Kristy

Just an overview: The Adrenal Glands Anatomy of the adrenal glands: Adrenal glands, which are also called suprarenal glands, are small, triangular glands located on top of both kidneys. An adrenal gland is made of two parts: the outer region is called the adrenal cortex and the inner region is called the adrenal medulla. Function of the adrenal glands: The adrenal glands work interactively with the hypothalamus and pituitary gland in the following process: the hypothalamus produces corticotropin-releasing hormones, which stimulate the pituitary gland. the pituitary gland, in turn, produces corticotropin hormones, which stimulate the adrenal glands to produce corticosteroid hormones. Both parts of the adrenal glands -- the adrenal cortex and the adrenal medulla -- perform very separate functions. What is the adrenal cortex? The adrenal cortex, the outer portion of the adrenal gland, ?secretes hormones that have an effect on the body's metabolism, on chemicals in the blood, and on certain body characteristics. The adrenal cortex secretes corticosteroids and other hormones directly into the bloodstream. The ?hormones produced by the adrenal cortex include: corticosteroid hormones hydrocortisone hormone - this hormone, also known as cortisol, controls the body's use of fats, proteins, and ?carbohydrates. corticosterone - this hormone, together with hydrocortisone hormones, suppresses inflammatory reactions in the body and also affects the immune system. aldosterone hormone - this hormone inhibits the level of sodium excreted into the urine, maintaining blood volume and blood pressure. androgenic steroids (androgen hormones) - these hormones have minimal effect on the development of male ?characteristics. What is the adrenal medulla? The adrenal medulla, the inner part of the adrenal gland, is not essential to life, but helps a person in coping with physical and emotional stress. The adrenal medulla secretes the following hormones: epinephrine (also called adrenaline) - this hormone increases the heart rate and force of heart contractions, facilitates blood flow to the muscles and brain, causes relaxation of smooth muscles, helps with conversion of glycogen to glucose in the liver, and other activities. norepinephrine (also called noradrenaline) - this hormone has little effect on smooth muscle, metabolic processes, and cardiac output, but has strong vasoconstrictive effects, thus increasing blood pressure. This is from the University of Maryland Medicine at http://www.umm.edu/endocrin/adrengl.htm In simplist terms, if you have a pituitary tumor that is secreting ACTH, the receptors that are sensitive to ACTH react to the ACTH and respond. The cells are telling the body "we have done what you ask", but the tumor isn't listening. It still produces ACTH. The cells still listen as that is their genetic coding. In the case of fat, the cells still store fat because the pituitary is telling the cells (through ?cortisol)... store fat! If you have an adrenal tumor that is secreting too many adrenal hormones, the receptors that react to the adrenal hormones respond. The cells are telling the body "we have done what you ask", but the tumor isn't listening. It still produces too many hormones. In the case of fat, the cells still store fat because the adrenal tumor is telling the cells (through cortisol).... store fat! The feedback mechanism is disrupted, so the control mechanism isn't working. (Have you ever had a hose spigot that had a broken valve and water kept on dripping out? - What happened over time if you didn't fix it?) For this reason, Cushings is a system wide disease as it effects the entire body. How's that? hehe.gif

There was alot unsaid in the interview. I respect a family's privacy. It is most unfortunate that her daughter did pass away. When the pituitary completely quits working, there are several key hormones that are critical. Do you know which ones they are? (Besides ACTH - that is a given). Food for thought.

http://www.pituitary.org/default.htm

Also, cross check for neurosurgery....

The new 2002 rankings is out! "America's Best Hospitals 2002 If you're looking for the best in medical care, check out the 13th annual edition of "America's Best Hospitals." We rank 205 top medical centers in 17 specialties." http://www.usnews.com/usnews/home.htm baaa.gif

Here is the link to the The National Institutes of Health The National Heart, Lung, and Blood Institute WOMEN'S HEALTH INITIATIVE There are more in-depth details on this website: http://www.nhlbi.nih.gov/whi/ :con:

I ordered one, and I thought it was great!

