Wednesday, January 26, 2011

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.

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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.


Bilateral adrenocortical carcinoma in a patient with multiple endocrine neoplasia type 1 (MEN1) and a novel mutation in the MEN1 gene

The incidence of adrenal involvement in MEN1 syndrome has been reported between 9 and 45%, while the incidence of adrenocortical carcinoma (ACC) in MEN1 patients has been reported between 2.6 and 6%. In the literature data only unilateral development of ACCs in MEN1 patients has been reported.

We report a 31 years-old female MEN1-patient, in whom hyperplasia of the parathyroid glands, prolactinoma, non functioning pancreatic endocrine carcinoma and functioning bilateral adrenal carcinomas were diagnosed. Interestingly, a not previously described in the literature data, novel germline mutation (p.E45V) in exon 2 of MEN1 gene, was detected.

The association of exon 2 mutation of the MEN1 gene with bilateral adrenal carcinomas in MEN1 syndrome, should be further investigated.

Author: John Griniatsos, Nikoletta Dimitriou, Athanassios Zilos, Stavroula Sakellariou, Konstantinos Evangelou, Smaragda Kamakari, Penelope Korkolopoulou, Gregory Kaltsas
Credits/Source: World Journal of Surgical Oncology 2011, 9:6

Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please make sure to read our disclaimer prior to contacting 7thSpace Interactive. To contact our editors, visit our online helpdesk. If you wish submit your own press release, click here.


Monday, January 24, 2011

It's Literally Impossible To Have Cushings

This video was made by Tofu on the message boards. She wrote: "Maxhirez had made a funny movie showing a doctor/patient interaction. So I stole inspired by his idea and made my own movie. These are the fruits of my insomnia tonight. Hope you enjoy!"

Endocrinologists sometimes have a hard time diagnosing cushing's disease. Here is a scene between one concerned patient and her endocrinologists.


MaryO'Note: I found this to be so true. It's very nearly like many of the conversations I have had over the years with far too many doctors.

Read other comments or add your own to the original thread here.

Sunday, January 23, 2011

Efficacy of Cabergoline in Uncured (Persistent or Recurrent) Cushing Disease After Pituitary Surgical Treatment with or without Radiotherapy

JournalEndocrine Practice
PublisherAmerican Association of Clinical Endocrinologists
ISSN1530-891X (Print) 1934-2403 (Online)
IssueVolume 16, Number 6 / November-December 2010
Online DateMonday, May 24, 2010

Anurag R. Lila, MD1, Raju A. Gopal, MD, DM1, Shrikrishna V. Acharya, MD, DM1, Joe George, MD, DM1, Vijaya Sarathi, MD, DM1, Tushar Bandgar, MD, DM1, Padma S. Menon, MD1, Nalini S. Shah, MD, DM1

1Department of Endocrinology, Seth Gordhandas Sunderdas Medical College, King Edward Memorial Hospital, Mumbai, India


Objective: To evaluate the efficacy of cabergoline therapy in patients with Cushing disease who remained uncured (had persistent or recurrent disease) after a pituitary surgical procedure with or without radiotherapy.

Methods: We undertook a prospective, open-label, single-arm study, with short-term (5 months) and longterm (1 year) evaluations. In 20 patients with uncured Cushing disease, treatment was initiated with cabergoline at a dosage of 1 mg/wk, with a monthly increment of 1 mg, until midnight serum cortisol (MNSC) or low-dose dexamethasone suppression serum cortisol (LDSC) (or both) normalized or a maximal dosage of 5 mg/wk was reached.

Results: Overall, 5 of 18 patients (28%) responded in terms of LDSC or MNSC (or both) at a mean dosage of 3.6 mg/wk (range, 2 to 5). When the response was defined with use of either LDSC or MNSC level as an isolated criterion, it was achieved in 4 of 16 patients (25%) and 3 of 18 patients (17%), respectively. Four patients were treated for 1 year, and the response was persistent in 2 and 3 patients on the basis of MNSC and LDSC levels, respectively. Lower baseline serum cortisol (basal, MNSC, and LDSC) values were predictive of a therapeutic response.

Conclusion: Cabergoline was an effective therapy in 28%, 25%, and 17% of patients with uncured Cushing disease in terms of LDSC or MNSC (or both), LDSC alone, and MNSC alone, respectively. Further studies are needed to address the persistence of the drug response and the effects on the dynamics of the hypothalamic-pituitary-adrenal axis.

