew nothing would ever be the same again.

I didn't tell Donal immediately because I didn't want to add to his stress levels. But once he knew his reaction was to scan the internet for any information on the condition. I had done the same, but the more I found out, the more the knowledge weighed me down. It didn't help that my father had died recently, leaving me feeling more vulnerable than ever.

Three days after the MRI, the neurologist slotted the scans on to the light box and explained what they showed. Our family's future, it seemed, now depended on a tiny nodule - an 'abnormality' - on my pituitary gland.

The bad news was that, yes, I had a tumour, but the good news was that it was small, treatable and manageable. The prognosis was very positive, although the threat will never go away. The neurologist compared it to having a loaded gun pointed at my head. That gun will always be present but drugs can hold the trigger in check.

Despite the neurologist's sugaring of the pill, I was literally shaking as Donal and I sat in his office. I was petrified. A tumour alert is less a diagnosis than an event - it is the end of one way of living and the beginning of a new lifestyle.

The first thing I did was return to my GP, who prescribed a short course of antidepressants to help me get through the day without being dragged down.

While I was dealing with my health issues, Donal was working for channel Five on a number of projects that required him, as ever, to spend a lot of time away from home. I wanted him around and he wanted to give up work and stay at home but, on the other hand, he had to earn a living and life has to go on.

'Don't imagine this means you can pack in the job and laze around the house watching sport,' I told him. We both knew I was trying to make light of something we were going to have to live with for a long time.

But I wasn't in despair. Donal's great friend and canoeing partner, Alexis Gohar, had lived with a pituitary gland tumour for a decade. His condition was chronic and much more severe than mine but his experience and encouragement gave us a great deal of hope.

Alexis had been a guinea pig for radical treatment at the Endocrine Unit at St George's Hospital in Tooting and although he lost sight in one eye, he remained an excellent canoeist, competing for many years after his diagnosis.

I was sent to see an endocrine specialistat Kingston Hospital in Surrey, just down the road from where Alexis lived.

The specialist told me more about the pituitary gland, a small ovalshaped gland found at the base of the brain, below the optic nerve. It helps control the other glands in the body and releases key hormones that affect growth and other body functions.

Pituitary gland tumours are mostly benign but they can grow and exert damaging pressure on the brain and the optic nerves. That was what had been affecting my vision, and causing the agonising headaches.

The tumour was also interfering with the regulating hormones that the gland produces, which was what was causing me to lactate.

I was prescribed a drug called bromocriptine to stabilise my tumour and to inhibit the production of excess hormones.

Researching this medication on the internet, Donal was fascinated to discover-that some men had used it for what one website delicately termed 'sexual enhancement'.

'Your wife's got a brain tumour and you've got one thing on your mind,' I scolded him.
Bromocriptine was a lifesaver. Within months, my symptoms were reduced. Soon the good days out-numbered the bad.

The deterioration of my eyesight was halted and after eight weeks my vision was back to normal. I returned to being a size six. Furthermore, because the treatment worked I escaped having to undergo radio or chemotherapy.

Finally one evening, I realised I had gone the whole day without a headache. I broke down and wept tears of relief.

At the same time, lactation ceased. And there was a wonderful 'side effect'. The consultant had said that the treatment might help with ovulation and could even help me conceive. And that's exactly what it did. The result is our gorgeous two-year-old girl, Tiger.

When I became pregnant, the consultant suggested I come off the drugs. The after-effect of the initial treatment kept the symptoms at bay but now, after two years without the drugs, some problems have returned.

My headaches are back and my periods have become irregular again. I recently put on some weight, just like before.

This has meant more scans and clinics with the endocrinologist and the neurologist.
Last time, these appointments gave me nightmares. This time I have been feeling much more confident and I am facing my uncertain future with fortitude, or endeavouring to at least.

We had been trying for another child without success and had considered IVF but that was on hold until we got the results of my most recent tests. They reaffirmed the previous condition and I am now back on the same medication and treatment.

Tragically, our friend Alexis was not so fortunate as I have been. He had what is called transsphenoidal surgery for his tumour - usually carried out by making a small incision on the inside of the roof of the nose or by making a small opening under the lip to be able to reach the pituitary gland. The singer Russell Watson underwent the same procedure to have a tumour 'the size of two golf balls' removed.

But Alexis didn't make it. He died last November at the age of just 46. His untimely death really brought home to Donal and me just what we are up against.

As a family we have now recalibrated our priorities. Wherever Donal works around the world, he tries to bring the children --school allowing - and me.

The world of television has never been particularly family friendly but we have decided to make the work fit around us, rather than vice versa.

It was me who decided - very much against Donal's will - that he should do the ITV show Dancing On Ice earlier this year, as I knew it would give him a chance to spend more time with me and the kids.

I don't think I've ever seen a man pushed so far outside his comfort zone, although he quickly grew to love it.

A tumour can change your life, and the lives of those around you, in ways you don't anticipate.

All the time Dancing On Ice was on air I was managing my reacquaintance with my old symptoms. At one stage during the last few weeks of the show, Donal considered dropping out to concentrate on looking after me but I wouldn't let him entertain the idea of quitting. It was a family experience we all shared and enjoyed, from baby Tiger to Allegra. Tiger would even hug the TV screen when Daddy appeared.

Because of my illness, Donal and I have become more spiritual. Donal is not particularly religious but he has always accepted that his Catholic heritage and Christian values are embedded in his DNA. In a way, he views religion as a celestial insurance policy - Pascal's Wager, the philosophers call it, after the French thinker who argued that there was much to gain and nothing to lose from believing in God.

I hesitate to say we have renewed faith, but we have decided to baptise the children into the Church. My family, who are Muslim, understand that we have to do what we feel is right for us. I am determined to be christened at the same time as the children.

Just recently Donal was attacked by thugs in a wine bar in Surrey. I was with him, having earlier in the day undergone another brain scan. I was punched and kicked during the attack and actually ended up with more bruises than my husband. But we're used to living with this kind of threat and now we are learning to cope with a different kind of danger.

