(doi:10.3109/09513590.2012.683057)
Francesco Ferraù1, Marco Losa2, Oana Ruxandra Cotta1, Maria Luisa Torre1, Marta Ragonese1, Francesco Trimarchi1, Salvatore Cannavò1
1Department of Medicine and Pharmacology, Section of Endocrinology, University of Messina, Messina, Italy
2Department of Neurosurgery, Istituto Scientifico San Raffaele, Milan, Italy
Correspondence: Francesco Ferraù, MD, Department of Medicine and Pharmacology, Section of Endocrinology, University of Messina, AOU Policlinico “G. Martino” (Pad. H, floor 4), Via Consolare Valeria 1, 98125 Messina, Italy. Tel: +39 090 2213507. Fax: +39 090 2213945. E-mail: ferrau1@interfree.it
Data concerning pregnancy in women with Cushing’s disease treated by gamma-knife (GK) are scanty. We present and discuss the course and outcome of five pregnancies in two women with Cushing’s disease (CD), the first of whom was treated only by GK, and the second one treated by surgery, GK and ketoconazole.
In the first patient, pregnancy was uneventful and full-term. During gestation, plasma ACTH, serum cortisol and 24-h urinary free cortisol (UFC) levels were steady, and always in the normal range for healthy non-pregnant individuals. The newborn was healthy and normal-weight.
In the second woman, two pregnancies, occurring 3 years after GK and few months after ketoconazole withdrawal, were interrupted by spontaneous abortion or placental disruption despite normal cortisol levels. This patient became again pregnant 3 years later and delivered vaginally a healthy full-term infant.
Seven months after the delivery, the patient became pregnant again and at the 39th week of gestation delivered vaginally a healthy male. Hypoprolactinemia and/or central hypothyroidism occurred in both cases. In women with CD treated by GK, pregnancy can occur. However, pregnancy is at risk even when ACTH and cortisol levels are normalized by treatment. After GK, evaluation of pituitary function is mandatory due to the risk of hypopituitarism.
Read More: http://informahealthcare.com/doi/abs/10.3109/09513590.2012.683057
Roberto Franceschi 
Italian Journal of Pediatrics 2011, 37:15doi:10.1186/1824-7288-37-15
| Published: | 7 April 2011 |
Objective and Importance: despite recent progress in imaging, it is still difficult to distinguish between pituitary adenoma and hyperplasia, even using Magnetic Resonance Imaging (MRI) with gadolinium injection. We describe an example of reactive pituitary hyperplasia from primary hypothyroidism that mimicked a pituitary macroadenoma in a child.
Clinical Presentation: a 10 year old boy presented with headache and statural growth arrest. MRI revealed an intrasellar and suprasellar pituitary mass. Endocrine evaluation revealed primary hypothyroidism.
Intervention: the patient was started on levothyroxine with resolution of the mass effect.
Conclusion: primary hypothyroidism should be considered in the differential diagnosis of solid mass lesions of the pituitary gland. Examination of thyroid function in patients with sellar and suprasellar masses revealed by MRI may avoid unnecessary operations which can cause irreversible complications.
Nov 1, 2010 11:39 AM | By Nicole Sparrow, Longevity Magazine
You’ve tried every diet in the book and failed. What’s stopping you from dropping the superfluous kilos?
It seems like every time you turn around, there’s a new diet on the block. Low fat, low carbs, low GL. Baffled? We don’t blame you. As it turns out, weight loss is a complex science and there’s a lot we still don’t know. But, the good news is scientists are definitely getting better at cracking the fat riddle.
Diet traps
‘HEALTHY’ DOESN’T MEAN LOW-KJ
You think you’re a healthy eater. Your morning meal is a healthy fruit and yoghurt smoothie followed by oats and honey with wholewheat toast. So how come you’re still putting on weight? You could be falling for the “healthy food” trap. You pop into a local healthy fast-food chain. You opt for the healthy sarmie with hummus on low-GI bread, you not only eat the whole sandwich, but decide to have a smoothie, too. Unfortunately, while this is a nutritious choice it’s still a whopper when it comes to your waistline. Ultimately a kilojoule is still a kilojoule and if you eat too much, regardless of whether it’s healthy, you’ll gain weight.
