Thursday, January 26, 2012

Expanding treatment options for Cushing's disease

Contact: Karen Honey 
Journal of Clinical Investigation

Expanding treatment options for Cushing disease

Cushing disease is a hormone disorder that causes a diverse array of symptoms, including fat accumulation, high blood pressure, osteoporosis, muscle wasting, and ultimately death. It is caused by a tumor in the anterior pituitary gland that results in the secretion of excess amounts of adrenocorticotropic hormone (ACTH). Treatment options are essentially limited to surgical resection.

However, tumors commonly recur, meaning that new treatment options are needed. A team of researchers, led by Shlomo Melmed, at Cedars-Sinai Medical Center, Los Angeles, has now identified a potential new therapeutic target -- the protein EGFR, which is the target of a drug used to treat some patients with non–small cell lung cancer (gefitinib).

As discussed by Melmed and colleagues in their paper, as well as Frederic Wondisford, at Johns Hopkins University School of Medicine, Baltimore, in an accompanying commentary, the data generated in human, canine, and mouse models provide strong support to investigate the clinical effects of gefitinib in patients with Cushing disease.

TITLE: EGFR as a therapeutic target for human, canine, and mouse ACTH-secreting pituitary adenomas


Shlomo Melmed

Cedars-Sinai Medical Center, Los Angeles, California, USA.

Phone: 310-423-4691; Fax: 310-423-0119; E-mail:

ACCOMPANYING COMMENTARY TITLE: A new medical therapy for Cushing disease?



Fredric E. Wondisford

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Phone: 410-502-5761; Fax 410-502-5779; E-mail:

Signifor: Novartis Drugs Backed by CHMP

By: Zacks Equity Research

Novartis (NVS) recently announced that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) rendered positive opinion for two of its drugs.

First, the CHMP gave a positive opinion to update the label of its marketed drug Gleevec for extended use of adjuvant treatment for three years in patients with KIT (CD117)-positive gastrointestinal stromal tumors (GIST) versus the standard one-year treatment currently approved.

Secondly, the CHMP issued a positive opinion on Novartis’ pipeline candidate Signifor (SOM230) for the treatment of Cushing's disease, for which no medicines are currently available in the European Union (EU).

The positive opinion on Gleevec was based on data from a large phase III trial (n=400) which demonstrated that Gleevec led to significant improvement in both recurrence-free survival and overall survival after three years of adjuvant treatment in patients with KIT (CD117)-positive GIST versus the standard one-year treatment currently approved.

This is the first-ever study demonstrating the survival benefits of longer-term treatment with Gleevec. Novartis is also seeking approval for a Gleevec label update in the US and has been granted priority review by the US Food & Drug Administration (FDA). Besides GIST, Gleevec is currently marketed for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia (Ph+CML).

The Signifor positive opinion was based on data from a phase III trial in which the candidate demonstrated significant efficacy in reducing the level of urinary free cortisol (UFC). In the US, Novartis filed a new drug application (NDA) in June 2011 for Cushing's disease which was subsequently withdrawn due to some problem in the chemistry, manufacturing and controls (CMC) section.

The NDA will be resubmitted following discussion with the FDA. Other than Cushing's disease, Signifor is also being studied for the treatment of acromegaly and carcinoid syndrome in phase III trials.

Earlier this month, Novartis also announced that its drug Lucentis has been approved in China for the treatment of wet age-related macular degeneration (wet AMD). Lucentis is currently marketed for wet AMD as well as visual impairment due to diabetic macular edema (DME) and macular edema following retinal vein occlusion (RVO) in many countries including the US and EU. Novartis’ diabetes drug, Galvus, was also launched in China recently as an add-on to metformin, the standard of care.

Our Recommendation

Currently, we have a Neutral recommendation on Novartis. The company carries a Zacks #3 Rank (Hold rating) in the short run. Though pleased with Novartis’ wide range of products and its efforts to diversify further, as is evident by the acquisition of eye-care company Alcon, we prefer to remain on the sidelines in the long term due to the imminent patent cliff faced by the company.

Read the full analyst report on NVS


Dr. Theodore Friedman's Interviews

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

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

Read Dr. Friedman's First Guest Chat, November 11, 2003
Read Dr. Friedman's Second Guest Chat, March 2, 2004

Listen to Dr. Friedman First Live Voice Interview, January 29, 2009
Listen to Dr. Friedman Second Live Voice Interview, March 12, 2009
Listen to Dr. Friedman Third Live Voice Interview, February 13, 2011.


