MaryO

The duplicate posts have been removed - thanks for letting me know. If you see anything else like that, please tell me - I guess that particular board got imported twice. I'm not sure what you mean about the starting post is imbedded among the replies - can you give me a link so I can check that out, please? Thanks

The chatroom and Cushings-help links are working now I love the Board Summary, too - that's one of my favorite features here along with "My Assistant". Also, the View New Posts shows all the latest posts since you were here last.

Remember, the old boards when a category said This area contains...then it listed about 10 boards? That's what this question is about. Do you like it better as is (number 1), or as it was?

Doreen, these notices "expire" after 30 days, so if you want to keep getting them, you need to renew them pretty regularly. I suspect that this was done this way for people on boards where a post may change it's "flavor" every few weeks and people don't want to be annoyed getting the emails anymore. Go to your Control panel and click where it says Topic Tracker. It will tell you how many days, if any, you have on the subscription to each topic. I imagine yours have expired, if you're not getting the notifications anymore.

Are you a woman with pituitary problems? Women with a history of pituitary problems are at an increased risk for heart disease, low muscle mass, high body fat, and a decreased quality of life. We are therefore conducting a research study to investigate whether growth hormone replacement therapy improves the risk of heart disease, sense of well-being, and the distribution of body fat and muscle in women with growth hormone deficiency. Growth hormone is a hormone that is made by the pituitary gland in your brain. If you have a history of surgery or radiation to your pituitary gland and/or hypothalamus or you have had problems with your pituitary gland, you may have growth hormone deficiency. Free growth hormone testing is available to those who meet other eligibility criteria. If you qualify for the study and are interested in participating, you will be randomly assigned to receive growth hormone or placebo for 6 months. For the following 6 months all participants will receive growth hormone replacement at no cost. If you decide to enroll, study visits will take place over a 12-month time period. We hope that theresults of this research will help to improve treatments for women with growth hormone deficiency. Location: Massachusetts General Hospital in Boston, MA Enrollment period: 2003 and ongoing Patient Compensation: Up to $300 stipend and free growth hormone for 6-12 months available to those who qualify. If you are between the ages of 18 and 65 and are interested in finding out about this year-long research study, please contact: Julie Jones, Nurse Practitioner Phone: (617) 724-1837 Email: jjones18@partners.org Address: 55 Fruit St. BUL 457B Massachusetts General Hospital Boston, MA 02114 or Catherine Beauregard, MD Phone: (617) 726-8855 Email: cbeauregard@partners.org Address: 55 Fruit St. BUL 457B Massachusetts General Hospital Boston, MA 02114

Here's what some other people have on their bracelets, etc... Darlindebe:size> Medic alertsize> Adrenal Insuff. In Emergency needs hydrocortisone. Diabetes, HTN, Allergic to PCNsize> Edith:size> Medic alertsize> Bilateral Adrenalectomy, Cushing's disease, Addison's Disease, On Steroids. In my wallet I list the steroids (prednisone and florinef) that I'm on along with other medical info: i.e. doc phone numbers, how to give a hydrocortisone injection, where to find my injection kit, etc...)size> Erin:size> Medic alertsize> Cushing's Disease, Hydrocortisone, Allergic: Ceclorsize> Jackson M. Dean, Jr.:size> ?size> Cushings DiseaseHypopituitary Low Cortisol Taking Cortef Dr. Kemick Telephone # size> jaycee:size> ?size> I have on the bracelet:adrenalectomies on seroid and other medical informations no related to cushing with me all the time: emergency letter, with instructions and phone numbers list of meds extra cortef with me most of the time: solucortef injection ki water, salt enough essentials pills to cover two days size> JenS:size> Medic alertsize> idopathic thrombocytopathysize> Lorrie:size> Medic alertsize> Adrenal insufficiency, needs stress dose steroidssize> MaryO:size> Medic alertsize> Adrenal Insufficiency, wears contact lenses, allergic to iodine dyesize> Renea:size> KidsID, Inc?size> BILATERAL ADRENALECTOMY, STEROID/THYROID REPLACEMENT, 90% PITUITARY REMOVAL, CUSHING'S DISEASE, O NEGATIVE ATIVAN ALLERGY, DOCTOR'S NAME AND NUMBERsize> ReneeD:size> Medic alertsize> Diabetes, No adrenal glands, cortisone dependentsize> Shauna:size> Medic alertsize> Adrenal Insufficiency, Needs stress dose steroids, allergic to PCN (penicillin).size> Valerie:size> Medic alertsize> steroid dependent and needs stress dose cortisone. I have my entire medical history on the Medic alert file with all docs number, family member numbers, what meds I'm on and to administer Solucortef 100mg if in an emergency or trauma situation.size>