THE SLOW METABOLISM MYTH
Loads of people complain that they can’t lose weight because of a slow metabolism. There’s no easy way to break this to you so we’re just going to be blunt: there’s a good chance you don’t. Dr Donald Hensrud from The Mayo Clinic in the US, says that yes, there is such a thing as a slow metabolism, but “it’s rare, and it’s usually not what’s behind being overweight”. In fact, he notes that overweight people are likely to have a higher metabolism than their thinner counterparts because bigger people burn more kilojoules, even at rest. If you are convinced you have a slow metabolism, he advises you talk to your doctor about doing medical tests to establish whether this is the case. Certain medication or rare conditions like Cushing’s syndrome and hypothyroidism can slow down your metabolic rate.
UNDERESTIMATING YOUR KILOJOULE CONSUMPTION
“Researchers have observed that overweight people underestimate how much they eat by twice as much as normal-weight people do,” say experts at Cornell University in the US. “It is because everyone consistently underestimates size as things get larger – distance, weight, height of buildings and loudness. And that applies to estimating how many calories [kilojoules] we eat.” The answer then, is to eat smaller meals. And while we hear a collective “duh” from your direction, Cornell University experts maintain that the smaller your meal, the better you become at accurately predicting its kilojoule content.
Top tips on getting the upper hand
EAT SOUP
You know how you’ve been advised to drink a glass of water before a meal, the idea being that you’ll feel fuller quicker and therefore eat less? This is only right in part. Taking in liquid with your food will make you full faster, but it won’t last for very long, unless you blend it all together. If you eat soup, your stomach stays distended for longer (i.e. you feel full) and keeps a dieter’s enemy – those frustrating hunger pangs – at bay. A great tip is to opt for low-kilojoule, veggie-based soups as these are also a good source of fibre and nutrients.
GET ENOUGH CALCIUM
For ages people watching their weight were encouraged to avoid dairy based on the fear that it would make them gain weight. However, in 2000, findings from the University of Tennessee’s Nutrition Institute suggested that eating calcium could make your body better at burning fat. In a study of overweight lab mice, the team found that those who ate dairy calcium lost more weight. Later studies have confirmed these findings in humans and have also established that while calcium supplements also work, for some reason dairy calcium is more effective.
WATCH YOUR PORTION SIZE
Remember the popcorn containers at the movies when you were a kid? They didn’t just seem smaller – they were. Over the years portion sizes have become bigger and so have our waistlines. Even food portions in Da Vinci’s masterpiece, The Last Supper, have been super-sized over the years. And when it comes to that primitive, Homer Simpsonesque “must eat food” part of our brains, we simply haven’t figured this out, so portions get bigger and we continue to eat more. To lose weight and keep it off, you need to wise up to this and opt for smaller portions or plates.
EAT PROTEIN
Advocates of diets like Atkins maintain eating protein helps you feel full for longer and we’ve now established why: it’s all down to peptide YY (PYY), a hungerfighting hormone. Protein is better than other foods at triggering the release of PYY. Eating protein at meals will help keep those gnawing hunger pangs at bay for longer. Not only that, but other research has found that if weight loss is your goal, eating protein helps you lose more weight and keep it off longer.
From http://www.timeslive.co.za/lifestyle/article737846.ece/The-new-diet-rules
Paola Fierabracci, Aldo Pinchera, Silvia Martinelli, Giovanna Scartabelli, Guido Salvetti, Monica Giannetti, Andrea Pucci, Giulia Galli, Ilaria Ricco and Giorgia Querci, et al.
Bariatric surgery allows stable body weight reduction in morbidly obese patients. In presurgical evaluation, obesity-related co-morbidities must be considered, and a multidisciplinary approach is recommended. Precise guidelines concerning the endocrinological evaluation to be performed before surgery are not available. The aim of this study was to evaluate the prevalence of common endocrine diseases in a series of obese patients scheduled for bariatric surgery.
We examined 783 consecutive obese subjects (174 males and 609 females) aged 18–65 years, who turned to the obesity centre of our department from January 2004 to December 2007 for evaluation before bariatric surgery. Thyroid, parathyroid, adrenal and pituitary function was evaluated by measurement of serum hormones. Specific imaging or supplementary diagnostic tests were performed when indicated.
