Midnight Salivary Cortisol Versus Urinary Free and Midnight Serum Cortisol as Screening Tests for Cushing’s Syndrome

Posted on October 2, 2016 by MaryO

From PubMed

Gafni RI, Papanicolaou DA, Nieman LK.
Developmental Endocrinology Branch, National Institute of Child Health and Human Development, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892-1862, USA.

OBJECTIVE: There is currently no optimal test to screen for endogenous Cushing’s syndrome (CS) in children. Traditional 24-hour urine or midnight serum cortisol values may be difficult to obtain or elevated by venipuncture stress. We hypothesized that salivary cortisol measurement is a reliable way to screen for CS in children.

STUDY DESIGN: Sixty-seven children (5-17 years) were studied: 24 obese volunteers, 29 non-obese volunteers, and 14 children with CS. Saliva was obtained at 7:30 AM, bedtime, and midnight for measurement of free cortisol by radioimmunoassay.

RESULTS: Salivary cortisol was detectable in all morning and evening samples from patients with CS but was frequently undetectable in healthy children at bedtime (66%) and at midnight (90%). With cut points that excluded healthy children, a midnight salivary cortisol value of 7.5 nmol/L (0.27 microg/dL) identified 13 of 14 patients with CS, whereas a bedtime value >27.6 nmol/L (1 microg/dL) detected CS in 5 of 6 patients. The diagnostic accuracies of midnight salivary cortisol and urinary free cortisol per square meter were the same (93%).

CONCLUSION: Salivary cortisol measurement at bedtime or midnight rules out CS in nearly all cases. Nighttime salivary cortisol sampling is thus a simple, accurate way to screen for hypercortisolism in children. PMID: 10891818 [PubMed – indexed for MEDLINE]

THE PRINCIPLE RESEARCHER FOR SALIVARY CORTISOLS IS HERSHEL RAFF AT THE UNIVERSITY OF WISCONSIN. HE IS A RESEARCH SCIENTIST, NOT A DOCTOR. YOU CAN CONTACT HIM DIRECTLY FOR ORDERING INFO.

Salivary Cortisol: A Screening Technique

By: Dr. Hershel Raff

Cushing’s syndrome – endogenous hypercortisolism – is characterized by a loss of circadian rhythmicity. In normal patients, cortisol levels peak in the early morning hours and decrease to substantially lower levels at night. Rather than the normal decrease in late evening cortisol, patients with Cushing’s syndrome of any cause fail to decrease cortisol secretion in the late evening. Therefore, the measurement of elevated late evening cortisol is helpful in the diagnosis of Cushing’s syndrome. Obtaining a late night, unstressed plasma cortisol is virtually impossible in most clinical practices. Salivary cortisol is in equilibrium with the free, biologically active portion of cortisol in the plasma. Therefore, if one obtains a saliva sample in patients at bedtime in their homes under unstressed conditions, one can make the diagnosis of endogenous hypercortisolism.

A simple way to sample saliva is by using a Salivette made by the Sarstedt Company (Newton, NC). This device consists of a cotton tube and plastic tubes. The patient only has to chew the cotton tube for 2-3 minutes and place it in the plastic tube. The tube is then transported to our lab for analysis.

Late-evening salivary cortisol is not intended to replace the current standard screening test – measurement of a 24 hr urine free cortisol. However, the salivary cortisol test can be extremely useful for patients suspected of having intermittent Cushing’s syndrome. Due to the convenience of sample collection, the patient can sample saliva several evenings in a row. In fact, our clinical endocrinologists routinely order 2-3 consecutive late-evening salivary cortisol samples.

Our research (Raff H, Raff JL, Findling JW. 1998 LATE-NIGHT SALIVARY CORTISOL AS A SCREENING TEST FOR CUSHING’S SYNDROME. J Clin Endocrinol Metab. 83:2681-2686) has shown that the combination of late-evening salivary cortisol and urine free cortisol is very accurate in diagnosing Cushing’s syndrome in most patients. Doctors can obtain a kit by contacting ACL Client Services at 1-800-877-7016.

Editor’s Note: DR. HERSHEL RAFF, PH.D. IS A PROFESSOR OF MEDICINE AND PHYSIOLOGY AT THE MEDICAL COLLEGE OF WISCONSIN’S ENDOCRINE RESEARCH LABORATORY AT ST. LUKE’S MEDICAL CENTER IN MILWAUKEE, WISCONSIN.