Wednesday, January 25, 2012

Have You Been Diagnosed With Cushing's? Earn $125 or $250

We invite you to help us create better information, tools, and resources

for people with Cushing’s Syndrome 

  • How: Share your opinions and give input in a one-on-one confidential interview. Your opinions will remain confidential. The overall results will help others with Cushing’s Syndrome.  

  • When: Market research interviews can be conducted by phone or in-person, in a location near you. The interview will last approximately 45 minutes. 

  • If you are interested in a phone interview or in-person interview, please contact Clair Carmichael Johnstone (see details below). More information (including cities and locations for in-person interviews) will be provided on the phone.  

  • Am I Eligible? If you’ve been diagnosed with Cushing’s Syndrome and still experience symptoms of Cushing’s you are eligible to participate. Cushing’s Syndrome includes: Cushing’s Disease, ectopic Cushing’s and adrenal Cushing’s. Patients should have been diagnosed within the last 10 years.  

  • At this time, patients who are in remission, were diagnosed more than 10 years ago, or have had a bilateral adrenalectomy are not eligible for research. 

  • Details: Participants eligible for market research will be asked to participate in the 45-minute interview. Patients participate also receive an honorarium (payment) for your time. Those who participate in an in-person interview will be compensated $250 and those who choose a phone interview will receive $125 for their time. 

  • Why?  Corcept Therapeutics is interested in hearing from people who suffer from Cushing’s Syndrome in order to improve treatment and information available. This can lead to improved education and resources for those with Cushing’s and physicians treating Cushing’s.


How do I find out more?

If you have questions or would like to participate, please contact Clair Carmichael Johnstone at: 

Toll-free number: (800) 856-6706, or



Please provide your name, phone number, and the best times to reach you so we can follow up promptly. 

Friday, January 20, 2012

Novartis drug Signifor® recommended by CHMP for EU approval to treat patients with Cushing's disease

Basel, Switzerland, Jan 20, 2012 (Thomson Reuters ONE via COMTEX) -- Novartis International AG / Novartis drug Signifor® recommended by CHMP for EU approval to treat patients with Cushing's disease . Processed and transmitted by Thomson Reuters ONE. The issuer is solely responsible for the content of this announcement.

- If approved, Signifor (SOM230, pasireotide) would be the first approved medication targeting Cushing's disease[1]

- In clinical trials, pasireotide suppresses overproduction of cortisol caused by an underlying pituitary tumor, a critical factor in controlling the disease[2],[3],[4]

- A debilitating endocrine disorder, Cushing's disease most commonly affects women from 20 to 50 years old[2],[5]

Basel, January 20, 2012 - The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion for Signifor® (SOM230, pasireotide) for the treatment of Cushing's disease. There are currently no approved medicines in the European Union (EU) targeting Cushing's disease, a debilitating endocrine disorder caused by excess cortisol in the body due to the presence of a non-cancerous pituitary tumor[1],[2].

"We are pleased with the decision by the CHMP in support of pasireotide in the European Union," said Herve Hoppenot, President, Novartis Oncology. "We are now one step closer to being able to offer patients in Europe the first approved medical treatment for Cushing's disease."

In the EU, the European Commission generally follows the recommendations of the CHMP and delivers its final decision within three months of the CHMP recommendation. The decision will be applicable to all 27 EU member states plus Iceland and Norway. Pasireotide has orphan drug designation for Cushing's disease, a condition which affects no more than five in 10,000 people in the EU, the threshold for orphan designation[6].

The CHMP positive opinion is based on data from the Phase III PASPORT-CUSHINGS (PASireotide clinical trial PORTfolio - CUSHING'S disease) trial, the largest randomized study to evaluate a medical therapy in patients with Cushing's disease[4].

In the study, patients were randomized to receive pasireotide subcutaneous (sc) injection in doses of 900ug and 600ug twice daily. For the 900ug group, the study met the primary endpoint of normalizing urinary-free cortisol (UFC) levels, the key measure of biochemical control of the disease[4].

Urinary-free cortisol levels were normalized in 26.3% and 14.6% of patients randomized to receive pasireotide 900ug and 600ug twice daily, respectively, at six months of treatment. After 12 months of treatment, results confirmed the durability of the effect. On average, as UFC levels were reduced, clinical manifestations of Cushing's disease improved including reduction of blood pressure, total cholesterol, weight and body mass index[4].

The most frequently reported adverse events (AE) (>10%) by investigators for pasireotide were diarrhea, nausea, hyperglycemia, cholelithiasis, abdominal pain, diabetes mellitus, injection site reactions, fatigue and increased glycosylated hemoglobin (HbA1c), with most events being Grade 1-2. The tolerability profile of pasireotide was similar to that of other somatostatin analogs with the exception of the greater degree of hyperglycemia[4].