Audio tapes are available from the Endocrine Society 2002 meetings at this link. and from the AACE 2002 meeting at this link. You can purchase a single tape for which lecture you are interested in for 12 or 13 dollars per tape, or you can purchase the entire conference series. Neato!!!

June 24, 2002 NEW YORK (Reuters Health) - New study findings indicate that patients with Cushing's Syndrome (CS) often demonstrate brain volume loss and that correction of their elevated cortisol levels can reverse at least a portion of this loss. While the neuropsychiatric manifestations of CS are well described, relatively little attention has been paid to the actual changes in brain morphology that occur. Furthermore, only two small studies have addressed whether these changes are reversible with appropriate therapy. Dr. C?line Bard and colleagues from the Centre Hospitalier de l'Universit? de Montr?al, in Qu?bec, Canada, compared brain imaging studies of 38 CS patients with those of 18 patients with non-ACTH-secreting sellar tumors and 20 control subjects. The CS patients included 21 with Cushing's disease and 17 with adrenal CS. The researchers' findings are published in the May issue of The Journal of Clinical Endocrinology and Metabolism. Based on readings by two independent radiologists, 86% of patients with Cushing's disease and 100% of patients with adrenal CS demonstrated brain volume loss. In addition, the average third ventricle and bicaudate diameter of the pooled CS group was significantly higher than that of the control group (p = 0.001 for both). Brain volume loss was reevaluated in 22 CS patients who underwent correction of their hypercortisolism. In 21 patients, the disorder was corrected surgically, while in one patient medical therapy was employed. Reimaging an average of 39.7 months after eucortisolism was achieved revealed a significant improvement in third ventricle diameter and bicaudate diameter. Furthermore, the radiologists' subjective evaluation of the scans had also improved significantly. "Signs of cerebral atrophy should be evaluated in patients" with CS, the authors emphasize. Still, "further studies will be necessary to determine whether complete reversal of brain volume loss is possible and whether these observations correlate with neuropsychological improvement." J Clin Endocrinol Metab 2002;87:1949-1954. Loss of Brain Volume in Endogenous Cushing?s Syndrome and Its Reversibility after Correction of Hypercortisolism Isabelle Bourdeau, C?line Bard, Bernard No?l, Isabelle Leclerc, Marie-Pierre Cordeau, Manon B?lair, Jacques Lesage, Lucie Lafontaine and Andr? Lacroix The Journal of Clinical Endocrinology & Metabolism Vol. 87, No. 5 1949-1954 Abstract Chronic exposure to excess glucocorticoids results in cognitive and psychological impairment. A few studies have indicated that cerebral atrophy can be found in patients with Cushing?s syndrome (CS), but its evolution after cure has not been studied extensively. We report the presence of apparent cerebral atrophy in CS and its reversibility after the correction of hypercortisolism. Thirty-eight patients with CS, including 21 with Cushing?s disease and 17 with adrenal CS were studied. The control groups consisted of 18 patients with other non-ACTH-secreting sellar tumors and 20 normal controls. Twenty-two patients with CS were reevaluated after cure. Subjective loss of brain volume was present in 86% of patients with Cushing?s disease and 100% of patients with adrenal CS. The values for third ventricle diameter, bicaudate diameter, and subjective evaluation were significantly increased in CS groups in comparison with the control group (P 0.001). Imaging reevaluated at 39.7 ? 34.1 months after achieving eucortisolism showed an improvement of the third ventricle diameter (P = 0.001), bicaudate diameter (P