Please find the correct topic for posting your topic, rather than using this one as a "dumping place". ?Questions about urine testing belong in the Testing, Testing area: Diagnostic Tests for Cushing's: Urine and so on. Please take a few moments to look at all the boards that are here. Near the bottom right of each area is a "Forum Jump" where you can see the list of all the various areas here. Here's a copy of another post, about why not to have duplicate topics, such as we have had with the Main Board... Several times in the last day or so, the boards wouldn't load at all for me. The message boards are starting to slow down again. This is the 3rd or 4th board that we've had already and I don't particularly want to have to start from scratch again. I'm sure that no one else wants to, either. Some ideas which have been suggested to help have been to restrict the starting of new posts by allowing only people who have posted at least X amount of times to start a new topic; having all new topics moderated (approved) before they are shown on the board or by closing the main board altogether to new posts. One or more of these may have to be implemented to keep the boards moving fairly quickly. If the boards keep slowing down, I may have to restrict the starting of new posts altogether, and allow responses only. Please help out here... New posts: Every time that there's a new post, the board has to make up a new qualifier for it, such as &quotact=ST;f=72;t=19" or &quotact=ST;f=78;t=73" depending on when the post was made, and what board it was on, etc. The more posts we have, the more of these different crazy qualifers we have and the harder it is for the board to come up with a given post when you click on the link in the index of posts. So, with every new post, the boards get a little slower. How to help this? It's not necessary to have a new post for everything. The main board itself already has several posts titled something like "UFCs"; "Weaning" and other topics which have been discussed several times already. If that's what you're posting about, find one of those to continue in. Even better would be to continue one of the threads on the Urine Testing Board or the Cortisol Withdrawal / Adrenal Insufficiency. After 10 days it will be moved there, anyway. I see a lot of people who have posted the exact same thing on several boards. Each additional one slows things down just a bit. If you really can't decide which board it goes on, post it on the Main Board and, after 10 days of no response it will be moved to where the moderators think it should go. There are topics about every possible topic here, though, and you should be able to find a good home for your post. Responses: I've seen this a few times. There will be a post. Then a new post will come along with a title like "In response to the post about...", then another post "responding to..." Please keep all those together, in one thread. It's easier to keep track of who said what, and helps keep this board running a little faster. Same goes for posts of your own. If you start a thread about an upcoming MRI or surgery, whatever, please post the response(s) and continuations in the same thread. As I said above, it's easier to keep track of who said what, and helps keep this board running a little faster. A lot of posts, such as those about how to do UFCs, or how to wean off cortisone, have been answered many, many times already. Please take a moment to look through the older posts on the boards, or on the dropdown menu at the bottom of every page. I've compiled a lot of information already, from a variety of sources, as a reference for everyone. Also, the boards and website have great search engines for your use. The website search page. The board search engine.Check them out - your question may have already been answered. Thanks for helping out While I'm on a roll... If you're posting a surgical date, please put it on the Please Post Dates for the Pop-Up Calendar Here board, or I might not see it and be able to add it to the Pop-Up Calendar, news scroller and email newsletter. Thanks. ~~~~~~~~~ A reminder of the guidelines that are in place on these boards: Rules of the Road... Please Follow The Cushing's Help and Support Message Board Guidelines The new, improved Cushing's Help and Support Message Board has many new features. The board is divided into individual subjects. We recommend you first look around, familiarize yourself with the new format and features. Before you can begin posting, it is necessary for you to register. You can do so by clicking "Register" on the menu at the top of your screen. Once done, feel free to select subjects of interest to you and post to your heart's content, but please read these guidelines before posting. ** It is recommended that when registering you keep your E.mail address "private." Anyone interested in connecting with another member can utilize the "messenger" feature to send a message. This can be located on the menu bar at the top of the screen, or in each person's posted message. Another option would be to Email the Moderator requesting someone's address. The board administrator will obtain permission from the requested party to provide their E.mail address. Guidelines: 1) Please conduct yourself in the same courteous, respectful manner you would in any public forum. 2) Messages linked to commercial sites are not permitted. 3) Messages advertising products and services are not permitted. 4) Messages requesting participation in and information for books, newspaper or magazine articles and school papers or theses are not permitted. 5) Links to E.commerce sites are not permitted. 6) Profanity is not permitted on these boards, nor are links to sites containing pornography. 7) Please do not attack other participants. Messages of a confrontational manner are not permitted and will be removed at the discretion of the Board Administrator. If you take issue with the nature of a message, address the message. Please do not attack the messenger. 8) Messages or behavior which does not comply with the Cushing's Help and Support Message Board Guidelines will be removed at the discretion of the Board Administrator. 9) Those who repeatedly refuse to abide by these guidelines may be banned from future participation in these forums. 10) Those found to be harvesting E.mail addresses from these message boards for the purpose of selling products will have their accounts terminated immediately. 11) Please do not begin a new topic without first checking to see that a topic doesn't already exist that would be suitable for your message. 12) No doctor-bashing. If you feel you have to say something negative about a doctor, please do not post his/her name or other identifying information on the boards. This site and these boards are a haven for support and friendship. They are NOT for people pushing or selling products nor for MLM marketing. This is a non-sectarian community. We are people from every ethnic and religious background. This community respects everyone's personal beliefs, but links to religious sites are not permitted. If you have any questions about these guidelines or how these message boards work, feel free to ask in the New Boards - Questions and Answers topic or Email the board administrator. Thank you for your cooperation. We hope you enjoy the new Cushing's Help and Support Message Boards. For more information, be sure to visit the entire Cushing's Help and Support Web site. Join the Cushing's Help and Support Mailing List for news and chat announcement by signing up here. To get back to the Main Board at any time, click on your browser's back button, or the drop-menu (Forum Jump) in the lower righthand corner of each topic's screen, click on "Boards" (or you can jump to any board) and you'll see a list of boards you can view, or click on "Cushing's Help and Support Board" at the top of this screen next to the Cushing's Help and Support Message Board logo. Welcome to Cushing's Help and Support!

