This study is being done to examine the effects of a medication called mifepristone in children with Cushing’s disease. This medication has been approved by the Food and Drug Administration (FDA) for use in adult patients with Cushing’s syndrome. It is not FDA approved for use in children.
The study will investigate how children’s bodies absorb and process mifepristone, how it works in children and what effect it has on the use of sugar in the body, on the child’s weight and on growth hormone. An important part of the study is to determine the proper dosing and to evaluate the side effects of mifepristone in children.
Children 6 to 17 years old will be enrolled in the study if they have had surgery for Cushing’s disease and currently have elevated cortisol levels.
National Institute of Child Health and Human Development
Background:
– There are currently no approved therapies for children with Cushing’s disease who are not cured by surgery alone. A drug called mifepristone has been approved to treat adults with Cushing’s syndrome and elevated blood glucose caused by Cushing’s. The drug is marketed under the name Korlym(Registered Trademark). The study drug may have a different effect on a child’s body than an adult’s, so researchers want to know how much of the drug to give children and what effect it will have. They want to learn if mifepristone improves Cushing’s disease in children as it does in adults. They also want to know about the drug’s side effects in children.
Objectives:
– To study the effect of a medication called mifepristone in children with Cushing’s disease that has not been helped by pituitary surgery.
Eligibility:
– Children ages 6 to 17 with active Cushing’s disease following pituitary surgery and who have a body weight higher than expected for their height and age.
Design:
– Participants will be screened for up to 8 weeks with a physical exam, medical history, and medical tests including blood tests and X-rays.
– Participants will take tablets of the study drug each day for 12 weeks.
– Participants will stay at the clinic for 4 nights at the beginning of the study. They will have three 1-day visits during the study. They will stay at the clinic the last 3 days of the study.
– At these visits, participants will be given several tests. In one test, a small wire is inserted under the skin of the belly and a small monitor is attached taped to the belly. In another, the participant drinks a liquid and blood samples are taken.
– Follow-up visits will occur 4 weeks and 12 weeks after the study ends.
INCLUSION CRITERIAPatients who are eligible for enrollment must meet the following eligibility criteria:
– Males and females 6-17 years at informed consent
– Active Cushing’s disease as demonstrated by the following:
–24 hour Urinary Free Cortisol greater than the upper limit of normal for age on two urine collections during screening and
— midnight serum cortisol > 4.4 mcg/dL (mean of two determinations on a single day at 2330 and 2400 during screening)
– Previous trans-sphenoidal surgery (TSS) for ACTH secreting pituitary tumor at least 3 months prior to screening
– Increased body weight defined by BMI Z-score of 1.5 or above
– Able to provide consent/assent
– Able to swallow study drug tablets (not crushed or split)
– Willing to use non-hormonal method of contraception in patients of reproductive potential
– Primary health care provider in home location
EXCLUSION CRITERIA:
– Hypercortisolism not due to Cushing’s disease.
– Type 1 diabetes mellitus
– HbA1c geater than or equal to 9.5% at Screening
– Body weight < 25 kg
– Use of certain medications that are CYP3A substrates with narrow therapeutic ranges, such as simvastatin, lovastatin, cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus during the 4 weeks prior to starting study drug. Use of these medications is also prohibited until 2 weeks after end of dosing.
– Use of certain medications that are strong CYP3A inhibitors such as itraconazole, nefazodone, ritonavir, nelfinavir, indinavir, atazanavir, amprenavir, fosamprenavir, boceprevir, clarithromycin, conivaptan, lopinavir, mibefradil, posaconazole, saquinavir, telaprevir, telithromycin, and voriconazole during the 2 weeks prior to starting study drug.
Use of these medications is also prohibited until 2 weeks after end of dosing. Grapefruit and grapefruit juice are prohibited during this time frame.
– Use of certain medications that are strong inducers on CYP3A such as rifampin, rifabutin, rifapentin, phenobarbital, phenytoin, carbamazepine, St. John’s wort during the 2 weeks prior to starting study drug. Use of these medications is also prohibited until 2 weeks after end of dosing.
