MaryO

Millions of Women Facing Adult Acne

Dermatologists Key to Diagnosis and Treatment

NEW YORK, July 29 /PRNewswire/ -- For all too many women, the acne that they once feared would flare up just in time for prom as a teenager has resurfaced into their adult years -- causing anxiety for events from weddings to job interviews. The reason? Chronic, persistent acne is a common medical condition for women who either have suffered with it since adolescence or for those who first develop it during adulthood. Either way, the physical and emotional toll that acne causes can be devastating.

Speaking at ACADEMY '04, the American Academy of Dermatology's summer scientific session in New York, dermatologist Diane S. Berson, M.D., an assistant professor of dermatology at the Weill Medical College of Cornell University in New York, N.Y., discussed the causes of adult acne in women and various treatment options.

"When adult women experience acne outbreaks, hormones are usually the primary culprit," said Dr. Berson. "Hormonal acne can be particularly frustrating because it may not respond to the same over-the-counter treatments that worked for some women during their teenage years."

Hormones and Acne

While acne typically first appears during adolescence, hormonally influenced acne usually begins in the early-to-mid twenties and can persist well into adulthood. The cause of hormonal acne is most often linked to androgens, which are the hormones that stimulate the sebaceous -- or oil -- glands and hair follicles in the skin. When the sebaceous glands are over- stimulated by androgens, acne flare-ups can occur. Nearly half of all women experience acne flare-ups and increased facial oiliness during the week preceding menstruation.

Dr. Berson emphasized that while most women with acne have normal androgen levels, some women may have a more serious medical condition for which acne is just one symptom.

"When persistent acne is accompanied by excess facial hair, known as hirsutism, and hair loss or thinning hair, it could signal increased androgen production common in conditions such as polycystic ovaries and adrenal hyperplasia," said Dr. Berson. (What about Cushing's?" said MaryO) "In addition, women with hormonal acne also may experience irregular menstrual cycles, obesity, infertility or diabetes. It's vitally important for these women to consult with their physician, as a blood test can determine the cause of these symptoms and the best treatment option."

Treating Hormonal Acne

There are several treatment options available for women with hormonal acne, including topical retinoids, topical antimicrobials (such as benzoyl peroxide and antibiotics), and oral antibiotics that are prescribed when the inflammation is more severe. A dermatologist also may prescribe isotretinoin for women with cystic acne that is accompanied by scarring.

For women with hormonal acne who still develop premenstrual flares, oral contraceptive pills (OCPs) can be used successfully. OCPs contain an estrogen and progestin. They regulate the menstrual cycle and decrease the androgen activity responsible for acne, leading to decreased breakouts. Dr. Berson explained that most women who take OCPs to control acne can continue them for extended periods, especially if they are not currently planning to have children.

Another medication that may be prescribed in conjunction with an oral contraceptive is spironolactone, an anti-androgen. Spironolactone prevents excessive oil production by blocking androgen receptors and decreasing androgen production in both the ovaries and adrenal glands. The result is fewer acne flares.

While OCPs are effective in treating hormonal acne, they can cause side effects. Mild side effects, which usually subside after the first month or two after starting the medication, include breast tenderness, bloating and nausea. However, more serious complications such as blood clots or strokes are now less common with the newer formulations that contain less estrogen.

"Women prone to the more serious side effects of OCPs are those with existing hypertension, a history of blood clots or those over the age of 35 who also smoke," said Dr. Berson. "On the other hand, women taking OCPs actually may benefit from a decrease in developing osteoporosis and protection against endometrial and ovarian cancer. That's why it's important for women considering taking OCPs to control their acne to discuss the pros and cons with their dermatologist."

Dr. Berson also explained that women who are pregnant often experience bouts of acne, but treatment options are limited due to concerns regarding potential penetration of active medication through the skin. In this instance, topical antimicrobial agents are usually prescribed. In addition, it is not uncommon for women to develop post-menopausal acne due to a decrease in estrogen levels. However, traditional acne therapies, as well as antiandrogens, are good treatment options.