My illness has changed us in ways we never expected - the arrival of Tiger, new directions in Donal's own career, a shift in our life philosophy. Surprisingly, the changes are almost all for the better. We know we will get through this.

Centre for hormone production that's the size of a pea

The pea-sized pituitary gland sits in the centre of the brain, just above the back of the nose. It is linked by a stem to the hypothalamus and both are vital in producing essential hormones for the growth and functions of other glands in the body.

The most common problem with the pituitary is when a benign tumour develops.

Graphic

There are nearly 100 different types of brain tumour and about ten per cent of these are in the pituitary gland. More common in older people, they grow slowly and do not spread to other parts of the body.

There are six types of pituitary tumour, from tumours that produce growth hormones (which can cause acromegaly or gigantism) to prolactin-producing tumours (where the hormone stimulates a woman to lactate and disrupts her menstrual cycle).

Symptoms can also include headaches and visual problems caused by the tumour pressing on the optic nerve.

Treatment ranges from surgery to radiation therapy and drug therapy.

Read more: http://www.dailymail.co.uk/health/article-1205178/Now-I-know-feels-like-gun-held-head-Ameera-MacIntyres-battle-brain-tumour.html#ixzz0Nh9gw5SP

Thursday, July 23, 2009

Today in Health History

Master Of The Endocrines

The pituitary, which is located at the base of the brain, is considered the master gland because it controls the other endocrine glands and produces a number of hormones that stimulate growth, metabolic or sexual functions. Much is now known about this tiny organ, but three doctors at Yale University School of Medicine broke new ground more than 60 years ago by being the first to isolate a pituitary hormone in pure form.

On this date in 1937, Drs. Abraham White, Hubert Catchpole and Cyril Long announced their findings in the journal Science. Researchers have since isolated nine hormones in three sections of the pituitary.

From http://www.intelihealth.com/IH/ihtIH/WSIHW000/333/7087/1339844.html

Saturday, July 18, 2009

Addison's Disease

Medical Codes


ICD-9-CM:

255.4 - Disorders of Adrenal Glands, Addisons Disease (Corticoadrenal Insufficiency)

255.5 - Disorders of Adrenal Glands, Other Adrenal Hypofunction; Adrenal Medullary Insufficiency

279.4 - Autoimmune Disease, Not Elsewhere Classified; Autoimmune Disease NOS

 

Definition

Addison's disease (adrenal insufficiency) occurs when the outer layer of the adrenal gland, the cortex, is damaged, causing it to produce insufficient amounts of certain corticosteroid hormones that are essential for life. The three types of corticosteroids are androgens and estrogens, which affect sexual development and reproduction; glucocorticoid hormones such as cortisol, which maintain glucose regulation, suppress immune responses, and provide stress responses; and mineralocorticoid hormones such as aldosterone, which regulate sodium and potassium balance.


Adrenal insufficiency can occur for a variety of reasons. In 70% of cases of primary adrenal insufficiency, the body's immune system attacks and slowly destroys the adrenal glands (autoimmune disease). Tuberculosis, once the most common cause of Addison's disease, is responsible for only about 20% of cases of primary adrenal insufficiency. Since the appearance of acquired immunodeficiency syndrome (AIDS), tuberculosis is once again on the rise and a corresponding increase in Addison's disease caused by tuberculosis is expected. Less common causes of primary adrenal insufficiency include chronic infections, particularly fungal infections and viral infections (cytomegalovirus or CMV) associated with AIDS; amyloidosis; hemorrhage of the adrenal glands; and surgical removal of the adrenal glands. Waterhouse-Friderichsen syndrome is primary adrenal insufficiency that occurs due to adrenal gland hemorrhage during meningococcal infection.

 
In secondary adrenal insufficiency, the adrenal glands are healthy but the body fails to stimulate them to release hormones. This occurs when the pituitary gland, which is located at the base of the brain, fails to secrete adrenocorticotrophic hormone (ACTH), which normally stimulates the adrenal gland to release cortisol. Causes of secondary adrenal insufficiency include long-term use of steroids such as prednisone or surgical removal of pituitary tumors, either cancerous or non-cancerous. Less common causes are loss of blood flow to the pituitary gland, surgical removal of a portion of the pituitary gland, or surgical removal of the area of the brain called the hypothalamus.

 

Risk: Addison's disease tends to run in families. Individuals who take steroids over a long period of time and then develop a severe infection, injury, or undergo a surgical procedure are at increased risk of developing Addison's disease. It is slightly more common among women than men. It can appear at any age but is more often diagnosed in individuals between the ages of 30 and 50 (Odeke). Other conditions that may be associated with adrenal insufficiency include diabetes mellitus, hypoparathyroidism, hypopituitarism, pernicious anemia, testicular dysfunction, Graves' disease, chronic thyroiditis, and myasthenia gravis.

 

Incidence and Prevalence: Addison's syndrome is a rare disorder, with a prevalence of 40 to 60 cases per 1 million people in the US and Europe (Odeke).

 

Diagnosis

History: In most cases of Addison's disease, symptoms appear gradually. Individuals often complain of progressively increasing weakness and fatigue, loss of appetite (anorexia), and unintentional weight loss. Many report dizziness or light-headedness especially when rising from a seated position. Abdominal pain, decreased tolerance to cold, hair loss (alopecia) particularly in women, and cravings for salty foods may also be reported. Nausea, vomiting, and chronic diarrhea occur in about 50% of cases. Women may report that their menstrual cycles have become irregular (dysmenorrhea) or stopped altogether (amenorrhea). Moodiness, irritability, or depression may be evident. In advanced cases, the individual may experience what is known as an Addisonian crisis characterized by abdominal pain; severe vomiting and diarrhea; hypotension; agitation, confusion and loss of consciousness.

