Kristy

What I found interesting is the clearly identified importance of elevations of cortisol in the bloodstream and its effects on cognitive function and the effects on the bone. In pregnancy, It really underscores the underlying stress process cause early delivery and poor brain development in the fetus. Thanks for sharing Sandy! I hope Dr. Berga continues her research!

Herb found ineffective for moderate depression NEW YORK, Apr 09 (Reuters Health) - Although promoted as an alternative therapy for depression, the herbal supplement St. John's wort appears ineffective for people with moderate clinical depression, findings from a US study suggest. Read the rest of the story here: http://www.reutershealth.com/archive....08.html Effect of Hypericum perforatum (St John's Wort) in Major Depressive Disorder A Randomized Controlled Trial Hypericum Depression Trial Study Group Context Extracts of Hypericum perforatum (St John's wort) are widely used for the treatment of depression of varying severity. Their efficacy in major depressive disorder, however, has not been conclusively demonstrated. Objective To test the efficacy and safety of a well-characterized H perforatum extract (LI-160) in major depressive disorder. Read the entire study here: http://jama.ama-assn.org/issues/v287n14/rfull/joc11936.html

This is really neat info Suzi...you are on top of the news today!

I wonder... but still... I was wondering if the docs forget about women needing testosterone too... hmmm.... maybe a women's testosterone patch? Novel idea!

http://www.sma.org/smj2001/decsmj01/hamdy.pdf Hormonal Replacement Therapy: Fact or Fiction? from Southern Medical Journal Ronald C. Hamdy, MD, FRCP, FACP "For over half a century hormonal replacement therapy (HRT) has been accepted as the standard of care for postmenopausal symptoms and many other illnesses associated with and following the menopause. HRT was introduced in the pharmacopeia before rigorous evidence of the efficacy and safety of medications were required by the FDA and other regulatory agencies." This is an update of where science is and where is is going...if you are interested....

Outstanding! Thanks Dandy!

I stumbled upon this when browsing the university webpage and thought it a good link to post: http://www.healthtalk.com/live/past_eds.html You can look into topics such as: April 18, 2001 "How to Get the Best Treatment" May 2, 2001 "Understanding Clinical Trials" May 16, 2001 "How to Get the Support You and Your Family Need" May 30, 2001 "Sex and Intimacy when you are living with a Serious Health Condition" June 26, 2001 "Understanding Your Laboratory Test Results" July 24, 2001 "Managing Drug Side Effects and Avoiding Harmful Drug Interactions" August 22, 2001 "Overcoming Denial and Pain When You are Newly Diagnosed" Some new topics upcoming are: "Can Spirituality Help You Heal?" "How to Get Insurance or Someone Else to Pay Your Medical Bills" "Protecting Your Privacy When You've Had a Serious Illness" "What Makes a Great Doctor and How to Get One?" "How to Protect Yourself from Medical Mistakes"

I was doing the 5:00 goof off and stumbled across this slide show....there are actually some really good slides and some really good explanations about the endocrine system. I now know (haha) what and where the hypothalmus is...I'm dangerous! And those veins going into the pituitary are tinie tiny...ooohh whee and they sinus sample those thingies.... Anyways...for the curious...(not that there is really a bunch to learn), but the pictures are good. http://pathophysiology.uams.edu/Spring0....001.htm

Well...you can never tell can you? Thanks for the info Lynne!

