Enzyme linked to obesity

Researchers find that increased levels of an enzyme in fat cells lead to dangerous levels of abdominal obesity.

Previous studies have shown that the stress hormone cortisol can lead to an accumulation of fat round the abdomen. For instance, people with Cushing’s disease – where there’s excess cortisol in the blood – have too much abdominal fat. It’s bad for health to have fat in this area – it’s linked to diabetes and heart disease. That’s why it’s healthier to be a ‘pear shape’ rather than an ‘apple shape’. The distribution of fat in your body really does matter.

Researchers in Scotland and the US have now focussed upon an enzyme that produces cortisol to see what effect it has on abdominal fat. Working on mice genetically-modified to produce the enzyme – and therefore cortisol – in fat cells, they find that even a small increase in levels produces dramatic effects. The mice, compared with normal animals, gained fat in the abdominal area even on a low fat diet. They developed diabetes, high blood pressure, and also tended to eat more. It opens up the possibility of further studies on human obesity, and also perhaps could lead to therapies that block this enzyme and so reduce fat accumulation.

From http://www.tele-management.ca/2013/09/enzyme-linked-to-obesity/

Researchers Find the Cause of Cushing’s Disease

A team of researchers may have zeroed in on the cause of Cushing’s disease, a condition that leads to diabetes, obesity and the risk of premature death.

More women than men get the disease, which begins usually between 20 and 50 with mostly benign tumors in the pituitary gland. It’s known that that condition results in excess production of adrenocorticotrophic hormone (ACTH). But until now, scientists haven’t been sure what drives the production of ACTH.

Now, UCLA researchers and their colleagues have zeroed in on the culprit: excessive production of testicular orphan nuclear receptor (TR4). By reducing the TR4 in lab mice, they were able to reverse tumor growth and excess ACTH production.

The findings, published in the journal Proceedings of the National Academy of Sciences, could point the way to targeted treatment of Cushing’s.

From http://www.thirdage.com/medical-care/researchers-find-the-cause-of-cushing-s-disease

Cushing’s Syndrome, Prostate Cancer and Adrenocortical Carcinoma

Orphagen has identified and characterized small molecule antagonists to steroidogenic factor-1 (SF-1). SF-1 binds to and regulates DNA promoter elements in the major transporters and enzymes required for adrenal steroid synthesis. It is also required for development of the adrenal gland. SF-1 antagonists inhibit cortisol secretion in adrenal cells and have potential application in two orphan indications, Cushing’s syndrome and adrenocortical carcinoma. In addition, SF-1 appears to have an important role in the progression of advanced prostate cancer.

 

  Cushing’s syndrome: An estimated 20,000 people in the US have Cushing’s, with more than 3,000 new cases diagnosed each year. The incidence is similar in Europe. Cushing’s syndrome disproportionately affects females, who make up about 75% of the diagnosed cases. Symptoms of Cushing’s syndrome can include obesity, diabetes, psychiatric disorders, osteoporosis and immune suppression. Cushing’s syndrome is caused by elevated secretion of cortisol from the adrenal gland, in association with pituitary, adrenal or other cancers. Orphagen has identified small molecule antagonists to SF-1 that have the potential to suppress cortisol levels in all Cushing’s patients without serious side effects.

  Adrenocortical carcinoma (ACC): ACC is a rare malignancy with an extremely poor prognosis (5-year overall survival: 37-47%). Complete surgical resection offers hope for long-term survival but surgery is not an option in up to two-thirds of patients because metastasis has usually occurred by the time of diagnosis. SF-1 is recognized as a potential mechanism-based therapeutic target for control of ACC and an SF-1 antagonist could be used in the treatment of ACC.

  Pediatric ACC: Pediatric ACC is a very rare but aggressive cancer with a long-term survival rate of about 50%. Approximately 60% of children with adrenocortical tumors are diagnosed before the age of four. The SF-1 gene is amplified and SF-1 protein is overexpressed in the vast majority of childhood adrenocortical tumors strongly implicating SF-1 in pediatric adrenocortical tumorigenesis.

  Castration resistant prostate cancer (CRPC): CRPC is the most common cancer in males. Surgery is not an option if the cancer has spread beyond the prostate gland, at which point patients typically receive hormonal therapy, essentially chemical castration. This course of therapy usually fails within two years, resulting in castration resistant prostate cancer (CRPC). Most patients eventually succumb to CRPC, which is the second leading cause of cancer deaths in men. SF-1 antagonists may: (1) block the adrenal androgens that circumvent chemical castration, and are a primary cause of CRPC; and (2) inhibit synthesis of androgens within the prostate tumor itself, where SF-1 may control induction of enzymes for de novo androgen synthesis in treatment-resistant cancers. From http://www.orphagen.com/research_cushings.html

Cushing's Syndrome after Hemodialysis for 21 Years

Koki Mise, Yoshifumi Ubara, Keiichi Sumida, Rikako Hiramatsu, Eiko Hasegawa, Masayuki Yamanouchi, Noriko Hayami, Tatsuya Suwabe, Junichi Hoshino, Naoki Sawa, Masaji Hashimoto, Takeshi Fujii, Hironobu Sasano and Kenmei Takaichi

- Author Affiliations

Nephrology Center (K.M., Y.U., K.S., R.H., E.H., M.Y., N.H., T.S., J.H., N.S., K.T.), Surgical Gastroenterology (M.H.), Pathology (T.F.), and Okinaka Memorial Institute for Medical Research (Y.U., K.T.), Toranomon Hospital, 1058470 Tokyo, Japan; and Department of Pathology (H.S.), Tohoku University Graduate School of Medicine, 9800872 Sendai, Japan

Address all correspondence and requests for reprints to: Koki Mise, M.D., Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Kajigaya, Takatu-ku, Kawasaki-shi, Kanagawa-ken, 213-0015, Japan. E-mail: kokimise@yahoo.co.jp.

Abstract

Context: Hyperkalemia and weight loss are critical clinical problems for hemodialysis patients. There have been no documented reports of adrenal Cushing's syndrome with central obesity and hypokalemia in a hemodialysis patient.

Objective: The aim of the study was to report a patient with Cushing's syndrome after chronic hemodialysis, review the published literature, and discuss the significance of hypokalemia and obesity in anuric hemodialysis patients from the perspective of cortisol metabolism.

Patient: A 61-yr-old woman who had been on hemodialysis for 21 yr presented with persistent hypokalemia and central obesity. In 2002, her dry weight was 48.1 kg, but thereafter she gained weight to 60 kg.

