11 Temmuz 2012 Çarşamba
Day 24 of the Cushing's Challenge: When the "gold standard" becomes tarnished....
10 Temmuz 2012 Salı
Day 24 of the Cushing's Challenge: When the "gold standard" becomes tarnished....
9 Temmuz 2012 Pazartesi
Low Testosterone and Your Muscles
There is a lot more detail to the answer Bret Contreras provides to the guy who asked, “Can someone be consistently on the lower end of the normal range for testosterone and still be muscular?” … but the simple answer, per Bret, is:
As you can see, there are multiple (and many redundant) pathways to muscular hypertrophy, and even though testosterone helps tremendously, one can still see dramatic gains despite suffering from low testosterone levels.
Day 23 in the Cushing's Awareness Challenge: Why do we overeat? Underexercise? Is it a matter of willpower?
I'd like to talk to you a bit about what it is like with Cushing's high cortisol surging through one's system and the hunger it brings.
Have you ever been on steroids for anything? Do you remember the hunger you felt on them? That's all I remember feeling in my life prior to my bilateral adrenalectomy. I have always been hungry. Ok, let me clarify "always". Let's say 80% of my life I was hungry. Between the flu and what I now know were "lows*", I had periods of no hunger. But for the most part, I was somewhere between stomach-growling hungry to ravenous, bite-my-arm-off hungry.
Does that mean I had no willpower? No. I managed, with the help of my very nutritionally wise mother, to stay at a normal weight even through college. I did put on the freshman 15 in my sophomore year of college, but also managed to lose it by essentially living on caffeine and a diet of books. (Study, that is.) Labs are not good places to eat, and I basically lived in one.
Was that easy? NO! I confess to binge eating at times. I don't think I ever purged. I don't remember doing that. I was so absolutely hungry and nothing would sate my appetite. Nothing. I know my mother knew it, too. I remember slipping into the kitchen when I was small and "stealing" bread or crackers hoping she wouldn't notice. She never mentioned it, but she was sharp. She knew. I would panic at the thought of not being able to have food even at a young age.
Snacks were forbidden when I grew up unless we picked an apple off the tree or a tomato out of the garden. We ate three nutritional meals a day, drank skim milk, and lived outside. Yes, I exercised. Only we called it "play", then. Bicycles were star ships and swings were space stations. Lightening bugs were made by God to be chased. Dusk was a time for hide-and-seek. But I digress...
After college and graduate school, I got married. Had babies. Couldn't lose weight. You can read all about that in Metamorphosis. The thing is, I was hungry all the time. But I DID NOT EAT all the time. Sure, it absolutely possessed my every thought, my every action and my every plan. I had to know food was available even if I didn't eat it. And yes, sometimes I lost control and I overate. I wanted so much to be free of that obsession with food.
I managed to lose that obsession one time on phentermine. However, I started gaining weight even then. I was in a "low*", either induced by the phentermine or just coincidentally, prior to that gain. I vote for the latter.
My disease accelerated. I became "florid" or "classical" as my neurosurgeon coined it. I daily went from periods of nausea in the morning to periods of starvation by afternoon. Ok...it felt that way. I WANTED FOOD! I wanted to EAT! But did I? Most of the time, no. I counted calories, I measured food, I watched my carbs, I measured fat grams, I ate high fiber, I tried to exercise.
Let me emphasize: I TRIED to exercise. Have you ever walked through mud? How about walking in the waves in the ocean? That's how my legs felt when I tried to do anything. That started a long time ago, but I persisted in trying to build them up. Even when I was at my worst before my first surgery to remove my pituitary surgery, I did water aerobics and/or swam several times a week. I did that until the pain became unbearable. I even hired a trainer who eventually told me something was very wrong with me because I could not build muscle.
Did I lack willpower? I don't think so. Only a few people know the magnitude of the will it took to find someone to help me, understand me, diagnose me and get me on the road to recovery. I fought hard every day to lose weight. I fought hard to get well. I fought hard to live! To work! To be here for my daughters, my grandson, my brother, and my parents. I fought the "establishment" called medicine, too. And I still fight for all that. And I am not alone. Zebras do exist.
I am no longer hungry for food. Since my BLA in June 2010, I can exercise plus I am seldom starving. I often have to remind myself to eat. I am hungry for understanding, however. Not just for me, but for all who fight as I do for others to see beyond the obesity to the true problem of Cushing's Disease/Syndrome.
*"lows": periods in the cycle of cyclic/intermittent/episodic Cushing's where cortisol is low.
Day 24 of the Cushing's Challenge: When the "gold standard" becomes tarnished....
Urinary Free Cortisol (UFC) testing has long been the "gold standard" for determining the need for more evaluation in the diagnosis of Cushing's Disease/Syndrome (CS). However, recent research belies the paradigm, especially with cyclic/episodic and mild/subclinical CS.A fairly recent testing protocol, late-night salivary cortisol (NSC), is often touted as a replacement for the late-night serum cortisol. The ease of use at home has made it a practical application for testing cortisol levels. It, too, has limitations in testing for cyclic and/or mild CS.
A third application, the dexamethasone suppression test (DST), is another standard by which practioners evaluate their patients for CS. Again, there are limitations when evaluating cyclic/mild CS.
In a recent study, the full text article examines the three tests mentioned above. They found UFC's were of limited value whe diagnosing "mild" CS.
However, UFC may not accurately reflect the cortisol secretory state in patients with even the modest impairment of renal function (8). In addition, most of the cortisol secreted during a 24-h period is between 0400 h and 1600 h. Subtle increases in nighttime secretion, as may be seen in mild CS, may not be detected or only intermittently detected in a 24-h urine collection.
Notice the majority of the tests fell below the "normal" line on the graph.
In turn, the NSC was more accurate, but there were many "normals" in the results, with multiple repeats with several patients before obtaining a "high" result. The authors speculate this is due to cyclic CS or a "variability around a mildly elevated set point."
Of the 11 patients evaluated, all had surgery, and 10 of the 11 had pathology proven CS. (Sometimes it is hard to get enough sample tissue for a decent pathology with pituitary surgery.)The DST was evaluated in this same study with those patients who were tested via that means, but not all patients were. However, in another study, the use of the DST was found to be of limited value for those patients with cyclic/mild CS.
These results demonstrate that the great majority of patients with mild and/or periodic Cushing's syndrome suppress to overnight dexamethasone. Since patients with mild and/or periodic Cushing's syndrome are the patients in whom the identification of hypercortisolism is difficult, our results from this relatively small study suggest that this test should no longer be used to exclude these patients from further workup for Cushing's syndrome.It is important to remember that no one test adequately evaluates a patient for Cushing's. Even more important, multiple tests may have to be repeated multiple times. The authors in the first article emphasize this when they say, "Obviously [NSC and UFC ] may need to be performed several times before the suspected diagnosis of endogenous hypercortisolism can be correctly identified."