A really good collection of articles is in the new Pituitary Patient's Resource guide. Carrie, you have a good doctor. Sometimes, in early Cushings, the diagnosis part is tough. Alot of the studies that were published that differentiated Cushing from normal people, the folks that had Cushings had FLORID Cushings. See, my gynoc had acromegly when he was an intern and he spent alot of time at the NIH in the 70s doing some protocol testing for acromegly. When I told him that I was being evaluated for Cushings, he said...Oh no...I've seen Cushings...you don't look like those folks I saw at the NIH... but here I am, and I have Cushings, it's just that now with me, do I have pituitary or ectopic? Thank goodness I have a doctor that is patient and allows the dimension of time to make things more clear. Early on, I had several other endos that blew me off (or at least I felt like they did). One just told me that I was depressed and needed prozac. This particular one spent 45 minutes of my appointment telling me all of the reasons why I needed prozac. I told him that he needed to rule out medical conditions before prescribing psychiatric drugs. Oh I know all about the med student sickness syndrome...just because you are a nurse doesn't mean you can't get sick. I don't think there is anything wrong with seeking out mental health either, as I did consult with a psychiatrist who also is a neurologist who did spend some time explaining to me the difference between clinical depression and sadness caused by being overwhelmed with pituitary disease (there is an excellent article in the pituitary resource guide that addresses this by the way). Besides, if you have a mental health expert on your side....this can be advantageous no? If the tests are not forthcoming right away, your doctor should work with you to try to find out the answers. Diagnosis in early Cushings can be elusive at first. Dr. F. also has a wonderful article in the pituitary resource guide about differentation between Cushings and Pseudo-Cushings...he states "The distinction between Cushing's syndrome and pseudo-Cushing's states is often difficult, leading to frustration for both patient and physician. To prevent this frustration, working closely with a good endocrinologist who sees many patients with Cushing's syndorme is needed. Patience is also needed. With time, most patients will "declare themselves" and develop a clearer picture consistent with either Cushing's syndrome or a pseudo-Cushing's state" I promise my doc must be cut out of the same mold 'cause I can't count how many times he has asked me if I was frustrated yet....or how many times he has said that in time things will be more clearer.... Maybe your doc at Mayo is out of the same mold too? It's o.k. to be really frustrated and worried. ((((Carrie))))

That's a good point, Pattie. One of the doctor's that I was consulting with...I'll call him Dr. Researcher... sent me a letter and his letter, he felt like too many cooks spoil the... I wrote him back and told him that I didn't feel that way, but because my case was hard to diagnose, I needed the best and brightest minds I could find to contribute to my care and that I valued his contributions and his role will be..... His role hasn't been much in play in my case here lately, but I have a feeling it will be important. Another good point, Pattie, about calling attention to Cushings being a rare disorder. Most doctors will never see a Cushing's patient their entire lifetime...or if they do or have, they didn't realize it....even if it was right in front of them.

That is why, Carrie, we are working so you, the patient, can easily pull this information together. This way, you are impowered to assemble the data in a way to introduce it to your doctor so he/she can be enlightened...so to speak. In plain terms...print out....highlight areas of interest in yellow....make a list of questions....send to doctor in letter format and attach journal articles....teehee. Challenge your doctors....you need to become the expert. BUT...keep in mind...as I have learned....that my doctor...and there are others like my doctor....are sharp...and have already thought way outside the curve....and I am actually peddeling to catch up to him and his knowledge... cause he knows more in his 30 years of practice than my 18 months of being a patient..... Not all Cushing's patients fit in the neat tidy box.... and that is exactly what the paragraph of your article refers to. Each patient is unique and must be fully investigated.