Results: Adrenal Cushing's syndrome was diagnosed from endocrinological findings such as increased cortisol secretion without a circadian rhythm and suppression of plasma ACTH. Spironolactone was administered (25 to 50 mg/d), and her serum potassium became normal. Then, left adrenalectomy was performed by laparoscopic surgery. The resected specimen contained a well-circumscribed adrenal adenoma expressing P450c17. After surgery, hypokalemia improved gradually without medication, and her weight gain stopped.

Conclusions: This is the first documented case of adrenal Cushing's syndrome in a patient on long-term hemodialysis, although several authors have reported a relation between hypokalemia and primary hyperaldosteronism in hemodialysis patients.

From The Journal of Clinical Endocrinology and Metabolism

Body composition and cardiovascular risk markers after remission of Cushing's disease: a prospective study using whole-body MRII

Geer EB, Shen W, Strohmayer E, Post KD, Freda PU.

J Clin Endocrinol Metab. 2012 May; 97(5):1702-11

John Newell-Price and Miguel Debono, University of Sheffield, UK. F1000 Diabetes & Endocrinology

26 Jun 2012 | Confirmation, Good for Teaching

Excess endogenous glucocorticoids cause central obesity with an increased visceral to total fat ratio and this is associated with the metabolic syndrome and insulin resistance, increasing the cardiovascular risk. This is a prospective study in 14 subjects where whole-body magnetic resonance imaging (MRI) has been used for the first...

Read this article at http://f1000.com/717297977

A New Link in the Stress Response Could Mean Better Treatment Soon

Hoping to pave the way for improved treatment options, researchers have found that they can significantly reduce our response to stress.

 

A team at Tufts University appears to have found an important step in the body's stress reaction, and blocking this step from occurring can significantly reduce the response. The finding may pave the way for improved treatments for depression and anxiety.

The stress cascade is governed by the brain's hypothalamus, which communicates with the pituitary and adrenal glands, which in turn secrete stress hormones like cortisol. Disruptions in this pathway are also connected with problems like postpartum depression, obesity, Cushing's syndrome (hypercortisolism), premenstrual syndrome (PMS), epilepsy, and osteoporosis, according to the study's press release.

Using mice as their subjects, the researchers set out to fill in some of the blanks in the cascade of events that leads to the secretion of the stress hormone coriticosterone (the mouse equivalent to our cortisol). They used brain samples from mice, and tracked the activity of the brain cells that release corticotrophin-releasing hormone (CRH), which ultimately stimulates the secretion of stress hormones.

They discovered that specific "neurosteroids" are needed to bind to receptors on the CRH neurons to activate them, serving as an important early step in the stress response. The team reasoned that disrupting the synthesis of the neurosteroids should significantly reduce the stress response by stopping it almost before it begins.

This is just what they found. When they blocked the neurosteroids' synthesis in live mice, their coriticosterone levels were reduced after stressful situations compared to normal mice. Additionally, if neurosteroid synthesis was halted, the mice did not show anxiety-like behaviors after they had been stressed.

One of the authors, Jamie Maguire, said that the data "suggest that these receptors may be novel targets for control of the stress-control pathway. Our next work will focus on modulating these receptors to treat disorders associated with stress, including epilepsy and depression-like behaviors."

The study is published in The Journal of Neuroscience.

From http://www.theatlantic.com/health/archive/2012/01/a-new-link-in-the-stress-response-could-mean-better-treatment-soon/250570/

Red alert: Hypertension on the prowl

The family of Mr. Adulphus Opara of Umunokwu in Okwuato, Aboh Mbaise Local Government Area of Imo State was shocked to its nerves as the man slumped from the chair on which he was sitting and cuddling his little daughter who was just less than five months. Scampering and running up and down, all efforts by family members to revive their breadwinner were too little and too late as he died that sunny Saturday afternoon. It was later revealed by doctors at a private hospital that Adolphus died of hypertension attack.

The case of Adolphus is just one out of the numerous complaints of the havocs wreaked by untreated or unchecked hypertension. Medical experts say it has sent so many victims to their untimely grave. 

Dr. Francis Duru, a physician and senior lecturer in Human Anatomy, College of Medicine, University of Lagos Teaching Hospital (LUTH), Idi Araba, described hypertension as a silent killer and the major cause of most sudden deaths in Nigeria. He said high blood pressure is when one’s BP is consistently above 140/90 mmHg. 

According to him, “Normal blood pressure is when your blood pressure is measured at 120/80 mmHg most of the time. If your blood pressure is consistently above 140/90, then the person has hypertension or is hypertensive. Untreated hypertension can lead to many health complications and the worst of all is sudden death.”

MedicinePlus, a medical publication, defines hypertension or high blood pressure as a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump blood around the body. Blood pressure involves two measurements, systolic and diastolic. Normal blood pressure is 120/80 mm/Hg. 

The first figure is the systolic blood pressure, the pressure there is in the arteries when your heart is contracting. The second, or lower figure, is the diastolic blood pressure, which is the pressure in your arteries between heartbeats. High blood pressure is anything above 140/90 mm/Hg. Hypertension is the opposite of hypotension. Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorised as “primary hypertension,” which means high blood pressure with no obvious medical cause. 

The remaining 5–10% of cases (secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system. MedicinePlus added: “Persistent hypertension is one of the risk factors for stroke, myocardial infarction, heart failure and arterial aneurysm, and is a leading cause of chronic kidney failure. Moderate elevation of arterial blood pressure leads to shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment may prove necessary in patients for whom lifestyle changes prove ineffective or insufficient.” 

The American Heart Association, in one of its recent reports, made it known that the World Health Organisation (WHO) attributes hypertension, or high blood pressure, as the leading cause of cardiovascular mortality. The World Hypertension League (WHL), an umbrella organisation of 85 national hypertension societies and leagues, recognised that more than 50% of the hypertensive population worldwide are unaware of their condition. To address this problem, the WHL initiated a global awareness campaign on hypertension in 2005 and dedicated May 17 of each year as World Hypertension Day (WHD). Over the past three years, more national societies have been engaging in WHD and have been innovative in their activities to get the message to the public. In 2007, there was record participation from 47 member countries of the WHL. During the week of WHD, all these countries – in partnership with their local governments, professional societies, nongovernmental organisations and private industries – promoted hypertension awareness among the public through several media and public rallies. 

Causes and risk factors

Although Duru noted that there were several causes of hypertension, he still insisted that there were instances when it had no direct link or cause. He said: “Medically, we have causes, incidences and risk factors that are associated with hypertension. I am talking about factors that can cause or lead to hypertension. In this case we have issues like the level of water or salt in a person’s body; ability or inability of some organs like the kidneys or blood vessels to function at optimum levels; life history, that is, does hypertension run in your family? lifestyle, that is, the type of food you eat; lack of exercises and always being in a noisy place or being in a state of anxiety all the time. Let me also quickly add that excessive smoking and over-indulgence in alcohol can lead to hypertension.” 