The overall prevalence of endocrine diseases, not including type 2 diabetes mellitus, was 47.4%. The prevalence of primary hypothyroidism was 18.1%; pituitary disease was observed in 1.9%, Cushing syndrome in 0.8%, while other diseases were found in less than 1% of subjects. Remarkably, the prevalence of newly diagnosed endocrine disorders was 16.3%.
A careful endocrinological evaluation of obese subjects scheduled for bariatric surgery may reveal undiagnosed dysfunctions that require specific therapy and/or contraindicate the surgical treatment in a substantial proportion of patients. These results may help to define the extent of the endocrinological screening to be performed in obese patients undergoing bariatric surgery.
Keywords Bariatric surgery - Obese patients - Endocrinological evaluation
Monday, August 02, 2010
Over 20 million children under the age of five are overweight, indicate latest WHO statistics. Obesity is on the rise and has reached epidemic proportions in the world. About twenty percent of children are either overweight or obese.
The Body Mass Index (BMI) estimates the ideal weight of a person based on his size and weight. It is valid for an adult man or woman (18 to 65 years). Doctors often use it to measure obesity. BMI is equal to a person's weight in kilograms (kg) divided by his height in meters (m) squared. Adults with a BMI of 30 or higher are considered obese. But those having a BMI of 40 or more are extremely obese.
It's a common belief that eating too much and exercising too little is the main cause of gaining weight. But this is not true all the time. It is my personal observation that some people eat a lot but they do not gain weight. They are quite healthy, slim and smart. And there are many who take very little food, but they are overweight. You may also have observed the same.
There is another set of people who eat a lot but keep losing weight. It shows there are other factors involved in obesity rather than the eating habit alone.
Genes play a great role in tendencies to gain weight or lose weight. There may be more chances to develop obesity if one or both parents are obese. Some studies have shown that certain drugs, such as steroids, antidepressants, high blood pressure, medications used to lower blood sugar such as insulin may cause excessive weight gain.
For some people, emotions influence their eating habits. Many people eat excessively in response to boredom, sadness, stress or anger. While most overweight people have no more psychological disturbances than normal weight people, about 30 percent of the people who seek treatment for serious weight problems have difficulties with binge eating. Diseases such as hypothyroidism, insulin resistance, polycystic ovary syndrome and Cushing's syndrome also contribute to obesity.
Women tend to be more overweight than men. Men burn more energy at rest than women, so men require more calories to maintain their body weight. The metabolic rate decreases in women when they reach the postmenopausal age. That is partly why many women gain weight after menopause.
Obesity is not just a cosmetic consideration. It is widely known that obesity is the fertile land for disease. Health problems start when someone starts getting overweight, and the likelihood of problems increases as someone becomes more and more overweight. Many of these conditions cause long-term suffering for individuals and families such as cardiovascular disease, type 2 diabetes, osteoarthritis (degenerative arthritis) of the knees, hips, and the lower back.
A very interesting Norwegian study showed that obesity tended to increase blood pressure more significantly in women than in men. The risk of developing high blood pressure is also higher in obese people who are apple shaped (central obesity) than in people who are pear shaped (fat distribution mainly in hips and thighs).
There are a lot of treatments available in the market for obesity. But almost all of them are associated with serious side effects and toxicity except homeopathy. Homeopathy is a time tested, proven method to cure obesity. The writer has also seen amazing results in treating obesity in the patients who were determined and followed the instructions carefully.
International research shows that homeopathic medicines are extremely effective in reducing weight by improving the metabolic system, digestive system and elementary system.
Homeopathy is the fastest growing system of medicine in the world. There is wider acceptance of homeopathy in such countries as France, Germany, Mexico, Argentina, India and Great Britain. The British royal family is patronizing the Royal London Homoeopathic Hospital for the last one hundred years and prefer taking homeopathic treatment when needed.
It is not necessary to achieve an 'ideal weight' to derive health benefits from obesity treatment. Instead, the goal of treatment should be to reach and hold to a 'healthier weight.' The emphasis of treatment should be to commit to the process of life-long healthy living including eating more wisely and increasing physical activity. In sum, the goal in dealing with obesity is to achieve and maintain a 'healthier weight.'