Still a third study (Findling, et al) says, "Even more problematic is the interpretation of the results of these tests, particularly if they are not in agreement with each other. This is particularly so in mild Cushing's syndrome; if the symptoms are subtle, the biochemical abnormalities are likely to be subtle as well." This is a very long article, chock full of information.
How important is it to screen for "mild" CS? "Mild" is a misleading term, sometimes more appropriately called subclinical CS. Findling, et al, point out a huge population where CS is generally overlooked and the depressing mortality for those same folks.
Dr. Theodore Friedman, et al, , in their research High Prevalence of Normal Tests Assessing Hypercortisolism in Subjects with Mild and Episodic Cushing’s Syndrome Suggests that the Paradigm for Diagnosis and Exclusion of Cushing ’ s Syndrome Requires Multiple Testing point out no one test is conclusive for testing for Cushing's Disease/Syndrome:
The probability of having Cushing’s syndrome when one test was negative was 92 % for 23:00 h salivary cortisol, 88 % for 24-h UFC, 86 % for 24-h 17OHS, and 54 % for nighttime plasma cortisol. These results demonstrated that episodic hypercortisolism is highly prevalent in subjects with mild Cushing’s syndrome and no single test was effective in conclusively diagnosing or excluding the condition.
Why is CS generally overlooked, then? Findling lists many reasons, including a study done by Cartagi, et al, where an extraordinarily large percentage of diabetic patients actually had CS. It is often too easy to pin a diagnosis of diabetes or hypertension without realizing it is a symptom.
The recognition of mild/subclinical and cyclic CS has changed the diagnostic approach. Sadly, too many patients are never seen by those who know that. And most of all, there really is no such thing as "mild" Cushing's. It damages the body just as much as "florid".~~~~~~~~~~~~~~~~~~~~~~(For more information on how these tests are done, see Testing 101: Biochemical analysis.For problems/errors to watch for when testing, see When lab tests don't rate an A+, or even a C-..... )
Kidambi, S., Raff, H., Findling, J.W. (2007). Limitations of nocturnal salivary cortisol and urine free cortisol in the diagnosis of mild Cushing's syndrome. European Journal of Endocrinology, 157(6), 725-731. DOI: 10.1530/EJE-07-0424
Day 28 of the Cushing's Awareness Challenge: Getting it right...
I do believe my allergies are worse since my BLA. Perhaps the high cortisol treated them? I don't know. I do know this spring allergens are worse in my area than they usually are. Everything seemed to bloom and spout pollen all at once.
Someone asked me the other day why we are so concerned about awareness for Cushing's. "Isn't is a really rare disease?"
"No", I said, "It's just rarely diagnosed."
And there is research to back up my statement. One recent research article is one you should take to your doctor if you believe you have Cushing's. It talks about the reality of testing for Cushing's Disease/Syndrome and that it requires a lot of testing. One can have a lot of normal tests and still have Cushing's.
As I go through my daily life, I see a lot of people who have the signs of Cushing's. It's a daily conundrum deciding whether to approach a person about it or not. Many times when I have, I've been met with cynicism or been ignored totally. Other times, folks want information. A few times, I've been contacted by these saying either a) my doctor thinks I'm full of it or b) my doctor thinks you may be right but doesn't know what to do from here. It's tough, having this disease. Although there are a lot of textbooks for doctors describing how to test and diagnose, so many of us aren't truly textbook cases. That's the problem with textbooks. They are a "one size fits all" type of diagnosis/testing. We come in all sizes, shapes, and genders. We don't fit the textbook mold. Slowly, the textbooks are changing. Recent research is changing how doctors test and diagnose. In my opinion, it's going to take another generation or two of doctors to really get it right. Until then, many people won't be diagnosed and treated.
Day 29 of the Cushing's Awareness Challenge: Life goes on
Life doesn't stop because one gets a rare illness or is diagnosed with a disease. However, mine seems to be delineated by before Cushings, after Cushing's, before BLA and after BLA. Before Cushing's is a gray area. I'm not sure exactly when I started getting symptoms. Some of my symptoms went as far back as childhood but others were more recent when I realized what was wrong with me. I was 47-48 at that time. I'm sure I had symptoms of Cushing's (verified by my photo evidence) from the age of 24.
Skipping ahead past those years between ages 47 and 52 when I was going through testing, diagnosis, pituitary surgery to remove the tumor, recurrence, and re-testing/diagnosis though my BLA, I am in the after BLA era. Does anyone else see her life this way? I know most folks look at graduation, job, marriage, children, etc. as the defining moments of their lives. And my children, plus my grand-child, are definitely more important to me, but I still categorize them in the pre-BLA/post-BLA eras.
Isn't it crazy that one event can be so momentous in one's life? I sit here typing this after a day of being lonely and wishing I was closer to my family and my grandson. Part of me wants to make the big leap and just "do it". Life is short. Just do it. The other, conservative part of me says, "You have to make it to retirement. You have to have something to live on and you don't want to lose this money." And once I do this, which I will someday, I know it will be a defining moment and I'll classify it post-move. I think that's a good thing. I'm tired of living my life around a disease.
8 Temmuz 2012 Pazar
Testosterone levels and our ability to woo women.
Way back, when I was something like 20 and testosterone pretty much dripped off me much as it does most 20-year-old males, I would sometimes go to a local store that sold overstocks of printed sports team shirts and what-not. Of all the trips I made to the store I remember buying two items. One was a red shirt that had “Red Onion” printed on it in big white letters – the letters were made of just the right type of stuff and positioned in just the right manner that they’d rub my nipples raw if I jogged in the shirt. The other item was a hoodie with “Wayne State” printed on the front.
I never found out what “Red Onion” was supposed to be about. While I’d no idea what Wayne State was when I bought the hoodie, I’d eventually find out it was a university in Michigan.
Well, it seems the good folks at Wayne State do more than just supply overstocks to clearance stores. They’ve recently published a study that links testosterone with men’s ability to "woo" potential mates.
According to Richard Slatcher, Ph.D., assistant professor of psychology in WSU’s College of Liberal Arts and Sciences and a resident of Birmingham, Mich., the effects of testosterone on dominance behaviors were especially pronounced among men who reported having a high need for social dominance. In his study, "Testosterone and Self-Reported Dominance Interact to Influence Human Mating Behavior," published online Feb. 28 in the journal, Social Psychological and Personality Science, these men showed a strong positive association between their own testosterone and their own dominance behaviors and, most surprisingly, a strong negative association between their own testosterone and their opponents’ dominance behaviors. In other words, men both high in testosterone and who reported a high need for social dominance appeared to be able somehow suppress their competitors’ ability to attract potential mates. However, when men reported low need for dominance, there was no association between testosterone and dominance behaviors-either their own or their competitors’.
Low T, Diabetes and Death
The Daily Mirror recently published story titled, Diabetic men with low testosterone more likely to die. While I’m of the mind we’re all likely to die regardless of the levels of testosterone we have, eventually, I was curious enough about the headline to click the link in my newsreader and have a read.