He added: ‘“You can easily become hypertensive when you reach the stage of adult age because one’s blood vessels are stiffer as one reaches old age. This leads to HBP. I can also tell you that high blood pressure increases your chances of having a stroke, heart attack, heart failure, kidney disease, and early death. I must also state it here that there are some conditions of health one will find oneself and one will surely expect to be hypertensive. For instance, some pregnant women are usually hypertensive especially from the sixth month until they put to birth. Diabetic patients are sometimes hypertensive although there is no causal relationship between hypertension and diabetes.

People who are obsessed are at risk of suffering from hypertension just as chronic kidney diseases and poor conditions or disorders of the adrenal glands can as well lead to hypertension.” The LUTH medical expert revealed that wrong or too much application of some drugs could also lead to hypertension. “Wrong application or continuous administration of some medications such as birth control pills, diet control pills, cold medications, etc are other ways by which hypertension can hit at a person”, he warned. Meanwhile, Duru noted that there were some instances when hypertension had no cause or trace and it is described as essential hypertension. 

Symptoms 

Most medical experts agree that hypertension, in most cases, has no external symptoms. To this effect, Duru said: “You can now see why we call hypertension a silent killer. It is a silent killer because it gives no sign, no symptom and no warning before it strikes. I must comment here that most Nigerians are suffering from hypertension without knowing it. This is why we also recommend that people should go for BP check regularly to confirm their status. Based on these facts, so many Nigerians develop sicknesses like heart diseases, kidney failures and other complications without any prior knowledge that all their problems started from untreated or unchecked hypertension. 

It is also important to note that a hypertensive patient can live his normal life if he abides by medical advice and that means taking his drugs.” ADAM Medical Encyclopedia listed certain conditions as symptoms of hypertension. According to its report, “If you have a severe headache, nausea or vomiting, bad headache, confusion, changes in your vision, or nosebleeds you may have a severe and dangerous form of high blood pressure called malignant hypertension.” The publication recommended that there should be several checks before it could be ascertained that one has hypertension. It noted that: “Your health care provider will check your blood pressure several times before diagnosing you with high blood pressure. It is normal for your blood pressure to be different depending on the time of day. Blood pressure readings taken at home may be a better measure of your current blood pressure than those taken at your doctor’s office.”

Among the tests to be taken to confirm whether or not one has hypertension, according to Duru, are physical examinations to look for bad conditions of the heart or diseases severely affecting it, poor state or damage of the eyes, as well as other bad physical changes in your body. In this case, tests that enable doctors to handle the situation well include: cholesterol level; level of heart disease like echocardiogram or electrocardiogram; level of metabolic panel/ urinalysis or ultrasound of the kidney and this is when the case has become a chronic one.

Types

A widely posted medical material stated: “A blood pressure is usually classified based on the systolic and diastolic blood pressures. Systolic blood pressure is the blood pressure in vessels during a heartbeat. Diastolic blood pressure is the pressure between heartbeats. A systolic or the diastolic blood pressure measurement higher than the accepted normal values for the age of the individual is classified as pre hypertension or hypertension. Hypertension has several sub-classifications, including hypertension stage I, hypertension stage II, and isolated systolic hypertension. Isolated systolic hypertension refers to elevated systolic pressure with normal diastolic pressure and is common in the elderly. 

These classifications are made after averaging a patient’s resting blood pressure readings taken on two or more office visits. Individuals older than 50 years are classified as having hypertension if their blood pressure is consistently at least 140 mmHg systolic or 90 mmHg diastolic. Hypertension is also classified as resistant if medications do not reduce blood pressure to normal levels.” 

Accelerated hypertension – this is associated with headache, drowsiness, confusion, vision disorders, nausea, and vomiting. These symptoms are collectively called hypertensive encephalopathy. Hypertensive encephalopathy is caused by severe small blood vessel congestion and brain swelling, which is reversible if blood pressure is lowered. 

Secondary hypertension– some additional signs and symptoms suggest that the hypertension is caused by disorders in hormone regulation. Hypertension combined with obesity distributed on the trunk of the body, accumulated fat on the back of the neck (“buffalo hump”), wide purple marks on the abdomen (abdominal striae), or the recent onset of diabetes suggests that an individual has a hormone disorder known as Cushing’s syndrome. Hypertension caused by other hormone disorders such as hyperthyroidism, hypothyroidism, or growth hormone excess will be accompanied by additional symptoms specific to these disorders. For example, hyperthyroidism can cause weight loss, tremors, heart rate abnormalities, reddening of the palms, and increased sweating.

In pregnancy–Hypertension in pregnant women is one symptom of pre-eclampsia. Pre-eclampsia can progress to a life-threatening condition called eclampsia, which is the development of protein in the urine, generalised swelling, and severe seizures. Other symptoms indicating that brain function is becoming impaired may precede these seizures such as nausea, vomiting, headaches, and vision loss.

In children –Some signs and symptoms are especially important in newborns and infants such as failure to thrive, seizures, irritability, lack of energy, and difficulty breathing. In children, hypertension can cause headache, fatigue, blurred vision, nosebleeds, and facial paralysis. Even with the above clinical symptoms, the true incidence of paediatric hypertension is not known. In adults, hypertension has been defined due to the adverse effects caused by hypertension. However, in children, similar studies have not been performed thoroughly to link any adverse effects with the increase in blood pressure. Therefore, the prevalence of paediatric hypertension remains unknown due to the lack of scientific knowledge. 

Essential hypertension– this is the most prevalent hypertension type, affecting 90–95% of hypertensive patients. Although no direct cause has been identified, there are many factors such as sedentary lifestyle smoking, stress, visceral obesity, potassium deficiency (hypokalemia), obesity (more than 85% of cases occur in those with a body mass index greater than, salt (sodium) sensitivity, alcohol intake, and vitamin D deficiency that increase the risk of developing hypertension. Risk also increases with aging, some inherited genetic mutations, and having a family history of hypertension. An elevated level of rennin, a hormone secreted by the kidney, is another risk factor, as is sympathetic nervous system over activity. 

Secondary hypertension–By definition, this results from an identifiable cause. This type is important to recognise since it’s treated differently to essential hypertension, by treating the underlying cause of the elevated blood pressure. Hypertension results in the compromise or imbalance of the path physiological mechanisms, such as the hormone-regulating endocrine system, that regulates blood plasma volume and heart function. 

Treatment

According to an ADAM Medical Encyclopedia research work, “The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you. If you have pre-hypertension, your health care provider will recommend lifestyle changes to bring your blood pressure down to a normal range. Medicines are rarely used for pre-hypertension. You can do many things to help control your blood pressure, including: Eat a heart-healthy diet, including potassium and fibre, and drink plenty of water. 