There seems to be a lot of differing opinion on this. At the University of Virginia, Dr. Vance (endo) says it's NOT the brain, while Dr. Laws, the surgeon, says it is. Personally, if I'm telling someone about my surgery, it's easier to say brain because everyone knows where that is. If I say pituitary, I often get a blank stare. Whatever the "correct" terminology is, this sounds like a great cause - good idea on the CUSH Hat, too, Shauna

The Teddy Bear and the 2 sizes of mugs with "Be My Cushie Sweetie" are still there. The Cushie Store is open all the time at Cushing's Online Store. Some items go on sale periodically. I see that the various sweatshirts are on sale now. Some of these might be good to wear to UVa and other Cushing's meetings

To help kick off the new year, they are having a Winter Sale. Now through January 16th, customers can save $4 when they purchase over $35 worth of merchandise by using coupon code ILOVE2004. If you're thinking of getting a Tshirt or something else to take to UVa, maybe this is the time to get it, while the sale is on. Cushie Store

Some Questions and Answers About Flu .c The Associated Press ATLANTA (AP) - Health officials say this year's flu outbreak, which has spread faster and earlier than usual, appears to be the worst in at least three years. Here are answers to some common flu season questions: Q: What's the difference between a cold and flu? A: Colds usually begin slowly and last only two to seven days, although it can be two weeks. They start with a scratchy, sore throat, followed by sneezing and a runny nose. You may get a mild cough later. Infants and young children can sometimes run temperatures up to 102 F. with a cold. Flu often begins with a sudden headache and dry cough, possibly a runny nose and sore throat; also achy muscles and extreme fatigue. You may run a fever up to 104. Most people feel better in a couple of days, but the tiredness and cough can last for two weeks or longer. Flu can cause severe illness and life-threatening complications in some people. Children may have symptoms - nausea, vomiting or diarrhea - that are not common for adults. Flu can be confirmed with a test if given within two to three days after symptoms begin, but getting it isn't always practical. Q: What flu symptoms are dangerous? A: A combination of symptoms - sustained fever and chills, chest pain that gets worse when taking a deep breath and sputum that's a yellow color - can indicate pneumonia and a doctor should be consulted. Q: Can I get the flu even though I got a flu shot this year? A: Yes, although it often lessens the severity of the virus and can prevent deadly complications. Typically, the flu shot protects between 70 percent and 90 percent of healthy people under age 65. The elderly are more susceptible. The power of the flu shot also depends on how well it matches the flu virus in circulation. The current Fujian flu strain that is affecting most people is not the strain in this year's flu shot. But disease experts say it is a close enough match that considerable protection should be provided. Q: What are complications from the flu? A: They include bacterial pneumonia, dehydration and worsening of chronic medical conditions such as congestive heart failure, asthma or diabetes. Seniors and those with chronic medical conditions are at highest risk. Q: How is flu spread? A: It spreads when an infected person coughs, sneezes or talks and the virus is sent into the air. Q: How soon can I get sick from the flu? A: It takes one to four days - on average two days - for a person exposed to the flu virus to develop symptoms. Q: How do I protect myself? A: The best way for individuals, particularly those at high risk for its serious complications, is to get a flu shot. It is particularly recommended for the elderly and children 6 months to 23 months. Q: How many people get sick or die from the flu? A: It's estimated 10 percent to 20 percent of U.S. residents get the flu and 114,000 are hospitalized each season for flu-related complications. Typically, it kills about 36,000 people in the United States each year, but experts say this year could be worse. Source: Centers for Disease Control and Prevention. On the Net: CDC information: http://www.cdc.gov/ncidod/diseases/flu/facts.htm