In the end the title gave most of it away: Low T + Diabetes 2 = earlier death
The article goes on to say that hormone replacement therapy has been effective in prolonging the lives of men with the low T/diabetes combination.
A little bit of Googling turned up the original release from which I’ve clipped the following snippet:
Professor Hugh Jones, Consultant Endocrinologist and Hon. Professor of Andrology, Barnsley Hospital NHS Foundation Trust and the University of Sheffield, said:
“This is potentially a very exciting finding. Whilst we have shown that low testosterone levels can put diabetic men at greater risk of dying, we have also demonstrated for the first time the potential benefit that testosterone replacement therapy holds for this group of patients.
“It is well known that men with type 2 diabetes often have low testosterone levels, so it is important that we investigate the health implications of this. We now need to carry out a larger clinical trial to confirm these preliminary findings. If confirmed, then many deaths could be prevented every year.”
Blood Work – June 2, 2011
As always, you can find the record of my blood work history – from July 2001 to present – in this Hormone Table.
Blood was drawn on a Thursday morning prior to my weekly meds so I should have had the least bit of Cabergoline in me as possible.
I continue to take .25 mg of Cabergoline weekly. I’ve been taking a vitamin B supplement and I’d taken the vitamin a couple of hours before my blood draw.
I weighed 299 pounds, which puts me up 10 pounds from last visit. Yes, yes, yes… I keep talking about needing to lose weight but that’s all I’m doing – talking about it. I’ve got no sense that I’m seriously trying to lose weight and having no luck at it.
Hormone Info
Prolactin: 8.5 (4.0-15.2)
Regarding Vitamin B6
Effect of pyridoxine on human hypophyseal trophic hormone release: a possible stimulation of hypothalamic dopaminergic pathway
Delitala G, Masala A, Alagna S, Devilla L.
Abstract
A single dose of pyridoxine (300 mg iv) produced significant rises in peak levels of immunoreactive growth hormone GH and significant decrease of plasma prolactin PRL in 8 hospitalized healthy subjects. Serum glucose, luteinizing hormone LH, follicle stimulating hormone FSH and thyrotropin TSH were not altered significantly. In addition, in 5 acromegalic patients who were studied with both L-dopa and pyridoxine, inhibition of GH secretion followed either agent in a similar pattern. These data suggest a hypothalamic dopaminergic effect of pyridoxine.
and
Pyridoxine (B6) suppresses the rise in prolactin and increases the rise in growth hormone induced by exercise
Barletta C, Sellini M, Bartoli A, Bigi C, Buzzetti R, Giovannini C.The influence of vitamin B6 in a dosage of 300 mg X 2 in 24 hrs, on circadian rhythm of plasmatic ACTH, cortisol, prolactin and somatotropin have been studied in 10 normal women. After vitamin B6 24 hrs pattern of ACTH and cortisol is unchanged; prolactin levels are slightly lower, in a statistically unsignificant proportion the night peak of growth hormone is higher in a statistically significant proportion (p. 0.05). The effect of vitamin B6 is likely to me mediated by dopaminergic receptors at hypothalamic level as previous studies by other Authors appear to prove.
Boll Soc Ital Biol Sper 1984 Feb 28;60(2):273-8
N Engl J Med. 1982 Aug 12;307(7):444-5.
Sometimes I get mail
A week or so ago I went to Williamsburg to help my brother do some post-hurricane-Irene rebuilding. (Well, and to visit, mostly.)
During the visit I’d check my phone periodically and noticed I’d received an email from someone regarding pituitary tumors, meds, and, I think, nausea. I read just a few sentences, realized it would require a longer reply – if the mail ended with a a question (it may have been just sharing info) – than I was willing to type up on a smartphone and I closed it… intending to give it proper attention when I was back at work and in front of my computer.
And now I can’t find it.
I don’t know if I deleted it off my phone. Maybe my email client at work sorted it to a folder and I’ve lost it. Maybe Gremlins from the Kremlin were involved.
So… if you were the person who mailed me, let me apologize for being such a poor steward of your mail. Especially if you are someone I’ve exchanged mail with before. More especially if you are someone I went to school with. Most especially if you are a relative of mine.
If you were writing to share your experience with pituitary tumors or had a question you thought I might know something about, please resend your mail.
Based on the bits I remember about the mail – meds and nausea – I’ll toss this out:
During the course of treatment for my pituitary tumors, I was on two different meds. The first was Bromocriptine (parlodel) and the second Dostinex (cabergoline). Bromocriptine didn’t do anything to reduce my prolactin levels (though I’ve read accounts of people having great success with it.) I typically took it before bed but forgot one night and took it the next morning – as I recall this led to some jitteriness.
Dostinex worked well, after the dosage was tweaked appropriately, to control my prolactin. Twice (as I recall) had developed nausea – both times I thought I was getting the flu — and each time it was just after my dose had been increased. The nausea occurred just the first time my dose was increased; that is, both times the dose was increased, I’d have flu-like symptoms just once… the first time I took the higher dose.
January 5, 2012 Blood Work
First, my apologies for taking so long to get this up. I had to cancel the blood draw scheduled for for December (twice) due to being busy. That same busy-ness has kept me from posting.
First, the new news: I’m off my cabergoline. I was taking .25 mg weekly (down from a high of 1.5 mg twice a week – or 3 mg weekly), which is 1/2 of a Tic-Tac sized pill. My prolactin has been in good shape for long enough that the doc and I thought we’d see what happens if I quit taking it all together.
I will start having monthly blood draws.
Now the summary for the most recent blood draw: Blood was taken Thursday morning. I’d not had any cabergoline since the previous Thursday, so I’d have had the least bit in my system I could have. I’ve not taken any vitamins in months – we moved a couple of months back and I’ve just not gotten back into the habit. (This is not to say my past blood draws involved having vitamins in me – I’d just never kept track and they were typically hit-or-miss from day to day. This draw I know it’s been a good long while since my last vitamins.) My weight is about 297… I keep saying I need to do something about it but I’ve just been too busy to pay close attention. (My being an all-or-nothing personality type sort of works against me here… I have trouble dieting without exercising and I’ve not had time to – per me – to exercise on a regular schedule.)
Changes: The testosterone scale has changed again. The normal range used to be 300-1000 ng/dL, then 241-827 ng/dL, then 280-800 ng/dL. The most recent shows 348 to 1197 ng/dL
Results:
Prolactin 7.2 ng/mL (4.0-15.2) – the last draw was 8.5 (4.0–15.2)
Total Testosterone 532.5 ng/dL (348-1197) – the last record was 519 (280-800)
At 519 ng/dL where 280-800 is “normal” I was at 65% of the high end.
At 532.5 ng/dl where 348-1197 is “normal” I am at 44% of the high end.
