staticnrg

Hi! I've missed a lot of posts lately, too, so I haven't seen this elsewhere. This is VERY INTERESTING!! Thank you for sharing it. Hugs!! Robin

I'm with Dawn.... How'd they know what was what? I'm glad my eyes will be covered.... (I know...I know...I'll be out) Thanks, MaryO!! Robin

Excellent article! It is an ugly disease. Not so much for what it makes us look like, but for what it does to our lives and the difficulties of diagnosis. This was well-written. The author took some time to get good information. Thanks, Mary!! Robin

http://www.jstage.jst.go.jp/article/endocr...0609250041/_pdf

Well, well, well............ Hugs!! Robin

I got a response already!!

Hi, Shelley! This is very, very interesting. I've been saying for a long time they need to develop an at-home cortisol test similar to the glucometer for diabetes where one can have an immediate reading. This would be another way that could happen, perhaps! I went to the home page of the developer of this test and found the contact page (click me) where I found an email address. I emailed them with my idea. It won't hurt! Hugs! Robin

Link to actual study (PDF file)

The Washington Times www.washingtontimes.com -------------------------------------------------------------------------------- Chemical in drinking water harms female thyroid By Joyce Howard Price THE WASHINGTON TIMES Published October 9, 2006 -------------------------------------------------------------------------------- Scientists have linked exposure to small levels of a chemical found in public drinking water supplies in 26 states to suppressed thyroid function in more than a third of women and girls 12 and older. The exposure to perchlorate, a study showed, was most acute in women with low levels of iodine in their systems, said Dr. James L. Pirkle, director of sciences in the federal Centers for Disease Control (CDC) and Prevention's Environmental Health laboratory and the study's author. "It's already been known that high levels of exposure to perchlorate [reduce] thyroid function, but this large study of more than 1,100 women marks the first time this effect has been shown from exposure to perchlorate at lower levels found in the general population ... the effect is not trivial," Dr. Pirkle said. Levels of perchlorate commonly found in the population range from 0.2 micrograms per liter up to 100 micrograms per liter. Perchlorate, both a naturally occurring and man-made chemical primarily used in making rocket fuel, may not be a household world across the nation, but it is well-known in California, where it seeped into the ground from operations of defense contractors and military bases. The chemical contaminated more than 450 wells and other water sources in Los Angeles, Sacramento and four other counties. Perchlorate also is found in milk, cheese and lettuce, as well as in human breast milk and baby formula. A report last year by the National Academy of Sciences found that perchlorate has been detected in the public drinking water supplies of more than 11 million Americans in 26 states. In the new research, published online in the journal Environmental Health Perspectives, investigators explained that perchlorate blocks the thyroid gland's uptake of iodine, slowing metabolism and causing medical problems such as fatigue, depression and weight gain, especially in women with low levels of iodine. Infants and fetuses are also at risk from perchlorate exposure. The CDC said the new research shows "that even small increases in perchlorate exposure may inhibit the thyroid's ability to absorb iodine from the bloodstream." Findings from the CDC research indicate perchlorate puts women at much greater risk of thyroid disorders than they had previously thought. However, no such association was found with men. The new data may help the Environmental Protection Agency as it considers whether to impose a drinking water standard. Such a standard is opposed by the Pentagon and its contractors, because they say cleaning up perchlorate could cost billions and there are no proven health benefits. The CDC researchers are not calling their findings definitive. They plan another trial involving 1,200 to 1,400 women to try to duplicate their results. If confirmed in the second study, their findings would be significant, given that 36 percent of U.S. women have low iodine levels. "It would mean 36 percent of regular women in the U.S. population have a relationship between thyroid function and levels of perchlorate in the environment," Dr. Pirkle said. Found here (click me).