Here is a great study that addresses the question..... after treatment...will I get better? Hey...Dr. F.! http://jcem.endojournals.org/cgi/content/full/82/3/912 The Longitudinal Course of Psychopathology in Cushing?s Syndrome after Correction of Hypercortisolism The Journal of Clinical Endocrinology & Metabolism Vol. 82, No. 3 912-919 Copyright ? 1997 by The Endocrine Society Lorah D. Dorn, Ellen S. Burgess, Theodore C. F., Billinda Dubbert, Philip W. Gold and George P. Chrousos School of Nursing, University of Pittsburgh (L.D.D.), Pittsburgh, Pennsylvania 15261; Developmental Endocrinology Branch, National Institute of Child Health and Human Development (L.D.D., G.P.C.), and the Departments of Behavioral Pediatrics (B.D.) and Clinical Neuroendocrinology (P.W.G.), National Institute of Mental Health, Bethesda, Maryland 20892; Butler Hospital, Brown University (E.S.B.), Providence, Rhode Island 02912; and Cedar-Sinai Medical Center (T.C.F.), Los Angeles, California 90048 Address all correspondence and requests for reprints to: Dr. L. D. Dorn, University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania 15261. Endogenous Cushing?s syndrome (CS) is associated with significant psychopathology during the course of the disease. The purpose of this study was to evaluate the psychological and endocrine status of patients with CS after correction of their hypercortisolism. Thirty-three patients with active CS were examined before and at 3 months (28 patients), 6 months (25 patients), and 12 months (29 patients) after correction of hypercortisolism. Before cure, 66.7% of the patients had significant psychopathology, with the predominant diagnosis of atypical depressive disorder (AD) in 51.5% and/or major affective disorder in 12%. After cure, overall psychopathology decreased significantly to 53.6% at 3 months, 36% at 6 months, and 24.1% at 12 months, when there was a parallel recovery of the hypothalamic-pituitary-adrenal axis assessed by serial morning ACTH stimulation tests. There was an inverse correlation between psychological recovery and baseline morning cortisol, but no correlation with ACTH-stimulated cortisol values at 60 min. AD continued to be the prevailing diagnosis after correction of hypercortisolism, whereas the frequency of suicidal ideation and panic increased. The presence of AD before and after correction of hypercortisolism might be due to glucocorticoid-induced suppression of hypothalamic CRH secretion. The slight increase in the incidence of panic after correction of hypercortisolism might be due to a decreased glucocorticoid restraint at the central arousal/sympathetic catecholaminergic system. We conclude that CS is associated with AD symptomatology, which gradually improves with time after correction of hypercortisolism. Health care providers should be aware of changes in symptomatology, including suicidal ideation and panic attacks, that occur in a subgroup of patients.

Hormone Replacement Therapy - HRT - Is a HOT topic in medical circles. I think it is a really good topic for us to consider too since we have a real hormone balacing act going on anyways! Here are some really excellent web sites that address HRT: http://www.queendom.com/articles/womenshea...t-overview.html http://www.cdc.gov/nchs/data/misc/hrt_booklet.PDF Here is the site of the North American Menapause Society and the studies they list: http://www.menopause.org/news.html

New for 2002 - Updated guidelines for the management of type 1 and type 2 diabetes: http://www.aace.com/clin/guidelines/

What a wonderful Link Lynne! Of course I understand it and the timing is perfect! I just posted a link from the NIH that just issued a statement about adrenal masses and their management. I had posted it under Adrenal Cushings, but I think I will post the link here too as it fits very nicely with the link that you provided above. http://www.nih.gov/news/pr/feb2002/omar-06.htm The NIH will be holding a conference in the near future and is issuing new guidelines on the management of adrenal masses. I expect this topic will be updated once the proceedings have been held and the guidelines have been released. How exciting! Lynne - I was just amazed how much your article matched the tone and issues of the NIH in their press release! For all of you with adrenal issues - please check these links out!

Hey Lynne - Here's the link to your article: http://www.washingtonpost.com/wp-dyn/artic...3-2002Feb5.html

Wow Lynne - especially about the tall girls - I had heard that from a lady when my daughter reached 5'-9. My husband is tall so I blew her off. There are different kinds of estrogens too. Perhaps when I get home, I'll pull all of the info I have together on that. The horse derived estrogen is supposed to be the one that is widely used and is supposed to be one-size fits all and it isn't - there are better meds that are closer to our own natural estrogen. What a great topic!

I am going to go ahead and post this cause our docs do read the New England Journal of Medicine. You need to keep in mind that this does generally apply, but I do wish the first thing out of a doctor's mouth wasn't Lose Weight and Excercise...Excercise is good and it helps ward of type II diabetes and here is a new study that looks at excercise vs drug therapy in the control of type 2 diabetes: (I can't get the full text yet) Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin Diabetes Prevention Program Research Group ? ? ? Diabetes ? ABSTRACT Background Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors ? elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle ? are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. Methods We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. Results The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. Conclusions Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin. Source Information The writing group (William C. Knowler, M.D., Dr.P.H., Elizabeth Barrett-Connor, M.D., Sarah E. Fowler, Ph.D., Richard F. Hamman, M.D., Dr.P.H., John M. Lachin, Sc.D., Elizabeth A. Walker, D.N.Sc., and David M. Nathan, M.D.) takes responsibility for the content of this article. Address reprint requests to the Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852.