Exercise regularly — at least 30 minutes of aerobic exercise a day. If you smoke, quit – find a programme that will help you stop. Limit how much alcohol you drink — one drink a day for women, two a day for men. Limit the amount of sodium (salt) you eat — aim for less than 1,500 mg per day Reduce stress — try to avoid things that cause you stress. You can also try meditation or yoga. Stay at a healthy body weight — find a weight-loss program to help you, if you need it. 

There are many different medicines that can be used to treat high blood pressure but must be prescribed by well-qualified physician. Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication. Most of the time, high blood pressure can be controlled with medicine and lifestyle changes. 

Effects 

It has been gathered through various medical work that a patient is at risk and may likely suffer from complications when BP is not treated or controlled. The ADAM Medical publication warned that the following poor conditions of health might result as an evidence of poor treatment: Bleeding from the aorta, the large blood vessel that supplies blood to the abdomen, pelvis, and legs. Chronic kidney disease, heart attack and heart failure, poor blood supply to the legs, stroke and problems with the vision. 

Here Duru was of the view that most of the sudden death now recorded in Nigeria was as a result of untreated hypertension. ‘ I have explained earlier that most Nigerians are hypertensive without knowing it. In other words, they carry on their daily activities or life style without undergoing the tests and living the medically prescribed way a hypertension victim suppose to observe’. ‘ The effect’, he explained, ‘is that the patient might likely be attacked or hit by stroke, kidney failure or heart attack which leads to instant death. You know I described it as a silent killer and this is exactly what I mean. 

So many Nigerians have been killed by heart failure resulting from hypertension. In some instances the person slumps at home, on the road, in the office or anywhere as the case might be. At some other time, the victim goes to bed and does not wake up. When we experience such situations, some us, in the usual Nigerian way, blame it on the wicked landlord, the envious next door neighbour or a witch or wizard in the village.’ 

Prevention

Doctors have unanimously agreed that hypertension has no permanent cure. At best, it can be managed or controlled. Duru explains further. He said: ‘first, for now, there is no permanent cure for hypertension, medically speaking. As a Christian, I believe in miracles but in medical terms, it is yet to be proved that hypertension has any known permanent cure. If you a victim, it means that you have to be on drugs all the days of your life. And such a patient must be ready to go for BP check regularly. He has to abstain from certain behaviour like too much salt in-take, smoking, taking more than two bottles of beer daily and he must watch his weight and do regular exercises.

I am aware the trado-medicine people usually come up with so many claims but they are also not bold enough to submit their claims to empirical proves or thorough laboratory tests.’ A medical sponsored by the American National Heart, Lung and Blood Institute reported that the prevention depends on so many factors: It wrote thus: ‘ The degree to which hypertension can be prevented depends on a number of features including current blood pressure level, sodium/potassium balance, detection and omission of environmental toxins, changes in end/target organs (retina, kidney, heart, among others), risk factors for cardiovascular diseases and the age at diagnosis of pre hypertension or at risk for hypertension. 

A prolonged assessment that involves repeated blood pressure measurements provides the most accurate blood pressure level assessment. Following this, lifestyle changes are recommended to lower blood pressure, before the initiation of prescription drug therapy. According to the British Hypertension Society, the process of managing pre hypertension includes lifestyle changes such as the following: Weight reduction and regular aerobic exercise (e.g., walking): Regular exercise improves blood flow and helps to reduce the resting heart rate and blood pressure. Reduce sodium (salt) in the body by disuse of condiment sodium and the adoption of a high potassium diet, which rids the renal system of excess sodium. 

Many people use potassium chloride salt substitute to reduce their salt intake.’ In 2003 the American Heart Association recommended the following drugs for the treatment of hypertension: Potassium - is essential for the proper functioning of the heart, kidneys, muscles, nerves, and digestive system. Usually the food you eat supplies all of the potassium you need. 

Bosentan - is used to treat Pulmonary Arterial Hypertension (PAH, high blood pressure in the vessels that carry blood to the lungs). Bosentan may improve the ability to exercise and slow the worsening of symptoms in patients with PAH. Tadalafil (Cialis) is used to treat erectile dysfunction (impotence; inability to get or keep an erection) in men. Tadalafil (Adcirca) is used to improve the ability to exercise in people with pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness.

 

From http://www.sunnewsonline.com/webpages/features/icon/2012/jan/01/icon-01-10-2012-003.html

A Pill That Stops Stress In Your Brain Before You Feel It

Stress makes many of us miserable — but it can also kill you. Besides just causing horrible anxiety and depression, the physiological basis for stress has also been linked to diseases as varied as obesity, postpartum depression, Cushing's syndrome, epilepsy, and osteoporosis. But what if we could just turn your brain's stress response off?

Now, researchers from Tufts claim to have pinpointed the way that stress hormones hit specific receptors in your brain — and they've even been able to block them. This could lead to the next great psychopharmaceutical breakthrough.

The Tufts researchers discovered that stress pathways are activated by neurosteroids acting on corticotrophin-releasing hormone neurons in what's known as the Hypothalamus-Pituitary-Adrenal axis. By blocking the synthesis of the neurosteroids, they stopped the elevation of corticosterone, and prevented anxiety in mice.

"We have identified a novel mechanism regulating the body's response to stress by determining that neurosteroids are required to mount the physiological response to stress. Moreover, we were able to completely block the physiological response to stress as well as prevent stress-induced anxiety," said author Jamie Maguire, PhD.

Now the team is focusing on modulating the neuroreceptors to treat some of the diseases that accompany stress — be they depression, anxiety, or epilepsy.

From http://io9.com/5867762/a-pill-that-stops-stress-in-your-brain-before-you-feel-it

DH investigating suspected case of Cushing's syndrome with history of taking medicines prescribed by Chan Kwok-wing

Hong Kong (HKSAR) - The Department of Health (DH) is today (November 30) investigating a suspected case of Cushing's syndrome involving an eight-year-old girl who patronised Mr Chan Kwok-wing of PCRC Chinese Medicine Clinic in Mongkok for management of allergic conditions.

The case was reported to the DH by the Hospital Authority. The girl, who had history of eczema and allergic rhinitis, consulted Chan for around two months since mid-September 2011 and was supplied with some pills, including pills in orange and black colour respectively, and green capsules and green tablets.

"The girl has stopped taking the pills after noting DH's announcement on November 28 of a previous incident related to Chan involving a seven-year-old patient who developed features compatible with steroid overdose after taking pills supplied by Chan," a spokesman said. However, her mother started to notice that the girl had some features of obesity and moon face.