Dr. Asghar Ali Shah
Homeopathic Physician
European Journal of Endocrinology (2009) In press
DOI: 10.1530/EJE-09-0884
Copyright © 2009 by European Society of Endocrinology
Stefanie Hahner, Melanie Loeffler, Benjamin Bleicken, Christiane Drechsler, Danijela Milovanovic, Martin Fassnacht, Manfred Ventz, Marcus Quinkler and Bruno Allolio
S Hahner, Endocrinology and Diabetes Unit, University of Wuerzburg, Wuerzburg, D-97080 , Germany
M Loeffler, University of Wuerzburg, Endocrinology and Diabetes Unit, Würzburg, Germany
B Bleicken, Dept. of Medicine I, University of Wuerzburg, Würzburg, Germany
C Drechsler, Dept. of Nephrology, University of Würzburg, Würzburg, Germany
D Milovanovic, University of Wuerzburg, Endocrinology and Diabetes Unit, Würzburg, Germany
M Fassnacht, Dept. of Medicine I, University of Würzburg, Würzburg, Germany
M Ventz, Dept. of Medicine I, University of Wuerzburg, Würzburg, Germany
M Quinkler, Dept. of Medicine I, University of Wuerzburg, Würzburg, Germany
B Allolio, University of Wuerzburg, Endocrinology and Diabetes Unit, Würzburg, Germany
Correspondence: Stefanie Hahner, Email: hahner_s@medizin.uni-wuerzburg.de
Objective: Adrenal crisis (AC) is a life-threatening complication of adrenal insufficiency (AI). Here we evaluated frequency, causes and risk factors of AC in patients with chronic AI.
Methods: In a cross-sectional study 883 patients with AI were contacted by mail. 526 patients agreed to participate and received a disease specific questionnaire.
Results: 444 data sets were available for analysis (primary adrenal insufficiency, PAI n=254, secondary adrenal insufficiency, SAI n=190). 42% (PAI 47%, SAI 35%) reported at least one crisis. 384 AC in 6092 patient years were documented (frequency of 6.3 crises/100 patient years). Precipitating causes were mainly gastrointestinal infection and fever (45%) but also other stressful events (e.g. major pain, surgery, psychic distress, heat, pregnancy). Sudden onset of apparently unexplained AC was also reported (PAI 6.6%, SAI 12.7%). Patients with PAI reported more frequent emergency glucocorticoid administration (42.5% vs 28.4%, p=0.003)) Crisis incidence was not influenced by educational status, BMI, glucocorticoid dose, DHEA treatment, age at diagnosis, hypogonadism, hypothyroidism or growth hormone deficiency. In PAI, patients with concomitant non-endocrine disease were at higher risk of crisis (OR=2.02, 95% CI 1.05-3.89, p=0.036). In SAI, female sex (OR=2.18, 95%CI 1.06-4.5, p=0.035) and diabetes insipidus (RR=2.71, 95%CI 1.22-5.99, p=0.014) were associated with higher crisis incidence.
Conclusion: AC occurs in a substantial proportion of patients with chronic AI, mainly triggered by infectious disease. Only a limited number of risk factors suitable for targeting prevention of AC were identified. These findings indicate the need for new concepts of crisis prevention in patients with AI.
Helena Filipsson and Gudmundur Johannsson
H Filipsson, Endocrinology, Göteborg, Sweden
G Johannsson, Endocrinology, Medicin, Gothenburg, SE-413 45, Sweden
Correspondence: Gudmundur Johannsson, Email: gudmundur.johannsson@gu.se
Severe growth hormone deficiency (GHD) in adults has been described as a clinical entity. Some of the features associated with GHD could, however, be due to unphysiological and inadequate replacement of other pituitary hormone deficiencies. This may be true for glucocorticoid replacement that lacks a biomarker making dose titration and monitoring difficult.
Moreover, oral oestrogen replacement therapy decreases insulin growth factor 1 (IGF-I) levels compared to transdermal route, which attenuates the responsiveness to GH replacement therapy in women. In addition, in untreated female hypogonadism, oral oestrogen may augment the features associated with GHD in adult women. Important interactions between the hormones used for replacing pituitary hormone deficiency occur. Introducing GH replacement may unmask both an incipient adrenal insufficiency and central hypothyroidism.
Therefore, awareness and proper monitoring of these hormonal interactions are important in order to reach an optimal replacement therapy. This review will focus on the complex hormonal interactions between GH and other pituitary hormones in GHD and in GH replacement.