I’ve added percentages to the Hormone Table that I use to track all of my blood draws. There are now values in red that mark where I stand with regard to being at the high end of the prolactin and testosterone scales.
7 Temmuz 2012 Cumartesi
Day 23 in the Cushing's Awareness Challenge: Why do we overeat? Underexercise? Is it a matter of willpower?
I'd like to talk to you a bit about what it is like with Cushing's high cortisol surging through one's system and the hunger it brings.
Have you ever been on steroids for anything? Do you remember the hunger you felt on them? That's all I remember feeling in my life prior to my bilateral adrenalectomy. I have always been hungry. Ok, let me clarify "always". Let's say 80% of my life I was hungry. Between the flu and what I now know were "lows*", I had periods of no hunger. But for the most part, I was somewhere between stomach-growling hungry to ravenous, bite-my-arm-off hungry.
Does that mean I had no willpower? No. I managed, with the help of my very nutritionally wise mother, to stay at a normal weight even through college. I did put on the freshman 15 in my sophomore year of college, but also managed to lose it by essentially living on caffeine and a diet of books. (Study, that is.) Labs are not good places to eat, and I basically lived in one.
Was that easy? NO! I confess to binge eating at times. I don't think I ever purged. I don't remember doing that. I was so absolutely hungry and nothing would sate my appetite. Nothing. I know my mother knew it, too. I remember slipping into the kitchen when I was small and "stealing" bread or crackers hoping she wouldn't notice. She never mentioned it, but she was sharp. She knew. I would panic at the thought of not being able to have food even at a young age.
Snacks were forbidden when I grew up unless we picked an apple off the tree or a tomato out of the garden. We ate three nutritional meals a day, drank skim milk, and lived outside. Yes, I exercised. Only we called it "play", then. Bicycles were star ships and swings were space stations. Lightening bugs were made by God to be chased. Dusk was a time for hide-and-seek. But I digress...
After college and graduate school, I got married. Had babies. Couldn't lose weight. You can read all about that in Metamorphosis. The thing is, I was hungry all the time. But I DID NOT EAT all the time. Sure, it absolutely possessed my every thought, my every action and my every plan. I had to know food was available even if I didn't eat it. And yes, sometimes I lost control and I overate. I wanted so much to be free of that obsession with food.
I managed to lose that obsession one time on phentermine. However, I started gaining weight even then. I was in a "low*", either induced by the phentermine or just coincidentally, prior to that gain. I vote for the latter.
My disease accelerated. I became "florid" or "classical" as my neurosurgeon coined it. I daily went from periods of nausea in the morning to periods of starvation by afternoon. Ok...it felt that way. I WANTED FOOD! I wanted to EAT! But did I? Most of the time, no. I counted calories, I measured food, I watched my carbs, I measured fat grams, I ate high fiber, I tried to exercise.
Let me emphasize: I TRIED to exercise. Have you ever walked through mud? How about walking in the waves in the ocean? That's how my legs felt when I tried to do anything. That started a long time ago, but I persisted in trying to build them up. Even when I was at my worst before my first surgery to remove my pituitary surgery, I did water aerobics and/or swam several times a week. I did that until the pain became unbearable. I even hired a trainer who eventually told me something was very wrong with me because I could not build muscle.
Did I lack willpower? I don't think so. Only a few people know the magnitude of the will it took to find someone to help me, understand me, diagnose me and get me on the road to recovery. I fought hard every day to lose weight. I fought hard to get well. I fought hard to live! To work! To be here for my daughters, my grandson, my brother, and my parents. I fought the "establishment" called medicine, too. And I still fight for all that. And I am not alone. Zebras do exist.
I am no longer hungry for food. Since my BLA in June 2010, I can exercise plus I am seldom starving. I often have to remind myself to eat. I am hungry for understanding, however. Not just for me, but for all who fight as I do for others to see beyond the obesity to the true problem of Cushing's Disease/Syndrome.
*"lows": periods in the cycle of cyclic/intermittent/episodic Cushing's where cortisol is low.
Day 24 of the Cushing's Challenge: When the "gold standard" becomes tarnished....
Urinary Free Cortisol (UFC) testing has long been the "gold standard" for determining the need for more evaluation in the diagnosis of Cushing's Disease/Syndrome (CS). However, recent research belies the paradigm, especially with cyclic/episodic and mild/subclinical CS.A fairly recent testing protocol, late-night salivary cortisol (NSC), is often touted as a replacement for the late-night serum cortisol. The ease of use at home has made it a practical application for testing cortisol levels. It, too, has limitations in testing for cyclic and/or mild CS.
A third application, the dexamethasone suppression test (DST), is another standard by which practioners evaluate their patients for CS. Again, there are limitations when evaluating cyclic/mild CS.
In a recent study, the full text article examines the three tests mentioned above. They found UFC's were of limited value whe diagnosing "mild" CS.
However, UFC may not accurately reflect the cortisol secretory state in patients with even the modest impairment of renal function (8). In addition, most of the cortisol secreted during a 24-h period is between 0400 h and 1600 h. Subtle increases in nighttime secretion, as may be seen in mild CS, may not be detected or only intermittently detected in a 24-h urine collection.
Notice the majority of the tests fell below the "normal" line on the graph.
In turn, the NSC was more accurate, but there were many "normals" in the results, with multiple repeats with several patients before obtaining a "high" result. The authors speculate this is due to cyclic CS or a "variability around a mildly elevated set point."
Of the 11 patients evaluated, all had surgery, and 10 of the 11 had pathology proven CS. (Sometimes it is hard to get enough sample tissue for a decent pathology with pituitary surgery.)The DST was evaluated in this same study with those patients who were tested via that means, but not all patients were. However, in another study, the use of the DST was found to be of limited value for those patients with cyclic/mild CS.
These results demonstrate that the great majority of patients with mild and/or periodic Cushing's syndrome suppress to overnight dexamethasone. Since patients with mild and/or periodic Cushing's syndrome are the patients in whom the identification of hypercortisolism is difficult, our results from this relatively small study suggest that this test should no longer be used to exclude these patients from further workup for Cushing's syndrome.It is important to remember that no one test adequately evaluates a patient for Cushing's. Even more important, multiple tests may have to be repeated multiple times. The authors in the first article emphasize this when they say, "Obviously [NSC and UFC ] may need to be performed several times before the suspected diagnosis of endogenous hypercortisolism can be correctly identified."
Still a third study (Findling, et al) says, "Even more problematic is the interpretation of the results of these tests, particularly if they are not in agreement with each other. This is particularly so in mild Cushing's syndrome; if the symptoms are subtle, the biochemical abnormalities are likely to be subtle as well." This is a very long article, chock full of information.
How important is it to screen for "mild" CS? "Mild" is a misleading term, sometimes more appropriately called subclinical CS. Findling, et al, point out a huge population where CS is generally overlooked and the depressing mortality for those same folks.