The girl was admitted to the Prince of Wales Hospital today where the girl was found to have moon face, truncal obesity and recent weight gain.

Her clinical diagnosis was iatrogenic Cushing's syndrome. Cushing's syndrome can be caused by steroid overdose. The patient is now in stable condition.

The spokesman added, "Investigation of the present case, including testing of the pills for adulteration of western medicines, is in progress,"

The spokesman again appealed to members of the public, who patronised Chan for management of allergy and was supplied with a type of green and another type of orange oral tablets, to consult healthcare professionals for advice as soon as possible.

"Chan is suspected of practising Chinese medicines without licence as there is no record to show that he is either a registered medical practitioner or a pharmacist.

DH is assisting with Police investigation," the spokesman said.

Source: HKSAR Government

Not the Usual Suspects: Animal Study Finds Surprising Clues to Obesity-Induced Infertility

Source: Johns Hopkins Medicine

FOR IMMEDIATE RELEASE

Newswise — Infertility is common among obese women, but the reasons remain poorly understood and few treatments exist. Now a team of Johns Hopkins Children's Center scientists, conducting experiments in mice, has uncovered what they consider surprising evidence that insulin resistance, long considered a prime suspect, has little to do with infertility in women with type-2 diabetes, polycystic ovary syndrome (PCOS) and metabolic syndrome, all obesity-related conditions in which the body becomes desensitized to insulin and loses the ability to regulate blood sugar.

In a report, published online Nov.10 in the journal Diabetes, the Johns Hopkins scientists say the real culprit appears to be insulin sensitivity in the ovaries and the pituitary.

The Johns Hopkins team said its findings show that these organs escape insulin resistance and, awash with high levels of circulating insulin common in obesity, develop abnormal cell signaling that disrupts ovulation and eventually leads to infertility.

"Our findings suggest that the focus should shift from treating insulin resistance in peripheral tissue to taming insulin sensitivity in the pituitary and ovaries," says lead investigator Sheng Wu, Ph.D., of the Johns Hopkins Children's Center. Scientists traditionally have treated obesity-induced infertility by lowering blood insulin to counter the effects of insulin resistance.

A 2010 study by the same team discovered that the pituitary gland, insensitive to insulin in lean mice, became sensitive to elevated levels of insulin seen in human and rodent obesity. By knocking out the insulin receptors in the pituitary glands of obese mice, the researchers were able to partially restore fertility, thus proving that abnormal insulin signaling in the pituitary was only part of the story.

"In the original study, disrupting insulin signaling in the pituitary restored 50 percent of fertility in obese mice, but the search was on for the accomplice," says senior investigator Andrew Wolfe, Ph.D., an endocrinologist at the Johns Hopkins Children's Center. "Our new findings point to the ovaries."

In the pituitary, faulty insulin signaling stimulates increased secretion of luteinizing hormone, the researchers say. In the ovary, it puts testosterone production into overdrive. Both disrupt ovulation, the researchers explain.

In the latest study, lean mice and mice made obese on a three-month high-fat diet received injections of progressively higher doses of insulin to mimic the effects of high circulating insulin seen in obesity, diabetes and PCOS. In lean mice, the ovaries and pituitaries were insensitive to the hormone at low-dose injections, and responded only when injected with higher doses of insulin. The "trigger" doses corresponded to insulin levels typically seen in obesity. Obese mice with naturally elevated insulin levels exhibited high levels of insulin signaling in their pituitary and ovarian cells. When injected with insulin, the livers and muscles of obese mice showed greatly reduced response to insulin -- or insulin resistance. Their ovaries and pituitary glands, however, responded to insulin injections, confirming that in obese mice, these reproductive organs escape the insulin resistance seen in other organs.

To determine insulin sensitivity, the researchers focused on two signaling proteins, IRS-1 and IRS-2, regulators of cell-insulin communication involved in the development of insulin resistance in liver and muscle tissue. The scientists hypothesized that in the pituitary and ovaries, these messenger proteins would remain dormant under normal insulin levels, but would get activated once exposed to high levels of insulin. Indeed, the researchers found, the pituitary glands of obese mice showed higher IRS-2 signaling activity compared with lean mice, while the ovaries of obese mice had higher signaling activity in both IRS-1 and IRS-2 proteins, compared with lean mice.

In a follow-up study now under way, the Hopkins team is trying to determine whether knocking out the insulin receptors in both the ovaries and the pituitary would fully restore fertility in obese mice with high insulin levels.

Other co-investigators on the study included Sara Divall, M.D., and Fred Wondisford, M.D., both of the Johns Hopkins Children's Center.

The research was funded by the Endocrine Fellow Foundation, by The Eunice Kennedy Shriver National Institute of Child Health and Human Development, part of the National Institutes of Health, and by the Baltimore Diabetes Research and Training Center, which is supported by the National Institute for Diabetes and Digestive and Kidney Diseases.

 

 

Founded in 1912 as the children's hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, treating more than 90,000 children each year. Hopkins Children's is consistently ranked among the top children's hospitals in the nation. 
Hopkins Children's is Maryland's largest children's hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. For more information, please visitwww.hopkinschildrens.org

From http://www.newswise.com/articles/not-the-usual-suspects-animal-study-finds-su.../articles/list&category=medicine&page=1&search%5Bstatus%5D=3&search%5Bsort%5D=date+desc&search%5Bsection%5D=10&search%5Bhas_multimedia%5D=

Diabetes in Cushing syndrome: basic and clinical aspects

Diabetes mellitus is a frequent complication of Cushing syndrome (CS) which is caused by chronic exposure to glucocorticoid excess, either endogenous or exogenous, and that is characterized by several clinical symptoms such as central obesity, purple striae, proximal muscle weakness, acne, hirsutism and neuropsychological disturbances.

Diabetes occurs as a consequence of an insulin-resistant state together with impaired insulin secretion which are induced by glucocorticoid excess. The management of patients with CS and diabetes mellitus includes the treatment of hyperglycemia and, when possible, the correction of glucocorticoid excess.

This review focuses on the disorders of glucose metabolism in patients exposed to glucocorticoid excess, addressing both the pathophysiological aspects and the clinical and therapeutic implications.