Abstract 1: Clin Endocrinol (Oxf). 1990 Aug;33(2):279-89. Diurnal salivary cortisol patterns during pregnancy and after delivery: relationship to plasma corticotrophin-releasing-hormone. Allolio B, Hoffmann J, Linton EA, Winkelmann W, Kusche M, Schulte HM. Medizinische Klinik II und Poliklinik, Universitat zu Koln, Universitats Frauenklinik, Koln, FR Germany. The circadian rhythm of salivary cortisol was studied in 10 healthy women every 4 weeks throughout pregnancy. In addition, in 12 women the diurnal patterns of salivary cortisol, serum cortisol, plasma ACTH, plasma CRH and serum progesterone were analysed in late third trimester pregnancy and again 3-5 days after delivery. Salivary cortisol profiles exhibited a clear circadian rhythm during pregnancy with an increase in mean salivary cortisol from the 25th to 28th week onwards reaching concentrations in late pregnancy more than twice as high as in non-pregnant controls, rapidly returning to normal concentrations after delivery. The coefficient of variation of salivary cortisol profiles decreased in third trimester pregnancy due to a parallel upward shift of cortisol concentrations (40.2 +/- 3.4% vs 77.6 +/- 6.6% after delivery, P less than 0.01). A diurnal pattern was also found for plasma ACTH and serum cortisol before and after delivery with lower concentrations post-partum (P less than 0.01). In late pregnancy, progesterone concentrations were significantly higher in the evening (930 +/- 85 nmol/l vs 813 +/- 74 nmol/l at 0900 h, P less than 0.01) but showed no diurnal variation post-partum. Plasma CRH was significantly elevated in late third trimester pregnancy (1.22 +/- 0.23 micrograms/l at 0900 h) but showed no diurnal change (1.30 +/- 0.28 micrograms/l at 1900 h). Moreover, no correlation between the free cortisol increase in late pregnancy and plasma CRH was noted despite a wide range of CRH levels (0.13-3.60 micrograms/l). In contrast, a significant correlation was observed between the serum progesterone increase and the salivary cortisol increase in late pregnancy (r = 0.70, P less than 0.05). These findings demonstrate that placental CRH is not the only regulator of maternal ACTH and cortisol release. Instead, our study suggests that placental CRH has little influence on baseline maternal adrenocortical function in pregnancy. The elevated salivary cortisol levels in pregnancy may be explained by glucocorticoid resistance owing to the antiglucocorticoid action of high progesterone concentrations. PMID: 2225483 [PubMed - indexed for MEDLINE] ~~~~~~~~~~~~~~~ Abstract Am J Obstet Gynecol. 1981 Feb 15;139(4):416-22. Related Articles, Links Maternal plasma adrenocorticotropin and cortisol relationships throughout human pregnancy. Carr BR, Parker CR Jr, Madden JD, MacDonald PC, Porter JC. Adrenocorticotropin (ACTH) and cortisol in plasma were measured weekly from early in gestation through delivery in five women whose pregnancies were normal. During the twelfth week of pregnancy, the concentration of ACTH in plasma of blood samples obtained between 0800 and 0900 hours was 23 +/- 4.6 pg/ml (mean and SEM) and rose progressively to 59 +/- 16 pg/ml at 37 weeks. The levels of ACTH in plasma were significantly lower throughout pregnancy than those found in nonpregnant women. During labor and delivery, ACTH levels rose strikingly to values of 301 +/- 137 pg/ml. As pregnancy advanced, the concentration of cortisol in plasma increased progressively from 149 +/- 34 ng/ml (mean and SEM) at 12 weeks to 352 +/- 90 ng/ml at 26 weeks' gestation but changed minimally thereafter until labor commenced, during which values of 706 +/- 148 ng/ml were achieved. ACTH and cortisol secretory patterns over a 24-hour period were also investigated in one subject during each trimester of pregnancy. Diurnal variations were observed that were qualitatively similar to those seen in nonpregnant women. From the results of these studies, we conclude that ACTH levels are suppressed in plasma of normal pregnant women but are higher in late pregnancy than in early pregnancy. The rise in plasma ACTH concentrations, as pregnancy advances, in spite of increasing levels of plasma cortisol, estrogens, and progesterone, is suggestive of the possibility that a source of ACTH exists that is not subject to negative feedback control, that the clearance of free cortisol increases as pregnancy advances, or that there is an alteration in the metabolism of the ACTH precursor protein produced by the pituitary and/or placenta. PMID: 6258436 [PubMed - indexed for MEDLINE]

I'm moving this down to the Main Board, where more people are likely to see it and respond

I know a lot of us have said we have psoriasis... New Psoriasis Drug Wins FDA Approval .c The Associated Press WASHINGTON (AP) - A new drug for the itchy-skin condition psoriasis won the Food and Drug Administration's approval Monday. Raptiva was developed by the companies Genentech and Xoma and is an antibody intended for treatment of moderate to severe psoriasis in people at least 18 years old. Genentech spokeswoman Tara Cooper said the drug should be available by Thanksgiving. She said the average patient would pay more than $14,000 annually for weekly injections of the drug. The chronic skin condition is thought to form when the immune system runs amok and cells called memory effector T cells prompt skin inflammation. The condition, characterized by inflamed skin with scaly patches, affects about 1.5 million Americans. Raptiva, known by the technical name efalizumab, is intended to keep the T-cells that cause the inflammation from binding to other cells in the skin. The National Psoriasis Foundation said clinical trials found side effects of the drug included moderate flu-like symptoms with the first few doses and occasional headache, chills, upset stomach and fever. In January the FDA approved another new treatment for psoriasis called Amevive, also designed to target the T-cells involved in development of the condition.