Dr. Theodore Friedman, et al, , in their research High Prevalence of Normal Tests Assessing Hypercortisolism in Subjects with Mild and Episodic Cushing’s Syndrome Suggests that the Paradigm for Diagnosis and Exclusion of Cushing ’ s Syndrome Requires Multiple Testing point out no one test is conclusive for testing for Cushing's Disease/Syndrome:
The probability of having Cushing’s syndrome when one test was negative was 92 % for 23:00 h salivary cortisol, 88 % for 24-h UFC, 86 % for 24-h 17OHS, and 54 % for nighttime plasma cortisol. These results demonstrated that episodic hypercortisolism is highly prevalent in subjects with mild Cushing’s syndrome and no single test was effective in conclusively diagnosing or excluding the condition.
Why is CS generally overlooked, then? Findling lists many reasons, including a study done by Cartagi, et al, where an extraordinarily large percentage of diabetic patients actually had CS. It is often too easy to pin a diagnosis of diabetes or hypertension without realizing it is a symptom.
The recognition of mild/subclinical and cyclic CS has changed the diagnostic approach. Sadly, too many patients are never seen by those who know that. And most of all, there really is no such thing as "mild" Cushing's. It damages the body just as much as "florid".~~~~~~~~~~~~~~~~~~~~~~(For more information on how these tests are done, see Testing 101: Biochemical analysis.For problems/errors to watch for when testing, see When lab tests don't rate an A+, or even a C-..... )
Kidambi, S., Raff, H., Findling, J.W. (2007). Limitations of nocturnal salivary cortisol and urine free cortisol in the diagnosis of mild Cushing's syndrome. European Journal of Endocrinology, 157(6), 725-731. DOI: 10.1530/EJE-07-0424
Day 28 of the Cushing's Awareness Challenge: Getting it right...
I do believe my allergies are worse since my BLA. Perhaps the high cortisol treated them? I don't know. I do know this spring allergens are worse in my area than they usually are. Everything seemed to bloom and spout pollen all at once.
Someone asked me the other day why we are so concerned about awareness for Cushing's. "Isn't is a really rare disease?"
"No", I said, "It's just rarely diagnosed."
And there is research to back up my statement. One recent research article is one you should take to your doctor if you believe you have Cushing's. It talks about the reality of testing for Cushing's Disease/Syndrome and that it requires a lot of testing. One can have a lot of normal tests and still have Cushing's.
As I go through my daily life, I see a lot of people who have the signs of Cushing's. It's a daily conundrum deciding whether to approach a person about it or not. Many times when I have, I've been met with cynicism or been ignored totally. Other times, folks want information. A few times, I've been contacted by these saying either a) my doctor thinks I'm full of it or b) my doctor thinks you may be right but doesn't know what to do from here. It's tough, having this disease. Although there are a lot of textbooks for doctors describing how to test and diagnose, so many of us aren't truly textbook cases. That's the problem with textbooks. They are a "one size fits all" type of diagnosis/testing. We come in all sizes, shapes, and genders. We don't fit the textbook mold. Slowly, the textbooks are changing. Recent research is changing how doctors test and diagnose. In my opinion, it's going to take another generation or two of doctors to really get it right. Until then, many people won't be diagnosed and treated.
Day 29 of the Cushing's Awareness Challenge: Life goes on
Life doesn't stop because one gets a rare illness or is diagnosed with a disease. However, mine seems to be delineated by before Cushings, after Cushing's, before BLA and after BLA. Before Cushing's is a gray area. I'm not sure exactly when I started getting symptoms. Some of my symptoms went as far back as childhood but others were more recent when I realized what was wrong with me. I was 47-48 at that time. I'm sure I had symptoms of Cushing's (verified by my photo evidence) from the age of 24.
Skipping ahead past those years between ages 47 and 52 when I was going through testing, diagnosis, pituitary surgery to remove the tumor, recurrence, and re-testing/diagnosis though my BLA, I am in the after BLA era. Does anyone else see her life this way? I know most folks look at graduation, job, marriage, children, etc. as the defining moments of their lives. And my children, plus my grand-child, are definitely more important to me, but I still categorize them in the pre-BLA/post-BLA eras.
Isn't it crazy that one event can be so momentous in one's life? I sit here typing this after a day of being lonely and wishing I was closer to my family and my grandson. Part of me wants to make the big leap and just "do it". Life is short. Just do it. The other, conservative part of me says, "You have to make it to retirement. You have to have something to live on and you don't want to lose this money." And once I do this, which I will someday, I know it will be a defining moment and I'll classify it post-move. I think that's a good thing. I'm tired of living my life around a disease.
Korlym: New drug to treat Cushing's Disease
Korlym blocks the activity of cortisol and is proven to reduce high blood sugar (hyperglycemia), a key symptom of Cushing's. Korlym has a unique way of working. Instead of reducing cortisol levels, it blocks the action of cortisol, thus preventing the effects of excess cortisol.1Korlym has many side effects and cannot be taken by everyone. Once the patient stops taking Korlym, she will continue to have Cushing's. The biologic half-life of Korlym is approximately 85 hours. If a patient suffers adrenal insufficiency or crisis, massive amounts of hydrocortisone or dexamethasone are needed to alleviate these and will have to be continued for the duration of the drug in his system.
To follow a patient who has just started taking Korlym, you will find her blog here: Cushing's Disease
5 Temmuz 2012 Perşembe
Moving to New Hardware
I thought I’d post this just in case there are some folks who use a newsreader to manage subscriptions. I’m upgrading the server hardware and server software – sometimes this breaks whatever it is that updates things like Google Reader et al.
I have new blood work to post. I’ll put it up after I get the new server going. (In a nutshell though, I’ve been off my cabergoline for almost three months and have seen just the smallest uptick in prolactin – still not as high, though, as it had been sometimes while on the cabergoline.)
'Safe House,' 'Haywire': Watch Them Back To Back
Which is not to say I didn't have a good time with Denzel and company's slick, state-of-the-art engineering. Safe House is fashioned to suit Washington's most successful persona: the bad guy who's so cool that he inspires you even as he poses a threat to the social order. He plays Tobin Frost, a CIA agent who wrote the book on modern interrogations before becoming the company's most notorious traitor. Now, he has no allegiances and no relationships outside of work — he only takes pleasure in old and expensive wine.
As the movie opens, Frost is selling especially incendiary intelligence in South Africa when he's set upon by unknown assassins — who are expert enough to scare him into taking refuge at the nearby American Embassy, where at least he knows he won't be killed. Promptly arrested, he's transported to a safe house managed by frustrated junior agent Matt Weston, played by Ryan Reynolds. As Weston watches more senior agents interrogate Frost, the safe house is breached, and with gunfire coming closer, he finds himself alone with the soft-talking traitor, who tells Weston that he must protect him.
After everyone else is shot down, Weston escapes with Frost in handcuffs, not sure where he's going but committed to prove himself by keeping the infamous ex-agent in custody. Amid all the car chases and bullet dodging, Frost works to psych Weston out, in part by planting doubts about his relationships with his superiors and even his French doctor girlfriend.