 

Physical exam: Findings usually include low blood pressure (hypotension) that may worsen when the individual stands after sitting or lying down (orthostatic hypotension). The individual may be dehydrated. Skin changes are also commonly noted and include freckling and darkening of the skin. The skin darkening may resemble a deep tan but will be present even on parts of the body not exposed to the sun. The skin darkening may also be more visible on scars; pressure points, such as elbows, knees, and toes; lips; mucus membranes; and in skin folds.

 

Tests: The most specific test for Addison's disease is the ACTH stimulation test. In this test, blood is drawn to measure baseline levels of the hormones cortisol and aldosterone. Synthetic ACTH (Cortrosyn, cosyntropin, or Synacthen) is administered intravenously or by intramuscular injection. Blood is drawn again at 30 minutes to measure changes in the cortisol and aldosterone levels. In order to rule out the diagnosis of Addison's disease, there must be an increase in the baseline cortisol value by 7 mcg/dL or more, and the cortisol level must rise to 20 mcg/dL or more in 30 minutes (Odeke). In a healthy individual, the cortisol levels are higher after the injection of synthetic ACTH; in individuals with Addison's disease, there is little or no change in cortisol levels.


If an abnormal result is obtained, a variation of this test in which ACTH is given over a 2 to 3 day period may be conducted. Blood and/or urine samples are collected before and during this 2 to 3 day period. In this longer ACTH stimulation test, the cause of adrenal insufficiency can be determined. Primary adrenal insufficiency results in little or no cortisol production for the entire 72 hour period; secondary adrenal insufficiency, on the other hand, will show an adequate response by the second or third day. Elevated morning ACTH levels confirm a primary adrenal cause.


If the ACTH stimulation test is inconclusive, other tests may be conducted either to help confirm the diagnosis or help rule out other conditions. An insulin-induced hypoglycemia test evaluates the functioning of the pituitary gland and the hypothalamus. In this test, blood sugar (glucose) and cortisol levels are measured and then fast-acting insulin is given. The normal response is for glucose to fall and cortisol to rise, indicating a normal pituitary gland and hypothalamus.


Other blood tests that may prove helpful include a complete metabolic panel (CMP), a complete blood count (CBC) and a thyroid-stimulating hormone level (TSH). Individuals with Addison's disease generally have low sodium and cortisol levels, but high potassium, calcium, blood urea nitrogen (BUN), and creatinine levels. If the individual has not eaten prior to the blood test, there may be low blood sugar (hypoglycemia) and high ACTH levels.


When an autoimmune disease is the cause of adrenal dysfunction, adrenal antibodies may be present in the blood. An abdominal or chest x-ray may help reveal calcium deposits in the adrenal glands—a sign of tuberculosis infection. An abdominal CT may be performed to determine if the adrenal glands are smaller or larger than normal. Small adrenal glands may be a sign of autoimmune adrenal disease and larger than normal adrenal glands may be an indication of hemorrhage or infiltrative disease. Biopsies of the adrenal glands can rule out cancer.

 

Treatment

In the rare instances of Addisonian crisis, potentially life-threatening low blood pressure (hypotension), low blood sugar (hypoglycemia), and high levels of potassium (hyperkalemia) may occur. Individuals experiencing Addisonian crisis require immediate hospitalization. Treatment will include immediate intravenous (IV) or intramuscular (IM) injections of steroids along with saltwater (saline) fluid replacements and sugar (glucose). Oral steroid medications may also be given.


Most cases of Addison's disease, however, do not require inpatient treatment. The goal of therapy is to replace the hormones that the body is not producing. Oral steroid medications are usually a combination of glucocorticoids and mineralocorticoids and are taken for the remainder of the individual's life. The individual is counseled to avoid dehydration by drinking plenty of fluids. An identification and medical instruction bracelet is often advised, and individuals are urged to carry injectable steroid medication for emergency use if medical care is not available.


Individuals with Addison's disease need to recognize the consequences of not closely following their medical regimen. Any stress such as illness, fever, hot and humid weather, profuse sweating, and even emotional stress can precipitate a sudden worsening of the condition and must be met with an increase in replacement hormones. Most individuals with Addison's disease are taught to give themselves an emergency injection of hydrocortisone in times of stress.
If an underlying disease, such as tuberculosis, is responsible, treatment of the underlying disease is important for recovery or resolution of symptoms.

 

Prognosis

With careful management, an individual with Addison's disease can live a full, relatively active life. However, illness, stress, and even general anesthesia for surgery can bring on an adrenal crisis necessitating special care and adjustments in replacement hormone dosages.


Untreated, Addison's disease is a progressive condition that can gradually result in severe abdominal pain, extremely low blood pressure, and kidney failure. Addisonian crisis must be treated immediately or coma and death can occur.

 

Complications

Illness, injury, or any type of stress can result in an Addisonian crisis, a potentially life-threatening condition that is managed with an increase of the hydrocortisone dose.


Other possible complications include extremely high fever (hyperpyrexia), psychotic reactions, accidental overdose of steroid medications and, rarely, a temporary paralysis due to low levels of potassium.


Additional complications related to the individual's underlying disease might also occur and will vary depending upon the particulars of that disease.

 

Return to Work (Restrictions / Accommodations)

In most cases, work accommodations or restrictions are not necessary for individuals with Addison's disease. Taxing physical labor, such as working in hot humid environments or work that carries a great deal of stress, is unsuitable for an individual with Addison's disease. The particulars of the necessary accommodations vary significantly depending on the individual, severity of symptoms, individual's response to treatment, and job requirements.

 

Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

 

Regarding diagnosis:

  • Was diagnosis of Addison's disease confirmed through an ACTH stimulation test?
  • Was the cause of the adrenocortical insufficiency, such as an autoimmune disorder, infection, tumor, or hemorrhage in the adrenal glands identified?
  • Were underlying causes also addressed?