Well, dang, Kellyann! This is "spot on" as Liz would say!! (Right, Liz?) I've said for a long time I know it's feasible to develop a stick test just like they did for blood sugar. You know it's possible. I wish someone would do it!!!! We need to push for it! Hugs! Robin

PDF of the article for you to use however you need it. I've emailed this PDF to several folks because I know they won't click on a link. Hugs! Robin

I'm a subscriber to the digital version, but it's not up, yet. Remind me, and when it is, I'll get the text. I can't wait to read it myself! Robin

Some things are available via Medscape (free account). Some of these I get through VCU's online library (using daughters' accounts). Some I still can't get, either, without paying. Eventually I can. But at first, they cost. In a few months they won't. I know...it's aggravating. Hugs! Robin

Article pasted below (readable, although format isn't great). I have the PDF, also. Much easier to read. Dr. J. is listed multiple times in bibliography. This is his technique. Transnasal Endoscopic Surgery of the Pituitary: Modifications and Results Over 10 Years [Triological Society Papers] Kelley, Richard T. MD; Smith, Joseph L. II MD; Rodzewicz, Gerald M. MD From the Departments of Otolaryngology and Communication Sciences (r.t.k., j.l.s.) and Neurosurgery (g.m.r.), Upstate Medical University, Syracuse, New York, U.S.A. Editor?s Note: This Manuscript was accepted for publication May 10, 2006. Podium presentation at the Triologic Society Southern Section Meeting, Naples, Florida, U.S.A., January 19-21, 2006. Send correspondence to Dr. Richard T. Kelley, Department of Otolaryngology and Communication Sciences, Upstate Medical University, 750 East Adams Street, Syracuse, New York, 13210. E-mail: kelleyr@upstate.edu. Abstract Objective: A 10-year retrospective review of three endoscopic approaches used by the authors for pituitary gland surgery is presented. We review our results and complications and outline the advantages and disadvantages of each. The variations in nasal anatomy that factor in the endoscopic approach are tabulated and discussed. Methods: A chart review and examination of computed tomography and magnetic resonance imaging scans of patients who have had endoscopic pituitary surgery by the authors was performed. We gathered specific details of the operative approach, nasal-sinus anatomy, tumor location, required ancillary nasal procedures, and postoperative complications. Results: Ninety patients had endoscopic pituitary surgery. Operative reports and review of radiographic studies were possible for 75 patients. The surgical approach progressed over 10 years from endoscopic transseptal (42) to bilateral transostial (13) to unilateral transostial (20). Adequate exposure for the degree of resection was achieved in all patients. Complications included hemorrhage requiring return to the operating room (1), transient visual field loss (2), and transient diabetes insipidus (7). Four patients subsequently had craniotomy to resect suprasellar tumor extension. The average follow-up was 6 years. One patient required revision endoscopic resection 3 years later for tumor recurrence. Anatomic findings included nasal septal deflections in 36 (48%) of the patients, abnormalities of the turbinates in 42 (56%), and variances of the sphenoid sinus septum in 59 (79%) of the patients. In the unilateral transostial approach, the operative side was often determined by anatomic factors. Conclusion: The authors have exclusively used endoscopic surgery of pituitary gland tumors for over 10 years. Modifications to the approach have occurred as a result of increased surgeon experience and improved technology. The unilateral transostial approach is safe, effective, and recommended. INTRODUCTION Endoscopic techniques are considered state of the art in many areas of surgery because there has been a trend toward minimally invasive procedures. It has been over 12 years since pituitary surgery using endoscopes initially was reported.1?3 Endoscopic pituitary surgery is seen as an effective, less-invasive way to adequately remove or debulk tumors. The early concern of lack of three-dimensional viewing has not lessened the apparent adoption of the endoscope. Several reports demonstrate the advantages of decreased nasal morbidity, improved visualization of the sella, decreased operative time, and possibly decreased hospitalization time, thus implying medical cost savings.4?8 Newer instrumentation allows for more efficient and less traumatic endoscopic surgery. Narrower endoscopes provide more room for other instrumentation. Microdebrider instruments are now widely used by endoscopic surgeons, and a variety of blades and burs are available. Unlike the open, retractor-placed transseptal approach, however, the endoscopic technique requires the surgeon negotiate through and around intranasal structures. Nasal and sphenoid sinus anatomy has a wide range of variability, which may affect the ease of performing endoscopic pituitary surgery.9,10 