Addisonian Crisis Precipitated by Thyroxine Therapy: A Complication of Type 2 Autoimmune Polyglandular Syndrome Physicians should be alert to the potential for additional endocrine conditions, particularly adrenal failure, in all patients with autoimmune endocrine diseases, especially those with insulin-dependent diabetes and autoimmune thyroid conditions. South Med J 96(8) 2003 Leland Graves III, MD, Robert M. Klein, PHD, Anne D. Walling, MD Abstract and Introduction Abstract Hypothyroidism is a common condition. Rarely, it may occur in combination with autoimmune failure of other endocrine glands (autoimmune polyendocrinopathy syndrome type 2, previously known as Schmidt's syndrome). In such cases, restoring normal thyroid function may precipitate adrenal failure. Clinicians should have a high index of suspicion for this condition in patients with Addison's disease, those with a family history of autoimmune endocrine gland failure, patients with one autoimmune endocrine disease who develop nonspecific or serious illness, and patients with type 1 diabetes mellitus whose insulin requirements drop without obvious explanation. Introduction Both autoimmune thyroid disease and type 1 diabetes mellitus are common conditions. Rarely, one or both of these conditions is the presenting feature of potentially fatal auto-immune failure of several endocrine organs known as auto-immune polyendocrinopathy syndrome type 2 (APS2). A high index of suspicion for adrenal failure should be maintained when patients with autoimmune thyroid disease or type 1 diabetes mellitus develop nonspecific but serious illness. Case Reports Patient 1 A 44-year-old white woman consulted her primary care physician because of fatigue increasing over several months. Additional symptoms of numbness of her hands and feet, change in skin condition from oily to dry, and recent onset of breathlessness on exertion were elicited by detailed questioning. The patient appeared unusually well and was coping with a busy schedule as a day-care provider as well as being responsible for her own four children plus two elderly relatives. Her pulse rate of 60 beats/min and blood pressure of 90/60 mm Hg were not significantly different from previous readings, but a weight loss of approximately 10 pounds had occurred during the previous 18 months. Family history and physical examination revealed no significant new information. On initial testing, her thyrotropin was 230 ?IU/ml (normal range 0.35-5.5 ?IU/ml) with a decreased free thyroxine index. Microsomal antibodies were significantly increased at 2,966 IU/ml (normal range, 0-99 IU/ml). A diagnosis of autoimmune hypothyroidism was made, and she quickly improved both clinically and by laboratory evaluation with thyroid replacement therapy. Approximately 4 months later, the patient reported return of fatigue and had lost an additional 2 pounds in weight. In spite of being euthyroid by clinical and laboratory examination, her pulse and blood pressure remained low, and she appeared unusually tanned. PM serum cortisol measured 1.2 ?g/dl (normal range, 3.0 -15.0 ?g/dl) with an adrenocorticotropin (ACTH) of 1,462 pg/ml (normal range, 9-52 pg/ml). The patient was treated for impending Addisonian crisis and has remained well on thyroid and adrenal replacement therapy with regular monitoring for associated conditions. Patient 2 A 25-year-old white man consulted his primary care physician because of inability to continue his aggressive physical fitness program owing to progressive fatigue, weakness, and unintentional weight loss of 15 pounds during a 4-month period. He had previously been in excellent health and participated in endurance sports. Family history was significant for hypothyroidism in his maternal grandfather and two aunts. On physical examination he appeared healthy, with a blood pressure of 110/70 mm Hg and a resting pulse of 60 beats/min. His skin was mildly dry, but no other significant features were noted. Laboratory testing confirmed hypothyroidism with an elevated thyrotropin of 68 ?IU/ml, and a deceased thyroxine. Thyroid replacement therapy was initiated. Two weeks later, the patient reported increasing fatigue and weakness to the extent of being unable to carry out daily activities. He also reported dizziness on standing and recent onset of nausea and vomiting. On examination, he appeared acutely ill, with tachycardia (120 beats/min). His supine blood pressure of 90/60 mm Hg fell to 80/50 mm Hg on sitting, and he was unable to stand because of dizziness. His skin was universally tanned, with excessive pigmentation in the palmar creases. The diagnosis of Addison's disease was confirmed by laboratory testing. Electrolyte studies showed a decrease in serum sodium and bicarbonate with an elevation of potassium, a decreased serum cortisol of 2.2 ?g/dl, and elevated ACTH of 639 pg/ml (normal range, 9-52 pg/ml), all consistent with Addison's disease. Antimicrosomal, antithyroglobulin, and antiparietal cell antibodies were all significantly elevated. After initial inpatient management of Addisonian crisis, the patient has remained well on treatment with hydrocortisone and levothyroxine. He has not developed other manifestations of endocrine failure. Discussion The original description by Schmidt in 1926 of autoimmune disease affecting more than one endocrine organ concerned a patient with thyroiditis and hypoadrenalism.[1,2] The syndrome is now defined as autoimmune adrenal disease associated with autoimmune thyroid disease and/or type 1 diabetes and is referred to as APS2. The most common combination (around 75% of cases) is of thyroid and adrenal failure, and either organ may fail first.[3] In those patients who have a combination of type 1 diabetes and adrenal failure, the diabetes typically occurs first,[4] and an unexpected fall in insulin requirements may be the earliest indication of impending adrenal failure.[5] About 10% of cases have all three of the major conditions[3] (type 1 diabetes mellitus plus autoimmune adrenal and thyroid disease). Other autoimmune diseases, especially of the skin, stomach, and gonads, occur with increased frequency in patients with APS2 (Table 1). APS2 is one of a group of autoimmune polyendocrinopasyndromes (Table 2),[6] but new findings in molecular biology and genetics[7,8] may lead to changes in classification. The traditional concept of distinct autoimmune endocrine diseases (such as Addison's and Hashimoto's diseases), each resulting in damage to a specific end organ, is being expanded to include appreciation of autoimmune attack on multiple endocrine organs. The autoimmune process is increasingly recognized as directed against enzymes.[9] It is now estimated that 40 to 50% of autoimmune adrenocortical failure (classical Addison's disease) are due to APS2.