All I could think was Where does this information put the Cushing's patient, who has disruption of the diurnal rhythm?. I am a little cranky today. I haven't been sleeping well. I am having problems focusing today ??? From Reuters: http://www.reutershealth.com/archive....28.html "SAN FRANCISCO (Reuters Health) - Just a few hours of sleep deprivation could impair daily functioning and affect hormonal levels in the body, researchers reported here Saturday at the annual meeting of the Endocrine Society." Check out the 2002 Daily Highlights: http://www.endo-society.org/scimeet....s20.cfm Abstract: Effects of One Week of Modest Sleep Restriction to 6 Hours Per Night on Daytime Sleepiness, Performance, IL-6, TNF, and Cortisol Plasma Levels. Alexandros N Vgontzas, Manolis Zoumakis, Edward O Bixler, Hung-Mo Lin, Heather Follett, George P Chrousos Sleep Res and Treatment Ctr, Psychiatry, Penn State Coll of Med, Hershey, PA; Pediatric and Reproductive Endocrinology Br, NIH, Bethesda, MD; Hlth Evaluation Scis, Penn State Coll of Med, Hershey, PA Objectives: Total sleep deprivation or severe sleep restriction (50% or 4 hours per night for several nights) is associated with daytime sleepiness, performance decrements and stimulation of daytime IL-6 secretion. The goal of this study was to assess the effects of modest sleep restriction by 2 hours (25%) to mimic "real life situations." Methods: Young healthy normal sleepers, both men and women, were recorded in the sleep laboratory for 12 consecutive nights (4 baseline nights during which subjects were allowed to sleep for 8 hours followed by 1 week of sleep restriction to 6 hours). At baseline and following 1 week of sleep restriction, we obtained measures of daytime sleepiness (multiple sleep latency test [MSLT]), performance (psychomotor vigilance test [PVT]), and serial twenty-four hour plasma measures of IL-6, TNF, and cortisol. Results: Preliminary analysis of 13 young men showed that after one week of sleep restriction, there was a significant increase of daytime sleepiness. The average sleep latency on MSLT was significantly decreased post-deprivation compared to baseline (P Conclusions: Modest sleep loss for a short period increases sleepiness and deteriorates the performance of young healthy subjects. Furthermore, it is associated with a shift of IL-6 secretion from sleep to wake and an elevation of circulating TNF levels. These findings suggest that modest sleep loss appears to be a significant risk in terms of public safety, i.e., traffic accidents and through the stimulation/alteration of IL-6, and TNF secretion increases the risk of major health hazards associated with insulin resistance and smoldering systemic inflammation, such as cardiovascular disease and osteoporosis. Supported by the National Institutes of Health

Hmmm. I thought this was interesting, but wouldn't know if it would help a child who is panhypopituitary: http://www.pslgroup.com/dg/200382.htm **************************************** Hypothalmic obesity syndrome - damage to the hypothalamus (VMH) and termed "hypothalamic obesity", is characterized by weight gain that is unresponsive to diet, exercise, and pharmacotherapy. VMH damage leads to increased weight gain. Severe obesity after VMH damage due to brain tumors or cranial irradiation were treated for 6 months to 1 year. Obese children and adults exhibit a syndrome of Primary Insulin Hypersecretion; for which a specific etiology, pathogenesis, diagnosis, and pharmacotherapy are now identified." *********************************************** This is something new that just came out: You will have to register, but it is free. What is interesting about this article is that Ghrelin is a hypothalmic energy balance modulator. This is new science... something to watch. http://www.the-scientist.com/yr2002/jun/hot_020610.html. Elusive Ligand Ghrelin Could Have Numerous Roles HOT PAPERS | The ligand is linked to growth hormone release, feeding regulation, energy homeostasis, and the cardiovascular system.

Really? Perhaps you need to download the latest version of realplayer first or windows media. When I tried MaryO's link, my windows shut down. The link I provided is the one healthology e-mailed me. ??? http://www.healthology.com/focus_w....megaly#

Great video Mary...cept the link isn't right...try This Link.