From http://www.eje.org/cgi/content/abstract/EJE-09-0319v1
Q. I am a third-year medical student doing a rotation in endocrinology. A patient I saw recently has type 2 diabetes, absence of menses, high cholesterol, hypothyroid, hypertension and obesity (especially in the upper body). She was tested for Cushing's, which showed a slightly elevated level of cortisol, but it was within normal range. Is it possible to have Cushing's if the level is still within normal range? What are other indicators of this disease? Are there other diagnoses to consider?
A.There are two parts to the diagnosis of Cushing's syndrome: an increased cortisol production and a failure to suppress endogenous cortisol secretion when dexamethasone is administered. Indicators appear in the physical examination (muscle weakness, cutaneous striae, bruising, moon facies, buffalo hump, truncal obesity) and the lab (osteoporosis, hypokalemia, hypochloremia, metabolic alkalosis). Since your patient has a normal cortisol level, however, Cushing's would be extremely unlikely.
Whenever you are confronted with a patient with multiple problems, it is nice to find a single diagnosis to explain all the findings. This will not usually happen, though. In this case many possible combinations of diseases might be suggested. For example, the diabetes, hypercholesterolemia, hypertension and obesity mean the patient might have Syndrome X. Also, hypothyroidism is often associated with amenorrhea. So it may be the patient has two problems (hypothyroidism and Syndrome X) instead of one (Cushing's). As you can see, there are many other possible combinations.
From http://www.myfreedoctor.com/faq/other/614/cushings-or-syndrome-x/
Many people diagnosed with mental illnesses seek the help of psychiatrists and other mental health care providers. It seems the obvious treatment. What many people with depression, anxiety and phobias, do not do, is seek out consultations to find a possible medical cause for their symptoms.
There are many endocrine,neurological and cardiac diseases that present symptoms of depression, anxiety and even
intermittent bouts of rage. Proper treatment of these disorders can reduce and often times resolve the psychiatric symptoms. Some patients will benefit from both psychiatric and medical interventions. This is not to say that every person with a mental illness is misdiagnosed, but many are.
The endocrine system, is a complex group of glands. These glands make hormones which help to control activities in
your body. Along with growth, metabolism,reproduction and development, hormones control the way you respond to your
surroundings. Diseases that alter the hypothalamic -pituitary-axis may produce anxiety-like states. It important to differentiate between medically induced and primary anxiety disorders. Treatment with psychotropic medications alone may not significantly improve the emotional symptoms and may, in some cases, contribute to the hormonal imbalances.
Anxiety frequently occurs in endocrine patients with adrenal dysfunction, Cushing's Disease, Carcinoid syndrome, hyperparathyroidism, pseudohyperparathyroidism, hyperglycemia, hyperinsulinemia, pancreatic tumors, pheochromocytoma and thyroid diseases including hyperthyroidism, hypothyroidism and thyroiditis. These diseases can be the organic basis for an anxiety disorder and with proper diagnosis and treatment can improve the quality of life of many anxiety sufferers.
Polycystic Ovarian Syndrome is another very common endocrine disorder which, in a large percentage of patients, causes anxiety and depressive states. PCOS is caused by irregular levels of estrogen, progesterone and testosterone. It is estimated that 1 in 10 women have PCOS. Women with PCOS may suffer from acne, excessive hair growth, loss of hair, infertility, loss of menses, diabetes and weight gain. Some data reports that almost 80% of these woman suffer from anxiety, depression and other mood disorders. Treatment with birth control pills as well as medications to regulate insulin along with proper diet and exercise can significantly improve the physical and emotional symptoms of this syndrome.
Along the way you may have what is referred to as an incidental finding. These unanticipated findings in the course of testing or medical care can hold they key to some anxious states. An incidentaloma is a tumor (-oma) found by coincidence (incidental) without clinical symptoms or suspicion. In our case it was a pituitary tumor, a microadenoma. Cushings Syndrome -an endocrine disease known to cause anxiety and phobic states -is suspected.
Although I have primarily focused on the endocrine - anxiety connection, the list of diseases, disorders, syndromes, and medications that can contribute to or cause anxiety and depression is significant.
Treating depressive and anxiety disorders, in some cases, needs to be a joint effort with a team of psychiatric as well as specializing physicians working in harmony.