About Cushing's disease

Cushing's syndrome is an endocrine disorder caused by excessive cortisol, a vital hormone that regulates metabolism, maintains cardiovascular function and helps the body respond to stress[2]. Cushing's disease is a form of Cushing's syndrome, in which excess cortisol production is triggered by an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma[1]. The first-line and most common treatment approach for Cushing's disease is surgical removal of the tumor[2].

Cushing's disease is a rare but serious disease that affects approximately one to two patients per million per year[7]. It most commonly affects women from 20 to 50 years old[2],[5]. Cushing's disease may present with weight gain, central obesity, moon face, severe fatigue and weakness, striae (purple stretch marks), buffalo hump, depression and anxiety[1],[5].

About pasireotide

Pasireotide, an investigational multireceptor targeting somatostatin analog (SSA), binds with high affinity to four of the five somatostatin receptor subtypes (sst 1, 2, 3 and 5)[1].

For the treatment of Cushing's disease, pasireotide has been studied as a twice-daily subcutaneous (sc) injection and is currently being evaluated as a long-acting release (LAR), once-monthly intramuscular (IM) injection as part of a global Phase III program. Pasireotide LAR is also being studied in three large-scale, global Phase III clinical trial programs: two in patients with acromegaly and one in patients with metastatic carcinoid tumors whose disease-related symptoms are inadequately controlled by somatostatin analogs.

Information about Novartis clinical trials for pasireotide can be obtained by healthcare professionals at .

Important Safety Information about pasireotide

Pasireotide is contraindicated in patients with hypersensitivity to pasireotide or to any of the excipients and in patients with severe liver impairment. Hyperglycemia is commonly reported as an adverse event and elevated glucose was the most frequently reported Grade 3 laboratory abnormality (23.2% of patients) in the Phase III study in Cushing's disease patients. Glycemic status should be assessed prior to starting treatment with pasireotide. Patients need to be monitored for hyperglycemia; if hyperglycemia develops, the initiation or adjustment of antidiabetic treatment is recommended.

Mild transient elevations in AST (aminotransferases) are commonly observed in patients treated with pasireotide. Rare cases of concurrent elevations in ALT (alanine aminotransferase) greater than 3 times the upper limit of normal (ULN) and bilirubin greater than 2 times ULN have also been observed. Patients need to be monitored closely for liver function for the first 3 months and thereafter as clinically indicated. Therapy should be discontinued if the patient develops jaundice, other clinical signs of significant liver dysfunctions, sustained AST or ALT increase 5 times ULN or greater, or if ALT or AST increase 3 times ULN with concurrent bilirubin elevation greater than 2 times ULN.

Patients with cardiac disease and/or risk factors for bradycardia need to be closely monitored. Caution is to be exercised in patients who have or may develop QT prolongation. Hypokalemia or hypomagnesemia must be corrected prior to initiating therapy and monitored thereafter.

Treatment with pasireotide leads to rapid suppression of ACTH (adrenocorticotropic hormone) secretion in Cushing's disease patients. Patients need to be monitored for signs and symptoms of hypocortisolism. Temporary exogenous steroid (glucocorticoid) replacement therapy and/or dose reduction or interruption of pasireotide therapy may be necessary.

Pasireotide should not be used during pregnancy unless clearly necessary. Breast feeding should be discontinued during treatment with pasireotide.

Pasireotide may affect the way other medicines work, and other medicines can affect how pasireotide works. Caution is to be exercised with the concomitant use of drugs with low therapeutic index mainly metabolized by CYP3A4, bromocriptine, cyclosporine, anti-arrhythmic medicines or drugs that may lead to QT prolongation.

The most frequently reported adverse events (AE) (>10%) by investigators for pasireotide were diarrhea, nausea, hyperglycemia, cholelithiasis, abdominal pain, diabetes mellitus, injection site reactions, fatigue and increased glycosylated hemoglobin (HbA1c), with most events being Grade 1-2. The tolerability profile of pasireotide was similar to that of other somatostatin analogs with the exception of the greater degree of hyperglycemia.