This issue was shown in my high performance management class this week...awesome!!! I had stopped by a bookstore yesterday to pick it up but they were out...will try today. Fortunately...Time has the article...and MORE on their website. Luisa, Tammie Goode, you will like this very much I think! http://www.time.com/time/covers/1101020610/story.html

Hey everyone! I stumbled onto more of the story from Reuters.... Stress hormone in skin may trigger acne, oily skin http://www.reutershealth.com/archive....19.html Check out more of the story!

Here is an article citing the importance of missed periods. http://www.reuters.com/news_ar....1043840 "According to the results, most women with the disease may overlook missed menstrual periods as being medically important, thus delaying the diagnosis of premature ovarian failure and treatment to prevent bone thinning." SOURCE: Obstetrics & Gynecology 2002;99:720-725 Volume 99 / Number 5 / May 2002 Meeting the Needs of Young Women With Secondary Amenorrhea and Spontaneous Premature Ovarian Failure More aggressive evaluation of young women with secondary amenorrhea or oligomenorrhea might help them avoid bone loss related to estrogen deficiency. Nahrain H. Alzubaidi, Heather L. Chapin, Vien H. Vanderhoof, Karim Anton Calis, Lawrence M. Nelson

Moving up! Don't be afraid to participate in DHEA studies!

Thanks Ali, Thanks for the wonderful information. For those of you who use CRF antagonists...keep your eyes peeled for phase II studies. Remember to contact your mental health professional if you have questions about CRF antangonist drugs. If you are suffering from depression related to your disease...see a professional. Clinical depression is concerning...don't be afraid to ask for help. Heck...I was evaluated and don't have clinical depression...but golly...I'm such an interesting patient...my psychiatrist wants me to check in every 6 months...just to see how I'm doing (must think I'm a real babe! ) lmao

I'd like to add that I notified Mary. I notified Mary because the HTML file that was attached was a picture of the Cushing's Help website! AACK! Also attached was the other information she posted above. I have been getting hit with downloadables at my home 4,5,6 times a day. I have McAfee Viruscan Online and I don't open the files! I checked my machines this weekend just to be double sure and they are fine!!!! Please do the same!

Maybe he needs to reduce your meds for your prolactinoma? I'd ask....

We were just talking.... Thanks MaryO!

http://www.medscape.com/viewart....-1 NEW YORK (MedscapeWire) Apr 26 ? There may be new truth to the slogan that milk does a body good, at least if that body is overweight. Results from the Coronary Artery Risk Development in Young Adults (CARDIA) study linking dairy intake to reduced risk of insulin resistance syndrome (IRS) are reported in the April 24 issue of The Journal of the American Medical Association. "Our study suggests that dietary patterns characterized by increased dairy consumption may protect overweight individuals from the development of obesity and IRS, which are key risk factors for type 2 diabetes and cardiovascular disease," write Mark A. Pereira, PhD, of Children's Hospital and Harvard Medical School in Boston, and colleagues. This population-based, multicenter prospective study involved 3157 black and white adults aged 18 to 30 years followed in the CARDIA study from 1985-1986 to 1995-1996. Among individuals who were overweight, but not among leaner individuals, dairy consumption was inversely associated with the incidence of all IRS components, including obesity, glucose intolerance, hypertension, low high-density lipoprotein cholesterol levels, and high triglyceride levels. Overweight individuals who ate 35 or more dairy servings weekly had a 72% reduction in risk of developing IRS compared with those who consumed fewer than 10 servings weekly. Each daily occasion of dairy consumption lowered odds of IRS by 21%. These associations were similar for blacks and whites and for men and women. Milk intake has decreased significantly over the past 3 decades while the prevalence of obesity and type 2 diabetes has increased. "For most of the past 3 decades, the US Department of Agriculture and the American Heart Association have recommended low-fat diets in the prevention and treatment of cardiovascular disease," the authors write. "Some have questioned these recommendations out of concern that high-carbohydrate consumption might promote IRS." Because this was an observational study, the authors could not rule out residual confounding and could not infer a causal relationship between increased dietary intake and decreased incidence of IRS. For the full study...select here: http://jama.ama-assn.org/issues/v287n16/abs/joc12065.html