This one is NOT in medline. Let me know if you would like a copy of this study. SNAILMAIL or fax only (message me) - for personal use only as it is copywrighted material. Endocrinology and Metabolism Clinics Volume 30 ? Number 3 ? September 2001 Copyright ? 2001 W. B. Saunders Company NEUROENDOCRINOLOGY ------------------------------------------------------------------- DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF CUSHING'S SYNDROME James W. Findling 1 3 MD Hershel Raff 2 3 PhD 1 Endocrine-Diabetes Center (JWF) 2 Endocrine Research Laboratory (HR), St. Luke's Medical Center 3 Medical College of Wisconsin, Milwaukee, Wisconsin (JWF, HR) -------------------------------------------------------------------------------- Address reprint requests to Hershel Raff, PhD Department of Endocrinology St. Luke's Physician's Office Building, Suite 245 2801 W KK River Parkway Milwaukee, WI 53215 e-mail: hraff@mcw.edu Here is the Summary.... "In the early part of the twentieth century, two clinical syndromes were described--one in Europe (metabolic syndrome X)[2] and one in the United States (Cushing's syndrome)[16] --that were as clinically indistinguishable then as they are now at the beginning of the twenty-first century. Metabolic syndrome X has emerged as one of the most important public health problems in the United States, whereas Cushing's syndrome has become the most challenging diagnostic problem in clinical endocrinology.[26] The differentiation of patients with true spontaneous Cushing's syndrome from the large number of patients with the Cushing's phenotype can be clinically difficult, especially when the degree of hypercortisolism is mild.[14] [40] [63] The recognition of subclinical hypercortisolism in some patients with incidentally discovered adrenocortical tumors and the clinical improvement observed in these patients following adrenalectomy illustrate the importance of discovering even mild Cushing's syndrome.[63] Several comprehensive reviews of this topic have been published recently.[26] [48] [50] This article highlights the liabilities of the traditional diagnostic approach to Cushing's syndrome and reviews some of the new diagnostic studies that are available that can aid endocrinologists in the diagnosis and differential diagnosis of this disorder." Here is the outline...if the topics interest you...message me.... CLINICAL FEATURES BIOCHEMICAL DIAGNOSIS Urine Free Cortisol Low-Dose Dexamethasone Suppression Testing Late-Night Serum and Salivary Cortisol Dexamethasone-Corticotropin-Releasing Hormone Desmopressin Stimulation Test Iatrogenic Cushing's Syndrome Owing to Inhaled/Nasal Corticosteroids DIFFERENTIAL DIAGNOSIS Plasma Corticotropin High-Dose Dexamethasone Suppression Testing Inferior Petrosal Sinus Sampling Pituitary Magnetic Resonance Imaging SUMMARY References

OMG - I saw an endo that spent 45 minutes leading up to the point of why I needed to be on Prozac lol! I think a BIG problem with doctors is that real issues aren't investigated until they become REAL ISSUES.

If you want to participate in a study, just click on the link to get more information. I don't know if you have to get assistance from you doctor or not, but you might. Some of the studies for Cushings are to develop better testing protocols for Cushings. Those who end up having Cushings will be approved for Surgery - free. I believe the cost to the patient is getting there - right Mary? There are also studies available for other kinds of endocrine disorders and adrenal tumors. Some of the studies are all over the country, so you should find out what you can. Long-term studies may be able to be managed over long-distances with your local practioner and only have to check in once a year - depending on what it is. If you don't check it out, you don't know!