It has been my experience as a parent of a child with a severe anxiety disorder,that what you see is not always what you get. Proper diagnosis is the key. Finding the origin of a mental illness is often like finding a needle in a haystack.
It took seven years and four endocrinologists before the proper treatment was initiated, a lot of time lost.
References: http://www.drrichardhall.com/anxiety.htm
In This Issue
Welcome to the latest Cushing's Newsletter!
Cushing's on Facebook and Twitter
Robin writes: Adult Onset Growth Hormone Deficiency: Phenotype and Benefits of Treatment
Help Keep The Cushing's Sites Going
Endo News: Diagnosing Cushing’s syndrome
Endo News: Cushing’s syndrome (Hypercortisolism) from NLE Review Bullets
Endo News: Back Pain and Cushing's
Endo News: Pituitary-directed medical treatment of Cushing’s disease
Endo News: About Cushing's from OHSU
New and Updated Bios
New Bio May 16, 2009
Melanie (Melanie W) is from Oklahoma. She has many Cushing's symptoms and has been diagnosed with PCOS and mild hypothyroidism so far.
New Bio May 15, 2009
Shirley (SBett) is from Ronan, Montana. After 6 years her doctor finally found a pituitary tumor on an MRI. She is testing and has high cortisol and growth hormone.
New Bio May 13, 2009
Jodi (Jodi) is from Rochester, Michigan. She had surgery to remove half her pituitary. She is now having issues with adrenal insufficiency.
New Bio May 12, 2009
angelp (angelp) is from London, England. She had her first pituitary surgery in January 2009 and a second in March 2009. She will have an adrenalectomy and radiotherapy to remove the rest of her pituitary tumor.
New Bio May 11, 2009
Sue (Sue) is from Lombard, Illinois. She has many Cushing's symptoms and her cortisol levels are very high but the source of her Cushing's hasn't been found yet.
New Bio May 10, 2009
Kate (kate22) is from Richmond, Virginia. She is not yet diagnosed with Cushing's but she is testing. She has many Cushing's symptoms.
New Bio May 10, 2009
Angie (dermpat) is from Melbourne, Australia. She is not yet diagnosed with Cushing's but is testing for cyclic Cushing's.
New Bio May 10, 2009
Vanessa is from Phoenix, Arizona. She has recently been diagnosed with a pituitary tumor and is looking for an endo.
New Bio May 10, 2009
Rachael (RachaelB) is from Charlotte, North Carolina. She was recently diagnosed with Cushing's and will be having her pituitary tumor removed in August.
New Bio May 4, 2009
Shiloh (Shiloh) is from Fort Collins, Colorado. She is not formally diagnosed. She is trying to manage her symptoms with healthy eating, massage and acupuncture.
New Bio May 3, 2009
Luisa (Luisa) is from Knoxville, Tennessee. She was originally misdiagnosed with PCOS and is testing for Cushing's currently.
New Bio May 1, 2009
Song is temporarily outside of U.S.A. She is not yet diagnosed. Someone at a party saw her buffalo hump and asked is she knew about Cushing's. Her own research says she might have this and testing shows elevated cortisol.
New Bio May 1, 2009
Alisha (gbsawyer) is from Kirksville, Missouri. She is not yet diagnosed but has many symptoms and is seeing a new endo.
New Bio April 30, 2009
Lulu is from Corona, California. She had transnasal surgery 10/2007 and stereotactic surgery 8/2008. Both surgeries have failed. She tried Ketoconozole for a month and ended up in the hospital because the medication was affecting her liver. She is currently doing nothing for her Cushing's.
New Bio April 29, 2009
Melissa (meltizzle) is from Santa Fe Springs, California. She was recently diagnosed with Cushing's and thinks she had it since 2007.
New Bio April 29, 2009
Aly is from Arizona. She has had diabetes for 18 years and is a brand new mom. About two years ago she started getting Cushing's symptoms and is scheduling adrenal surgery.
New Bio April 27, 2009
Patty (pattycakes) is from Cincinnati, Ohio. She has many Cushing's symptoms but doctors are calling her pituitary tumor a Rathke Cleft cyst so she is still trying to get answers.