– Use of medications used to treat hypercortisolism from the duration indicated below prior to Day 1. Use of the medications is also prohibited until after the end of study 4 week follow up visit.
–steroidogenesis inhibitors such as ketoconazole, metyrapone: 4 weeks
–cabergoline, bromocriptine, somatostatin analogs such as octreotide, lanreotide, pasireotide long acting formulations: 8 weeks (immediate release formulations: 2 weeks)
–mitotane: 8 weeks
– Use of systemic glucocorticoid medications beginning 1 month prior to screening or anticipated use of these medications except for the treatment of adrenal insufficiency. Use of glucocorticoid medications is prohibited during the study until after the end of study 4 week study visit.
– Inflammatory, rheumatological, proliferative or other disorder(s) that would be anticipated to worsen with glucocorticoid blockade (e.g. inflammatory bowel disease, rheumatoid arthritis, psoriasis, etc.).
– Uncontrolled hypo- or hyperthyroidism.
– Uncorrected hypokalemia (< 3.5 mEq/L). The screening period may be used to correct hypokalemia prior to starting study drug. Use of potassium and/or mineralocorticoid antagonists is permitted during the study.
– QTc geater than or equal to 450 msec on Screening electrocardiogram
– Unexplained vaginal bleeding in females and/or any history of endometrial pathology.
All terms used to describe a football team’s offensive line.
More often than not, it takes a special breed of player to be willing to do battle in the trenches.
Humboldt State right guard Dillon Reagan can without a doubt be bestowed with the title of special.
From overcoming Cushing’s Syndrome — a rare disease which left him with the use of only one lung — to the depression that was associated with the disorder, the Issaquah, Wash. native has definitely taken the road less traveled.
”The hardest part,” Reagan began, “was the first four months. (Doctors) didn’t know what was necessarily wrong with me. I was misdiagnosed as bipolar.”
Reagan displayed the initial symptoms of Cushing’s in 2009 after earning second-team All-State honors as a freshman at College of the Redwoods. A disorder caused by a tumor on one of the endocrine glands, Cushing’s causes a massive secretion of hormones which can affect behavior and physical appearance.
It did that and more to Reagan.
”I had full-ride scholarships taken away,” he said.
A full-body scan revealed a softball-sized tumor wrapped around his heart and left lung. Open heart surgery remedied the situation but his left lung useless.
In the midst of all this, Reagan also developed diabetes.
It would have been quite easy for the 6-foot-3 kid from Washington to call it quits. No one would have blamed him.
But an offensive lineman never quits.
”I never changed my approach,” Reagan said. “It’s a position of dominance and perseverance. Being an offensive lineman helped me get through all that. It helped me not feel sorry for myself.
”It was a long road back to full speed, but, your body reacts to how you push it.”
And push he did.
Reagan hit the weight room and transformed his body — which ballooned to 380 pounds due to Cushing’s — back to the muscular 300-pound frame he showcased his freshman year. He returned to Redwoods for his sophomore campaign and again displayed the skills that made him a Division I commodity.
”I ended up getting All-California,” Reagan said. “And with the use of only one lung.”
Looking to further his football career at the university level, there was really only one option.
”I wanted to go to a good program,” Reagan said. “That clear answer was Humboldt State.”
Reagan noted the close ties Redwoods and Humboldt shared as a deciding factor. His coach at CR was Duke Manyweather, a former HSU player himself. Reagan also sought the guidance of Humboldt State strength and conditioning coach Drew Petersen during his road to physical recovery.
Reagan asked to join Humboldt State as a non-scholarship athlete during the 2012 Spring semester and head coach Rob Smith and his coaching staff were more than happy to have him.
The following season, Reagan showed why.
As a junior, Reagan started 11 games for the Jacks providing a stabilizing force for a unit which paved the way for running backs to gain 2,152 total yards. He also earned second-team all conference honors.
It is amazing how high Reagan has risen after seeing how far he had fallen. An inspiration and uplifting athlete, it is easy to label him special.
Just don’t tell Reagan that.
”It takes me a little longer to warm up and get to game speed. But I don’t want to be treated differently than my teammates,” he said.