Thanks Lynne... looks like this is the drug used in the CRH stim test. This link pretty much explains the test: http://www.rxlist.com/cgi/generic2/corticorelin_ids.htm

Dr. Baile is here at M.D. Anderson in Houston. He was featured in one of our weekly Network Newsletter http://www.mdanderson.org/publications/net...m#communication I really liked his point of views on physican/patient communication. I decided to 'look up' Dr. Baile, and I found this wonderful web book that he coauthored. It is geared to the Physician. I was so enthralled, I thought I'd share! http://www.conversationsincare.org/web_book/web_book.htm Web-book Introduction The issues surrounding physician/patient communications are many. Anxiety, fear and embarrassment can all impact the way a patient communicates with his/her doctor, and make it difficult to articulate concerns and participate effectively in their treatment. A physician is no less likely to feel anxiety from trying to meet both the psychosocial as well as the medical needs of a patient, or fear at having to break traumatic news. The Conversations in Care? Web-book will address topics chapter by chapter, with each chapter authored by a leading expert in the field of communications. You can sign up on our home page so that you will be notified on the debut of each chapter. We also welcome your feedback for topics you would like to see addressed in the future. Web-book Chapter 1 The Importance of Physician:Patient Communications By Walter F. Baile, MD Table of contents What is Communication? The Crucial Role of Physician:Patient Communication Communication Skills as a Vehicle for Treating the Whole Person Enhancing Listening Skills and Relationships with Patients Dealing with the Anxiety of Giving Bad News Assume That Patients Don't Always Understand Gaining Valuable Information Benefiting From Enhanced Communication Skills Talking Saves Time Reducing the Threat of Legal Actions Good Physician, Good Patient Physicians Hold Positions of Power Take-Home Messages What's Next? References Web-book Chapter 2 How Effective Is Your Nonverbal Communication? By Debra L. Roter, DrPH Table of contents Introduction Respect Cultural Differences Setting The Scene First Impressions Count Take A Seat The Comforting Touch A Smile Works Wonders Eye Contact Positioning Yourself "Hmm, I See" Facial Expressions What To Do With Your Hands And Feet The Perils Of Distracting Habits Depression Affects Interpretation Of Body Language Interpreting Your Parents' Body Language Initial Consultations Understanding Emotion Gender Differences In Communication Styles Conclusion Take-Home Messages What's Next? References Web-book Chapter 3 Communication in Crisis By Rosanne M. Radziewicz, APRN, BC Table of contents Introduction Why Is Communicating In A Crisis Difficult? Responding To Crisis And Trauma Common Emotional Reactions To A Crisis Psychiatric Disorders That Can Occur In Reaction To Crisis Cancer And Stress Course Of Normal Grief Reactions What Persons In Crisis Need The Value Of Hope Assessing Your Patients' Sense Of Safety How Can I Communicate To Avoid Overreaction And Moderate Stress? How Can I, As A Health Professional, Manage My Own Fears And Feelings Regarding A Crisis? Tips To Protect Your Sense of Personal Safety Renew Yourself Referring Patients To Mental Health Professionals Summary Take-Home Messages What's Next? References Web-book Chapter 4 Stress, Burnout and Renewal By Lidia Schapira M.D. Table of contents Introduction The Good Stresses - Emotional and Physical Signs and Symptons of Negative Stress What is Burnout? From Stress to Burnout Who is at Risk for Burnout? The Changing Face of Medicine Burnout in Oncology Dealing with Losses Enhance Communication Skills, Decrease Stress Communication Training Options Wellness and Self-Care Achieving Renewal Through Perspective, Balance and Communication Conclusion Take-Home Messages What's Next? References

Moving up