The Importance of Proper Skin Care

Since women with acne often have drier and more sensitive skin than they experienced during their adolescent years, Dr. Berson advised that they should talk to their dermatologist about appropriate skin care. Gently washing the face with mild facial cleansers is usually recommended and vigorous scrubbing should be avoided, as it can irritate the skin and make acne worse. In addition, toners containing glycolic acid or salicylic acid may help remove surface oils during the premenstrual period, which can contribute to acne flares, or for those with oily skin. Since some acne therapies can cause dryness, Dr. Berson recommended that women use a light moisturizer.

"Making slight modifications to your daily skin care regimen can go a long way in improving the appearance of your skin," said Dr. Berson. "For instance, daily sun protection is essential as some acne medications can increase the skin's sensitivity to sunlight. Also, when buying cosmetics or other skin or hair care products, look for ones labeled noncomedogenic -- meaning that they do not clog pores and are less likely to cause acne. Your dermatologist is the best source of information when choosing skin care products that can work in tandem with your acne therapy to improve the overall appearance of your skin."

Headquartered in Schaumburg, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 14,000 dermatologists worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the AAD at 1-888-462-DERM (3376) or http://www.aad.org .

SOURCE American Academy of Dermatology

CO: American Academy of Dermatology; ACADEMY '04

ST: New York, Illinois

SU: WOM TDS SVY

Web site: http://www.aad.org

http://www.prnewswire.com

07/29/2004 07:05 EDT

I got this from a nice woman named Barbara who we met at UVa this last year. She may be our next upcoming guest in a Guest Chat This is a WORD file from the doctor that Barbara forwarded to me.....

Dear Mary,

    You may not remember me but I met you at the April Pituitary Days in Charlottesville VA.  I have been on quite a journey with many ups and downs in my healing since removal of my pituitary gland in Nov. of 2003.  My hormones are still not stable.  I increase the dose of one and it puts the others out of wack.  I guess you are familiar with all this.  I do continue to improve though and do not give up.

    I am writing for another reason also, A Dr. Roberto Salvatori at Johns Hopkins has recieved a large grant from NIH to study the consequenses of lack of growth hormone and it's affects on heart function, bone density, muscle strength, and fat metabolism.  It is a wonderful study but he has run into a problem with a delay in recieving the funding.  It apparently had to go through the Brazilian Gov. which is where the study will take place in a population of dwarfs that genetically have no growth hormone (a perfect study sample).  Reciept of the funds may be delayed anywhere from three to six months.  The study is scheduled to begin July 1 and an Endocrinology fellow, Dr. Danilo Fintini from Italy, is hired to do the research and begin July 12th, however there are no funds available yet to pay him.  NIH grants require that the work be completed within a framework of time.  To delay the project may cause a loss of the grant.  What I would like to ask is that a request for donations be posted on the network.  Any donation is tax deductable and greatly appreciated.  $11,210 will be needed for the first three months and then another $11,210 for the next three months.  This research when completed will help patients that are hypopituitary be treated with greater knowledge of the problem and insights in to how to help them recover strength, normal heart function and fat metabolism.  I have attached a letter Dr. Salvatori sent to me asking for my help in this endeaver.  I plan to give $1000 dollars to the effort.  Even a donation of $20 will be accepted.  I would appreciate any ideas for raising the funds as well.  If I can help you in any way with the website or teaching classes, I can do that also.

    Thank you for your consideration in this matter.  Please do not hesitate to ask for more verification or information about the project.  I look forward to hearing from you soon.