Entering his senior season, Reagan is being counted upon to be a stalwart right guard as he is only one of two returning starters (center and good friend David Kulp the other) from last season’s road graders.
Reagan is more than ready.
”As an offensive lineman, you show up every day, no matter what happens outside of practice, no matter what’s going on at home, no matter how beat up you are. You do it again and do it every day,” he said. “We set the tempo for the rest of the practice, rest of the game. If we don’t know up, it’s hard for everyone else to show up.”
Three positions are up for grabs on the Jacks’ front line. Reagan likes what he is seeing from the player stepping up to the plate.
”Start with tackle,” Reagan began, “(Jonathon) Rowe has made tremendous contributions at camp. He’s really growing up for his in a short time. Jonathan Bajet, he’s moving over from the defensive line, and he’s been really neck-and-neck for a starting guard position. David (Kulp), he’s a great guy to play next too, a great guy to have in your corner. It just works. We don’t have to say anything, we know what we’re doing. And (Jarrett) Adams has stepped up a bit. In the last few weeks he’s learned how to play right tackle.”
Humboldt is still knee-deep in competition in preparation for the Sept. 7 season-opening home contest against Simon Fraser. Reagan notes practicing daily against a defensive line which features returners Alex Markarian, Silas Sarvinski and Tommy Stuart, to name a few, helps both the O and D.
”They are adapting to our fast offense,” Reagan said. “You’re only as good as you practice. No one shows up game day and plays good. We challenge each other every day. It gets intense. But it’s all out of competition. Competition is a thing that drives a football team.”
If everything falls into place, all the Jacks’ hard work will result in one thing: Great Northwest Athletic Conference supremacy.
There’s simply no better lasting impression for Reagan.
”A GNAC Championship,” he said. “That puts you down in the books forever, that GNAC Championship.”
Title or not, it’s a pretty safe bet Reagan has already left a lasting impression.
Jordy is a British man who has been dealing with Cushing’s and many surgeries.
He finds rollercoasters boring, barely broke a sweat zip-wiring off the Tyne bridge and even a parachute jump did not raise his heart rate.
Just a few years ago even the thought of daredevil exploits would have terrified him, but now Jordy Cernik is frightened of nothing.
While that might sound an ideal scenario, the 38-year-old’s new-found bravery is actually the unexpected side-effect of surgery for a rare condition.
Cushing’s Syndrome resulted in the dad-of-two having an operation to remove the gland which produces adrenalin, the hormone which makes us feel scared.
He says: “I would never have had the guts to do any of this, but now nothing fazes me. I’m up for anything – I’m even thinking about doing a wing-walk on a plane too.
“I nearly did a bungee jump a few years ago, but I just couldn’t do it.
“Now I just take whatever is thrown at me and if a challenge helps me raise money for charity, the more daring the better.”
Over the past four months he has completed the parachute jump and zip-wired from the top of Newcastle’s Tyne Bridge and now he is getting ready to complete the last of a trio of challenges – next month’s Bupa Great North Run.
“The doctors didn’t tell me this could be one of the side-effects of the operation,” says Jordy. “But then the condition is so rare I don’t think they know everything about Cushing’s yet.
“Doing the skydive was the ultimate test. I thought that if I was ever going to get scared again then that would be the moment.
“But as we took off in the plane I felt nothing, and when I edged towards the door to jump I felt nothing, and even when I leapt out and pulled my parachute, I didn’t feel scared at all.
“It can be quite frustrating as well though.
“The first time I realised I had changed was when I went on the rides at a theme park with my kids and I just didn’t feel a thing. I just sat there, bored.”
However, the last of his hat-trick of challenges, the Run, will require him to push through the ever-present pain which he has endured for years as a result of Cushing’s.
Britain’s biggest mass participation event, for which The Daily Mirror is a media partner, takes place over a 13.1 mile course from Newcastle to South Shields.
But the syndrome has left Jordy, from Jarrow, near Newcastle, with arthritis, back problems and brittle bones. Worse still, the absence of adrenalin means he now lacks one of the body’s natural painkillers.