Regarding treatment:

  • Is individual on oral cortisol with or without fludrocortisone?
  • Does current method of treatment appear to be effective?
  • Has individual continued to experience any symptoms of adrenal crisis, such as vomiting, diarrhea, fever, confusion, low blood pressure, or dehydration?
  • If current treatment is not effective, is individual a candidate for surgery or radiation therapy?
  • Is individual on and able to maintain a diet high in fluids, carbohydrates, and protein?
  • Would individual benefit from instruction in stress management techniques?
  • Does individual wear an identification/medical instruction bracelet?
  • Does individual carry injectable steroid medication for use in an emergency if medical care is not available?

Regarding prognosis:

  • Were underlying causes, such as autoimmune disorders, infection, tumor, or tuberculosis resolved or brought under control?
  • Does individual realize that Addison's disease is a lifelong condition that requires careful management, including avoiding stress and infection?
  • Is individual able to adhere to oral therapy and dietary recommendations?
  • Does individual attend regular follow-up visits with physician?
  • Has individual experienced any complications related to the Addison's disease?
  • Does individual have an underlying condition that may impact recovery?

 

Cited References

Odeke, Slyvester, and Steven B. Nagelberg. "Addison Disease." eMedicine. Eds. Daniel Einhorn, et al. 25 Nov. 2003. Medscape. 14 Sep. 2004 http://emedicine.com/med/topic42.htm.

 

From http://www.mdguidelines.com/addisons-disease

Monday, July 6, 2009

Accidental death verdict on 40-year-old mum

Published Date: 03 July 2009 By Garth ApThomas
A CORONER has recorded a verdict of accidental death at the inquest held into the death of a 40-year-old Wrexham mother.


Marie Richardson, of Bryn Hafod, died in March at the Maelor Hospital.


A post mortem examination found that she had died as a result of a haemorrhage involving the pituitary gland, which plays a key role in the body's hormonal system.


The inquest was told a post mortem examination had been conducted by Dr Anthony Burdge.


Giving evidence, Dr Burdge said that it was probable the bleeding had been caused as a result of thinning of the blood and not a trauma such as a fall.


Contributory factors in Mrs Richardson's death had been Cushing's disease, a very rare condition involving a hormone disorder, and bronchial pneumonia.


The court was told by Mrs Richardson's husband, Andrew, that his wife had started to experience ill health, including swollen legs and constant backache.
Her mobility was badly affected. Mrs Richardson was admitted to the Maelor Hospital.


Consultant physician Dr Stephen Stanaway said that as part of the treatment, Mrs Richardson received a small dose of a blood-thinning drug to help ensure she did not fall victim to clots.


She had been given a scan involving the pituitary and there was no evidence of a tumour.


It transpired the post-mortem had found Mrs Richardson did have a tumour, which had experienced bleeding.


Dr Stanaway said that Mrs Richardson had not liked the scanning process and moved at one point – it was important for patients to remain still.


Acting coroner John Gittins asked if Mrs Richardson would have been administered with blood thinner if the tumour had been known about at the time of treatment.


Dr Stanaway said it would have to be a balanced decision but he felt that she would have been.


Legal representatives for Mrs Richardson's family and the NHS Trust were present at the inquest. Dr Stanaway was asked a series of questions about whether anything further could have been done about Mrs Richardson's treatment while at the Maelor.


He said that with hindsight the only potential other avenue may have been if she had been given steroids.


But Dr Stanaway stressed he doubted this would have been successful, emphasising Mrs Richardson was a very poorly woman and it would be impossible to say that administering steroids would have saved her.


Recording his verdict of accidental death Mr Gittins emphasised: "This is not an indication of responsibility, blame or judgement.


"That is not my jurisdiction.


My very sincere condolences go to the family."

On the Message Boards

From http://www.eveningleader.co.uk/news/Accidental-death-verdict-on-40yearold.5426530.jp

Tuesday, June 30, 2009

Crunching the (Sometimes Surprising) Numbers on Hormone-Related Disease

BALTIMORE, June 29 (AScribe Newswire) -- A dogged review of the medical literature has produced what is believed to be the nation's first comprehensive estimate of the extent of dozens of endocrine disorders in the United States.

Unsurprisingly, say the Johns Hopkins researchers who gathered the data, obesity and related conditions including metabolic syndrome and diabetes were the most common disorders and had the highest estimated rate of new cases per year -- what experts call "prevalence" and "incidence" respectively. However, the review also shed light on the significant impact that several other conditions have at the population level, such as osteoporosis. Surprisingly, the researchers say, their review showed that this bone-thinning condition appears to affect men and women nearly equally, with about seven percent prevalence for both sexes.

Health professionals have long assumed that osteoporosis occurs primarily in women after menopause, as a consequence of estrogen hormone loss.

"Endocrinologists confidently talk about how common or uncommon certain hormone-related conditions are, but we were lacking the hard numbers. Now we have compiled real data based on U.S.-based clinical studies," says Sherita Hill Golden, M.D., M.H.S., associate professor in the division of endocrinology at the Johns Hopkins University School of Medicine.

Golden says many endocrine disorders appear to be on the rise in the U.S. and around the world, but scientists have never amassed hard numbers in a unified source of prevalence or risk as they have for such medical conditions cancer and heart disease.

"Without such information, it's hard to get public health decision makers to focus on all endocrine disorders, develop preventive strategies, and allocate the right level of funding for research and treatment," Golden says.

To address the lack of information, Golden and her colleagues searched medical article databases for prevalence and incidence data for 54 endocrine disorders with both clinical and public health significance, identifying 2268 studies. They concentrated on the most recent (since 1998) 70 articles that had the most rigorous data on the general population, as opposed to studies involving small groups of patients from specialty clinics that see higher numbers of endocrine disorders.