Show References


Updated NIH Clinical Trials of interest to Cushing's patients

Thursday, January 20, 2011

Do You Have a Favorite Health/Medical App?

I don't have a Droid so most of my info will be about iPhone/iPad apps.  Please feel free to add any apps you might like and tell us a bit about them.  Thanks!


Part one was a blog post here.  That page includes comments and suggestions from readers.

National Library of Medicine Launches Mobile MedlinePlus to Meet the Health Information Needs of an On-the-Go Public

Wondering what the side effects are for your new prescription? Go to Mobile MedlinePlus ( while you're waiting for the pharmacist to fill your order!

Or, instantly look up the symptoms of H1N1 flu if you're at the supermarket and your child's school calls you to tell you he doesn't feel well.

The National Library of Medicine's Mobile Medline Plus builds on the NLM's MedlinePlus Internet service, which provides authoritative consumer health information to over 10 million visitors per month. These visitors access MedlinePlus ( from throughout the United States as well many other countries, and use desktop computers, laptops and even mobile devices to get there.

The mobile Internet audience is large and growing fast, almost doubling from February 2007 to February 2009. Some experts predict that within the next five years, more people will connect to the Internet via mobile devices than via desktop or laptop computers. People use their mobile devices to accomplish a variety of tasks, including finding health information. With this in mind, NLM developed the mobile version of MedlinePlus to bring high-quality health information to users on the go.

"We know that a huge number of people are seeking good health information on the Web, noted NLM Director Dr. Donald A.B. Lindberg. What better way to reach out to them than by offering this new mobile service, which delivers trustworthy, consumer-friendly information instantly, anywhere?"

Mobile MedlinePlus is available in English and Spanish ( and includes a subset of content from the full Web site. It includes summaries for over 800 diseases, wellness topics, the latest health news, an illustrated medical encyclopedia, and information on prescription and over-the-counter medications.

For instance, you could visit the "Talking With Your Doctor" page on Mobile MedlinePlus to learn how to get the most out of your doctor’s visit.

Mobile MedlinePlus can also help you when you're trying to choose an over-the-counter cold medicine at the drug store.

And if you're traveling abroad, you can use Mobile MedlinePlus to learn about safe drinking water.

Mobile MedlinePlus puts reliable health information at your fingertips.

*High resolution screen shot of Mobile MedlinePlus available upon request.

The National Library of Medicine is part of the National Institutes of Health, an agency of the U.S. Department of Health and Human Services. It is the nation's largest medical library.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit



smilez133 posted this on the message boards here

Massachusetts General Hospital Launches iPhone App to Locate Emergency Rooms

FindER Connects Users to the Most Complete Database of ERs in the U.S.

BOSTON—Researchers at Massachusetts General Hospital’s (MGH) Emergency Medicine Network (EMNet) announced today the launch of EMNet findER™, a free iPhone application designed to help users locate the closest emergency room to their current location, as well as provide directions and additional information with a touch of the screen. FindER uses the iPhone’s global positioning system to quickly direct patients to emergency rooms anywhere within the United States.

“FindER is designed to provide key information to people experiencing health emergencies,” says Carlos A. Camargo MD, of MGH’s Department of Emergency Medicine and EMNet director. “FindER uses information from EMNet’s own database of emergency departments, which is the most complete and accurate in the nation.”

Along with directions and general information, findER is designed for quick phone calls to both the care-center itself and in cases where necessary, 911 emergency services.

“EMNet researchers maintain a database of nearly 5,000 emergency rooms in the United States. Unlike a simple Google search where the results may include many emergency centers that have closed or moved, or even veterinary hospitals, findER’s results are based on an aggregation of emergency room listings from multiple sources that have been confirmed by researchers at EMNet,” says Camargo. “FindER is designed to help patients get to emergency rooms in the shortest amount of time.”

FindER is ideal for travelers, especially those suffering chronic medical conditions, or those traveling with friends or relatives with health problems. FindERis available now as a free download in the iTunes app store. Simply click this link or search "EMNet findER," to download. For a short demonstration video, users can visit YouTube.


MaryONote: Just as info - the iTunes store said that there was nothing called FindER when I did a search. I found it only by typing EMNet findER. I have the app - looks great - and I hope I never need it again!