[10] Patients with one autoimmune endocrinopathy should be considered at risk of failure of other endocrine organs regardless of classification or original diagnosis. The prevalence of APS2 is estimated to be 1.5 to 4.5/100,000 population.[3] The condition is most common in middle-aged women, with average age of onset between 35 and 40 years and a female/male ratio of around 4:1.[3] The destructive process in APS2 is believed to be a cell-mediated immune response and a loss of self-tolerance (Fig 1). Although the genetic basis of the condition has not been clearly defined, it is strongly linked to various alleles within the HLA-DR3-carrying haplotype or related genes.[7] As HLA molecules largely determine T-cell responses to antigens, both an external antigen stimulus and a genetic susceptibility may be required to initiate the autoimmune destructive process. The wide range of endocrine-related autoantibodies reported in APS2 indicates that B cells are activated and contribute to the pathologic process (Fig. 1).[8] Extensive tissue destruction must occur before the process becomes clinically apparent; one report estimated that 80 to 90% of adrenal tissue must be destroyed before symptoms of Addison's disease occur.[11] Figure 1. Schematic of involvement of both B-cell and T-cell responses in polyglandular autoimmunity. (IFN-, interferon-; IL-2, interleukin 2; CTL, cytotoxic T lymphocytes; Ab,antibody; MHC, major histocompatability complex.) The highest risk for polyglandular failure exists in patients with autoimmune adrenal failure and individuals with a family history of polyglandular failure. Approximately half of patients with APS2 report a family history of polyglandular failure. Several modes of inheritance have been suggested, including autosomal recessive, autosomal dominant, and polygenic.[3,8] The index of suspicion should also be elevated in patients with autoimmune adrenal insufficiency as at least half of these patients have one or more additional autoimmune endocrine disorders.[12] Patients with Addison's disease should be evaluated for thyroid dysfunction, type 1 diabetes mellitus, and pernicious anemia. In addition to thorough history and physical examination, laboratory assessment of autoantibodies to thyroid, adrenal, and parietal cell tissues may reveal potential endocrine failure. Associated conditions such as vitiligo, myasthenia gravis, thrombocytopenic purpura, Sj?gren's syndrome, rheumatoid arthritis, and primary antiphospholipid syndrome should be considered in patients with APS2. In some cases, these conditions may be the initial indication of APS2. In contrast to patients who present with Addison's disease, less than 1% of patients with autoimmune thyroid disease or type 1 diabetes develop adrenal insufficiency. Screening for adrenal insufficiency is not indicated unless there is a suggestive family history or clinical suspicion (including detection of one of the associated conditions listed above). Assessment of thyroid function is recommended in patients with type 1 diabetes. Unexplained reduction in insulin requirements should prompt a search for thyroid and/or adrenal insufficiency. Laboratory confirmation of thyroid dysfunction is best achieved with serum free thyroxine and thyrotropin-secreting hormone assessments. Adrenal insufficiency is more difficult to document owing to the variable secretion of cortisol and broad range of normal values. The two patients presented had profound adrenal failure. Patients with partial or compensated adrenal failure may have normal basal cortisol levels but be unable to produce a stress response. If the clinical suspicion is high but cortisol levels are normal, an ACTH stimulation test provides the best assessment of adrenal function. In this test, serum cortisol is measured before IV administration of 250 ?g of ACTH and 30 and 60 minutes after injection. A cortisol level of 20 ?g/dl or greater at any point during the test indicates normal adrenal function. Patients with adrenal failure may show multiple abnormalities of blood chemistry depending on the degree of destruction of the affected endocrine organs. Hyponatremia is reported in 90% of patients, hyperkalemia in 65%, and hypercalcemia in 6 to 66% of patients. Eosinophilia is reported in 20% of cases.[13] The management of APS2 is based on individualized, lifelong replacement therapy for the affected endocrine organs plus monitoring for development of insufficiency in other organs or the associated conditions listed in Table 1. Patients must be monitored regularly with history, physical examination, and appropriate laboratory evaluation. Medi-alert and other measures should be taken to ensure that adrenal function is taken into consideration during illness, surgery, or emergency situations. Family members should also be made aware of the increased risk of endocrine disease, especially of APS2. The great danger in APS2 (as illustrated by these cases) is treatment of a presenting hypothyroid state without recognition of concomitant hypoadrenalism. This may precipitate Addisonian crisis through two mechanisms. First, hypothyroidism reduces cortisol clearance. The addition of thyroid hormone replacement increases cortisol clearance, thus decreasing circulating cortisol availability. Second, hypothyroidism reduces the metabolic rate thereby reducing the need for cortisol. The increased metabolic rate accompanying thyroxine replacement increases the cortisol requirements that cannot be provided by the failing adrenals. Patients may die from ensuing Addisonian crisis. Conclusion The autoimmune destruction of several endocrine organs in APS2 results in clinical adrenal failure plus autoimmune thyroid disease or type 1 diabetes mellitus. Research indicates that autoimmune processes commonly attack multiple endocrine organs, although this may not result in sufficient damage to produce clinical symptoms. Physicians should be alert to the potential for additional endocrine conditions, particularly adrenal failure, in all patients with autoimmune endocrine diseases, especially those with insulin-dependent diabetes and autoimmune thyroid conditions. Reprint Address Reprint requests to Leland Graves III, MD, Division of Endocrinology, Metabolism, and Genetics, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160. Email: lgraves@kumc.edu Leland Graves III, MD, Robert M. Klein, PHD, and Anne D. Walling, MD, Division of Metabolism, Endocrinology and Genetics, Departments of Internal Medicine and Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas, and the Department of Family and Community Medicine, University of Kansas School of Medicine - Wichita, Wichita, Kansas South Med J 96(8):824-827, 2003. ? 2003 Lippincott Williams & Wilkins