With great appreciation,

Barbara Craven, PhD, RD, LD

Hello,

How do you go about ordering these things, I think I may be a bit cnofsude(confused)

Usually, if you go to a CUSH local meeting or Convention, one of the officers will have some available. You can also order online at http://www.cush.org/pins.htm

Introducing Leksell Gamma Knife® 4C for Treatment Solutions in the Brain

Leksell Gamma Knife® 4C: the most successful radiosurgery weapon in the fight against brain disorders

ATLANTA, July 1 /PRNewswire/ -- Leksell Gamma Knife® 4C* is the fourth generation of the most successful radiosurgery weapon in the fight against brain disorders, with enhancements designed to improve workflow, increase accuracy and provide integrated imaging capabilities. The integrated imaging, powered by Leksell Gamma Plan®, offers users an unprecedented ability to integrate images from multiple sources to achieve the most accurate treatment capability ever. These images can also be exported on a CD-ROM, so the referring physician can receive pre-op or post-op images for reference and follow-up.

To view the Multimedia News Release, complete with video and Hi-Res images, go to: http://www.prnewswire.com/mnr/elekta/12463/

The new features and advancements on Leksell Gamma Knife® 4C are both visually appealing and increase functionality. Operators now have the flexibility to view planning information on both sides of the couch, and the redesigned operator console is more intuitive and easier to use. The faster, more efficient helmet changer and robotic Automatic Positioning System® streamline operations and reduce treatment time.

*Leksell Gamma Knife® 4C and Leksell GammaPlan® 4C are works in progress and are not yet available for sales or distribution in the U.S.

Setting the Standard in Radiosurgery

Leksell Gamma Knife® remains the most proven means of performing intracranial stereotactic radiosurgery, and is the single most trusted and utilized solution for treating brain disorders without invasive surgery. Over 250,000 patients have been treated using Gamma Knife® surgery and there are 2,000 peer-reviewed published papers. Patients and physicians prefer the convenience and efficacy of a single dose achieved with clinical confidence using Leksell Gamma Knife®.

Leksell Gamma Knife® is part of a complete and successful practice, offering a proven business model that reduces risk while allowing centers to reach profitability faster. Leksell Gamma Knife® is installed in 200 clinics worldwide, and all original sites are still operating. With increasing patient volumes and a growing number of indications treatable using Gamma Knife® surgery, centers are finding their investment in Leksell Gamma Knife® to be sound. They also benefit from being perceived as a leader both in technology and thought leadership, as well as additional income from performing associated procedures.

Gamma Knife® surgery is used for a variety of neurological disorders, including AVMs, vestibular schwannomas, meningiomas, pituitary tumors, trigeminal nerve targets and brain metastases. Research is being conducted on other possible uses of Leksell Gamma Knife®, such as treating epilepsy, Parkinson's disease and uveal melanoma.

Fighting Serious Disease

The strength of Elekta's diverse and specialized treatment solutions provides a solid market position, which is being strengthened with the introduction of leading edge, emerging clinical applications of technology. With a robust pipeline of new orders for Leksell Gamma Knife® and Elekta Synergy™, Elekta has proven that it is a company that will continue to make a difference in the lives of patients today and in the years to come.

Elekta is a world-leading supplier of advanced and innovative radiation oncology and neurosurgery solutions and services for precise treatment of cancer and brain disorders. Elekta's solutions are clinically effective, cost efficient and gentle to the patient. The company's North American headquarters are located in Atlanta and corporate headquarters are in Stockholm, Sweden. For additional information about Elekta, please visit www.elekta.com

SOURCE Elekta

CO: Elekta

ST: Georgia

SU: BFA

Web site: http://www.elekta.com

http://www.prnewswire.com

07/01/2004 11:58 EDT

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:

Here's what some other people have on their bracelets, etc...

If the ABTA includes it, that's good enough for me! Though, Shauna, like you I've had the impression that "technically" the pituitary is not in the brain. I wonder what others have been told. Perhaps it's a "grey matter" (pardon the pun)

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 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 think we should bring this test (or create one!) to prospective endos. ?If they pass, we'll see them. ?If not, we're outta there. ?

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

A few years ago, Forbes magazine had this article on internet health sites, too http://www.forbes.com/best/2001/0625/026.html

The whole text, plus cover picture is available at http://www.cushings-help.com/forbes.htm ... because this site was a part of the article

Now, I want to know what BBC stands for.