New Bio April 24, 2009
McCall (McKenzie) is from Fairfax, Virginia. She was diagnosed with central adrenal insufficiency after an ITT (Insulin Tolerance Test) and is taking 15mg of Hydrocortisone a day for the ACTH replacement therapy. She is wondering if it is possible to have both adrenal insufficiency AND Cushing's.
New Bio April 22, 2009
Kirsty (kirstymnz) is from Hamilton, New Zealand. Her doctors couldn't find the source of her ectopic Cushing's. She had a lung nodule but removal didn't help so she had a BLA (bilateral adrenalectomy).
New Bio April 22, 2009
Jeff (akflier) is from Palmer, Alaska. He was diagnosed with pituitary Cushing's in July 2008 and had surgery in August 2008.
From http://lifeasamedicalstudent.blogspot.com/2008/10/endocrinology.html
Hormonal regulation is much more complex than I first imagined, but it is incredibly interesting too.
Endocrine System
Our recent studies have initiated investigations into the complex world of glands and their secretions.Complemented by histological examinations of cellular breakdown, endocrine physiology, too, has been presented for study. Our first stop was the pituitary followed by the thyroid.
The endocrine glands regulate bodily functions trying to keep us in a healthy state. When secretions become too low or too high, normal functions are compromised and disease ensues. The thyroid in particular has me quite fascinated, perhaps due to recency.
Thyroid
This butterfly like gland found just below our voice box controls many functions and is most commonly known to have an effect on our body's metabolism. It requires a minimal level of iodine from our diets which can be found in many water sources, salt, meat, fish and vegetables. In cases of hyperthyroidism (too much hormone) individuals commonly lose weight and have tissue swelling. The opposite, hypothyroidism, causes weight gain and can lead to the growth of thyroid tissue also known as a goiter. As with every other part of the body, thyroid cancer can have deleterious effects similar to those mentioned above.
These are only some of the effects of thyroid hormones and many others are integrated with various body systems. My first thought was why not give low doses of thyroid hormone to help people lose weight. It sounds like a rather easy solution until you start to factor in all the other problems that would arise from altering the normal hormonal levels. Needless to say, I am still a neophyte when it comes to all of this, but for the moment it piques my interest.
"Who are we worried about?
1. severe hypertension, or hypertension very refractory to treatment
2. onset of hypertension in those less than 30 years old (with no family history or obesity)
3. stable blood pressure values that acutely rise
4. onset of hypertension before puberty
What are some of the secondary causes of hypertension?
-Renal disease: virtually any cause
-Pheochromocytoma: remember to screen for MEN IIa and IIb
-Hyperaldosteronism: may have associated hypokalemia
-Cushing's syndrome: hypercortisolemia from any source
-Sleep apnea: zzzzzzz
-Medications: OCP, HRT, some NSAIDS, some antidepressants (eg Venlafaxine)
-Coarctation of the aorta
-Hypothyroidism
-Hyperparathyroidism
Canadian Hypertension Guidelines:
http://hypertension.ca/chep/"
"I'm not too nervous about the visit -- cautiously optimistic, I guess. Part of me is worried that I'll walk in and they'll repeat exactly what my old(current) doc did --- and I don't want to go that route again. I know it isn't a simple case of hypothyroidism - and I am not about to go back on Synthroid. I stopped taking birth control, which will allow for an important test to be done that will bring me closer to a Cushing's diagnosis....... but damn, I don't even know anymore. I know my adrenals are enlarged, my thyroid is enlarged, my cortisol is high, and I have a list of symptoms that can fit several different diseases -- one of which I've already been diagnosed with. I just can't let myself sink - and I know I'm resourceful enough to do my own research, and I hope I'm stable enough to not jump to conclusions and give a self-diagnosis.... which is very easy for me to do. Breatheeee...e.e.e.e."
"4. You May Be Gaining Weight Because of a Medical Condition
The most common medical condition that causes weight gain is hypothyroidism. A deficiency of thyroid hormone can decrease metabolism, causing appetite loss and weight gain.
If you are feeling fatigued, lethargic, swelling, hoarse voice, intolerance to cold, sleeping too much, or headaches, you should see your doctor for an easy test to determine if you have hypothyroidism.
Much rarer is a condition known as Cushing's syndrome -- a disorder caused by an excess of the hormone cortisol -- that can also result in weight gain."