The Mayfield Clinic & University Radiology Associates Launch Precision Radiotherapy Center at University Pointe High-Precision Radiosurgery Facility First in Region to Target Tumors Inside And Outside the Head WEST CHESTER, Ohio, Sept. 10 /PRNewswire/ -- The Mayfield Clinic and University Radiology Associates today unveiled the Precision Radiotherapy Center, the region's first facility to offer stereotactic radiosurgery for treatment of tumors both inside and outside the head. Candidates for treatment include patients with benign and malignant tumors of the brain, head, neck, spine, lung, liver and prostate. The center's breakthrough technology, Novalis® Shaped Beam Surgery™, attacks tumors and other lesions with shaped, high-dosage beams of radiation. The technology provides an alternative to invasive surgery in some cases, enabling physicians to treat patients with tumors and other abnormalities on an outpatient basis. Many patients will benefit by avoiding the risks associated with an open operation, hospitalization, and a prolonged recovery. Patients are treated with radiosurgery in different ways. Stereotactic radiosurgery can involve a single potent dose of radiation during a single visit; or it can involve a fraction of the complete radiation dose over the course of several visits. Single-fraction radiosurgery requires sedation, a head ring to keep the head immobile, and meticulous treatment planning. Fractionated, or multi-fraction stereotactic radiosurgery, requires patients to wear a mask to ensure immobilization. The addition of the Precision Radiotherapy Center to Greater Cincinnati's healthcare marketplace is the latest in a long line of developments that have helped position the Mayfield Clinic and University Radiology Associates among the nation's most advanced healthcare providers. The Precision Radiotherapy Center features the 16th U.S. installation of the Novalis Shaped Beam Surgery system, which is manufactured by BrainLAB AG, and the first Novalis system in the Tristate region. "It's a new tool that will help us do some of the things we've already done even better and do new things we've never done before," said Dr. John Breneman, professor of radiation oncology and neurosurgery at the University of Cincinnati. "It is a much more versatile machine than what we've had in the past. It allows us to treat lesions larger than what we could treat, and it will allow us to treat tumors and lesions outside the brain that are close to critical structures in the body, such as the spinal cord." Novalis Shaped Beam Surgery uses a precise, high-dosage beam of photon energy that is shaped to the contours of the tumor. The radiation beam damages the DNA of tumor cells, causing the cells to die without reproducing. The brain or other part of the body then rids itself of the remaining tumor debris through its own defense system. Meanwhile, because the radiation beam is precisely focused -- and because the beams penetrate the body from many different angles -- risk of injury to surrounding tissue or vital structures is minimized. The tumor location and radiation dose are determined prior to the procedure through a sophisticated software-driven treatment planning system. Shaped Beam Surgery™ can be used to treat tumors that are resistant to other forms of therapy because of their size or location, or because of the condition of the patient's health. And it can be used to treat patients with conditions other than tumors, including arteriovenous malformations, trigeminal neuralgia, acoustic neuromas and pituitary adenomas. "Patients who have previously undergone stereotactic radiosurgery for brain tumors have often asked me why we can't do stereotactic radiosurgery for tumors outside the brain," said Dr. Ronald Warnick, a neurosurgeon with the Mayfield Clinic and director of surgical neuro-oncology at the University of Cincinnati College of Medicine. "My answer has always been that we didn't have the technology to allow this kind of treatment outside the brain. Now we do. With Novalis we can image, immobilize and treat tumors outside the brain and extend the range of indications and help many more patients with radiosurgery than ever before." About The Mayfield Clinic The Mayfield Clinic & Spine Institute is recognized as one of the nation's leading physician organizations for clinical care, education, and research of the spine and brain. With 15 neurosurgeons, one neuro-oncologist and one neuro-intensivist, Mayfield treats 20,000 patients from 35 states and 13 countries in a typical year. Mayfield's physicians have pioneered surgical procedures and instrumentation that have revolutionized the medical art of neurosurgery for brain tumors and neurovascular diseases and disorders. About The Mayfield Spine Institute The Mayfield Spine Institute, a subsidiary of the Mayfield Clinic, features the largest and most experienced network of spine specialists in the Midwest. Mayfield's multidisciplinary team includes board-certified physicians in neurosurgery and physical medicine and rehabilitation, as well as licensed professionals in physical therapy, occupational therapy and chiropractic. About University Radiology Associates University Radiology Associates is affiliated with the UC College of Medicine's Department of Radiology and Division of Radiation Oncology. A member of UC Physicians, University Radiology Associates is staffed with 40 Radiologists and five radiation oncologists, and provides more than 200,000 procedures each year. Radiology services are provided at several sites locally, including The University Hospital, and consultative services are provided for patients around the world. The Division of Radiation Oncology has a long history of providing cutting-edge services in the Tristate region. About BrainLAB BrainLAB, based in Germany, is a worldwide leader in the innovation of Image-Guided Surgery (IGS) and stereotactic radiosurgery systems. www.brainlab.com