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Sweet 16

Posted on September 30, 2016 by MaryO
September 30, 2000 - Birth of the Message Boards

September 30, 2000 – Birth of the Message Boards

 

Today  is the birthday, or anniversary, of the boards starting September 30, 2000 (The rest of the site started earlier that year in July)

As of today, we have 12,468 members who have made 381,418 posts.

Find the message boards here: http://cushings.invisionzone.com/

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Pituitary Patient Support Group Meeting in Santa Monica, CA

Posted on September 19, 2016 by MaryO

patient-support-meeting

Pituitary Patient Support Group Meeting!
Saturday–November 19th, 2016
“We will be Live Streaming on Facebook!!!”

Speaker: Garni Barkhoudarian, MD
Topic: “Advancements in Pituitary Surgery-Better Treatments, Better Quality of Life”
Meeting: 10:00am-11:00am
Breakfast Snack will be served 10:00am-11:00am
Lunch will be served 11:30am following the meeting
Family and Friends Welcome!
Please RSVP: Sharmyn McGraw at pituitarybuddy@hotmail.com or message on FB

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Adiponectin level may serve as predictor of subclinical Cushing’s syndrome

Posted on September 13, 2016 by MaryO

Unal AD, et al. Int J Endocrinol. 2016;doi:10.1155/2016/8519362.

 

In adults with adrenal incidentaloma, adiponectin levels may help predict the presence of subclinical Cushing’s disease, according to recent findings.

Asli Dogruk Unal, MD, of the department of endocrinology and metabolism at Memorial Atasehir Hospital in Istanbul, and colleagues analyzed data from 40 patients with adrenal incidentaloma (24 women; mean age, 61 years) and 30 metabolically healthy adults without adrenal adenomas or hyperplasia (22 women; mean age, 26 years). All patients with type 2 diabetes were newly diagnosed and not on any antidiabetic therapies; included patients were not using statin therapy for about 12 weeks.

Participants provided blood samples

Among patients with adrenal incidentaloma, eight (20%) were diagnosed with subclinical Cushing’s syndrome; median adenoma diameter in these patients was 3.05 cm. The remaining patients were classified as nonfunctional adrenal incidentaloma. Compared with patients who had nonfunctional adrenal incidentaloma, patients with subclinical Cushing’s syndrome had a higher median midnight cortisol level (9.15 µg/dL vs. 5.1 µg/dL; P = .004) and urinary free cortisol level (249 µg per 24 hours vs. 170 µg per 24 hours; P = .007).

In two group comparisons, researchers found that only adiponectin level was lower in the subclinical Cushing’s syndrome group vs. the nonfunctional adrenal incidentaloma group (P = .007); there were no observed between-group differences for age, BMI, waist circumference, insulin levels, homeostasis model assessment for insulin resistance (HOMA-IR) or lipid profiles.

Adiponectin level was negatively associated with insulin level, HOMA-IR, triglyceride level and midnight cortisol level, and was positively associated with body fat percentage, HDL and adrenocorticotropic hormone levels. In linear regression analysis, age was found to be an increasing factor, whereas sex, HOMA-IR, LDL, waist circumference and presence of subclinical Cushing’s syndrome were decreasing factors.

In evaluating the receiver operating characteristic analysis, researchers found that adiponectin level had a predictive value in determining the presence of subclinical Cushing’s syndrome (area under the curve: 0.81; 95% CI, 0.67-0.96). Sensitivity and specificity for an adiponectin value of 13 ng/mL or less in predicting the presence of subclinical Cushing’s syndrome were 87.5% and 77.4%, respectively; positive predictive value and negative predictive value were 50% and 96%, respectively.

“Presence of [subclinical Cushing’s syndrome] should be considered in case of an adiponectin level of 13 ng/mL in [adrenal incidentaloma] patients,” the researchers wrote. “Low adiponectin levels in [subclinical Cushing’s syndrome] patients may be important in treatment decision due to the known relation between adiponectin and cardiovascular events. In order to increase the evidences on this subject, further prospective follow-up studies with larger number of subjects are needed.” – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.

From http://www.healio.com/endocrinology/adrenal/news/in-the-journals/%7B81c38f07-b378-4ca1-806b-d5c17bea064c%7D/adiponectin-level-may-serve-as-predictor-of-subclinical-cushings-syndrome

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Signs and Symptoms of Adult Growth Hormone Deficiency

Posted on September 12, 2016 by MaryO

Major Symptoms of Adult-Onset Growth Hormone deficiency

You may be wondering if the unusual symptoms you are feeling lately may be due to growth hormone deficiency. Growth hormone is now widely recognized as an important factor in the maintenance of health and well-being. However, research shows that most people won’t experience the debilitating effects of growth hormone deficiency during their lifetime as the condition is not a cause of aging but rather serious illness or injury. If you want to learn about growth hormone deficiency signs and symptoms and what clinics like the Nexel Medical can do about this problem, keep reading.

