Given Adrenal Symptoms, Blood Test Recommended

Posted on July 28, 2015 by MaryO

adrenal-glands

 

Q: My husband’s recent CT scan of his stomach and digestive system revealed that he has nodules on both adrenal glands. It was suggested that he undergo a blood test to determine whether the nodules are producing hormones.

For 21 months, he has experienced high blood pressure, nausea, diarrhea, anxiety and abdominal pain. Could this be the source of his problems? If so, what course of action would you recommend?

A: The adrenal gland is responsible for the production of several essential hormones.

Tumors, or nodules, of the adrenal glands are common. They can be categorized into those that make hormones and those that don’t, and also by whether the tumors are benign or malignant.

The most common, by far, are benign, nonfunctioning tumors. These are usually discovered on an ultrasound or a CT scan obtained for some other reason.

More than 4 percent of people have an adrenal mass, and 85 percent are nonfunctional.

The symptoms that your husband has, however, raise a concern that he might have a hormone-producing tumor.

Four types of hormones are commonly produced by adrenal tumors: cortisone, aldosterone, sex hormones (estrogen or androgens) and catecholamines (epinephrine and norepinephrine).

A cortisone-producing adrenal tumor causes Cushing’s syndrome. It usually causes weight gain, especially in the abdomen; skin changes, including striae, or “stretch marks”; high blood pressure; and a predisposition to diabetes. Anxiety and abdominal pain are uncommon.

Aldosterone raises blood pressure, so a person with a functioning adrenal tumor making aldosterone usually has high blood pressure, but the other symptoms you mention for your husband aren’t common for this type of tumor.

Adrenal tumors that make epinephrine and the related norepinephrine are called pheochromocytomas. Hypertension is almost universal with this condition, and anxiety is frequently reported.

Tumors that produce sex hormones are rare, and they are present in men with androgen excess or feminization, in the case of estrogen-secreting tumors.

Although your husband’s symptoms aren’t specific for any one condition, the combination of his symptoms and adrenal nodules concerns me.

I agree with the recommendation to look for excess amounts of hormones in the blood. This can often be achieved with a simple blood test; however, a catheter is occasionally placed in the adrenal vein to sample blood coming from the gland (and its nodule) directly.

By comparing one side against the other, doctors can determine which side might be producing excess hormones.

An endocrinologist is the expert most likely to be familiar with these conditions.

Dr. Roach answers letters only in his North America Syndicate column but provides an order form of available health newsletters at http://www.rbmamail.com. Write him at 628 Virginia Dr., Orlando, FL 32853-6475; or ToYour GoodHealth@med. cornell.edu.

From http://www.dispatch.com/content/stories/life_and_entertainment/2015/07/27/given-adrenal-symptoms-blood-test-recommended.html

Filed under: adrenal, Cushing's, Rare Diseases | Tagged: , , , , , , , , , , , , , , , , , | Leave a comment »

Webinar: Diagnosis and Management of Acromegaly: A Clinical Update

Posted on July 19, 2015 by MaryO

Presented by
Lisa Nachtigall, MD
Co-director Neuroendocrine Clinical Center
Massachusetts General Hospital

Register Here

After registering you will receive a confirmation email with details about joining the webinar.

Contact us at webinar@pituitary.org with any questions or suggestions.

Date: Monday, July 27, 2015
Time: 2:00 PM – 3:00 PM Pacific Daylight Time

Presenter Bio
Lisa B. Nachtigall, MD, is an Associate Professor of Medicine at Harvard Medical School, the clinical co-director of the Neuroendocrine Clinical Center at Massachusetts General Hospital and course director in Clinical Neuroendocrine at Harvard Medical School.

Dr. Nachtigall earned her medical degree from New York University (NYU) School of Medicine in New York City. She completed her internship and residency in internal medicine at Bellevue Hospital Center/NYU school of Medicine, and a clinical fellowship in endocrinology and metabolism, as well as a research fellowship in reproductive endocrinology at Massachusetts General Hospital/Harvard Medical School.

Dr. Nachtigall’s work has been published in the New England Journal of Medicine, the Journal of Clinical Endocrinology and Metabolism, Neurosurgery, Pituitary, and the Clinical Endocrinology among others. She serves on the editorial board of Pituitary and as an ad hoc reviewer for many endocrine journals. Dr Nachtigall has been a presenter at national and international medical conferences, and she is currently an investigator on several clinical studies of acromegaly and pituitary tumors.

Filed under: Meetings and Conferences, pituitary, Rare Diseases, Webinar | Tagged: , , , , | Leave a comment »

Lowest cortisol levels found in women with overweight, mild obesity

Posted on July 18, 2015 by MaryO

Women with overweight and class I obesity appear to have the lowest cortisol levels, while more significant obesity appears to be associated with higher cortisol levels, according to recent findings.

In the cross-sectional study, Karen K. Miller, MD, of Massachusetts General Hospital, and colleagues evaluated 60 premenopausal women aged 18 to 45 years: 28 with overweight or obesity, 18 with anorexia nervosa and 21 healthy controls at normal weight. Overweight was defined as BMI 25 to 29.9 kg/m2, and obesity was classified as class I (30-34.9 kg/m2) and class II (35-39 kg/m2).

Anorexia nervosa was classified based on DSM-IV criteria, which includes extreme fear of weight gain, body image dysmorphia, weight that is 85% of ideal body weight and cessation of menstruation for 3 consecutive months. Participants were asked to collect 24-hour urine samples, in addition to 11 p.m. and 7 a.m. salivary samples within 1 week of an inpatient hospital visit. For each sample, researchers assessed creatinine clearance, and urinary free cortisol/creatinine clearance was calculated for each specimen to account for the decreased creatinine and filtered cortisol linked to anorexia nervosa.

