Multiple aberrant hormone receptors in Cushing’s Syndrome

Posted on June 26, 2015 by MaryO
Eur J Endocrinol. 2015 May 13. pii: EJE-15-0200. [Epub ahead of print]
Multiple Aberrant Hormone Receptors in Cushing’s Syndrome.
El Ghorayeb N1, Bourdeau I2, Lacroix A3.

Author information

Abstract

The mechanisms regulating cortisol production when ACTH of pituitary origin is suppressed in primary adrenal causes of Cushing’s syndrome include diverse genetic and molecular mechanisms. These can lead either to constitutive activation of the cAMP system and steroidogenesis or to its regulation exerted by the aberrant adrenal expression of several hormone receptors, particularly G-protein coupled hormone receptors (GPCR) and their ligands.

Screening for aberrant expression of GPCR in BMAH and unilateral adrenal tumors of patients with overt or subclinical CS demonstrates the frequent co-expression of several receptors. Aberrant hormone receptors can also exert their activity by regulating the paracrine secretion of ACTH or other ligands for those receptors in BMAH or unilateral tumors.

The aberrant expression of hormone receptors is not limited to adrenal Cushing’s syndrome but can be implicated in other endocrine tumors including primary aldosteronism and Cushing’s disease. Targeted therapies to block the aberrant receptors or their ligands could become useful in the future.

PMID:
25971648
[PubMed – as supplied by publisher]

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Value of dynamic MRI imaging in pituitary adenomas Indrajit I K, Chidambaranathan N, Sundar K, Ahmed I – Indian J Radiol Imaging

Posted on June 24, 2015 by MaryO

Objectives : MRI has proven to be the best imaging modality in the evaluation of pituitary tumors. Dynamic Imaging is technically a new tool, which has emerged with lot of promise in the evaluation of pituitary adenomas, particularly in accurate delineation of those microadenomas with no contour abnormality and in differentiating residual/recurrent adenoma from surrounding post operative tissue. Dynamic MR imaging is not only useful in the evaluation of pituitary microadenomas but has an equally important role in the assessment of macroadenoma as well. This study analyses and reviews the value of dynamic MR Imaging in pituitary adenomas and postoperative pituitary tumors.

Materials and Methods : A prospective MR Study was undertaken in twenty-five consecutive patients with suspected pituitary adenomatous lesions. These patients were subjected to dynamic MR imaging at our Department from Jan 1997 to Dec 1998. The study was performed on a 0.5T super conducting MR imaging system with Fast Spin echo technique. Gadodiamide (0.1 mmol/Kg) was administered over sixty seconds by hand injection. Dynamic coronal images were obtained simultaneously from three different portions of the gland. Fifteen images were obtained from each of the three portions at an interval of twenty to thirty seconds between the images.

Result : Dynamic MRI was performed in nineteen patients with microadenoma and six cases of macroadenoma. Dynamic MRI study was of diagnostic value in comparison with routine contrast MRI in eleven of the nineteen patients. Dynamic study did not add to the diagnosis and was merely of confirmatory value in remaining eight patients. Dynamic MRI study was used to identify the optimal time for delineation of the adenomatous tumor, by virtue view of the simultaneous differential contrast enhancement patterns between normal pituitary gland and adenoma. Further the enhancement pattern of the normal pituitary gland, the adenomatous nodule and the optimal delineation were individually assessed. This evaluation revealed the average time in seconds for onset of enhancement and the peak enhancement of normal pituitary gland were 43.1 and 111.9 seconds respectively. In comparison the pituitary adenomatous nodules exhibited an average time of 105.8 seconds for onset of enhancement and 188.1 seconds for peak enhancement. The average time in seconds for optimal tumor delineation was 93.9 seconds.