It's British Broadcasting - TV, radio and such.  There's a list of the channels and stations here: http://www.bbc.co.uk/info/channels/

The BBC has an amusing little quiz on Cushing's.  Most everyone here should get a perfect score

Find it here: BBC Quiz

:cheese:

CenterWatch also provides educational materials on clinical trials for patients, care-givers and health consumers.  To view a more detailed description of these resources, please visit www.centerwatch.com/bookstore/pubs_cons_patientresources.html.

1) Adolesents and Women aged 8 - 35 wanted for Polycystic Ovarian Syndrome study. This study is being conducted in:

   - Charlottesville, VA (http://www.centerwatch.com/patient/studies/stu47598.html)

2) UCSF is currently seeking African American and Caucasian men and women for a Cholesterol and Simvastatin Pharmacogenetics study. This study is being conducted in:

   - San Francisco, CA (http://www.centerwatch.com/patient/studies/stu47754.html)

3) Do you have liver disease and high cholesterol?. This study is being conducted in:

   - Chevy Chase, MD (http://www.centerwatch.com/patient/studies/stu47531.html)

4) Adolesents and Women aged 8 - 35 wanted for Polycystic Ovarian Syndrome study. This study is being conducted in:

   - Charlottesville, VA (http://www.centerwatch.com/patient/studies/stu47599.html)

5) Effects of Lifestyle Intervention and/or Metformin in Women with Polycystic Ovarian Syndrome (PCOS) on Metabolic and Reproductive Function. This study is being conducted in:

   - Charlottesville, VA (http://www.centerwatch.com/patient/studies/stu47678.html)

6) Adolescents and Women aged 8 - 35 wanted for Polycystic Ovarian Syndrome study. This study is being conducted in:

   - Charlottesville, VA (http://www.centerwatch.com/patient/studies/stu47655.html)

7) A Multicenter, Randomized, Double-blind, Placebo-Controlled, Parallel-Group, Efficacy and Safety Study of a Flexible Dose of DVS-233 SR in Adult Outpatients with Major Depressive Disorder. This study is being conducted in:

   - Washington, DC (http://www.centerwatch.com/patient/studies/stu47614.html)

   - Orange, CA (http://www.centerwatch.com/patient/studies/stu47615.html)

   - New York, NY (http://www.centerwatch.com/patient/studies/stu47608.html)

   - Newport Beach, CA (http://www.centerwatch.com/patient/studies/stu47607.html)

   - Okemos, MI (http://www.centerwatch.com/patient/studies/stu47602.html)

   - Havertown, PA (http://www.centerwatch.com/patient/studies/stu47603.html)

   - Moorestown, NJ (http://www.centerwatch.com/patient/studies/stu47611.html)

   - New Britain, CT (http://www.centerwatch.com/patient/studies/stu47606.html)

8) Menopausal Women: Are Your Hot Flushes Giving You A Long Hot Summer?. This study is being conducted in:

   - Charlottesville, VA (http://www.centerwatch.com/patient/studies/stu47660.html)

9) A Study of the Effects of Guided Imagery on Outcomes of Pain, Functional Status, and Self-Efficacy in Persons diagnosed with Fibromyalgia. This study is being conducted in:

   - Charlottesville, VA (http://www.centerwatch.com/patient/studies/stu47671.html)

10) A Phase II Randomized, Double-Blind, Two-Dose, Placebo-Controlled Multicenter Study of 4-Hydroxy Tamoxifen Gel for Cyclical Mastalgia in Otherwise Healthy Pre-Menopausal Women with Regular Menstrual Cycles. This study is being conducted in:

   - Charlottesville, VA (http://www.centerwatch.com/patient/studies/stu47676.html)

Additional Educational Resources

CenterWatch also publishes educational resources for patients and their support network including:

Informed Consent: A Guide to the Risks and Benefits of Volunteering for Clinical Trials. If you would like to order this book click here: http://www.centerwatch.com/bookstore/pubs_...infconsent.html