The foregoing release contains forward-looking statements that can be identified by terminology such as "would," "will," "being evaluated," "being studied," or similar expressions, or by express or implied discussions regarding potential marketing approvals for pasireotide or regarding potential future revenues from pasireotide. You should not place undue reliance on these statements. Such forward-looking statements reflect the current views of management regarding future events, and involve known and unknown risks, uncertainties and other factors that may cause actual results with pasireotide to be materially different from any future results, performance or achievements expressed or implied by such statements. There can be no guarantee that pasireotide will be approved for sale in any market. Nor can there be any guarantee that pasireotide will achieve any particular levels of revenue in the future. In particular, management's expectations regarding pasireotide could be affected by, among other things, unexpected regulatory actions or delays or government regulation generally; unexpected clinical trial results, including unexpected new clinical data and unexpected additional analysis of existing clinical data; competition in general; government, industry and general public pricing pressures; unexpected manufacturing issues; the company's ability to obtain or maintain patent or other proprietary intellectual property protection; the impact that the foregoing factors could have on the values attributed to the Novartis Group's assets and liabilities as recorded in the Group's consolidated balance sheet, and other risks and factors referred to in Novartis AG's current Form 20-F on file with the US Securities and Exchange Commission. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those anticipated, believed, estimated or expected. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.


About Novartis

Novartis provides innovative healthcare solutions that address the evolving needs of patients and societies. Headquartered in Basel, Switzerland, Novartis offers a diversified portfolio to best meet these needs: innovative medicines, eye care, cost-saving generic pharmaceuticals, preventive vaccines and diagnostic tools, over-the-counter and animal health products. Novartis is the only global company with leading positions in these areas. In 2010, the Group's continuing operations achieved net sales of USD 50.6 billion, while approximately USD 9.1 billion (USD 8.1 billion excluding impairment and amortization charges) was invested in R&D throughout the Group. Novartis Group companies employ approximately 121,000 full-time-equivalent associates and operate in more than 140 countries around the world. For more information, please visit .

Novartis is on Twitter. Sign up to follow @Novartis at .


[1] Pedroncelli A.M. Medical Treatment of Cushing's Disease: Somatostatin Analogues and Pasireotide. Neuroendocrinology. 2010;92 (suppl 1): 120-124.


[2] National Endocrine and Metabolic Diseases Information Service. National Institutes of Health. Cushing's Syndrome. Available at . Accessed December 2011.


[3] Boscaro M., et al. Treatment of Pituitary-Dependent Cushing's Disease with the Multireceptor Ligand Somatostatin Analog Pasireotide (SOM230): A Multicenter, Phase II Trial. J Clin Endocrinol Metab. 2009; 94(1):115-122.


[4] Colao, A. Pasireotide (SOM230) provides clinical benefit in patients with Cushing's disease: results from a large, 12-month, randomized-dose, double-blind, Phase III study. Abstract# OC1.7. European Neuroendocrine Association (ENEA) 14th Congress.


[5] Newell-Price J, et al., The Diagnosis and Differential Diagnosis of Cushing's Syndrome and Pseudo-Cushing's States. Endocrine Reviews. 19(5): 647-672. Available at +html Published 1998. Accessed December 2011.


[6] European Medicines Agency. Committee for Orphan Medicinal Products. Public Summary of Positive Opinion for Orphan Designation of Pasireotide for the treatment of Cushing's Disease. Available at . Accessed December 2011.


[7] Lindholm S., et al. Incidence and Late Prognosis of Cushing's Syndrome: A Population-Based Study. J Clin Endocrinol Metab. 2001; 86 (1): 117-123.


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Novartis Media Relations



Thursday, January 19, 2012

Pregnancy-induced Cushing’s Syndrome: A Case Report


Cushing’s syndrome(CS) during pregnancy is a rare condition with fewer than 150 cases reported in the literature. Adrenal adenomas were found to be the commonest cause.The other causes include tumors in hypothalamus and pituitary. Ectopic ACTH secretion has been reported to cause CS.

There is a very rare condition. Cushing’s syndrome develops in pregnancy and resolving after delivery. The mechanisms underlying these conditions are poorly understood.

There are non-significant differences in the clinical features of pregnant and non-pregnant women with CS.The gestation dramatically affects the maternal hypothalamic-pituitary-adrenal axis, The normal gestational changes in the HPA axis alter these parameters and complicate the screening process for CS.

Comparing with non-pregnant women with CS, the treatment is different in Cushing’s syndrome during pregnancy.

We described here the case of a 25-year-old woman with CS during her forth [sic] pregnancy. Hypertension, diabetes, hypopotassaemia, purple striae and acne are present. Cushing’s syndrome in the patient resolved within four weeks of artificial termination. Eight months after artificial termination, the patient became pregnant again and rapidly developed Cushing’s syndrome with typical clinical symptoms and signs and laboratory results.

Title: Pregnancy-induced Cushing’s Syndrome: A Case Report

Category: Tumor Biology

Filename: Pregnancy-induced Cushing’s Syndrome: A Case Report.pdf

Pages: 101

Price: US$48.00


First potential Prader-Willi treatment among EMA’s orphan recommendations

Ferring’s carbetocin, potentially the first treatment for Prader-Willi syndrome, is among 16 new medicines recommended to receive orphan drug designation in Europe.