Conclusion : Dynamic MR Imaging has emerged as a technically refined tool in the evaluation of pituitary adenomas. The key questions in evaluation of pituitary adenomas include the presence or absence of a tumor, the number, the location of adenoma nodule, the invasive effects on adjacent structures and the post therapy status of adenoma. Clearly, dynamic MR Imaging is the foremost imaging modality answering these vital questions in patients with pituitary adenomas.

via Value of dynamic MRI imaging in pituitary adenomas Indrajit I K, Chidambaranathan N, Sundar K, Ahmed I – Indian J Radiol Imaging.

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Florida Doctors ~ So Far

Posted on June 20, 2015 by MaryO

florida

 

The doctors listed here have been recommended to Cushing’s Help by other patients as being helpful to them.  These physicians are familiar with the symptoms and treatment of Cushing’s Disease (pituitary) and Cushing’s Syndrome. Your primary care physician may be able to order very basic screening tests. Some of these doctors may require a referral and/or an abnormal test result prior to scheduling an appointment.

Cushing’s Help does not endorse any particular physician. Choosing a particular physician and substantiating his/her expertise is the responsibility of the individual patient.

To recommend your own doctor for this list, please fill out this form.

These doctors are also available on this map.  Please add yourself and/or your doctor.

This list is a continuing resource as new doctors are added, edited OR removed.

 

Florida

Jacksonville

Dr. Eric Sauvageau 

Specialty: Endovascular Neurosurgeon

Location: 800 Prudential Drive – Suite 1100
Jacksonville, FL

Phone: 904-388-6518

Website: http://www.baptistjax.com/doctors/endovascular-neurosurgeon/dr-eric-sauvageau-md

Patient Comment: I went to him for my IPSS procedure. I was VERY impressed by the care that I received. Dr. Sauvageau is Top-Notch! He answered all of my questions & made me feel more comfortable about the IPSS. Very caring. He made a REALLY scary test (that I had cried about many times) EASY PEASY. In fact, everyone at the hospital was super nice! I went to him based on the reviews of 2 other Cushies . He is highly experienced in the procedure and used to do IPSS tests at OSU. I had no pain afterwards and I could barely find where they went in.

 

More coming soon!

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California Doctors – So far

Posted on June 19, 2015 by MaryO

california

 

The doctors listed here have been recommended to Cushing’s Help by other patients as being helpful to them.  These physicians are familiar with the symptoms and treatment of Cushing’s Disease (pituitary) and Cushing’s Syndrome. Your primary care physician may be able to order very basic screening tests. Some of these doctors may require a referral and/or an abnormal test result prior to scheduling an appointment.

Cushing’s Help does not endorse any particular physician. Choosing a particular physician and substantiating his/her expertise is the responsibility of the individual patient.

To recommend your own doctor for this list, please fill out this form.

This list is a continuing resource as new doctors are added, edited OR removed.  

These doctors are also available on this map.  Please add yourself and/or your doctor

California

Beverly Hills

Cohan, Pejman 

Specialty: Neuroendocrine 

Location: 150 N Robertson Blvd # 210
Beverly Hills, CA

Phone: 310-657-3030

Patient Comment: He’s been my Endo for 15 years. Only sees neuroendocrine patients

Freemont

Kunwar, Sandeep

Specialty: Neurosurgeon

Hospital: Washington Hospital

Location: Freemont, CA

Hospital: UCSF

Location: San Francisco, CA

Website: http://www.ucsfhealth.org/sandeep.kunwar

Patient Comments: And dr kunwar at ucsf was my very skilled surgeon. I didn’t have to see his endo preop

I also had my surgery done with Dr. Kunwar at Washington Hospital in Fremont (East Bay). He does a few days a week in Fremont and the rest in SF. This is my third recurrence and I would definitely recommend him

Srinivasan, Lakshmi

Specialty: Endocrinologist

Hospital: Palo Alto Medical Foundation

Location: Freemont, CA

Patient Comments: My endo is Dr. Lakshmi Srinivasan at Palo Alto Medical Foundation in Fremont. She is fantastic–takes a lot of time during every appt and is very attentive and responsive to email and calls.