Volunteering for a Clinical Trial Pamphlet. If you would like to order this pamphlet click here: http://www.centerwatch.com/bookstore/pubs_...ochureform.html

For information on these and other educational resources click here: http://www.centerwatch.com/bookstore/pubs_...tresources.html

The article is at http://www.washingtonpost.com/wp-dyn....ptop_tb

I signed up for the do not call registry online (of course!) at www.donotcall.gov

washingtonpost.com

Do-Not-Call Registry to Begin Today

Industry Faults FTC on Steps to Block Unwanted Telemarketing

By Jonathan Krim

Washington Post Staff Writer

Friday, June 27, 2003; Page E01

Consumers angry and frustrated over telemarketing calls can take a significant step toward relief today, as the Federal Trade Commission launches a long-awaited nationwide registry for residents who want to block unsolicited advertising via their home and cellular telephones.

Under rules announced by FTC Chairman Timothy J. Muris yesterday, residents can list their numbers on the do-not-call registry free.

Companies or marketers have until Oct. 1 to remove any registered phone numbers from their calling lists. After that, enforcement will begin. Telemarketers who disregard the registry could face fines as high as $11,000 for each call.

Consumers can join the list via the Internet at www.donotcall.gov beginning at 8:30 a.m. After July 7, residents on the East Coast can call a toll-free number (888-382-1222) to join the list. West Coast residents can use the toll-free number today.

Commercial telemarketing is covered by the rule except for polling, surveys, and calls from political or charitable organizations. The rules also allow calls from firms with existing business relationships with consumers.

Although the FTC does not have jurisdiction over the banking, insurance and telecommunications industries, the Federal Communications Commission, which regulates telephone-based communication, jumped in yesterday and brought its rules into harmony. Consumers who choose not to use the registry can still stop individual telemarketers from calling by insisting that their numbers be removed from telemarketers' call lists. Federal law mandates that the telemarketers abide by the request.

More than half the states already offer do-not-call lists of various stripes, and many agreed to transfer their lists to the national database. But in some states, including Virginia, residents will have to register their numbers separately on the national list.

Calling it "a great day for American consumers," FTC Chairman Muris said the agency expects the list to grow to as many as 60 million numbers. The agency hired AT&T Corp. to operate a call center to accept registrations and log complaints.

Privacy advocates praised the rules and Muris for pushing forward despite stiff resistance from the marketing industry.

"Muris should be commended for his skill," said Chris J. Hoofnagle, deputy counsel at the Electronic Privacy Information Center. "He was able to negotiate substantial consumer protection . . . surprising in a pro-business administration and Republican Congress."

Muris said he was inspired by President Bush, who made clear his interest in personal privacy protections. A ceremony at the White House is planned for today.

Marketing industry executives said the rules would cost jobs and pledged to continue legal efforts to block them.

"We're not happy about it," said H. Robert Wientzen, president and chief executive of the Direct Marketing Association. "We still feel this is not an appropriate role for government; we would prefer this was a private-sector activity."

The marketing trade group and the American Teleservices Association, which represents call-center operators, filed separate suits that are pending. Among other things, they argue that the rules deny marketers their First Amendment rights to free speech.

"When you pick which types of calls that can be excluded, then it's the government deciding who's on the other end of the phone," said Tim Searcy, executive director of the Teleservices Association.

Wientzen said the telemarketing industry generates roughly $200 billion in sales each year and that it's possible that total could be cut in half. Many of the 4.2 million people who work in the industry, including part-timers, could lose their jobs, he said.

His association has maintained for years a working, private-sector equivalent of the national list that has roughly 8 million numbers, he added.

But Muris was neither impressed nor sympathetic.

"If the leadership of the industry had acted proactively a couple of years ago, they might have been able to head this off," he said.

Muris would not predict how quickly the agency could respond when a complaint is lodged against a telemarketer, but he said "we think we can be very quick." Consumers must be able to provide either the name of the company whose product is being pitched, or the name or phone number of the telemarketer.