The European Medicines Agency’s (EMA) Committee for Orphan Medicinal Products (COMP) said work on carbetocin’s use to treat the rare genetic disorder should be granted development incentives.

Prader-Willi syndrome, which is estimated to affect less than 1 in 5,000 people in the EU, causes a variety of symptoms, including a constant desire to eat food, leading to obesity, impaired function of the gonads, learning difficulties and behavioural problems.

Patients with the disease often have a significantly reduced life span and require lifelong care.

Carbetocin’s recommendation was supported by the European Organisation for Rare Diseases (Eurordis), a European alliance of patient organisations and individuals involved in the promotion of research for rare diseases and development of orphan drugs.

Other treatments to be recommended by the COMP for orphan drug designation, which is granted to products for life-threatening or very serious conditions that affect no more than 5 in 10,000 people in the EU, included Nexus Oncology’s diamidophosphate.

The drug, which is being investigated as a treatment for soft tissue sarcoma, was joined on the list by TMC Pharma Service’s chlormethine for treatment of cutaneous T-cell lymphoma and Laboratoire HRA Pharma’s ketoconazole for treatment of Cushing's syndrome.

Therapies for neglected tropical diseases also featured in the COMP’s recommendations, with Dafra Pharma’s oleylphosphocholine intended to treat leishmaniasis – a disease caused by sand fly parasites that is estimated to cause as many as 50,000 deaths per year.

The EMA said that orphan medicine incentives can be also used to support the development of treatments for similar neglected diseases, which would not be developed under normal market conditions.

All the COMP’s recommendations are now with the European Commission, which will make the final decision on each drug.

The full list of EMA orphan drug recommendations


Treatment Options in Cushing’s Disease

Download PDF


Authors: Ahmed Rizk, Juergen Honegger, Monika Milian and Tsambika Psaras

Publication Date: 11 Jan 2012

Journal: Clinical Medicine Insights: Oncology

Citation: Clinical Medicine Insights: Oncology 2012:6 75-84

doi: 10.4137/CMO.S6198



Endogenous Cushing’s syndrome is a grave disease that requires a multidisciplinary and individualized treatment approach for each patient. Approximately 80% of all patients harbour a corticotroph pituitary adenoma (Cushing’s disease) with excessive secretion of adrenocorticotropin-hormone (ACTH) and, consecutively, cortisol.

The goals of treatment include normalization of hormone excess, long-term disease control and the reversal of comorbidities caused by the underlying pathology. The treatment of choice is neurosurgical tumour removal of the pituitary adenoma. Second-line treatments include medical therapy, bilateral adrenalectomy and radiation therapy.

Drug treatment modalities target at the hypothalamic/pituitary level, the adrenal gland and at the glucocorticoid receptor level and are commonly used in patients in whom surgery has failed.

Bilateral adrenalectomy is the second-line treatment for persistent hypercortisolism that offers immediate control of hypercortisolism. However, this treatment option requires a careful individualized evaluation, since it has the disadvantage of permanent hypoadrenalism which requires lifelong glucocorticoid and mineralocorticoid replacement therapy and bears the risk of developing Nelson’s syndrome.

Although there are some very promising medical therapy options it clearly remains a second-line treatment option. However, there are numerous circumstances where medical management of CD is indicated.

Medical therapy is frequently used in cases with severe hypercortisolism before surgery in order to control the metabolic effects and help reduce the anestesiological risk. Additionally, it can help to bridge the time gap until radiotherapy takes effect.

The aim of this review is to analyze and present current treatment options in Cushing’s disease.



Healthy New Year Video Challenge

$5,000 in prizes!


Let’s get the new year off to a healthy start! The Office of the National Coordinator for Health Information Technology (ONC) Healthy New Year Video Challenge (#HealthIT4U2012) invites you to create a short, compelling video (up to 2 minutes in length) sharing one New Year’s resolution for improving your health or the health of a loved one, and how you will use technology to achieve your resolution. 

We encourage you to create videos that are creative, inspiring and instructive — share a resolution that others can relate to, and demonstrate how technology will make it easier to achieve. Your resolution can be anything health related, such as quitting smoking or drinking, eating healthier, losing weight, reducing stress, or managing a chronic condition. Videos must show how you will use information technology to achieve your resolution and how you plan to maintain it. Entries could include the following kinds of resolutions (these are just examples — be creative and craft your own resolution!):

  • I will set up an online personal health record for myself (or another family member) so I can have all of my health information conveniently stored in one place.
  • I will ask my doctor for a copy of my own health records — electronically if available — and help him or her to identify any important information that may be missing or need to be corrected.
  • I will find an online community that helps me figure out the best ways to manage my health condition (depression, cancer, diabetes, etc.)
  • I will use an electronic pedometer to help me track my physical activity and will try to take 10,000 steps per day.
  • I will find an app on my smartphone to help me track my food intake so I can lose 10 pounds by my high school reunion.
  • I will sign up for a text reminder program on my cell phone to help me stop smoking or remind me to take my medications on time.