Reporting In the June Journal of Clinical Endocrinology and Metabolism, Golden and her colleagues found, as expected, that obesity-related diseases such as diabetes were the most common endocrine disorders in the U.S., with 25 to 28 percent of the U.S. population being clinically obese and 10 percent having type-2 diabetes. The review suggests that more than a third of the population has metabolic syndrome, a collection of obesity-related conditions including blood fat disorders, insulin resistance and the presence of inflammatory proteins that increase the risk for heart disease and stroke.

The review also found that type-1 diabetes and tumors of the pituitary gland are among the least common endocrine disorders, affecting less than one percent of the population. Golden notes that there is a general lack of multi-ethnic, multi-racial studies, research needed to determine variable risk in specific populations.

The study was funded by a grant from The Endocrine Society.

Other researchers who participated in this study include Karen A. Robinson, M.Sc., Ian Saldanha, M.B.B.S., M.P.H., Blaire Anton, M.L.I.S., M.S., and Paul W. Ladenson, M.D.

       For more information, go to:

http://www.hopkinsmedicine.org/endocrinology/

http://www.hopkinsmedicine.org/endocrinology/faculty/faculty/golden.html

       - - - -

       CONTACT: Christen Brownlee, Johns Hopkins Medicine Media Relations and Public Affairs, 410-955-7832, cbrownlee@jhmi.edu

 

From http://newswire.ascribe.org/cgi-bin/behold.pl?ascribeid=20090629.105519&time=11%2007%20PDT&year=2009&public=0

Wednesday, June 10, 2009

Pituitary Patient Education Day

YOU’RE INVITED!!

What: Seattle Pituitary Center Patient Education Day

Who: Patients, families and friends and anyone else who want to learn more about pituitary disorders

When: Friday, July 10, 2009

Time: 9:00 – 4:30 p.m. (registration opens at 8:15 a.m.)

Where: Swedish Cherry Hill Campus, Education and Conference Center

Cost: No charge; Continental breakfast and lunch will be provided.

Hear from patients who will share their personal experiences living with a pituitary disorder, and chat with other patients and families in breakout discussion sessions.

Agenda topics include:

· Overview of pituitary disorders

· Overview of acromegaly

· Psychological aspects of living with a pituitary disease

· Pituitary hormone replacement

· Cushing’s syndrome

· Surgical and radiation treatment options for pituitary tumors

RSVP: Register online or call 206-386-2502.

Friday, May 1, 2009

With Endoscopic Surgery, Patient Has Large Pituitary Tumor Removed and Goes Home Two Days Later

From http://www.newswise.com/articles/view/551498/

Newswise — When Adam Mamelak, M.D., a neurosurgeon at Cedars-Sinai Medical Center, removed a large tumor from the pituitary gland of Riverside resident Sharon Moreland, he took a surgical route that many surgeons follow but used a tool that most do not.

Mamelak inserted an endoscope – consisting of a camera lens at the tip of a long tube – through a nostril, entering the skull base through the sphenoid sinus, which is located deep within the skull and below the pituitary gland. A decade ago, neurosurgeons removing pituitary tumors typically used a large, bulky surgical microscope and entered through an incision under the lip, which caused significant damage to nasal structures. Today, most surgeons use the nasal approach but continue to use the surgical microscope.

Mamelak, however, prefers the endoscopic approach because it is more maneuverable, reduces the patient’s pain considerably, leaves no visible scars, and lowers some of the overall surgical risk. The nostril is a very narrow corridor through which to work, he explains, and the endoscope fits within it, providing a panoramic view of the surgical site. In contrast, the microscope is larger and fixed, so the surgeon is working from a greater distance, through a very narrow cone, and trying to introduce instruments through the same corridor.

Over the past several years, Moreland experienced a variety of physical changes – including tinnitus, joint pain, dry mouth and skin, enlarged hands and feet, and vision problems – but she always found a reasonable explanation for each new symptom. The ringing in her ears, for example, she attributed to the 15 years she and her family photographed off-road car and motorcycle races. She thought her hand and knuckle pain were caused by carpal tunnel syndrome and arthritis. But her deteriorating peripheral vision led to the discovery of the true diagnosis.

In January, Moreland, 68, who has four adult children and four grandchildren, scheduled an appointment with her ophthalmologist. The doctor ruled out glaucoma and cataracts but recommended that Moreland see her primary care physician, who ordered an MRI. The image showed a large tumor wrapping around her pituitary gland.

“When I found out it was a tumor, you could have knocked me over with a feather. I was floored,” she said. “My kids looked at me and said, ‘Mom, are you OK?’ I think I was shocked more than anything. I couldn’t show an emotion. I just stared.”

After conducting a full medical workup, Moreland’s physician referred her to Mamelak, a neurosurgeon in the Department of Neurosurgery at Cedars-Sinai, who removed the benign tumor Feb. 24. She was released from the hospital – tumor-free and with only minor nasal discharge – two days later.

“Because there is so little tissue destruction with the endoscopic approach, we don’t need to pack the nose after the operation to minimize bleeding and drainage. Patients are much more comfortable and very happy with the results,” said Mamelak, who performs about 75 pituitary operations a year.

“The endoscope is especially advantageous in removing a very large, soft tumor like this where it is difficult but important to distinguish between the gland and the tumor,” he added. “The endoscope’s view stays wide, no matter how deep you go. In her case, the tumor extended far up and to the side, but the endoscope can be moved and tilted, which made it possible for us to remove the entire tumor.”

Moreland’s gradually worsening and wide-ranging symptoms had been the result of hormonal changes caused by the tumor’s effect on the pituitary gland and the pituitary’s control over the thyroid gland. Although removal of the tumor may be the only necessary treatment, lab tests will determine if a thyroid supplement may be added.

Within a week of the surgery, Moreland, who has been involved in philanthropic volunteer work for 36 years, noticed that her symptoms were fading and she did not need the anti-inflammatory pain medications she had grown to depend on. “My joint aching has cut down to probably 65 percent, and my mouth has cleared up, my saliva is back, my skin is wonderful and I can see out of my eyes – on the side and everything,” she said.