Los Angeles

Friedman, Theodore

Specialty: Cushing’s, Growth Hormone Deficient, Hypopituitary, adrenal, thyroid, fatigue

Address: 1125 S. Beverly Drive. Suite 730

Location: Los Angeles, CA

Hospital: Charles Drew

Website: http://goodhormonehealth.com

Patient Comments:  I am a Dr Friedman patient, he is wonderful.

 Orange

Linskey, Mark 

Specialty: Neurosurgeon 

Hospital: UCI

Location: Orange, CA

Website: http://www.ucirvinehealth.org/find-a-doctor/l/mark-linskey/

Patient Comment: The pit surgery was done by both Linskey and Bhendarkar and I am doing well post op, they are very diligent in their care. If I have to have another surgery for Cushing’s I will definitely use this team again.

Bhandarkar, Naveem

Specialty: ENT

Hospital: UCI

Location: Orange/Irving, CA

Website: http://www.ent.uci.edu/faculty/naveen-d-bhandarkar-md

Patient Comment: The pit surgery was done by both Linskey and Bhendarkar and I am doing well post op, they are very diligent in their care. If I have to have another surgery for Cushing’s I will definitely use this team again.

San Francisco

Kunwar, Sandeep

Specialty: Neurosurgeon

Hospital: Washington Hospital

Location: Freemont, CA

Hospital: UCSF

Location: San Francisco, CA

Website: http://www.ucsfhealth.org/sandeep.kunwar

Patient Comments: And dr kunwar at ucsf was my very skilled surgeon. I didn’t have to see his endo preop

I also had my surgery done with Dr. Kunwar at Washington Hospital in Fremont (East Bay). He does a few days a week in Fremont and the rest in SF. This is my third recurrence and I would definitely recommend him

More coming soon!

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“My feet are killing me!” An unusual presentation of Cushing’s syndrome

Posted on June 19, 2015 by MaryO

Adverse effects of steroid excess on bone metabolism are well established but presentation of Cushing’s syndrome with metabolic bone disease is reported to be uncommon. We describe a case of Cushing’s syndrome presenting with pathological fractures probably present for 8 years before diagnosis.

A 33 year old nurse first sustained spontaneous stress fractures of her metatarsals in 1994, with repeated fractures occurring up to 2002. In 2001 she developed hypertension, acute lumbar back pain and gained weight.

In 2002 she was admitted to hospital with chest/back pain. Lumbar spine X-ray showed new fracture of L3,old fractures of L4/5,with fractured ribs on CXR. Isotope bone scan revealed multiple hot spots. MRI showed collapse of T8 with features consistent with malignant disease. The primary malignancy was sought and a left-sided 1.5 centimetre thyroid nodule detected.

Suspicious cytology prompted thyroid lobectomy revealing follicular variant of papillary carcinoma. T8 biopsy revealed chronic infection with Propionobacteria rather than metastatic carcinoma. Despite antibiotic therapy further spontaneous vertebral fractures developed. Bone densitometry revealed Z scores of minus 2.4 at L2-4, minus 2.5 and 2.9 at the hips.

Referral to our centre prompted investigations for Cushing’s syndrome. Serum potassium was 4.1 millimols per litre, androgens, calcitonin and urinary catecholamines all normal. TSH was suppressed by T4 therapy. Urinary free cortisol values were raised,(563-959 nanomols per 24hours) with loss of diurnal rhythm in cortisol secretion (9am 429-586,midnight 397-431 nanomols per litre)and no suppression on low or high dose dexamethasone. Abdominal CT showed a 3.5 centimetre adrenal mass. These findings were consistent with adrenal dependent Cushing’s syndrome. Risedronate and metyrapone were commenced before adrenalectomy, completion thyroidectomy and ablative radioiodine.
Comment: Cushing’s syndrome may present with spontaneous fractures in both axial and appendicular skeleton in the absence of marked clinical features. This case demonstrates the importance of thorough investigation of unexplained fractures.

LM Albon, JD Rippin & JA Franklyn

From http://www.endocrine-abstracts.org/ea/0005/ea0005p26.htm

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