During the inpatient visit, participants underwent placement of an IV catheter and fasting blood was sampled every 20 minutes from 8 p.m. to 8 a.m. Fasting cortisol and cortisol binding globulin concentrations were measured at 8 a.m. Participants were asked to take 5 g of oral dexamethasone every 6 hours for 48 hours to decrease endogenous disparities in cortisol levels.

The researchers found that with the exception of dexamethasone-suppression-CRH testing, all cortisol measures exhibited a U-shaped association with BMI, most notably urinary free cortisol/creatinine clearance (P = .0004) and mean overnight serum cortisol (P < .0001).

The lowest cortisol levels were seen in the overweight-class I obesity range, and these were also associated with visceral fat tissue and total fat mass. Participants with anorexia nervosa had higher mean cortisol levels than participants with overweight or obesity. Attenuated inverse relationships were seen between lean mass and some measures of cortisol, and most measures of cortisol were inversely related to posterior-anterior spine and total hip bone mineral density.

According to the researchers, these findings have not determined the precise nature of the relationship between cortisolemia, hypothalamic-pituitary-adrenal activation and adiposity.

“The [hypothalamic-pituitary-adrenal] axis activation associated with obesity and excess adiposity raises the question of whether hypercortisolemia contributes to increased adiposity in the setting of caloric excess, whether increased adiposity drives [hypothalamic-pituitary adrenal] activation, or whether the relationship between hypercortisolemia and adiposity is bidirectional,” the researchers wrote. – by Jennifer Byrne

Disclosure: The researchers report no relevant financial disclosures.

From http://www.healio.com/endocrinology/obesity/news/online/%7B73cac1c4-af30-4f24-89e3-86f50d05aaa2%7D/lowest-cortisol-levels-found-in-women-with-overweight-mild-obesity

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Food-dependent Cushing syndrome: a new entity of organic hypercorticism

Posted on July 9, 2015 by MaryO
Matejka G, et al. Rev Med Interne. 1996.

Abstract

Diagnosis of Cushing’s syndrome is quite difficult in endocrinology. Spontaneous Cushing’s syndrome is usually divided into two subgroups, one which is dependent on corticotropin (ACTH) and another one which is not.

In the first class are Cushing’s disease, the ectopic corticotropin syndrome and the rare ectopic corticotropin-releasing hormone (CRH) syndrome; these ACTH-dependent Cushing’s syndrome have usually diffusely enlarged adrenal glands.

In the second class are cortisol producing unilateral adrenocortical adenomas or carcinomas, and the recent Cushing’s syndrome with food dependent periodic hormonogenesis.

This food dependent Cushing’s syndrome is an ACTH-independent Cushing’s syndrome with multinodular enlargement of both adrenal glands. Pathogenesis is an aberrant adrenal sensitivity to physiologic secretion of gastric inhibitory peptide (GIP). Ectopic expression of GIP receptors on adrenal cells involve pathologic food induced cortisol secretion.

Food dependent Cushing’s syndrome is a new cause of Cushing’s syndrome. Food induced cortisol secretion may have to be explored in the ACTH-independent Cushing’s syndrome.

PMID

8758532 [PubMed – indexed for MEDLINE]

Full text

Full text from provider (Elsevier Science) Article in French.

From http://www.ncbi.nlm.nih.gov/m/pubmed/8758532/

Biography of a Food-Dependent Cushing’s patient

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RARE Patient Advocacy Summit Details and Invitation

Posted on July 2, 2015 by MaryO

We would like to invite you and your community to join us for our fourth annual RARE Patient Advocacy Summit September 24 – 25, 2015 in Huntington Beach, California!  Join the community at this unique event for rare disease patients and advocates: Connect. Educate. Engage. Achieve. 

Registration is open!

This Summit is for every patient, patient advocacy leader, and anyone who cares about rare.  Please take a look at this year’s compelling agenda and consider participating in an event that you won’t want to miss!

 

Why attend? Here’s what you’ll gain:

  • Practical next steps for taking action in the areas of research, legislation, fundraising, and community support
  • Core fundamentals and skills to help you start, grow and strengthen your nonprofit organization
  • Strategies for building online communities and why they are essential for rare disease awareness
  • Understanding the power of genetic data and patient involvement for advancing research for your disease
  • Tools and insights into crafting successful collaborations with researchers, biotech, pharma and the FDA
  • Invaluable connections with advocacy leaders that will help you define and propel your rare disease priorities forward

Register for the Summit and learn more on travel scholarships

Register now and secure your spot at the leading conference for rare disease patient advocates today!  We have a limited number of travel scholarships available, which you may request here.  Scholarship applications will be accepted through July 27, 2015.

 

Want to learn more?  Sign up for our Information Session!

Sign up today for an information session on the Summit where we’ll walk you through the details, the agenda and opportunities to learn and connect, and more on how to share this with your community. Here’s how to register for the information session on July 15, 2015 at 2:00 p.m. PDT/5:00 p.m. EDT. Patients, advocates, advocacy group leaders – all are welcome to participate!

 

Can’t attend in person?

There is no reason you, your organizational leadership or community should miss out!  Sign up to join the conference via Livestream through your computer and learn more about how you can still be an active participant using Twitter.

 

We hope to see you at the Summit!

 

Sincerely,

Kym, Carrie & Lisa

 

Kym H. Kilbourne                                          

VP, Patient Advocacy                                     

kymk@globalgenes.org

 

Carrie Ostrea

Manager, Advocacy/Parent Advocate

carrieo@globalgenes.org

 

Lisa Schill

Advocacy Ambassador/Parent Advocate

lschill@globalgenes.org 

Filed under: Meetings and Conferences, Rare Diseases | Tagged: , , , , , , , | 1 Comment »

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