By the middle of Safe House, I predicted every twist to come but was goggle-eyed anyway. Director Daniel Espinosa is a Swede who has studied state-of-the-art Euro thrillers by Luc Besson, and above all the Bourne pictures. Safe House is color-coordinated down to the glossy, tutti-frutti storage units in one of the chase scenes. It's full of jump-cuts and fights in which the careening, hand-held camera goes tight on the blows and counter-blows and glass-and furniture-smashing. The stunt work is superb, but the movie is focused more on jolts than the actors' athleticism.
Steven Soderbergh, on the other hand, made Haywire as a vehicle for Gina Carano, a mixed-martial-arts champion given to single-minded pummelings. And as one of the few major directors who work as their own cinematographers — under the name "Peter Andrews" — he's unusually sensitive to where the camera is in relation to the actors. Here, he explicitly goes against action fashion by keeping a respectful distance, allowing us to ogle his leading lady from stem to stern.
She's something to see. As an espionage agent betrayed by forces unknown, Carano doesn't move like an actor but an athlete — someone trained to channel emotion rather than exhibit it, to conserve energy rather than expend it. The fights are staged and shot so that we can almost but not quite calculate her next move along with her. She's always faster — and meaner — than we expect, ever ready to swivel, kick out a limb and squeeze a windpipe shut between rock-hard thighs.
Soderbergh tends to have one thesis idea per film and stick with it, sometimes to a fault. In Haywire, he's so wedded to that objective camera that parts of the film seem under-energized, making me wish for just one or two high-octane close-ups to put a nice brutal button on a fight. I prefer what Brad Bird does in 2011's best action film, Mission: Impossible — Ghost Protocol, cunningly alternating long shots to establish the bodies in the space with head-snapping close-ups. But I applaud Soderbergh for reminding us that action — like dance, like gymnastics — can be savored from afar instead of so close it makes us motion-sick. Who goes to movies to be sick?
http://www.npr.org/2012/02/10/146644450/safe-house-haywire-watch-them-back-to-back
Different Styles of Oak Furniture
If you have a traditional style then there is a lot of oak furniture that would be suitable. Traditional styled houses usually contain matching items of furniture. Whether it's cupboards, lights, chairs or sofas usually everything is matching and without too many surprises. You won't find any sudden bursts of colour for example and neither will you find any furniture made from stainless steel or glass. In fact oak furniture is likely to be found throughout a house in the cabinets and dining room table, perhaps even in the beds.
Another style of home the people like is modern. Although not minimalist as such, modern homes do tend to be free from clutter and be light and airy. Usually antique furniture is not very common with more contemporary and modern designs being chosen. Wood is a material that is often found in modern homes, but usually in a contemporary way. Coffee tables could well be made from oak as could bedroom furniture too. The wood will be interspersed with other modern materials such as metal or glass to provide the overall look and effect of serenity and calm.
Formal style is the third category of style that most people fall into. Picture a public building or a hotel and you will get some idea of what formal interiors look like. All the furniture in the room is placed around a central feature. This may be a fireplace or a window or in a lot of cases around a television. Usually everything comes in pairs, particularly lamps and seating and the layout is rather grand in appearance. Large pieces, bright lights and an opulent feeling is the aim with formal layout. Oak furniture is particularly popular with those who have formal style. The grandeur of the wood makes it ideal for houses furnished in a formal way and you will probably find it scattered throughout a home that follows this particular style.
The third and final style that people tend to be drawn towards is that of casual. Have you ever been in homes where there seems to be no rhyme or reason for anything. Where the overall cosy feel is provided by all sorts of items, furniture, nic-nacs and materials? This is the casual style and it means that any type of material will be used, any style of furniture and anything can be made into a feature in the home. Oak is a popular material amongst those who like the casual look so the chances are good that it will be used here. The good thing about the casual style is that everything fits, nothing looks out of place so any item of furniture can be incorporated into the room.
Because oak can be used to make modern, traditional and even contemporary furniture, it is a very versatile wood and can be used (and look right at home) in most settings. Whether a home is formal with solid oak furniture positioned on an axis around a fireplace, or casual where everything is jumbled in together, there is plenty of room for all types of oak furniture. From an oak tv unit to coffee table and beyond you can enjoy dressing your home with this beautiful and versatile material.
By: Kathryn Dawson
Internet Printable Grocery Store Coupons
Have you ever wondered how the coupon queens can save so much on every grocery shopping trip? I am about to let you in on their secrets: they use tons of coupons, week in and week out. They never pay full price for anything, and they are diligent about stockpiling when they find items for pennies on the dollar.
Let me explain. In order to get the huge discounts the super shoppers do week in and week out, you need to have a ton of coupons at your disposal. Most preferably free coupons, but sometimes grocery coupons purchased through a coupon clipping service.
Having a lot of multiple coupons will allow you to buy many of the same items when you can find an exceptional deal. In order to do this efficiently, multiple like coupons are the way to go. When you find a freebie it is time to stock up.
What makes printable grocery store coupons an easy way to accomplish steep grocery savings is three fold. First, printable grocery store coupons are free. Something, in this case potential savings, for nothing is always good. Second, most online coupon sites allow you to print several of the same kind of coupon daily, take advantage of the opportunities when you find coupons for a product you use regularly. The limits on how many coupons you can print at once vary by site and offer, but you can always get more than one coupon at a time. Third, you print only what you need, as you need them. Having fewer coupons to sort and store saves a lot of time.
Printable grocery store discount coupons are simple to use, worth more than traditional coupons and offer around a dollar per item off on average. When you are looking for savings, printable grocery coupons are a good tool in your money saving tool box.
Why are printable grocery store coupons so great? They save tons of money for cash strapped consumers.
By:
Yankees' Rivera blows save
Diamondbacks 5, Giants 4 — Chris Young and Paul Goldschmidt hit first-inning home runs and Ryan Roberts broke a tie with a two-run double in the sixth as host Arizona beat Tim Lincecum (0-1) for the fourth straight time.
Orioles 4, Twins 2 — Jake Arrieta allowed two hits with four strike outs and two walks in seven scoreless innings and Nick Markakis homered and drove in three runs as victorious Baltimore marked the 20th anniversary of the opening of Camden Yards.
Rangers 3, White Sox 2 — After failing to reach a long-term deal before his deadline, Ian Kinsler homered, doubled and scored twice as host Texas spoiled the managerial debut of Robin Ventura, who before the game had his first meeting with Nolan Ryan since charging the mound 19 seasons earlier against the Hall of Fame pitcher. Ryan is president, CEO and part-owner of the Rangers.
Rockies 5, Astros 3 — Eric Young scored the go-ahead run on an error in the eighth and Troy Tulowitzki homered in the ninth to lift visiting Colorado.