Familiarity with the types and incidence of intranasal deformities that are encountered and determining when to avoid structures and when to remove obstructions to facilitate the tumor removal is beneficial. We reviewed our endoscopic pituitary surgery cases over the past 10 years and report modifications based on increased experience and technological advances; we also reviewed our complications. We list advantages and disadvantages to approach. We present salient radiographic and intranasal findings that influence the sidedness of our recommended unilateral endoscopic technique. METHODS A chart review and examination of computed tomography (CT) and magnetic resonance imaging scans of patients who have had endoscopic pituitary surgery by the senior authors from December 1994 until June 2005 was performed. Specific details of the nasal anatomy, tumor location, operative approach, required ancillary nasal procedures, and postoperative complications were reviewed. In evaluation of the anatomic radiographic findings, we reviewed the films of each patient and tabulated the findings. Septal deflections were divided into anterior, mid-septum, and posterior. Middle turbinate abnormalities were defined as presence of concha bullosa, marked hypertrophy, or paradoxic curvature. Sphenoid sinus septal configurations were listed as right or left predominant, multiple, or absent. Any other findings (e.g., polyps) were also noted. The anatomic findings in cases with use of the current technique of unilateral transostial endoscopic approach were tabulated. RESULTS Ninety patients underwent endoscopic pituitary surgery. Detailed operative reports dictated by the same surgeon and radiographic studies were found for 75. Several of the earlier patients in the review had films that had been destroyed. The average age of the patients was 51 and ranged from 23 to 83 years old. In the 75 patients included, there was a fairly even distribution of men and women (40 and 35, respectively). The pathology was primarily pituitary nonhormone secreting small cell adenoma (62) but other pathology included hormone-secreting adenoma (6), pituitary apoplexy (4), Rathke cyst (2), and craniopharyngioma (1). There was a progression from an endoscopic transseptal (42 patients) to a bilateral transostia (13) to a unilateral transostium (20) approach during the study period (Table I). In the first 5 years, transseptal was routinely used except for four patients who had previously undergone an open, nonendoscopic transseptal approach and subsequently required a second pituitary surgery because of tumor regrowth. These were all performed endoscopically by way of a transostial approach (3 bilateral and 1 unilateral). In the last 3 years, the transseptal approach was used only for two patients with significant bilateral septal and turbinate abnormalities and massive tumor filling the sphenoid sinus. The unilateral transostial approach was used for 84% (16/19) of the cases in the last 3 years. Graphic TABLE I. Distribution of Surgical Approaches to Pituitary Gland Used. Complications are reported in Table II. Four patients were readmitted to the hospital for persistent headache with a concern of a cerebrospinal fluid (CSF) leak. No CSF leaks were identified. One postoperative hemorrhage occurred, which resulted in a new visual field loss and required emergent evacuation of an operative bed hematoma. Two other patients had new, temporary postoperative visual field cuts that also completely resolved. Seven (9%) patients experienced transient diabetes insipidus (DI). Of the 75 procedures performed, 4 (5%) required further craniotomies secondary to inability to adequately resect suprasellar tumor extension. In the subpopulation of patients who had previously undergone an open transseptal approach (before 1994) and subsequently required a second pituitary surgery, all indicated less discomfort and quicker recovery with the endoscopic approach. Graphic TABLE II. Complications and Limitations. The average follow-up duration was 8 years (transseptal), 4.5 years (bilateral), and 2.5 years (unilateral). The degree of resection (usually subtotal) and need for subsequent radiation therapy ( Anatomic variations are listed in Table III. Radiographic findings included septal deflections and abnormal turbinates (concha bullosa, paradoxic curvature, or hypertrophy). Thirty-six (48%) patients had deviations of one or more regions of their septum, whereas 39 (52%) had no deflection. Mid-septal deflections were most common. A majority of patients, 42 (56%), also had variable middle turbinate anatomy. Asymmetric sphenoid sinus configurations were identified in 59 (79%) of the patients. Several other patients had polyps, inferior turbinate hypertrophy, or a marked bulla ethmoidalis. Graphic TABLE III. Anatomic Variations. On reviewing the operative reports in cases using the unilateral transostium approach, however, intranasal anatomy was clinically important (Table IV). The left-sided approach was used when the sphenoid septum was right