The goal of the challenge is to make 2012 a healthier year by motivating and inspiring others to use health information technology to be more engaged in improving health and increasing adoption of consumer health technology.

Note: To participate, you must be a citizen or permanent resident of the United States. Team members must be at least 18, but your video can include minors under 18 as long as a parent or legal guardian signs their consent forms. For details on eligibility, review the Official Rules.

More at http://healthynewyea...v/details/about

GH replacement therapy associated with development of diabetes

Posted on

Luger A. Diabetes Care. 2012;35:57-62.


The incidence of diabetes was increased in patients with growth hormone deficiency who were on growth hormone replacement therapy, according to researchers in Europe.

The researchers selected patients from KIMS — Pfizer International Metabolic Database. Patients were selected if they had severe adult-onset GH deficiency that was confirmed with a GH stimulatory test and naive to GH treatment. Patients with a history of Cushing’s disease or acromegaly or with diabetes at baseline were excluded.


The study included data from 5,143 patients. Plasma glucose, HbA1c values, lipid and insulin-like growth factor I concentrations and serum IGF-I measurements were obtained.

Five hundred twenty-three patients developed diabetes after a median of 1.7 years. Patients who developed diabetes were older, had higher BMI, waist circumference, waist-to-hip ratio and triglyceride concentrations. They also had higher systolic and diastolic blood pressure and lower HDL cholesterol.

The incidence of diabetes was 2.6/100 patient-years, decreasing from 4.1/100 patient-years during the first year of GH replacement therapy to 1/100 patient-years after more than 8 years of treatment. The overall observed cases/expected cases ratio was 6, decreasing from 10.8 in the first year of treatment to 1.9 after 8 or more years of treatment.

Sex, BMI, attained age during follow-up, years between pituitary diagnosis and GH treatment start and years since first treatment were significantly associated with diabetes occurrence. There was no significant association with GH dose. In patients who did not develop diabetes, plasma glucose concentrations increased from 84.4 mg/dL to 89.5 mg/dL, and HbA1c levels increased from 4.74% to 5.09% after 6 years of treatment.

“Despite widely demonstrated benefits of growth hormone replacement treatment in adult growth hormone deficiency, a marked increase in the risk of developing diabetes must be considered,” the researchers wrote. “All patients, but particularly those with an adverse risk profile, should be carefully followed regarding parameters of glucose metabolism.”




Tuesday, January 10, 2012

(Adrenal Cushing's) Tumour behind 7-yr-old's weight gain, moustache

By: Priyanka Vora   Date: 2012-01-03   Place: Mumbai


Tanzania resident Mohammad Abdulrazaq Jussa recuperating after city doctors removed 7-cm tumour from his adrenaline [sic] gland, which was responsible for his 12-kg weight gain, growth of facial hair

Painful and embarrassing stories about one's childhood years, when inexplicable physical changes take place, are not uncommon. But for Mohammad Abdulrazaq Jussa, a resident of Tanzania, it wasn't just ordinarily painful. The seven-year-old was harbouring a tumour in his adrenaline [sic] gland, causing him to suddenly gain 12 kg in a year, and develop a pencil moustache, much to the amusement of his classmates.

Growing pains: Mohammad at age six weighed 25 kg but suddenly his 
weight shot up to 37 kg without any explanation. Doctors are now hoping 
that after the removal of the tumour, the physical changes will regress.


The tumour was discovered last year when the boy suddenly started becoming fatter and started growing facial hair. "We had to start buying bigger clothes for him. Initially, my son was thin and active but suddenly, he began growing at a considerable pace.

"He would keep complaining to me about stomach pains but I thought it was just an excuse to miss school and the taunts he received from his friends. Now I regret not paying heed to his cries for help," said Bilkis, Mohammad's mother.

When the weight gain did not stop and he had put on about 12 kg, Mohammad's family sensed something was amiss and took him to doctors in Tanzania.

"The doctors we consulted at first told us that we should restrict his diet but when we told them that there was no change in his diet, doctors started investigating further. We even went to Jerusalem where physicians finally diagnosed that he had a tumour in his adrenaline gland. Seeking treatment for our son, we finally reached Mumbai," added Bilkis.