Read the entire article at http://www.cell.com/trends/endocrinology-metabolism/abstract/S1043-2760(11)00138-X

Current Clinical Practice Guidelines

Published Guidelines

Following are links to The Endocrine Society's published clinical practice guidelines. Download each guideline, free-of-charge,  from http://www.endo-society.org/guidelines/Current-Clinical-Practice-Guidelines.cfm

• (UPDATED, without CME) Evaluation and Treatment of Adult Growth Hormone Deficiency (available online only, not for sale)
  Order this updated guideline with CME
• Pituitary Incidentaloma
• Diagnosis & Treatment of Hyperprolactinemia
• Endocrine & Nutritional Management of the Post-Bariatric Surgery Patient
• Congenital Adrenal Hyperplasia Due to Steroid 21-hydroxylase Deficiency
• (UPDATED, without CME) Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes (available online only, not for sale)
  Order this updated guideline with CME
• Endocrine Treatment of Transsexual Persons
• Evaluation & Management of Adult Hypoglycemic Disorders
• Prevention and Treatment of Pediatric Obesity
• Primary Prevention of Cardiovascular Disease & Type 2 Diabetes in Patients at Metabolic Risk
• Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism
• The Diagnosis of Cushing's Syndrome
• Evaluation & Treatment of Hirsutism in Premenopausal Women
• Executive Summary: Management of Thyroid Dysfunction during Pregnancy & Postpartum
• Management of Thyroid Dysfunction during Pregnancy & Postpartum
• Androgen Therapy in Women

Ordering Information (100 copies or fewer)
Order bound versions of The Endocrine Society clinical practice guidelines.

Commercial Reprint Information (101 copies or more)
Please go to The Endocrine Society reprints page for more complete information on reprint options.

For More Information
Please contact the Government & Public Affairs Department at govt-prof@endo-society.org This e-mail address is being protected from spambots. You need JavaScript enabled to view it if you have any questions.

Stress Science: Neuroendocrinology

Research and Markets has announced the addition of Elsevier Science and Technology's new report "Stress Science. Neuroendocrinology" to their offering.

Stress is a universal phenomenon that impacts adversely on most people. This volume provides a readily accessible compendium that explains the phenomenon of stress, the neural, endocrine and molecular mechanisms involved, the clinical effects, and the impact on individuals and society. Clinical attention focuses on disorders of the stress control system (e.g. Cushing's Syndrome: Addison's Disease) and the adverse impact of stress on human physical and mental health. Detailed reviews address disorders such as PTSD, anxiety, major depression, psychoses and related disorders such as combat fatigue and burnout. The work covers interactions between stress and neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease, as well as stress-immune-inflammatory interactions in relation to cancer and autoimmune and viral diseases. Emphasis is also placed on the role of stress in obesity, hypertension, diabetes type II and other features of the metabolic syndrome which has now reached epidemic proportions in the USA and other countries.

• Chapters offer impressive scope with topics addressing animal studies, disaster, diurnal rhythms, drug effects and treatments, cognition and emotion, physical illness, psychopathology, immunology and inflammation, lab studies and tests, and psychological / biochemical / genetic aspects
• Richly illustrated with over 200 figures, 75 in color
• Priced affordably, this compendium of articles appeals to the end user interested in stress research who would not otherwise purchase the larger Encyclopedia of Stress
• Articles carefully selected by one of the world's most preeminent stress researchers and contributors represent the most outstanding scholarship in the field, with each chapter providing fully vetted and reliable expert knowledge

For more information visit http://www.researchandmarkets.com/research/02ce77/stress_science_ne

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Prevalence and Incidence of Diabetes Mellitus in Adult Patients on Growth Hormone Replacement for Growth Hormone Deficiency

1. Andrea F. Attanasio,
2. Heike Jung,
3. Daojun Mo,
4. Philippe Chanson,
5. Roger Bouillon,
6. Ken K. Y. Ho,
7. Steven W. J. Lamberts,
8. David R. Clemmons and
9. for the HypoCCS International Advisory Board

- Author Affiliations

1. Cascina del Rosone (A.F.A.), 14041 Agliano Terme, Italy; Lilly Deutschland GmbH (H.J.), 61352 Bad Homburg, Germany; Lilly Research Center (D.M.), Eli Lilly and Co., Indianapolis, Indiana 46285; University Paris-Sud 11 and Institut National de la Santé et de la Recherche Médicale Unité 693 (P.C.), 94270 Le Kremlin-Bicêtre, France; Katholieke Universiteit Leuven (R.B.), Laboratory for Experimental Medicine and Endocrinology, 3000 Leuven, Belgium; Garvan Institute of Medical Research (K.K.Y.H.), St. Vincent's Hospital, Sydney, New South Wales 2010, Australia; Department of Internal Medicine (S.W.J.L.), Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands; Department of Medicine (D.R.C.), University of North Carolina, Chapel Hill, North Carolina 27599

1. Address all correspondence and requests for reprints to: Prof. David R. Clemmons, Division of Endocrinology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599-7170. E-mail: david_clemmons@med.unc.edu.

Abstract

Context: GH replacement in adult GH-deficient patients may cause insulin resistance, raising concerns of potential increased risk of developing diabetes mellitus (DM).

Objective: Our objective was to assess DM prevalence and incidence in the international Hypopituitary Control and Complications Study (HypoCCS) surveillance database.

Design and Participants: GH-treated patients enrolled into HypoCCS (2922 U.S. and 3709 European patients) were assessed for DM, defined as recorded on the clinical report form, reported as adverse events, fasting glucose at least 7 mmol/liter recorded at least twice, or insulin treatment reported.

Results: DM prevalence was 8.2% [95% confidence interval (CI) = 7.6–8.9] overall, 11.3% in the United States and 5.7% in Europe. Incidence (n/1000 patient-years) was 9.7 (95% CI = 8.4–10.9) overall, 14.1 (11.5–16.7) in the United States, and 7.0 (5.6–8.3) in Europe. Overall incidence was 2.1 (0.9–3.3) for patients with body mass index (BMI) below 25 kg/m² increasing to 16.4 (13.7–19.1) for BMI over 30 kg/m². Obesity (BMI > 30 kg/m²) prevalence was higher in the United States than Europe and higher in U.S. patients than a U.S. reference population. After age, gender, and BMI adjustment, U.S. HypoCCS DM incidence was 10.6 (8.1–13.0), compared with 7.1 (6.0–8.1) in the National Health Interview Survey. In Europe, incidence for French and German patients was comparable to reference populations; for Sweden, the point estimate was higher than the reference population, but 95% CI overlapped. GH dose was not correlated with DM incidence.

Conclusions: The present analysis showed no evidence for increased DM incidence in GH-treated adult hypopituitary patients. However, those more prone to develop DM exhibited a higher than normal prevalence of obesity.

From http://jcem.endojournals.org/content/early/2011/05/04/jc.2011-0448.abstract

Cushing's Awareness Day passes but disease lingers for reader

Dear Dr. Gott: Would you please mention that April 8 was Cushing's Awareness Day

I was a healthy woman until the age of 55. After more a year, I was diagnosed with Cushing's disease. I have had two brain surgeries, Graves' disease, recurring Cushing's and 25 radiation treatments to the pituitary. Eight years later, I still live with the effects of this monster. Thank you, Dr. Gott.