About growth hormone deficiency in children

Growth hormone deficiency manifests differently in childhood than it does in adulthood. For normal development, there needs to be an adequate amount of circulating growth hormones in the body. The main symptom of growth hormone deficiency in children is stunted growth and developmental problems. This is a result of insufficient amounts of this important hormone in the body that is normally secreted by the pituitary gland. The pituitary gland is a small gland located at the bottom of the hypothalamus, at the base of the brain. Any damage to the pituitary gland will cause a drop in growth hormone levels that could be dangerous for children.

Growth hormone deficiency in adults

Although it would be natural to assume that there is no need for a growth hormone in the body once the growth process is over and we’ve reached adult height and weight, this is simply not the case. The human growth hormone plays a vital role in overall health up until old age. Damage to the pituitary gland from tumors is the most common cause of growth hormone deficiency in adults. People also tend to experience a decline in growth hormone levels that naturally come with age, but researchers agree that this decline is insignificant and shouldn’t cause any problems. However, damage to the pituitary gland will definitely cause major symptoms that require immediate treatment from clinics such as the Nexel Medical. According to an article published in the Indian Journal of Endocrinology and Metabolism, growth hormone deficiency has been associated with abnormalities of:

  • Neuropsychiatric and cognitive functioning

  • Cardiovascular functioning

  • The neuromuscular system

  • The skeletal system

Metabolic functioning

All these problems can be significantly reversed with growth hormone therapy. Growth hormone is now widely recognized as a hormone playing a role in the regulation of body composition, energy levels, and normal mental functioning.

Causes and symptoms of growth hormone deficiency

According to current research, 65% of all cases of growth hormone deficiency are caused by pituitary tumors. Other common causes are infections of the pituitary gland, pituitary hemorrhage, and idiopathic growth hormone deficiency. Traumatic brain injury may also lead to growth hormone deficiency in some cases. The clinical features or signs and symptoms of growth hormone deficiency are many and may seem unspecific at first. Those suspecting problems with the pituitary gland and growth hormone deficiency should look out for the following:

  • Cognitive changes (memory, processing, speed, attention)

  • Mood changes (depression, anxiety)

  • Social withdrawal

  • Fatigue and lack of strength

  • Neuromuscular dysfunction

  • Decreased bone mineral density

  • Decreased sweating

  • Weight gain and muscle loss

  • Metabolic changes (insulin resistance, dyslipidemia)

  • Treatment of growth hormone deficiency

Growth hormone deficiency in adults is usually treated with growth hormone replacement therapy. The hormone is in such cases administered intravenously or through dermal implants. A study published in the Journal of Clinical Endocrinology and Metabolism found that administering growth hormone to patients with growth hormone deficiency resulted in a reduction of visceral body fat by 30%. The researchers also noticed an improvement in bone metabolism and a decline in psychiatric complaints in these patients.

Why growth hormone pills don’t work?

Taking oral supplements claiming to contain the human growth hormone won’t work simply because the majority of it will be digested by your gastrointestinal tract before it gets the chance to reach your bloodstream. This is mainly because the human growth hormone is a protein and all proteins are broken down by the digestive tract. This was confirmed by studies as stated in an FDA-published article explaining how growth hormone administered to dairy cows cannot affect humans.

Conclusion

The human growth hormone is an important hormone for the maintenance of health, metabolism, and mental functioning. Studies on growth hormone deficiency show that most people have adequate levels of this hormone in their bodies. Although a decline in growth hormone levels comes with age, this decline is not enough to cause major changes in a person’s health and well-being. On the other hand, structural damage to the pituitary gland will cause some of the major conditions and symptoms of growth hormone deficiency. In such cases, growth hormone replacement therapy is highly advised. Clinics such as Nexel Medical are among many that offer different hormone replacement therapies including for growth hormone deficiencies.

References

https://www.hgha.com/hormone-replacement-therapy-clinic/

http://www.ncbi.nlm.nih.gov/pubmed/23435439

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183535/

http://www.ncbi.nlm.nih.gov/pubmed/19001512

http://www.ncbi.nlm.nih.gov/pubmed/8432773

http://www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation/ucm130321.htm

From http://theinscribermag.com/health-fitness/signs-and-symptoms-of-adult-growth-hormone-deficiency.html

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