predominant (8/11), and the tumor was left-sided (3/11). The right-sided approach was used when the sphenoid septum was on the opposite side (5/9). Middle turbinate partial resection was performed in each case of an abnormality to allow for wider access to the sphenoid. In cases of bilateral anatomic findings, the posterior abnormality dictated the sidedness of the approach. Graphic TABLE IV. Sidedness of Unilateral Ostium Approach and Anatomical Variability. DISCUSSION Over 10 years ago, we began using endoscopes for pituitary tumor surgery. During this period, there have been changes to our initial technical description.11 Sonnenberg et al.12 determined that there was not a statistical difference in complications using the same endoscopic technique and concluded a surgeon learning curve was not present. There has been, however, a learning curve in modifying the approach by deciding what works and what does not. At first, we sought to primarily replace the open sublabial approach with use of endoscopes through a smaller transseptal route. This exposure allowed for access to and obliteration of the sphenoid sinus with fat, and the sinus could then be sealed, with re-approximation of the septal mucosa. The advantages to this approach were the ability to place a retractor in the nasal septal incision for easy introduction of instruments and endoscopes, avoid turbinate or mucosal abnormalities, correct any septal deflection, convert to an open approach quickly if needed, avoid the sublabial incision, nasal spine removal and possible postoperative nasal tip droop, and identify and work in the midline. The disadvantages included additional operative time, oozing from the larger septal flaps obscuring the lens, patient discomfort, and need for septal splints or packing. In revision cases from previous ?open? transseptal surgeries, in which the septum was midline but scarred or perforated and did not allow for a transseptal approach, we opted to perform the more direct bilateral transostial approach. This had the advantage of placing the endoscope in one side, sometimes in a scope holder, while instruments were passed though the other nasal cavity. Use of an endoscope holder was not favored because it required additional set-up time and use of an endosheath to flush the scope clean in situ. The bilateral approach had problems with ?blind? passage of instruments and the need for straight access on both sides, necessitating correction of bilateral septal curvatures and all obstructing turbinates. After several cases, we believed that there was no compelling reason to use the bilateral approach except for tumor filling the sphenoid sinus. Last, we began using a unilateral transostial approach and continue to use this technique. Advantages include easy visualization of instruments as they are passed through the nasal cavity, decreased operative time, and minimal patient discomfort because no packing is required. Favorable anatomy is only required on one side, and a preferred side was chosen to maximize the exposure to the tumor with the least amount of nasal sinus mucosal disruption. The left side was chosen when there was a right posterior septum, left turbinate abnormality, right-sided sphenoid septum, or left tumor location. The right side was chosen when there was right turbinate abnormality or left sphenoid septum or equivocal anatomy by surgeon preference. Severe anterior deflections require that the opposite side be used or the deflection be endoscopically corrected. Middle turbinate abnormalities (concha bullosa, hypertrophy, and paradoxical curvature) may represent an obstruction in trying to reach the natural ostium of the sphenoid sinus. Seithi et al.10 found that 77% of sphenoid ostia could be visualized without middle turbinate removal. They did not comment on lateralization of the turbinates or on treatment of the superior turbinate. Carrau et al.13 describe never needing to resect the middle turbinate. Partial middle turbinate resection, however, can improve exposure of the posterior nasal cavity. Because concha bullosa often accompany a septal deflection to the opposite side, a partial sagittal middle turbinectomy not only increases exposure but also increases the intranasal workspace. We found partial middle turbinectomy to be useful 33% of the time. A transostial approach is off the midline. However, routine use of a high-speed angled burr and microdebrider to enlarge the ostial opening medially to include the posterior midline septum and sphenoidal crest allows a near-midline orientation of the endoscope and instruments. Otori et al.14 used a navigation system in 40 endoscopic pituitary cases but did not perform a comparative study to determine the value using it. We used a three-dimensional navigation system for three cases but found it added additional time, and at posterior wall of the sphenoid, there was often 2 mm or greater difference comparing the CT with endoscopic bony landmarks, which was unacceptable. Fluoroscopy was used for determination of sagittal