Cushing's disease has many signs

From http://www.southcoasttoday.com/apps/pbcs.dll/article?AID=/20090426/LIFE/904260303

By PAUL G. DONOHUE, M.D.

DEAR DR. DONOHUE: My daughter is 36. Two years ago, she fractured her hip. While recovering from that, she fractured a bone in her foot. Ever since, she has had a lot of swelling in her body, especially her face and stomach. She has a fatty hump on the back of her neck. Doctors have checked her for many things. The tests for Cushing's disease have come back positive. She takes a water pill. Her blood pressure is a little high. Please explain this.

— B.S.

Thin, fragile skin, a rise in blood pressure, a moon face, an increase in abdominal fat, muscle weakness and facial hair in women are some of the signs of Cushing's disease. A mound of fat below the back of the neck is another sign, and it's called a buffalo hump. Osteoporosis — fragile bones that break easily — is another Cushing's consequence. The swelling of your daughter's face and stomach might actually be fat, and, as I mentioned, it's a typical Cushing's sign. All of these signs and symptoms result from an overproduction of cortisone, something many people think is found only in medicine form. Our adrenal glands make it, and it's necessary for life. Too much of it, however, causes all sorts of mischief.

If her doctors say she has Cushing's disease, their next job is finding its source. It could be her pituitary gland, a small gland at the base of the brain. It makes the hormone ACTH, which stimulates the adrenal glands' production of cortisone. Tumors of the pituitary gland release too much ACTH, with the result being too much cortisone. Or, in fewer instances, the adrenal glands themselves might, on their own, be the overproducers of cortisone, with the same resulting signs and symptoms.

Surgical removal of the tumor — pituitary or adrenal — is the cure in most instances. Your daughter must undergo more tests to locate the source of the trouble: the pituitary or the adrenal. Scans and ultrasound pictures can pinpoint the correct site.

Sunday, April 19, 2009

Ask Dr. Gott: Persistent patient gets treatment

From http://www.montereyherald.com/health/ci_12177391?nclick_check=1

Peter Gott

Updated: 04/19/2009 01:42:53 AM PDT

Dear Dr. Gott: You have responded to several letters about the pituitary and adrenal glands, and I thought I should write to share my story. I am 75 years old, but this started when I was in my late teens. I started to have health problems but never gave them much thought.

Every doctor I saw gave me a diet sheet, treated my blood pressure and told me to lose weight. They didn't seem to care about the other symptoms and didn't understand I couldn't lose weight. Later, another doctor ordered tests. He told me that my adrenal glands were putting out too much hormone. The level should have been 17, but mine was 37. He gave me the diagnosis of Cushing's disease.

I became a research patient at The University of California Hospital in San Francisco. I had my adrenal glands removed in 1964. I was told I didn't have Cushing's anymore because the glands were gone, but now I had Addison's disease.

I now take two pills to replace hormones my adrenal glands produced. I have to be careful to limit my stress, but I am happy to be alive. I was told that if I went untreated, I would have only lived five years at most.

My primary reason for writing is to share my story and tell everyone not to be afraid to be a guinea pig. It was hard, but it was worth it. I have my life back.

Dear Reader: Cushing's disease, now known as Cushing's syndrome, is a condition in which the body is exposed to too much cortisol. This can occur because of abnormalities of the adrenal or pituitary glands, tumors that release the hormone adrenocorticotropin, and more.

Symptoms include high blood pressure, upper-body obesity, severe muscle weakness and fatigue, easy bruising, backaches and high blood sugar. In women, it may be accompanied by excess facial and body-hair growth and irregular and absent menstrual periods.

Treatment depends on the cause. In the late 1950s and early 1960s, not much was known about the disorder. You were lucky to have been diagnosed. Your surgery to remove the adrenal glands saved your life but made you rely on medication to do what your body is unable to do. Today, removing adrenal glands is a last resort used for persistent cases or those that are the result of tumors.

Addison's disease is the result of too little cortisol. Like its antithesis, it can be caused by abnormalities of the adrenal or pituitary glands, certain disorders, chronic infection, cancer and removal of the adrenal glands.

Symptoms include chronic and worsening fatigue, weight loss, muscle weakness, loss of appetite, nausea, vomiting, low blood pressure and more.

Treatment is replacing or substituting the hormones that are not being produced.

In both conditions, if there is an underlying cause, it must be treated. Both require monitoring by an endocrinologist.

To provide related information, I am sending you a copy of my Health Report "Medical Specialists." Other readers who would like a copy should send a self-addressed stamped envelope and a check or money order for $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Write to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, N.Y. 10016.

Friday, March 27, 2009

Rare Care for a Rare Disease

Ellen is a member of the Cushing's Help Message Boards

From http://www.mywheaton.org/locations/elmbrook_memorial/EM_HG_surg_Ptstory1.asp

Cushing’s Disease is a rare condition where a non-cancerous tumor in the pituitary gland causes the production of excess cortisol, a stress hormone. This can lead to diabetes, obesity, high blood pressure, heart disease, suppression of the immune system, and much more.

“It basically ages you prematurely, affecting every system in the body” says Ellen, who, until recently, was suffering with Cushing’s Disease.

A resident of Colorado, Ellen went to her doctor complaining of many new symptoms, including fatigue and headaches. He suspected she might have Cushing’s Disease. He referred her to an endocrinologist in California for further testing.

The endocrinologist determined that Ellen’s condition would require surgery, removal of the tumor in her pituitary gland. Following the surgery, however, Ellen’s Cushing’s Disease persisted. Two options remained: another pituitary surgery, or a more definitive treatment, removal of her adrenal glands, the glands that sit atop each kidney and, in Ellen’s case, were producing the excess cortisol that was making her sick.

Ellen chose to remove her adrenals. Her endocrinologist immediately recommended the best doctor he knew of for the procedure: Dr. Manfred Chiang at Wheaton Franciscan Healthcare – Elmbrook Memorial.