I just found a new iPhone app today which looks pretty good. You can add family members and send the info to another phone so everyone has the info they need. It's only $.99 in the iTunes store:

It's called Capzule PHR and the website is with help files at

There's a free version to try called Capzule PHR Free


* Push Notification to alert appointments
* Data Visualization via Interactive Timeline
* Edit records and upload files from Desktop/Laptop
* Record conditions and allergies
* Store doctor appointments
* Enter medications
* Email summary and graphs
* Print or download summary from Desktop/Laptop
* Maintain immunization records
* Enter vitals in Metric or Standard units
* Analyze line graphs of vitals and lab results
* Keep family, social, and medical history together
* Create custom health screening templates
* Enter notes, upload results and files
* Manage physician and insurance information
* Reset password when password is lost
* Categorize Notes and Attachments
* Email flowsheet data in CSV format along with graphs
* Email Summary with graphs embedded
* Backup and Restore from Desktop/Laptop
* Export CSV data from Desktop/Laptop
* Email documents
* Add files from other Apps (iOS 3.2+)
* Summary Reporting Filter

Saturday, January 15, 2011

Pediatric Endo in California?

Can anyone help with this? on the Cushing's Facebook Group  Danielle asks: "does anyone know of any Doctors names who specialize in Pediatric Cushing's in the California area? thx"

On the topic of endos, we can always use info for the Helpful Doctors lists.  If you have a doctor you'd like to add, please share his/her info here.  Thanks!  As always, advertising is not accepted.  Doctors (or doctor's staff members) may not submit his/her own information.

Friday, January 14, 2011

Something New...again

Whenever there's a new service, or site, I like to try it out to reach as many people with Cushing's as possible.  I know that all Cushies aren't on Facebook, or Twitter or even on the Cushing's Help message boards.  So, I'm giving this a whirl :)


The Basics:

Cushing's syndrome, also known as hypercortisolism or hyperadrenocorticism, is an endocrine disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol (in the blood) from a variety of causes, including primary pituitary adenoma (known as Cushing's disease), primary adrenal hyperplasia or neoplasia, ectopic ACTH production (e.g., from a small cell lung cancer), and iatrogenic (steroid use). It is relatively rare and most commonly affects adults aged 20 to 50. An estimated 10 to 15 of every million people are affected each year. Cushing's was discovered by American physician, surgeon and endocrinologist Harvey Cushing (1869-1939) and reported by him in 1932.

Normally, cortisol is released from the adrenal glands in response to ACTH being released from the pituitary gland. Both Cushing's syndrome and Cushing's disease are characterized by elevated levels of cortisol in the blood, but the cause of elevated cortisol differs between the two.

  • Cushing's disease specifically refers to a tumor in the pituitary gland that stimulates excessive release of cortisol from the adrenal glands by releasing large amounts of ACTH.
  • In Cushing's syndrome, ACTH levels will normally drop due to negative feedback from the high levels of cortisol. All forms of Cushing's are correctly called Cushing's Syndrome.

Cushing's syndrome occurs when the body's tissues are exposed to excessive levels of cortisol for long periods of time. Cortisol helps maintain blood pressure and cardiovascular function and is responsible for helping the body respond to stress. Many people suffer the symptoms of Cushing's syndrome because they take steroids such as prednisone for asthma, rheumatoid arthritis, lupus and other inflammatory diseases, or for immunosuppression after transplantation. Prednisone is well-known for a "bloating" look that it gives people who take it.

Others develop Cushing's syndrome because of overproduction of cortisol by the body due to a tumor on the pituitary (usually an adenoma or benign tumor of the pituitary glands) or adrenal glands, or elsewhere in the body Adrenal cancers, or other adrenal abnormalities may be the cause of Cushing’s Syndrome as well.

People who have been diagnosed with depression, alcoholism, malnutrition and panic attacks tend to have higher cortisol levels as well. These types of Cushing's may be called Pseudo-Cushing's.

The Signs and Symptoms of Cushing's

The message boards are very active and we have weekly online chats, local meetings, email newsletters, a clothing exchange, a Cushing's Awareness Day Forum in honor of Dr. Harvey Cushing's birthday April 8, phone support and much more. Whenever one of the members of the boards gets into NIH, we try to go to visit them there. Other board members participate in the "Cushie Helper" program where they support others with one-on-one support, doctor/hospital visits, transportation issues and much more.

Tuesday, January 11, 2011

Coping Strategies in Patients after Treatment for Functioning or Nonfunctioning Pituitary Adenomas

The Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2010-2490

Jitske Tiemensma*, Adrian A. Kaptein, Alberto M. Pereira, Johannes W. A. Smit, Johannes A. Romijn, and Nienke R. Biermasz
Departments of Endocrinology and Metabolism (J.T., A.M.P., J.W.A.S., J.A.R., N.R.B.) and Medical Psychology (A.A.K.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
* To whom correspondence should be addressed. E-mail:

Context and Objective: Coping strategies may affect quality of life, which is decreased in patients after treatment for Cushing's disease, acromegaly, or nonfunctioning pituitary macroadenomas (NFMA). We aimed to explore coping strategies in these patients because this has never been done before.