Another rule, which will take effect in January, will prohibit telemarketers from blocking their phone numbers from caller-ID systems.

Telemarketers also will be charged fees to help defray an estimated $18 million in costs for building and maintaining the registry and providing enforcement.

? 2003 The Washington Post Company

From: http://story.news.yahoo.com/news?tm...._cancer

Hormone Pills May Spur Breast Cancer  

By LINDSEY TANNER, AP Medical Writer

CHICAGO - Estrogen-progestin pills may cause an aggressive form of breast cancer (news - web sites) and make it harder to find tumors until they have reached a later, less-curable stage, according to one of the biggest, most authoritative analyses yet.

The study is part of a run of bad news recently about the hormones routinely taken by millions of women after menopause.

"Hopefully, it will convince women to reconsider," said Dr. Susan Hendrix of Wayne State University in Detroit, a co-author of the new analysis. "We've got to find a better way to help women with their menopausal symptoms."

Some previous studies suggested breast tumors might be less aggressive in hormone users; other studies indicated the opposite. Previous research also suggested that hormones might make breast tissue more dense, hindering the detection of tumors.

To try to answer the questions more definitively, the researchers took a closer look at data from the government's landmark Women's Health Initiative study, which was halted last summer after it was found that estrogen-progestin pills raise the risk of heart attack, strokes and breast cancer.

While last summer's findings led many women to stop taking hormones, an estimated 3 million women still use them, primarily to relieve hot flashes and other symptoms of menopause.

The latest findings appear in Wednesday's Journal of the American Medical Association.

The analysis involved 16,608 women ages 50 to 79 who used either combined hormone treatment or dummy pills for an average of five years.

As of January, breast cancer had developed in 245 women who used the combined hormone treatment and in 185 women who had taken dummy pills.

Hormone users' tumors were larger at diagnosis, 1.7 centimeters on average versus 1.5 centimeters in placebo women. Tumors had begun to spread in 25.4 percent of hormone users, compared with 16 percent of placebo women.

The researchers said this appears to mean that in women on estrogen-progestin, the tumors both grow faster ? that is, they are more aggressive ? and escape detection longer.

Overall, women on both hormones faced a 24 percent increased risk of breast cancer ? equal to eight extra cases of cancer per year for every 10,000 women taking the pills.

The increased risk did not appear in the first two years of treatment. But Hendrix said the tumors may have been present early on but were not detected until later because of hormone-induced breast density.

The new analysis did not examine breast density. But researchers think progestin may be the culprit because it can cause breast cells ? both normal and abnormal ? to proliferate, an effect that may be accentuated when the hormone is combined with estrogen.

Wyeth Pharmaceuticals, maker of the Prempro pills used in the study, said hormones remain an appropriate therapy when used at the lowest possible dose for the shortest possible time.

The latest analysis is by far the most conclusive, said Dr. Peter Gann, an associate professor of preventive medicine at Northwestern University who was not involved in the study.

It "further worsens the news for long-term hormone replacement therapy. It suggests the excess breast cancer risk is not trivial," Gann said.

Last summer's Women's Health Initiative findings shattered long-held beliefs that hormones are good for women's hearts. Last month, another analysis of data from the study found that instead of sharpening the mind, hormones may double the risk of Alzheimer's and other forms of dementia.

A second, smaller study in Wednesday's journal also confirmed a link between combined hormone treatments and breast cancer and suggested estrogen-only treatment may be safer.

The study involved 975 Seattle-area women ages 65 to 79. The greatest breast cancer risk was in women who used estrogen-progestin for at least five years, even if they took the progestin component only some days a month.

Those who used estrogen alone, even for 25 years or longer, showed no appreciable increased risk, according to the study, led by Dr. Christopher Li of Fred Hutchinson Cancer Research Center in Seattle.

Estrogen alone is recommended only for women with hysterectomies because it can cause uterine cancer unless balanced by progestin.

The researchers said more definitive answers will come from the continuing estrogen-only part of the Women's Health Initiative study.