Somewhat surprised that she was being referred to a hospital she’d never heard of in a small Wisconsin town, Ellen did some research. She discovered an online support group at www.cushings-help.com . She also learned that her endocrinologist was not steering her wrong.

“Dr. Chiang has a following,” explains Ellen. “Folks from all around the country had gone to him for their surgeries.” She decided to do the same.

When she met Dr. Chiang, she knew she had made the right choice. “He was wonderful; incredibly skilled and intelligent,” says Ellen. “He actively listened to me, followed through, and was exceptionally kind and compassionate.”

Her surgery went very well. Dr. Chiang performed the procedure laproscopically meaning it was minimally invasive. “There are very few hospitals in the country who regularly perform this unusual surgery,” says Ellen. “But fortunately, Dr. Chiang is considered one of the best bilateral adrenalectomy specialists in the nation.”

“I was up and about that same day,” says Ellen. “And I was finally free of Cushing’s!”

An excellent staff at Elmbrook Memorial enhanced Ellen’s experience.

“The entire experience was the most amazing I’ve ever had at a hospital,” Ellen says. “It was immaculately clean. I loved the warm colors, the layout, and the view. And the nurses were excellent; very intelligent, very willing and able to help. If I had an issue they figured out how to fix it and they fixed it. Every one of them introduced themselves to me, wrote their name on the board when they came into my room, and listened to me. That can be such a rare thing in a busy hospital. They really worked to make my hospital experience a good one.”

Ellen says at www.cushings-help.com she’s not the only one who feels this way. “I’ve never heard a negative word about Elmbrook Memorial.”

Friday, March 20, 2009

MASEP gamma knife radiosurgery for secretory pituitary adenomas: experience in 347 consecutive cases

From http://7thspace.com/headlines/305020/masep_gamma_knife_radiosurgery_for_secretory_pituitary_adenomas_experience_in_347_consecutive_cases.html

Secretory pituitary adenomas are very common brain tumors. Historically, the treatment armamentarium for secretory pituitary adenomas included neurosurgery, medical management, and fractionated radiotherapy.


In recent years, MASEP gamma knife radiosurgery (MASEP GKRS) has emerged as an important treatment modality in the management of secretory pituitary adenomas. The goal of this research is to define accurately the efficacy, safety, complications, and role of MASEP GKRS for treatment of secretory pituitary adenomas.


Methods: Between 1997 and 2007 a total of 347 patients with secretory pituitary adenomas treated with MASEP GKRS and with at least 60 months of follow-up data were identified.


In 47 of these patients some form of prior treatment such as transsphenoidal resection, or craniotomy and resection had been conducted. The others were deemed ineligible for microsurgery because of body health or private choice, and MASEP GKRS served as the primary treatment modality.


Endocrinological, ophthalmological, and neuroradiological responses were evaluated.


Results: MASEP GKRS was tolerated well in these patients under the follow-up period ranged from 60 to 90 months; acute radioreaction was rare and 17 patients had transient headaches with no clinical significance.


Late radioreaction was noted in 1 patient and consisted of consistent headache. Of the 68 patients with adrenocorticotropic hormone-secreting(ACTH) adenomas, 89.7% showed tumor volume decrease or remain unchanged and 27.9% experienced normalization of hormone level.


Of the 176 patients with prolactinomas, 23.3% had normalization of hormone level and 90.3% showed tumor volume decrease or remain unchanged. Of the 103 patients with growth hormone-secreting(GH) adenomas, 95.1% experienced tumor volume decrease or remain unchanged and 36.9% showed normalization of hormone level.


Conclusions: MASEP GKRS is safe and effective in treating secretory pituitary adenomas.


None of the patients in our study experienced injury to the optic apparatus or had other neuropathies related with gamma knife. MASEP GKRS may serve as a primary treatment method in some or as a salvage treatment in the others.


However, treatment must be tailored to meet the patient's symptoms, tumor location, tumor morphometry, and overall health. Longer follow-up is required for a more complete assessment of late radioreaction and treatment efficacy.


Author: Heng Wan, Ohye Chihiro and Shu BIN Yuan
Credits/Source: Journal of Experimental &Clinical Cancer Research 2009, 28:36

Friday, March 6, 2009

Pituitary Blog Posts March 6, 2009

With it being the way it is? | FAQ Sleep Apnea
By admin
Growth hormone, like a number of hormones, is produced by the pituitary gland. It is one in a series of hormones that control tissue growth .. Levels of growth hormone and related hormones also are affected by sleep, exercise, stress, ...
FAQ Sleep Apnea - http://www.faqsleepapnea.com/

 

Scientific Basis Of Fertility Awareness - MeDiCaLGeeK
By trimurtulu
The pituitary gland at the base of the brain secretes FSH (follicle-stimulating hormone) which, stimulates the ripening of follicles in the ovary. The ripening follicles produce increasing amounts of oestrogen. ...
MeDiCaLGeeK - http://www.medicalgeek.com/

 

Includes a video: Pituitary Tumors: A Neurosurgeon’s Perspective
By admin
There are non-surgical procedures (such as medication) that can shrink pituitary adenomas. These medicines are are often prescribed when a patient is exhibiting visual disturbances. If your MD or specialist is not helping or advising ...
Cure Tumor & Cancer - http://andridaulay.com/rs/

 

transsphenoidal pituitary adenoma - VKER Health
By vker.net
growth hormone deficiency, deficiency (also called GHD) of the pituitary gland disease (pygmy Pitu - itary dwarfism). The pituitary gland secretion of growth hormone, lobe adrenal cortical hormone, thyroid hormones and gonadal hormone ...
VKER Health - http://www.vker.net/

 

UNDERSTANDING BLOODWORK…A LAYMAN’S GUIDE | Muscle Sport Mag
By Leigh Penman
This is a glycoprotein secreted by the anterior pituitary gland and is responsible for triggering the Leydig cells to produce Testosterone. By measuring LH levels it can be determined whether a low testosterone reading is caused by the ...
Muscle Sport Mag - http://www.musclesportmag.com/

Tuesday, February 17, 2009

Stress for Success: Stress hormone may increase appetite, weight gain

From http://www.news-press.com/article/20090217/HEALTH/902170314/1013/LIFESTYLES

Jacquelyn Ferguson
Special to news-press.com

When stressed, even when simply thinking stressful (angry/fearful) thoughts, you trigger your body's physiological fight/flight reaction. The most potentially damaging of the 17 hormones that are part of this stress response is cortisol, a glucocorticoid.