Notebook
Injury updates — Houston shortstop Jed Lowrie (right thumb) went on the DL. ... Kendrys Morales returned to the Los Angeles Angels after missing nearly two years with a broken left ankle suffered celebrating a game-ending grand slam.
Associated Press
link
4 Temmuz 2012 Çarşamba
Body composition and cardiovascular risk markers after remission of Cushing's disease: a prospective study using whole-body MRII
Geer EB, Shen W, Strohmayer E, Post KD, Freda PU.
J Clin Endocrinol Metab. 2012 May; 97(5):1702-11
John Newell-Price and Miguel Debono, University of Sheffield, UK. F1000 Diabetes & Endocrinology
26 Jun 2012 | Confirmation, Good for Teaching
Excess endogenous glucocorticoids cause central obesity with an increased visceral to total fat ratio and this is associated with the metabolic syndrome and insulin resistance, increasing the cardiovascular risk. This is a prospective study in 14 subjects where whole-body magnetic resonance imaging (MRI) has been used for the first...
Read this article at http://f1000.com/717297977
This blog post is posted from Cushing's & Cancer at http://cushingshelp.blogspot.com/
2 Temmuz 2012 Pazartesi
Dr. Cargill Alleyne - Augusta, GA 2012 Best Doctors
Dr. Cargill Alleyne
Neurosurgeon
You’re going to work hard whatever you do, so work hard doing something you love,” says Dr. Cargill Alleyne, director of the neurosurgery residency program at Georgia Health Sciences University, among other professional appointments. Research, instruction, publishing, inventing and clinical practice stimulate, invigorate and energize him. “When you’re in the operating room, you’re dedicating all your energies, all your senses, to one specific problem and time flies,” he says. That experience of flow along with the element of human interaction drew him to medicine and specifically to neurosurgery.
His unique ability to be in the moment, tending to each patient one-on-one and, at the same time, to consider the bigger picture and how he can contribute to it distinguishes his approach to medicine. The model for his own career and his message to the neurosurgeons he teaches is this: Perform one surgery and change a single life. Teach another person to perform that surgery, change several lives. Conduct research and publish results and broaden the scope of impact by reaching practitioners around the world. Improve a current procedure or implement a new treatment paradigm and influence the healing of future generations of patients. Every element of this model supports a philosophy of providing the best care possible at the personal level and ensuring that every person receives the best care possible.
The brain is the last frontier, rife with the potential for specialties and sub-specialties. Despite technological advances made since Dr. Harvey Cushing (1869-1939), the undisputed Father of Neurosurgery, pioneered effective operations, the organ of the brain still holds many mysteries. Young residents, believes Dr. Alleyne, have the advantage of flexible thinking and, thus, possess the power to not just practice neurosurgery competently, but to improve it.
Interestingly, Dr. Alleyne has combined his love of Hollywood productions, his interest in medical history and his professional training in neurosurgery to write a screenplay, Hands of Gold, Feet of Clay–The Harvey Cushing Story, which won 13th place at the 2006 FilmMakers International Screenwriting Awards. Though he very humbly says, “It was something to do,” the project required extensive reading and research and took a year to complete. A collection of coincidences suggests that perhaps it was more than something to do; it was something he was meant to do. For example, Cushing, incidentally, had a brother named Alleyne. Cushing and Dr. Alleyne both attended Yale. And the Cushing Tumor Registry, a collection of glass jars containing brain tissues from Cushing’s many surgeries, was stored in the basement of the building in which Dr. Alleyne lived during medical school at Yale.
Neurosurgeons dedicate six to seven years beyond medical school to honing their craft. They perfect technically precise procedures. Many lose themselves in their careers. Cushing performed more than 2,000 brain surgeries and recorded volumes of detailed notes and illustrations, advancing successful treatment methods but spending little time with his wife and five children. Dr. Alleyne shares Cushing’s commitment. Yet, he also values building a strong family with his wife Audrey and their children, Nicole, 10, and Nathan, 12. Working hard at what he loves energizes him for the ones he loves.
Read more at Augusta Magazine
Cortendo Receives Positive Orphan Drug Opinion from EMA for NormoCort for Cushing’s Disease
Cortendo AB with support from their preclinical development partner, PharmaDirections, Inc. received a positive opinion from the European Medicines Agency for NormoCort.
Radnor, PA (PRWEB) June 26, 2012
Cortendo AB [ticker: CORT on the Norwegian NOTC-A], a biopharmaceutical Corporation focused on the development of new therapies in the field of Metabolic Diseases, obtained a positive opinion by the European Medicines Agency's Committee for Orphan Medicinal Products, on its application for orphan drug designation for NormoCort (COR-003) for the treatment of hypercortisolism (Cushing’s Syndrome). The positive opinion of the COMP for NormoCort has now been forwarded to the EU commission for final approval and publication in the EU community register. With orphan drug designation granted in the US by the FDA in March and now with this positive opinion from the EU’s COMP, Cortendo is well positioned to move NormoCort into pivotal global clinical trials in Cushing’s Syndrome.
Cortendo is a biopharmaceutical company that relies in part on quality consultants and CRO’s to support the research and development of its pipeline. For the past year, Cortendo has contracted with PharmaDirections for a number of key services ranging from CMC to US and European Regulatory support. PharmaDirections’ regulatory services have ranged from the successful preparation and support to orphan drug designation applications in both the US and Europe to support with both IND and CTA preparation. “Cortendo has appreciated the high quality of support particularly in the areas of regulatory, CMC, and project management services offered by PharmaDirections”, said Dr. Ted Koziol, COO of Cortendo.
“Our Cortendo relationship is a great example of a virtual company using outsourced resources to their maximum advantage” said Dr. Richard Soltero, President of PharmaDirections.
About Cortendo:
Cortendo is a pioneer in the field of cortisol inhibition. The development of the lead drug candidate NormoCort (COR-003), the 2S,4R-enantiomer of ketoconazole, has been directed to Cushing’s Syndrome. The company’s strategy is to focus its resources to opportunities where the path to commercialization or partnership is clear and relatively near-term. Strategically, Cortendo’s business model is to commercialize relevant opportunities in the United States while partnering its assets ex-US. Backed by a highly experienced leadership team Cortendo has plans to continue to implement its pipeline expansion efforts in osteoarthritis and diabetes, as well as other near term revenue opportunities.
About PharmaDirections:
PharmaDirections, Inc. provides pharmaceutical consulting and project management services with a focus on preclinical development, formulation development and CMC, and regulatory affairs. The company was founded in 2003 and is based in Cary, North Carolina.
From PRWeb
Genetic variant is linked to obesity and insulin resistance
A large study in people at risk of diabetes has found a direct association between the presence of a small genetic alteration in a hormone receptor and increased body fat and insulin resistance. The results, to be presented Tuesday at The Endocrine Society's 94th Annual Meeting in Houston, suggest an adverse role for a previously described genetic variant, the BclI polymorphism.