Dear Reader: Unfortunately, I was not able to print your letter on April 8, having only received it on April 6. It takes about three weeks before any letter appears in the newspaper.

Cushing's syndrome is a rare endocrine disorder. It occurs when the body produces or receives too much cortisol over an extended period of time.

Cortisol is a vital component in the body. It helps the body respond to stress, maintain blood pressure and cardiovascular function, regulates carbohydrate, fat and protein metabolism, reduces the inflammatory response of the immune system, and balances the effects of insulin.

The most common symptoms include a rounded face and upper body (abdomen, upper back, neck and between the shoulders ("buffalo hump"), obesity and relatively slender arms and legs.

Other symptoms can include acne, slow-healing cuts, bites or infection, bone loss, muscle weakness, fatigue, cognitive difficulties, high blood pressure, high blood glucose levels, headaches, thin skin with easy bruising, purple/red stretch marks, depression and/or anxiety, abnormal menstruation and excess body and facial hair in women, and erectile dysfunction and a decrease in libido and fertility in men. Children typically present with obesity and slowed growth.

Write to Dr. Gott, c/o NEA-United Media, 200 Madison Ave., Fourth Floor, New York, NY 10016.

From http://amarillo.com/news/local-news/2011-05-23/dr-gott-rare-cushings-causes-multiple-problems

Spinning Out of Control

Unexplained symptoms left Shana Leslie feeling like an old woman trapped in a 30-year-old’s body.

By Susan Flynn

Throughout 2007, Shana Leslie* developed acne, experienced increasingly shorter menstrual periods and gained more than 20 pounds, mostly in her midsection. Her friends were not surprised. “I had just turned 30, was in the middle of a divorce and had recently been promoted at work,” says Ms. Leslie. “So everybody told me it was related to stress.”

The explanation seemed reasonable to Ms. Leslie, a single mom raising a young son in northeast Ohio. She bought larger clothes and visited a dermatologist. But by November, she noticed more changes. Hair sprouted on her upper lip and grew farther down her hairline. Ms. Leslie’s periods stopped completely, and her ankles swelled.

“The only other time my ankles had been so swollen was when I was pregnant, so I went to my obstetrician,” she says. After ruling out pregnancy, the doctor sent Ms. Leslie to an internist. Her blood pressure was very high — 170/110.

Like the young woman’s friends, the physician thought stress might be partly to blame, so he prescribed anti-anxiety drugs and medicine to reduce blood pressure. A month later, during a work seminar in North Carolina, the room seemed to spin. “I had heart palpitations, and I felt like I was going to faint,” Ms. Leslie recalls. At the local hospital, emergency room doctors confirmed her blood pressure was high but couldn’t find anything else wrong.

Back home in Ohio, her internist changed Ms. Leslie’s medication, but an adverse reaction landed her in a nearby hospital. She underwent a gamut of tests: a CT scan, an MRI and blood work. Still, physicians found nothing wrong. Ms. Leslie’s frustration grew.

“My body was spinning out of control,” she says. “I was shaking all the time, and I couldn’t sleep.” Bruises began to dot her legs and stretch marks lined her stomach. In February 2008, Ms. Leslie hit an unrelated snag when she lost one of her contact lenses. This hitch was the turning point for her.

She visited an optometrist, who noticed she had ocular hypertension — higher than normal pressure inside the eye. She mentioned her high blood pressure. After informing her that the two were unrelated, the optometrist listened to Ms. Leslie’s whole story. “He said I had to be my own healthcare advocate,” she says. “He really made me start thinking.”

Ms. Leslie turned to the Internet and began researching secondary hypertension, the only clear-cut condition diagnosed so far. A website mentioned that one cause was Cushing’s syndrome, a rare disorder triggered by prolonged exposure to elevated levels of the hormone cortisol. “Everything on the list of symptoms fit me to a T,” she recalls.

She returned to her internist, who ordered a blood test to check her cortisol levels. They were off the chart. An endocrinologist ran two additional screening tests for Cushing’s. Both showed high cortisol levels. The endocrinologist referred Ms. Leslie to Amir H. ­Hamrahian, MD, an endocrinologist at Cleveland Clinic with expertise in pituitary disorders. “At this point, I couldn’t walk up the stairs,” says Ms. Leslie. “I felt like an old woman stuck in a 30-year-old’s body.”

Dr. Hamrahian recalls first meeting Ms. Leslie, who showed him photos of her thin and vibrant self from just a year before. “You couldn’t recognize the same person,” he says. “She was really in need of help.” Cushing’s syndrome can be tricky to diagnose because weight gain and anxiety are common. Depression, obesity, diabetes and other conditions can also elevate cortisol levels. However, looking at Ms. Leslie’s whole clinical picture, Dr. Hamrahian diagnosed Cushing’s. Excessive cortisol causes skin atrophy, loss of collagen and insulin resistance, the reasons for Ms. Leslie’s stretch marks, bruising and weight gain.

Dr. Hamrahian ordered an MRI to check for tumors on the pituitary gland at the base of the brain. The pituitary controls the amount of cortisol produced by the adrenal gland. Pituitary tumors are the most common cause of Cushing’s. The MRI showed nothing, but he did not give up. He sent his patient to the National Institutes of Health (NIH) in Bethesda, Md., for a procedure called inferior petrosal sinus sampling (IPSS), in which doctors draw blood from the inferior petrosal sinuses, which drain the pituitary. Doctors at NIH compared the levels of adrenocorticotropin hormone, which spurs release of cortisol, from Ms. Leslie’s petrosal sinuses to levels from a vein in her arm. The IPSS revealed higher levels in the sinuses, indicating that a tumor in the pituitary gland was causing her Cushing’s syndrome.

On May 30, 2008, Cleveland Clinic surgeon Robert Weil, MD, of the Neurological Institute and the holder of the Melvin H. Burkhardt Chair in Neuro-Oncology Clinical Research, removed two 3-millimeter tumors. Since then, Ms. Leslie has gradually returned to health. Her cortisol levels and blood pressure are normal, the acne is gone, her menstrual cycle has resumed, and she has lost 40 pounds. “In experienced hands, there is a good chance of cure or long-term remission,” says Dr. ­Hamrahian. “Most symptoms resolve, but patients need to be monitored lifelong for any signs of recurrence.”

Ms. Leslie is grateful for this second chance. “I’m working out, playing with my son and living my life the way someone my age should be,” she says.

* The patient’s name was changed to protect her privacy.