One of cortisol's roles during stress is to provide your body with energy. So, stress might lead you to eat more due to an increased appetite. The fuel your muscles need during the fight/flight response is sugar, so you crave carbohydrates when stressed.

"During the first couple of days following a stressful event, cortisol is giving you a cue to eat high-carbohydrate foods," says endocrinologist Ricardo Dr. Perfetti, M.D., Ph.D., of Cedars Sinai Medical Center in Los Angeles. "... you (can) quickly learn a behavioral response that you feel almost destined to repeat anytime you feel stressed."

This was adaptive for our ancestors because they actually physically fought or fled from, say, attacking beasts. But we modern humans have to apply the brakes to our stress energy to keep from punching someone out or running away from them, sending stress hormones coursing through our bodies.

When you're stressed over anything your body doesn't know that you're not physically fighting or fleeing, so it still responds with the hormonal signal to replenish nutritional stores, making you feel hungry. The resultant extra eating may cause weight gain.

So, cortisol has become the newest excuse for packing on the pounds. However, research disagrees on whether excessive cortisol actually causes weight gain and fat deposits in your abdominal area.

Some research shows that abdominal fat causes chemical changes that can lower metabolism and increase cravings for sweets, possibly leading to additional weight gain. However, Mayo Clinic dietitian Katherine Zeratsky doesn't believe that the amount of cortisol produced by a healthy stressed person is enough to cause weight gain.

She says that stress causes you to accumulate excess fat only when your body produces large amounts of cortisol due to side effects of medication or an underlying medical condition like Cushing's syndrome.

Others, like Dr. Caroline Cederquist, board certified family and bariatric physician the majority of whose patients have abdominal weight issues, believes our high stress lifestyles create cortisol-induced symptoms, including abdominal weight gain. This can also lead to higher cholesterol and blood sugar levels and elevated blood pressure, all factors for heart disease.

The research on the role of cortisol in obesity remains speculative. Blaming weight gain on stress ignores the possibility that you've developed a habit of eating in response to stress, a learned habit encouraged by brain chemistry that can be unlearned. Future research should settle this question. In the meantime, lower your stress, eat healthfully, exercise and avoid giving into the temptation of carbohydrates when stressed.

Here's the bottom line to weight loss. It always has been, which suggests it always will be - until a miracle weight loss treatment is invented. There are two ways to lose weight: eat fewer (and better) calories and burn more of those calories by moving your body more. Period.

Saturday, January 24, 2009

New York Times Article on Pituitary Tumors

at http://health.nytimes.com/health/guides/disease/pituitary-tumor/overview.html?scp=1&sq=pituitary%20tumours&st=cse

A pituitary tumor is an abnormal growth in the pituitary gland, the part of the brain that regulates the body's balance of hormones.

The pituitary gland is a pea-sized endocrine gland located at the base of the brain. The pituitary regulates and controls the release of hormones from other endocrine glands, which in turn regulate many body processes. These hormones include:

  • Adrenocorticotropic hormone (ACTH)
  • Growth hormone (GH)
  • Prolactin
  • Thyroid-stimulating hormone (TSH)

About 75% of pituitary tumors release hormones. When a tumor produces too much of one or more hormones, the following conditions may occur:

As the tumor grows, hormone-secreting cells of the pituitary may be damaged, causing hypopituitarism.

The causes of pituitary tumors are unknown, although some are a part of a hereditary disorder called multiple endocrine neoplasia I (MEN I).

There are other types of tumors that can be found in the same area of the head as a pituitary tumor:

  • Craniopharyngiomas
  • Cysts
  • Germinomas
  • Tumors that have spread from cancer in another part of the body (metastatic tumors)

About 15% of tumors in the skull are pituitary tumors. Most pituitary tumors are located in the anterior pituitary lobe and are usually noncancerous (benign).

Pituitary tumors develop in about 20% of people, although many of the tumors do not cause symptoms and the condition is never diagnosed during the person's lifetime...

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This article also includes causes; a comprehensive symptoms list; treatments and much more. Read it at http://health.nytimes.com/health/guides/disease/pituitary-tumor/overview.html?scp=1&sq=pituitary%20tumours&st=cse

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MaryONote: It's so nice to see articles like this getting out into the mainstream press. For so many years pituitary tumors weren't talked about. As a matter of fact, often when I've told people about my surgery they didn't even know where the pituitary gland was located. Many would indicate the abdominal area and think it was there.

Hopefully, with more news items in papers and on TV the general public will be more aware of the pituitary (and adrenal) and their various locations.

Someday...I wish...that people will be aware of Cushing's like they are of thyroid issues or diabetes. not that I wish that more people had Cushing's, of course, but I'd just like to see more awareness, knowledge and understanding.

Someday, I hope that people will be tested more routinely for these "orphan diseases", doctors won't automatically decide that the patient is causing his/her own symptoms and get to the diagnostic and treatment phases more quickly.

A statistic I've seen many times over the years, that 20% of all people have a pituitary tumor was mentioned in this article:

Pituitary tumors develop in about 20% of people, although many of the tumors do not cause symptoms and the condition is never diagnosed during the person's lifetime.

The last part is especially scary: "the condition is never diagnosed during the person's lifetime."

How about getting people diagnosed - and cured - while they're still alive?