Design: We conducted a cross-sectional study.

Subjects: We included patients treated for Cushing's disease (n = 42), for acromegaly (n = 80), and for NFMA (n = 61). These patients were compared with three reference populations: an a-select sample from the Dutch population (n = 712), patients with chronic pain (n = 59), and patients receiving primary care psychology services (n = 525). Furthermore, the three patient groups were compared with each other. Coping strategies were assessed by the Utrecht Coping List.

Results: Compared with the a-select sample, patients with pituitary adenomas reported less active coping (P < 0.0001), sought less social support (P < 0.0001), and reported more avoidant coping (P = 0.008). In contrast, patients treated for pituitary adenomas reported somewhat better coping strategies than patients with chronic pain and those with psychological disease. When patients with different pituitary adenomas were compared, patients treated for Cushing's disease sought more social support than patients treated for NFMA (P = 0.035).

Conclusions: Patients treated for pituitary adenomas display different and less effective coping strategies compared with healthy controls. A targeted intervention might help to stimulate patients to use a more active coping strategy and to seek social support instead of an avoiding coping strategy. This might, in turn, improve their quality of life.


Saturday, January 8, 2011

Symptoms of Addison’s disease

How to tell if your patient is having an acute crisis.

Fred W. Wurster III, AAS, NREMT-P | From the January 2011 Issue and Evolution in Resuscitation Issue

It’s 8:30 on a Tuesday morning, and your crew is responding to an unresponsive 18-year-old male patient. You and your partner are well-seasoned paramedics who have responded to thousands of calls in your careers. Your mobile data computer (MDC) provides further information from the 9-1-1-center that states, “patient is a known diabetic and the patient’s father is attempting to administer oral glucose.”

On arrival, you’re greeted by the patient’s stepmother. She says, “I think it’s his blood sugar.” You’re directed to the third floor of an old farmhouse. After climbing two sets of stairs, you find a male patient partially clothed, lying on the floor and moaning.

As you approach, his father states, “I tried to give him his oral glucose, but I don’t know how much I got him.”

The patient’s room is disheveled with no obvious threats to EMS, and it appears as though the patient may have been out of control or trashing around prior to your arrival. He continues to moan incomprehensibly.

When approached, he moans louder and becomes agitated. You also note that he’s partially covered in feces. After numerous attempts of trying to perform an assessment, the patient becomes more agitated, and you request assistance from the police department.

Patient Assessment
Although no immediate threats are noted, you maintain a safe distance from the patient until the police arrive. His father is able to calm him, so you can make contact. However, the patient still doesn’t communicate with you when questioned during your assessment, and he continues to moan.

The patient can be non-forcefully rolled over onto his back, and you’re able to obtain a baseline set of vital signs, including blood glucose level. The initial set of vital signs are as follows: heart rate is 86, blood pressure is 88/60, respiratory rate is 16, and non-labored, blood glucose level is 113 mg/dL.

His skin is warm, slightly pale and dry, and you note no visible trauma, bleeding or other abnormalities. While questioning the father further, he reports that his son may have overdosed on something because he found a blue liquid-like substance in a coffee cup next to the patient’s bed. The father says he’s unaware of the patient having any history of alcohol or substance abuse, although he believes the patient may occasionally use marijuana and does smoke cigarettes.

On further assessment, you notice a tattoo on the patient’s left forearm. In addition to the patient’s name, the tattoo reads “insulin dependent diabetic, Addison’s disease, no allergies.”

The crew comments about the tattoo having his medical information, and the father reports that because the patient has had many problems with his diabetes while out in public, he feels it was appropriate that the information be tattooed on his son’s arm.

The patient again becomes agitated and aggressive, attempting to bite your partner. With the assistance of the police department, he’s secured in a Reeves stretcher, and you begin to carry him down the stairs. He continues to thrash around, almost uncontrollably, and he almost slides out of the stretcher several times.

Your protocols don’t allow the use of Ativan without verbal orders from a physician, so you make contact with the medical command physician at the hospital to obtain orders to administer it in an attempt to chemically subdue the patient. A report is relayed to the medical command physician, and he authorizes your request to administer 1 milligram of Ativan and orders an additional 1 milligram if needed.