“I’m always in pain,” he says. “I’ve just had to learn to zone it out day-to-day and I’m going to have to do that even more when I’m on the run.”
Cushing’s affects around one in 50,000 people in Britain.
It causes a malfunction of the adrenal and pituitary glands which means increased amounts of corticosteroids are produced – often leading to massive, irregular weight gain.
In just three years 5ft 8in Jordy ballooned from 11st 5lb to almost 17st.
While his limbs remained slim, the former Territorial Army recruit saw the pounds pile around the major organs in his torso and head.
“I went through years of hell and I can only describe it as living in someone else’s body,” says the part-time radio presenter and events host.
“I developed this big round moon face and really quite large man boobs, which was so embarrassing.
“But there was absolutely nothing I could do about it. I could go to the gym six days a week and still couldn’t lose any of the weight.
“One of the worst things was that people would stare.
“Sometimes they’d take the mickey – often to try and make me feel better, by making light of things – but it would almost always hurt my feelings.
“And my career as a presenter suffered. I tried to play up to the character of being a big, jolly chap but I always felt I was too fat for TV, which is what I would have liked to do a lot more of.”
But it was the effect on his home life with wife Tracy, 43, and daughters Aimee, seven, and four-year-old Eive that for him was far worse.
“I had other really difficult symptoms which included profuse sweating which meant I couldn’t even hold my kids without wrapping them in towels first,” he says.
“Anyone who has children knows how hard that is, not to be able to do normal things. I often used to be in tears.
“Another symptom was extreme grumpiness, so I would find myself suddenly getting really angry and just exploding at them, plus I was always too exhausted to play with them. It was terrible.”
Jordy believes he can trace his symptoms back 15 years although his Cushing’s was only diagnosed in 2005.
He had visited his local surgery with a string of complaints, but by chance saw a different doctor one day and the syndrome was diagnosed.
“I don’t have any ill-feeling about that,” he says, “because the syndrome can be tricky to spot, partly because it is so rare.”
He went on to have both his pituitary and adrenal glands removed but needed a total of seven operations between 2005 and 2010 and not all went smoothly.
During one to remove his pituitary gland, which is inside the skull, the lining of his brain burst due to the stress of repeated surgery.
And while removing a rib to access the adrenal gland in his torso, his lung was punctured.
That wasn’t the end of the complications. He later developed severe meningitis and ended up on a life-support machine.
“But I still consider myself lucky,” he says. “The doctors told me, ‘You died twice really, you shouldn’t even be here’.”
Things have begun to look up in the past few years, however. The Cushing’s is in remission and Jordy has lost four stone.
His life hasn’t returned to normal entirely – he still has to take 30 pills a day, a cocktail of painkillers and hormones, plus drugs to slow the corrosion of his bones.
He has also been diagnosed with another rare condition, sarcoidosis, which creates nodules of irregular cells in the body and can cause serious complications. He’s convinced he has always had it but it has lain dormant until his body was at its most vulnerable.
At present the nodules can only be found on his skin and he’s being monitored to ensure that it doesn’t spread to his internal organs.
Thanks to the surgery, his life has improved enormously since 2010.
In July he had a breast reduction op which not only improved his appearance but also removed the dangerous accumulation of fat around his heart.
Part of this new chapter involves taking part in the Great North Run and raising money for the Cash for Kids appeal run by his local radio station Metro Radio.
The appeal aims to help children and young people in the North East who are disabled or have special needs, or those who suffer from abuse or neglect.
Jordy’s fundraising goal is a relatively modest £1,000, but for him joining the half marathon’s 56,000 participants on September 15 will be as rewarding as hitting his target.
“I really don’t know if I’ll be able to complete the course.” he says. “But I’m looking forward to it and I’m going to give it my best shot.
“Not feeling fear may feel like the power of a superhero, but what I really need for the Great North Run is superhero strength.”
The Bupa Great North Run is Britain’s biggest mass participation event and is organised by Nova International.
It will include world class athletes Mo Farah, Haile Gebrselassie and Kenenisa Bekele – plus 56,000 other runners.
The event is live on BBC One on Sunday 15th September between 9.30am to 13.30
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