"Our findings support the idea that even small variations in hormone receptor sensitivity can have metabolic implications, such as obesity or diabetes," said co-author Bastiaan Havekes, MD, PhD, of Maastricht University Medical Center, Maastricht, the Netherlands.
"Endocrinologists should not just focus on hormone levels themselves. Taking into account hormone receptor sensitivity could help in better understanding hormone-mediated effects on metabolism," he said.
The inherited BclI polymorphism occurs in the gene encoding for the glucocorticoid receptor, which controls the actions of glucocorticoids, steroid hormones that affect every system in the body. This small variant makes the receptor more sensitive to glucocorticoids, resulting in greater effects with similar hormone levels, Havekes said.
The effects of this change appear to be similar to, although much smaller than, the excessive glucocorticoid exposure that can occur from certain medications or diseases, Havekes said. Such excess exposure can result in weight gain, especially around the abdomen, as well as in disturbed blood sugar metabolism. This exposure most often occurs from long-term use of prednisone or other glucocorticoid medications, which are widely used to treat inflammatory diseases or to suppress the immune system. It also can result from endocrine diseases such as Cushing's syndrome. Cushing's causes overproduction in the body of the glucocorticoid cortisol, often called the "stress hormone."
Patients in this study, however, did not have known excess exposure to glucocorticoids, according to Havekes. He and his co-investigators studied 1,228 adults who participated in one of two Dutch studies focusing on diabetes in the general population. More than half of the study participants had either prediabetes (23 percent) or Type 2 diabetes (33 percent). All subjects underwent genetic testing for the BclI polymorphism.
The researchers found that 519 subjects did not carry the alternative form of the gene, or G-allele, for the BclI polymorphism on either chromosome. Another 540 subjects were heterozygous carriers, meaning the G-allele was present on one of the two chromosomes. The remaining 169 subjects were homozygous carriers and therefore carried the G-allele on both chromosomes.
Those who had the BclI polymorphism on each chromosome had a significantly higher body mass index and larger waist and hip circumferences than did noncarriers or heterozygous carriers, the authors reported. This was reflected by greater insulin resistance, meaning that insulin is less effective at lowering blood glucose (blood sugar).
"Determining an individual's genetic risk profile for metabolic disease is of paramount importance to prevent development of cardiovascular diseases," he said. "Future studies concerning cardiovascular risk profiling should perhaps consider the BclI polymorphism."
Provided by The Endocrine Society and posted by MedicalXPress.com
Cushing's syndrome
Betul A. Hatipoglu MD*
Article first published online: 27 JUN 2012
DOI: 10.1002/jso.23197
Keywords:
Cushing's syndrome; adrenal carcinoma; virilization; hypercortisolism
Abstract
Cushing's syndrome (CS) results from prolonged exposure to elevated endogenous cortisol. Majority of cases are caused by ACTH, pituitary, or ectopic origin. Primary adrenal hypersecretion is 15–20% caused by adenomas, carcinomas (ACC), and rarely by nodular adrenocortical disease. CS presents with all typical features.
Commonly recommended initial testing are urinary free cortisol, late-night salivary cortisol, and 1-mg overnight dexamethasone suppression test (DST). Imaging is the key to diagnosis. CS continues to pose diagnostic and therapeutic challenges; life-long follow-up is mandatory.
J. Surg. Oncol © 2012 Wiley Periodicals, Inc.
Read this article at Wiley Online Publications
Body composition and cardiovascular risk markers after remission of Cushing's disease: a prospective study using whole-body MRII
Geer EB, Shen W, Strohmayer E, Post KD, Freda PU.
J Clin Endocrinol Metab. 2012 May; 97(5):1702-11
John Newell-Price and Miguel Debono, University of Sheffield, UK. F1000 Diabetes & Endocrinology
26 Jun 2012 | Confirmation, Good for Teaching
Excess endogenous glucocorticoids cause central obesity with an increased visceral to total fat ratio and this is associated with the metabolic syndrome and insulin resistance, increasing the cardiovascular risk. This is a prospective study in 14 subjects where whole-body magnetic resonance imaging (MRI) has been used for the first...
Read this article at http://f1000.com/717297977
1 Temmuz 2012 Pazar
Day Nineteen, Cushing's Awareness Challenge
In Day 10 on April 10, 2012, I wrote about how we got the Cushing's colors of blue and yellow. This post is going to be about the first Cushing's ribbons.
I was on vacation in September, 2001 when SuziQ called me to let me know that we had had our first Cushie casualty (that we knew about).
On the message boards, Lorrie wrote: Our dear friend, Janice died this past Tuesday, September 4, 2001. I received an IM from her best friend Janine, tonight. Janine had been reading the boards, as Janice had told her about this site, and she came upon my name and decided to IM me. I am grateful that she did. She said that she knew that Janice would want all of us to know that she didn't just stop posting.
For all of the newcomers to the board that did not know Janice, she was a very caring individual. She always had something positive to say. Janice was 36 years old, was married and had no children. She had a miscarriage in December and began to have symptoms of Cushing's during that pregnancy. After the pregnancy, she continued to have symptoms. When discussing this with her doctor, she was told that her symptoms were just related to her D&C. She did not buy this and continued until she received the accurate diagnosis of Cushing's Syndrome (adrenal) in March of 2001. Tragically, Janice's tumor was cancerous, a very rare form of Cushing's.
Janice then had her tumor and adrenal gland removed by open adrenalectomy, a few months ago. She then began chemotherapy. She was very brave through this even though she experienced severe side effects, including weakness and dizziness. She continued to post on this board at times and even though she was going through so much, she continued with a positive attitude. She even gave me a referral to a doctor a few weeks ago. She was my inspiration. Whenever I thought I had it bad, I thought of what she was dealing with, and I gained more perspective.
Janice was having difficulty with low potassium levels and difficulty breathing. She was admitted to the hospital, a CT scan was done and showed tumor metastasis to the lungs. She then was begun on a more aggressive regimen of chemo. She was discharged and apparently seemed to be doing well.
The potassium then began to drop again, she spiked a temp and she was again admitted to the hospital. She improved and was set to be discharged and then she threw a blood clot into her lungs. She was required to be put on a ventilator. She apparently was at high risk for a heart attack. Her husband did not want her to suffer anymore and did not want her to suffer the pain of a heart attack and so chose for the doctors to discontinue the ventilator on Tuesday. She died shortly thereafter.
Janice was our friend. She was a Cushie sister. I will always remember her. Janine asked me to let her know when we get the Cushing's ribbons made as she and the rest of Janice's family would like to wear them in her memory. She said that Janice would want to do anything she could to make others more aware of Cushing's.
The image at the top of the page shows the first blue and yellow ribbon which were worn at Janice's funeral. When we had our "official ribbons" made, we sent several to Janice's family.
Janice was the first of us to die but there have been more, way too many more, over the years. I'll write a bit more about that on Day 21.