What doctors found

After the family finally reached city shores a week back, doctors at Saifee Hospital started treatment.

According to Mohammad's doctors, a tumour had grown inside his left adrenaline gland, causing the excess release of hormones resulting in weight gain. Doctors say that Mohammad is suffering from Cushing's syndrome

Under the knife

On Thursday, Mohammad underwent a laparoscopic surgery to remove the tumour, which was seven-cm long and weighed approximately 450 g.

"Mohammad's case was a challenging surgery as he is just seven and at the same time the tumour was as big as his kidney. As we did the surgery laparoscopically, there was no blood loss, giving us excellent post-operative results," said Dr Anup Ramani, uro-oncological surgeon at Saifee Hospital.

'Hoping for normalcy'

Now recuperating at the hospital, Mohammad and his family hope the boy starts looking his age again. Commenting on the changes, Bilkis said, "He was really active before but once he started putting on weight, he started becoming introverted and his studies were also affected. I now pray that everything returns to normal."

When asked about the pace of growth, Dr Ramani said most physical changes would regress in a year's time. "We have put him on a dose of steroids to compensate for the growth spurts he has experienced and hope that all the changes regress."

Cushing's syndrome

Cushing's syndrome is a hormone disorder caused by high levels of cortisol in the blood. This can be caused by taking glucocorticoid drugs, or by tumours that produce cortisol. Cushing's disease refers to one specific cause of the syndrome: a tumour in the pituitary gland that elevates cortisol.



Wednesday, January 4, 2012

What is the best long-term management strategy for patients with primary adrenal insufficiency?

Authors: Quinkler, Marcus1; Hahner, Stefanie2

Source: Clinical Endocrinology, Volume 76, Number 1, 1 January 2012 , pp. 21-25(5)

Publisher: Wiley-Blackwell

Abstract Summary

Primary adrenal insufficiency is treated with glucocorticoid and mineralocorticoid replacement therapy. Recent data revealed that health-related quality of life in adrenal insufficiency is impaired in many patients and that patients with adrenal insufficiency are also threatened by an increased mortality and morbidity. This may be caused by inadequate glucocortiocid therapy and adrenal crisis. Therefore, the optimization of hormone replacement therapy remains one of the most challenging tasks in endocrinology because it is largely based on clinical grounds because of the lack of objective assessment tools.

This article provides answers to the important daily clinical questions, such as correct dose finding, dose adaptation in special situations, e g, pregnancy, improvement of quality of life and measures for protection from adrenal crisis. Other important aspects discussed are side effects of glucocortiocid replacement therapy and interactions with other drugs.

Document Type: Research article


Affiliations: 1: Clinical Endocrinology, Charité Campus Mitte, Charité University Medicine Berlin, Berlin 2: Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany

Publication date: 2012-01-01


Synchronous bilateral adrenalectomy by midline incision: A reliable method for treatment of hypercortisolism

Sayyed Abbas Tabatabaee, Sayyed Mozaffar Hashemi, Mohamadreza Fazel Najafabadi, Amirhossein Davarpanah Jazi


  • Cushing syndrome is one of the diseases associated with adrenals secreting too much cortisol. The syndrome was first described by Harvey Cushing in 1932.1 It can be caused either by a tumor originating from the corticotroph cells located in pituitary glands, called corticotroph adenoma, or primary adrenal hyperplasia. It can be also the consequence of some other rare conditions such as ectopic corticotropin-releasing hormone (CRH) causing increased adrenocorticotropic (ACTH) secretion and macronodular adrenal hyperplasia (a primary pigmented nodular adrenal disease).2,3 To manage the situation, previous articles demonstrated some strategies including two main groups of surgical treatments and non-surgical procedures.

    Surgical interventions are very important to completely cure this condition. Pituitary surgery, referred to as transsphenoidal operation, is the treatment of choice for patients with secondary disease.2 However, in some situations, e.g. in patients with recurrent or persistent Cushing syndrome and those not responding to medical therapies after the surgery, the effectiveness of pituitary surgery is under question. Such patients are the best candidates for bilateral adrenalectomy. Some previous articles outlined this method.4 Laparoscopy is one of the methods recently used for adrenalectomy. During the surgery, some complications may occur which deteriorates patient's condition with noticeable rates of 9.5 to 12%. These complications are bleeding, organ damages, pain and deep vein thrombosis.7,8

    Although in recent years the experts have achieved great improvements in management and treatment of the patients suffering from Cushing syndrome, some controversies still exist. In this manuscript, we explained a new method to accomplish a reliable bilateral adrenalectomy to manage the disease and cure the condition completely.