The Endocrine Society had a link to this very article on their web page. I looked to see if there was a commentary, but didn't see one. I wonder if this Metabolic Syndrome has anything to do with some of the mousie research that revealed high cortisol cellular, but not caused by an ACTH source? Cushings - but not?! ??? Thanks for sharing the article! I found this on the American Association of Clinical Endocrinologists: Dysmetabolic Syndrome denotes a constellation of metabolic abnormalities in serum or plasma insulin/glucose level ratios, lipids (triglycerides, LDL cholesterol subtypes and/or HDL cholesterol), uric acid levels, coagulation factor imbalances and vascular physiology. Major criteria Insulin resistance (denoted by hyperinsulinemia relative to glucose levels) or Acanthosis Nigricans Central Obesity (waist circumference > 102 cm for men and >88 cm for women) Dyslipidemia (HDL cholesterol 150 mg/dl) Hypertension Impaired fasting glucose or Type 2 diabetes Hyperuricemia Minor Features Hypercoagulability Polycystic ovary syndrome Vascular endothelial dysfunction Microalbuminuria Coronary heart disease

Here is a second study of interest: Published online before print February 6, 2001, 10.1073/pnas.041483198; Proc. Natl. Acad. Sci. USA, Vol. 98, Issue 4, 1952-1957, February 13, 2001 Estrogen receptor , not , is a critical link in estradiol- mediated protection against brain injury Dena B. Dubal*, Hong Zhu, Jin Yu,, Shane W. Rau*, Paul J. Shughrue?,?, Istvan Merchenthaler?, Mark S. Kindy,, and Phyllis M. Wise*, Departments of * Physiology and Biochemistry, and Stroke Program of Sanders-Brown Center on Aging, University of Kentucky College of Medicine, Lexington, KY 40536; and ? Women's Health Research Institute, Wyeth Ayerst Research, Radnor, PA 19087 Edited by William H. Daughaday, University of California, Irvine, CA, and approved December 15, 2000 (received for review October 11, 2000) Estradiol protects against brain injury, neurodegeneration, and cognitive decline. Our previous work demonstrates that physiological levels of estradiol protect against stroke injury and that this protection may be mediated through receptor-dependent alterations of gene expression. In this report, we tested the hypothesis that estrogen receptors play a pivotal role in mediating neuroprotective actions of estradiol and dissected the potential biological roles of each estrogen receptor (ER) subtype, ER and ER, in the injured brain. To investigate and delineate these mechanisms, we used ER-knockout (ERKO) and ER-knockout (ERKO) mice in an animal model of stroke. We performed our studies by using a controlled endocrine paradigm, because endogenous levels of estradiol differ dramatically among ERKO, ERKO, and wild-type mice. We ovariectomized ERKO, ERKO, and the respective wild-type mice and implanted them with capsules filled with oil (vehicle) or a dose of 17-estradiol that produces physiological hormone levels in serum. One week later, mice underwent ischemia. Our results demonstrate that deletion of ER completely abolishes the protective actions of estradiol in all regions of the brain; whereas the ability of estradiol to protect against brain injury is totally preserved in the absence of ER. Thus, our results clearly establish that the ER subtype is a critical mechanistic link in mediating the protective effects of physiological levels of estradiol in brain injury. Our discovery that ER mediates protection of the brain carries far-reaching implications for the selective targeting of ERs in the treatment and prevention of neural dysfunction associated with normal aging or brain injury.

If you haven't figured it out yet, I will start with estrogen first, then will switch to testosterone. Here is the first study that I found interesting. Let me know if you want the full text: Vol. 8, No. 3, pp. 121-133, May/June 2001 Cellular and Molecular Mechanisms of Estrogen Regulation of Memory Function and Neuroprotection Against Alzheimer's Disease: Recent Insights and Remaining Challenges Roberta Diaz Brinton Department of Molecular Pharmacology and Toxicology and the Program in Neuroscience, University of Southern California, Pharmaceutical Sciences Center, Los Angeles, California 90033, USA This review focuses on recent advances in our knowledge of estrogen action in the brain. The greatest amount of attention was devoted to those studies that impact our understanding of estrogen regulation of memory function and prevention of degenerative diseases associated with memory systems, such as Alzheimer's disease. A review of recent advances in our understanding of estrogen receptors, both nuclear and membrane, is also presented. Finally, these data are considered in regard to their relevancy to the use of estrogen replacement therapy for cognitive health throughout menopause and the development of an estrogen replacement therapy designed for the unique requirements of the brain. LEARNING & MEMORY 8:121-133 ? 2001 by Cold Spring Harbor Laboratory Press ISSN1072-0502/01 $5.00