From http://cchealth.clevelandclinic.org/diagnosis-challenge/spinning-out-control

Obesity is a Predictor of Morbidity in 1,629 Patients Who Underwent Adrenalectomy

World Journal of Surgery

DOI: 10.1007/s00268-011-1070-2

Hadiza S. Kazaure, Sanziana A. Roman and Julie A. Sosa

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Abstract

Background  

We examined the impact of obesity on 30-day outcomes of adrenalectomy using a multi-institutional database.

Methods  

Patients who underwent adrenalectomy in 2005–2008 according to the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) data set were grouped by body mass index (BMI): normal weight (BMI = 18.5–24.9 kg/m²), overweight (BMI = 25.0–29.9 kg/m²), obese (BMI = 30.0–34.9 kg/m²), and morbidly obese (BMI ≥ 35 kg/m²). Outcomes of the higher BMI groups were compared to those of the normal BMI group using χ², analysis of variance (ANOVA), and multivariate regression.

Results  

There were 1,629 patients in the study: 22% were normal weight, 31% overweight, 22.2% obese, and 24.7% morbidly obese. Compared to normal-weight patients, obese and morbidly obese patients had a 12.5 and 16.7% increase in operation times (129 vs. 145 and 150 min, respectively, p ≤ 0.01) and sustained more wound complications (0.2 vs. 0.4 and 1.2%, p < 0.001), including superficial and deep wound infections (p < 0.001 and p < 0.01, respectively). Morbid obesity independently predicted overall complications (odds ratio [OR] 2.9, 95% confidence interval [CI]: 1.7–5.7), wound complications (OR 6.1, 95% CI: 2.0–18.9), and septic complications (OR 3.1, 95% CI: 1.1–8.8). Obesity independently predicted longer total time in the operating room (p < 0.006). There were no differences in rates of reoperation and length of hospital stay by BMI category.

Conclusion  

Obesity is an independent risk factor that needs to be considered in surgical decisions regarding adrenalectomy. Morbidly obese adrenalectomy patients are particularly at risk for wound and septic complications.

Presented in part at the 6th Annual Academic Surgical Congress, Huntington Beach, CA, 1 February 2011.

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From http://www.springerlink.com/content/w6n2p554w72wru47/

Cushing's Syndrome and Disease: A Disorder That Often Goes Undiagnosed

Obesity, excess neck fat and the ability to easily bruise are just a few signs of this commonly overlooked condition. Often it is caused by a tumor in the adrenal gland, which may be cancerous. Nancy D. Perrier, M.D., F.A.C.S., chief of the Section of Surgical Endocrinology at MD Anderson Cancer Center, discusses this disorder and the difference between the syndrome and disease.

Guest(s): Nancy D. Perrier, M.D., F.A.C.S.

• Listen to Cushing's Syndrome and Disease: A Disorder That Often Goes Undiagnosed
• Download Cushing's Syndrome and Disease: A Disorder That Often Goes Undiagnosed on iTunes

From http://www.mdanderson.org/newsroom/cancer-newsline/cancer-newsline-topics/2011/cancer-newsline-cushing-s-syndrome-and-disease-a-disorder-that-often-goes-undiagnosed.html

Diagnosed for obesity surgery in the US, 35 year Old American Lady weighing 136 kg was correctly detected of brain tumor

In the unique case which will strengthen the confidence of the World in the abilities of Indian doctors, team of specialist Fortis Hospitals Mulund correctly diagnosed and treated a 35 year old US national Ms Michelle Hardin of brain tumor. The US doctors had earlier diagnosed the condition as a case of obesity and recommended Gastric Bypass Surgery.

click to learn more

In the last few years Ms Hardin’s weight increased from 190 pounds to 300 pounds (86 kg to 136 kg). She also suffered from diabetes and hypertension. “I tried various diet control measures but to no avail. Also I had excessive thirst and would drink almost 8 liter of liquid daily and would feel always hungry. My obesity caused breathing difficulty (sleep apnea) and for which I used a special machine (CPAP Machine) to keep oxygen under pressure. Seven months back I took an expert opinion in US, where I was asked to undergo Gastric Bypass Surgery (GBS) to treat obesity. Since GBS was very expensive in US, I thought of undergoing the treatment in India.” Ms Hardin

Ms Hardin decided to visit Fortis Hospital to consult Dr Ramen Goel who has a vast experience of performing thousands of advanced laparoscopic surgeries including bariatric surgeries.

“Ms Hardin visited us with the known fact that she had to undergo Bariatric surgery through Gastric Bypass method. Detailed investigations at the hospital however revealed that she actually had a Pituitary Tumor on the right side of the pituitary gland of about 1cm in diameter. The weight gained was actually because of this pituitary tumour and not because of any case of obesity. I referred her to Dr Milind Vaidya, Consultant Neurosurgeon who has an expertise to remove the tumour through minimally invasive procedure.” said Dr Ramen Goel.

Dr. Milind Vaidya, Consultant Neurosurgeon, Fortis Hospitals Mulund said, “The tumor, situated in pituitary gland at the base of the brain, triggered excessive production of cortisol hormone by the adrenal glands leading to complications like uncontrolled diabetes, hypertension and weight gain. We treated her by transnasal- transsphenoidal excision of the pituitary tumor (a minimally invasive procedure) on 14th Jan 2011.”

Dr Vaidya used an endoscope & microscope to reach the tumour through her nostrils. He used both the nasal openings to reach the tumour to avoid incision or scar. He took special care to remove every bit of the tumour, to achieve cure and preserve the normal pituitary gland.

Ms Hardin had an uneventful excision of the right sided tumor and the normal pituitary on the left side was left untouched. Her nasal pack has been removed and she is doing well post-operation, with diabetes & hypertension under good control.

“I was shocked to learn that I suffered from tumour. I thank the doctors of Fortis Hospital. Had there been no timely intervention from them I wouldn’t know what would have happened to my life. Post operative my thirst & appetite have reduced markedly to normal levels. Doctor assured that my weight will be restored to normalcy gradually.” Ms Hardin.

According to Dr Vaidya, “Ms Hardin’s life is today safe and secure only because of timely detection. Had we continued the treatment of GBS or had we wrongly diagnosed the case, her condition could have been critical. Hence timely detection and right expertise is very crucial. This case is a testimony to the quality and credibility of Indian Healthcare expertise.”

Today India is considered as the best treatment destination by foreign patients as they can avail the finest medical facilities at affordable rates. Fortis has partnered with Indushealth in the US who has played a significant role in helping many such international medical travelers avail quality healthcare services at Fortis.

From http://fortishospitals.wordpress.com/2011/01/25/diagnosed-for-obesity-surgery-in-the-us-35-year-old-american-lady-weighing-136-kg-was-correctly-detected-of-brain-tumor-at-fortis-hospitals-mulund/

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