    After opening the abdomen, left adrenal gland is determined and adjacent vessels are ligated. Then, the enlarged adrenal gland would be entirely removed. However, adrenalectomy at the right side is not as simple as the left side. Renal vein detachment from the inferior vena cava can be a serious complication of right adrenalectomy if it is performed without enough exposure and experience. Massive bleeding in such clinical setting may significantly compromise patient's outcome. To avoid this complication during the procedure we can perform a new method explained below.
    Access to the right gland cannot be obtained by conventional retraction of the liver and it is necessary to mobilize the right hepatic lobe by fully incising the falciform ligament, the right triangular ligament, and rotating the right lobe medially. In this procedure, the bare area of the liver is dissected from the diaphragm. Care must be taken to avoid twisting and occluding the vena cava during this maneuver. After medial rotation of the liver in the proper position, the right adrenal and inferior vena cava can be directly visualized. This excellent exposure makes adrenalectomy very simple and minimizes the risk for renal vein detachment as a significant complication.

    This method was conducted on 6 cases admitted due to Cushing syndrome in Alzahra Hospital, Isfahan, Iran. While no major complications were observed, favorable outcomes were found in the 6-month follow-up period.

    Based on our experience, bilateral adrenalectomy via a midline incision is a promising and acceptable technique for patients with Cushing syndrome. However, due to excess adipose tissue and lack of enough exposure, adrenalectomy by lumbotomy in such patients has prominent limitations. Therefore, midline incision provides feasible exposure for direct visualization of both adrenals.

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Monday, January 2, 2012

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.


Disturbances of the hypothalamic-pituitary-adrenal axis and plasma electrolytes during experimental sepsis.

Michael A Flierl, Daniel Rittirsch, Sebastian Weckbach, Markus Huber-Lang, Kyros Ipaktchi, Peter A Ward and Philip F Stahel


Annals of Intensive Care 2011, 1:53 doi:10.1186/2110-5820-1-53

Published: 30 December 2011



Sepsis continues to be a poorly understood syndrome with a high mortality rate. While we are beginning to decipher the intricate interplay of the inflammatory response during sepsis, the precise regulation of the hypothalamic-pituitary-adrenal (HPA) axis and its impact on electrolyte homeostasis during sepsis remains incompletely understood.


Sepsis was induced in adult male Sprague-Dawley rats by cecal ligation and puncture (CLP). Plasma samples were obtained as a function of time (6-48 hrs) after CLP and compared to healthy animals (neg ctrl). Samples were analyzed for adrenocorticotropin (ACTH), corticosterone, and aldosterone levels as well as concentrations of sodium (Na+), potassium (K+), chloride (Cl-) and magnesium (Mg2+).


ACTH levels were found to be significantly reduced 6-24 hrs after CLP in comparison to baseline levels and displayed gradual recovery during the later course (24-48 hrs) of sepsis. Plasma corticosterone concentrations exhibited a bell-shaped response, peaking between 6 and 12 hrs followed by rapid decline and concentrations below negative control levels 48 hrs after injury. Aldosterone levels in septic animals were continuously elevated between 6 and 48 hrs. While plasma Na+ levels were found to be persistently elevated following CLP, levels of K+, Cl- and Mg2+ were significantly reduced as a function of time and gradually recovered during the later course of sepsis.


CLP-induced sepsis resulted in dynamic changes of ACTH, corticosterone and aldosterone levels. In addition, electrolyte levels showed significant disturbances following CLP. These electrolyte perturbations might be evoked by a downstream effect or a dysfunctional HPA-axis response during sepsis and contribute to severe complications during sepsis.


The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.



We have been Nominated for a Health Activist Hero 2011!

We were nominated for a wego Health Activist Hero 2011 award!


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Our Health Activist Awards program will award Health Activists for their outstanding achievements in online health leadership and advocacy in 2011.

Health Activist Hero 2011

 Who has changed your life? There are some people who can truly change your entire outlook on life just with their story, their dedication, their words, and their encouragement. Who is your Health Activist Hero? Who would you like to thank and why? For so many Health Activists, impacting the life of just one reader is worth more than 1,000s of page views. This award is an emotional one but will yield some incredible stories. 

Do you know a Health Activist who has changed your life, your condition, or your Health Activism?  Thank them by recognizing them as a Health Activist Hero!

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Award: Health Activist Hero (  


Reason: If it wasn't for MaryO's hard work in creating an online community I don't know if I'd have made it through all these years. She's a behind the scenes kind of person, she doesn't ask for much and often winds up on the periphery but despite her own health challenges she gives and gives and gives and has helped thousands of people.



Sunday, January 1, 2012

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. 


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.


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. 


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. 


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.’ 


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.