Hi! I was interested in advertising a research study in a newsletter or on the website of Cushing Help. I am involved in a research study here at Massachusetts General Hospital in Boston, MA. We are looking for women 18-50 years who have hypoadrenalism +/or hypogonadism as a result of a pituitary disorder. I noticed your webite contains information on panhypopituitarism, so I thought some of the people who obtain information from you organization may be interested in this study. In this study we are replacing testosterone via an investigational patch to normal female levels to find out if women have improved energy levels, sex drive, weight, muscle, and bone density. We are providing flight, hotel and remuneration of up to $600 to those who qualify. Please let me know how I may advertise this research study in your newsletter and on your web page. Best Regards, Julie Jones Nurse Practitioner Neuroendocrine Unit Massachusetts General Hospital- BUL 457B 55 Fruit Street Boston, MA 02114 Email: jjones18@partners.org Phone: 617-724-1837

Growth Hormone Treatment Helps Small Babies And Childhood Brain Tumor Survivors Reach Normal Adult Height CHEVY CHASE, Md., Aug. 11 /PRNewswire/ -- Growth hormone treatment may help children who suffer from specific health conditions, such as brain tumors, reach a normal height as an adult, according to two studies published this month in The Journal of Clinical Endocrinology and Metabolism (JCE&M). In the first study, researchers in the Netherlands found that short children who are born small for gestational age (SGA) and receive continuous growth hormone (GH) treatment may reach a normal adult height. The findings are the first to show that a lower dose of GH treatment for short children may be as effective as a higher dose for attaining a normal adult height. Approximately 15 percent of children who are born SGA do not catch up to normal height in the first two years of life. Furthermore, sixty percent of short children born SGA have low physiological GH levels. While previous studies have shown that five years of GH treatment can normalize height in children who are born SGA, this new research is the first to show the results of long-term continuous GH treatment in SGA children. Dr. Yvonne van Pareren and her colleagues evaluated two doses of long- term, continuous GH treatment in 54 short children who were born SGA. The children were treated with two doses of GH-either three IU/m(2)/d or six IU/m(2)/d-for approximately eight years. The findings indicate that long-term GH treatment in most short children who are born SGA can normalize the adult height. "In our study, long-term GH treatment resulted in an adult height in the normal range in 85 percent of the children and an adult height in the target range for 98 percent of the children," said Professor Anita Hokken-Koelega, the senior author on the study. The researchers also discovered that the two dosages did not result in significantly different adult heights and note that the 3 IU/m(2)/day dosage proved to be as effective as the higher GH dose (6 IU/m(2)/day). "Based on our findings, further studies are now needed to develop advanced prediction models that can indicate the best treatment options for each child," notes Dr. van Pareren. In a second GH study researchers reviewed the improvements that GH treatment has made to final adult height in childhood brain tumor survivors over the past 25 years. Brain tumors are the second most common form of cancer in children. Cranial radiotherapy along with spinal irradiation or chemotherapy can impact adversely on growth and reduce adult height. Furthermore, radiation therapy can induce GH deficiency in children. In a study of the largest cohort of brain tumor survivors from a single center, researchers in the United Kingdom concluded that a combination of GH and gonadotropin-releasing hormone analogue (GnRHa) helps survivors of childhood brain tumors reach normal height as an adult. The new findings provide the first conclusive evidence about factors affecting the height outcome of brain tumor survivors who receive GH replacement for radiation-induced GH deficiency. Professor Stephen Shalet and his colleagues at the Christie Hospital in Manchester, England, performed a 25-year retrospective study of 58 patients who reached full adult height and were treated with GH therapy for radiation- induced GH deficiency occurring as a consequence of brain tumor therapy. "We aimed to assess whether final height has improved in GH replaced childhood brain tumor survivors," explained Professor Shalet. "We found that the improved treatment schedules and early onset of GH replacement over the past 25 years as well as the combination of GH and GnRHa for those in early puberty has indeed improved final height among childhood brain tumor survivors." Professor Shalet and his group discovered that children who were treated with GH and GnRHa achieved improved various growth parameters, which allowed many of the children to reach their target height. Additionally, the researchers note that the auxological outcomes of the treatments were directly affected by the age of the child at the time of the radiation treatment, with the youngest children having the worst prognosis. The researchers also found that the age at irradiation correlated with the timing of the first assessment of GH status, older children being investigated more quickly presumably because of their more limited remaining growth potential. "In addition, we found that children who received radiation treatment later over the 25-year timescale were assessed earlier for GH deficiency and started on GH therapy earlier," notes Professor Shalet. "This change may explain the improvement in final height in more recent years." JCE&M is one of four journals published by The Endocrine Society. The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Endocrinologists are specially trained doctors who diagnose, treat and conduct basic and clinical research on complex hormonal disorders such as diabetes, thyroid disease, osteoporosis, obesity, hypertension, cholesterol and reproductive disorders. Today, The Endocrine Society's membership consists of over 10,000 scientists, physicians, educators, nurses and students, in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Bethesda, Maryland. To learn more about the Society, and the field of endocrinology, visit the Society's web site at www.endo-society.org. SOURCE The Endocrine Society CO: Endocrine Society ST: Maryland, Netherlands SU: CHI SVY Web site: http://www.endo-society.org http://www.prnewswire.com 08/11/2003 11:37 EDT

People With Type 2 Diabetes: Clinical Trial Opportunity August, 2003 People with type 2 diabetes are at an increased risk for developing eye disease, kidney disease and nerve damage. Clinical studies have shown that effective treatment of diabetes is essential to reducing these serious risks. Great strides have already been made in developing new medicines that help combat the long-term problems associated with type 2 diabetes. If you (or a loved one) have been told by a healthcare professional that you have type 2 diabetes, there is a doctor in your area looking for volunteers to take part in one of several research studies. These studies are testing the safety, effectiveness and tolerability of an investigational oral medicine to treat people with diabetes. If you are between the ages of 21 and 78 and are treating your diabetes with medicine or diet and exercise, you may qualify for one of these studies. During your participation in the research study, the study drug, study-related procedures and study visits will be provided at no financial cost. All tests and exams will be conducted by a medical doctor specializing in the management of type 2 diabetes. Qualified patients may receive compensation for travel-related expenses. Please call us toll-free at 1-866-756-9563 between the hours of 8 a.m. and 8 p.m. (Eastern Time) Monday through Friday to find out more. Our team of nurses is standing by to talk with you and provide additional information about these studies. We look forward to hearing from you soon. Sincerely, Christopher A. Haines, MD From Acurian News

I hope that they know a little more than what's covered on this quiz! LOL

K's Mom, your post has been moved to the Introduce Yourself board, where it will get more responses. Best of luck to you!

Fin, your post has been moved to the Introduce Yourself board, where it will get more responses. Best of luck to you!

Fin, your post has been moved to the Introduce Yourself board, where it will get more responses. Best of luck to you!

Fin, your post has been moved to the Introduce Yourself board, where it will get more responses. Best of luck to you!