The patient continues to be uncontrollable, and you have two failed attempts at IV access because of the patient’s thrashing around.

You then attempt to administer the Ativan intranasally, and the patient fights you. After several attempts, you decide to switch to the intramuscular route and are successful. After a minute or so, the patient calms down and is resting on the stretcher. At the patient’s father’s request, you transport the patient to a hospital that isn’t the closest.

Prior to departure, the patient’s father says he’s only seen his son act like this one other time he can remember, which was when he was diagnosed with Addison’s. During transport, your continued assessment reveals no major trauma, other than some abrasions on the patient’s shoulders and knees. You also note that he’s extremely thin, but he appears to be healthy and has a bronze hue to his skin.

The patient remains non-verbal and doesn’t respond appropriately when questioned. He appears to drift in and out of consciousness, but he maintains a patent airway.

The patients’ vital signs are reassessed with no changes noted, and an ECG is obtained with no abnormalities or ectopy present. The rhythm is sinus tachycardia at a rate of 118 beats per minute. You repeat a blood glucose test, which reveals a reading of 126mg/dL.

You’re able to successfully establish IV access with an 18-gauge needle and administer a 250 mL bolus of normal saline solution followed by titration to KVO. You also attempt to administer oxygen via numerous devices, but he fights off all efforts.

On arrival at the emergency department (ED), you ask your partner what he knows about Addison’s disease. Neither of you knows anything more than it causes renal insufficiency and that most people who have Addison’s also suffer from insulin-dependent diabetes. Your differential diagnosis is still leading to you think this patient may be suffering from some type of overdose or adverse reaction to an unknown substance.

You transfer the patient to the awaiting nursing staff and attending ED physician. After reporting your findings, assessment, scene and patient presentation, while you’re cleaning up your equipment, the ED physician comes over and asks whether you know that you saved the patient’s life. You and your partner look at each other
in amazement.

You ask him what’s wrong with the patient, and he replies that it’s an acute Addisonian crisis, explaining that the patient was at a critical level and could have potentially suffered irreversible effects. He said it would be several hours before they knew the outcome and that says he’s only seen one case like this in his 17 years of practicing medicine.

You wish the family well and clear the hospital. As you return to the station, you and your partner discuss the dynamics of the call.

Although you are both seasoned paramedics with lots of experience, you agree that you’ve never seen anything like this.

Addison’s Disease
After returning to the station, you contact your medical director and ask for some insight into the disease, its process and how to treat and recognize it should you cross paths with it again. He tells you that Addison’s disease is a rare disorder of the endocrine system caused by a lack of the steroid hormones that are produced by the adrenal glands.

Treatment is exactly what you did: monitor the patient, keep them safe and rapidly transport them to a hospital for definitive care. The disease initially presents subtly and without any real prodrome or awareness until the majority of symptoms present.

The most common symptoms include fatigue, lightheadedness, headache, muscle weakness and pain, fever, weight loss, nausea, vomiting, diarrhea, excessive sweating, sudden changes in mood and personality, excessive craving for salty foods and a bronzed or tanned skin color. Large populations of people with Addison’s disease also suffer from Type I diabetes and require insulin injections.

An acute Addisonian crisis presents when someone previously diagnosed with Addison’s suffers from an infection or traumatic injury or if they suddenly stop taking their glucocorticoids. This may also be how the onset of Addison’s is diagnosed for the first time in some patients.

Symptoms of an acute crisis include severe vomiting and diarrhea resulting in dehydration, hypotension, syncopal episodes leading to unconsciousness, confusion, psychosis, slurred speech, agitation, combativeness, hypoglycemia and seizures.

If untreated or improperly treated, an acute Addisonian crisis can be fatal. These patients require prehospital administration of steroids, such as Hydrocortisone, Prednisone, or Solu-Cortef to replace the missing cortisol.

When you identify someone with a past history of Addison’s who is presenting as this patient did, it’s paramount to protect the patient and rapidly transport them to a hospital for treatment. Remembering the signs and symptoms of Addison’s may make the difference between life and death for these patients especially when they’re in an acute crisis state.

This patient was admitted to the local hospital, was subsequently transferred to a pediatric specialty hospital and was discharged after two weeks.

He had been complaining of cold and flu-like symptoms for a few days prior to our encounter, which may have triggered the acute crisis. JEMS

This article originally appeared in January 2011 JEMS as
“Crisis Averted: Recognize the symptoms of Addison’s disease before they escalate.”


Friday, January 7, 2011

Congratulations to Donna Sellers, Founder of John’s Foundation for Cushing’s Awareness

Cambridge Who’s Who® member Donna Sellers is the founder of John’s Foundation for Cushing’s Awareness (JFCA, Inc.), a nonprofit foundation that raises awareness about Cushing’s syndrome in children. Ms. Sellers became involved in promoting Cushing’s awareness after her son, John, experienced a series of misdiagnoses before pediatricians determined that he had Cushing’s syndrome — a condition that occurs rarely in children. Through her work with JFCA, Inc., Donna Sellers empowers parents to push pediatricians to accurately diagnose children with Cushing’s syndrome by raising awareness of the disease.

Cushing’s syndrome occurs when the body accumulates too much cortisol, which is a hormone produced in the adrenal glands that regulates blood pressure and metabolism. When the body produces too much cortisol, significant changes occur in the body’s tissues and organs. Children diagnosed with the disease experience rapid weight gain accompanied by a decrease in growth rate (linear height). Other problems that may occur include: facial roundness; excess hair growth on the cheeks, arms and legs; development of pubic hair at a younger age than usual; irregular or absent menstrual periods; easy bruising; and, high blood pressure1. An estimated 10 to 15 of every one million people are affected each year, and only about 10 percent of new cases occur in children2.

Six years ago, Ms. Sellers took her son, who was five years old at the time, to his pediatrician because she noticed he weighed substantially more than other children his age. Within weeks after the doctor’s visit, John experienced a rapid weight gain and developed facial and pubic hair that normally develops in children between 10 to 12 years old. After notifying John’s pediatrician of the drastic changes, he underwent additional testing. Through a bone age scan, doctors found that John had the bones of an 8-year-old. They also found a tumor on his left adrenal gland that needed to be surgically removed. After the surgery, John was diagnosed with bipolar disorder, ADHD, OCD, borderline Asperger’s syndrome, and attachment disorder, among others, before his doctors were able to determine he had Cushing’s syndrome.

After enduring the experience of determining what was wrong with John physically, Donna Sellers decided to spread a message to physicians to encourage them to better recognize the symptoms of Cushing’s syndrome in children. She advocates for community education about Cushing’s, and provides support to families who are having their children tested for the condition. “I don’t want another family going through this alone,” Ms. Sellers noted. She continues to write articles about Cushing’s in local newspapers, and has reached out to government officials to sign proclamations for appropriate medical diagnoses in children.

Ms. Sellers home schools her son through the Georgia Cyber Academy, an online public school that offers Georgia students in grades K-12 an exceptional learning experience. The virtual school provides curriculum packages that include high-quality lessons with mastery-based assessments to ensure students achieve success at each and every grade level from elementary through high school. Georgia Cyber Academy accommodates gifted and special needs students who require a more rigorous or customized academic program, and students with health concerns that prevent them from learning in a traditional classroom setting.

To learn more about John’s Foundation for Cushing’s Awareness, or to receive information about Cushing’s syndrome, visit

1-2Keil, Meg (Winter, 2004) “Cushing’s Syndrome in Children” Retrieved November 5, 2010 from Cushing’s Support and Research Foundation website.


New National Drug Code for injective hydrocortisone (September 2010)

It has come to the attention of the PES (Pediatric Endocrine Society) that the National Drug Code (NDC) for injectable hydrocortisone (Solu-Cortef, Pfizer) has changed.  Pharmacies use NDCs when ordering drugs from suppliers, thus if the wrong NDC is used, then the drug is mistakenly believed to be 'discontinued' or 'back-ordered'.  Pharmacies may not be aware of the change in NDC and thus use outdated NDCs when ordering Solu-Cortef from suppliers.  Some families of patients with adrenal insufficiency have reported an inability to obtain the drug from pharmacies despite assurances from Pfizer that the drug is still in production.  Drug can be obtained if the correct NDC is used.

The new NDC numbers for Solu-Cortef are as follows:

Solu-Cortef 100 mg vial (without diluent)                                   NDC 0009-0825-01

Solu-Cortef 100 mg vial as Act-o-vial (w/2mL diluent)           NDC 0009-0011-03

Solu-Cortef 250 mg vial as Act-o-vial (w/2mL diluent)          NDC  0009-0013-05

If your patients have difficulty obtaining Solu-Cortef, please inform the families and local pharmacies about these updated numbers so that it can be ordered correctly.

More drug information is available at:

Drug and Therapeutics Committee