extent of curette location with tumor removal. The sphenoid anatomy we encountered is detailed in Table III. The 79% variability agrees with Renn and Rhoton 9 and Seithi et al.,10 who studied sphenoid anatomy and the variations in extent of pneumatization, dehiscence of optic nerve and the internal carotid artery, and sphenoid septum. In the 30 cases studied by Seithi et al., the sphenoid septum was found to be singular (70%) or multiple (30%), midline (40%) or asymmetric, (right dominant 27%, left 33%) complete, or partial extending to the midline sella or laterally to the carotid. The overall complication rate in our retrospective review was low. There were no alar or septal injuries. Four patients were readmitted for concern of CSF leak, but none were identified. The rate of CSF leak is reported as 2% to 3.8%.15 We used autologous fat and fibrin sealant for each case and found it to be universally effective. If an intraoperative CSF leak was apparent, the lumbar drain inserted at the beginning of the case was left in place. Short-term and transient DI has also been reported to occur in 5.5% to 20% of patients.5,15 Shah and Har-El 5 reported a higher incidence of immediate and short-term DI in patients undergoing the traditional open approach compared with the endoscopic approach. In our review, all seven patients with transient DI had surgery with the transseptal, endoscopic approach. No patients operated with a transostial technique developed DI. Determination of degree of resection and need for additional treatment with radiation was made by the neurosurgeon. Although angled endoscopic lenses are routinely used to help with visualization and tumor resection, 5% of our cases had suprasellar tumor and had craniotomies to complete resection. In the future, more aggressive endoscopic resections may allow for adequate removal of suprasellar tumor. Only one patient in our review required subsequent surgery for recurrence. CONCLUSION The endoscopic approach to the pituitary gland has been used for over 10 years by the authors. Conversion to an open approach has never been needed. There have been modifications to the originally described technique primarily because of operator experience. There have been few instrument improvements such as the angled burr, which allow for safe and more rapid exposure of the sphenoid sinus. A unilateral transostial approach is currently favored. A majority of patients had nasal anatomic variations that influenced the sidedness of the surgery, and there was often a need for septal or turbinate correction. Complication rates were low. Patients generally reported minimal nasal discomfort after surgery, and for those who had already undergone an open approach, they uniformly preferred the endoscopic approach. BIBLIOGRAPHY 1. Jankowski R, Auque J, Simon C, et al. Endoscopic pituitary surgery. Laryngoscope 1992;102:198?202. [Context Link] 2. Wurster CF, Smith DE. The endoscopic approach to the pituitary gland [Letter]. Arch Otolaryngol Head Neck Surg 1994;120:674. [Context Link] 3. Shikani AH, Kelly JH. Endoscopic debulking of a pituitary tumor. Am J Otolaryngol 1993;14:254?256. [Context Link] 4. J. HD, Alfieri A. Endoscopic transsphenoidal pituitary surgery: various surgical techniques and recommended steps for procedural transition. Br J Neurosurg 2000;14:432?440. [Context Link] 5. Shah S, Har-El G. Diabetes insipidus after pituitary surgery: incidence after traditional versus endoscopic transsphenoidal approaches. Am J Rhinol 2001;15:377?379. [Context Link] 6. Jame JA, Thapar K, Kaptain GJ, et al. Pituitary surgery: transsphenoidal approach. Neurosurgery 2002;51:435?442. Ovid Full Text Bibliographic Links [Context Link] 7. Cappabianca P, Cavallo LM, Colao A, et al. Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invas Neurosurg 2002;45:193?200. [Context Link] 8. J. HD, Alfieri A. Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invas Neurosurg 2001;44:1?12. [Context Link] 9. Renn WH, Rhoton AL. Microsurgical anatomy of the sellar region. J of Neuroscience 1975;43:288?298. [Context Link] 10. Sethi DS, Stanley RE, Pillay PK. Endoscopic anatomy of the sphenoid sinus and sella turcica. J Laryngol Otol 1995;109:951?955. Bibliographic Links [Context Link] 11. Rodziewicz GS, Kelley RT, Kellman RM, Smith MV. Transnasal endoscopic surgery of the pituitary gland: technical note. Neurosurgery 1996;39:189?193. Ovid Full Text Bibliographic Links [Context Link] 12. Sonnenburg RE, White D, Ewend MG, Senior B. The learning curve in minimally invasive pituitary surgery. Am J Rhinol 2004;18:259?263. [Context Link] 13. Carrau RL, J. HD, Ko Y. Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 1996;106:914?918. Ovid Full Text [Context Link] 14. Otori N, Haruna S, Kamio M, et al. Endoscopic transethmosphenoidal approach for pituitary tumors with image guidance. Am J Rhinol 2001;15:381?386. [Context Link] 15. Cappabianca P, Cavallo LM, Colao AM, deDivitus E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 2002;97:293?298. Bibliographic Links [Context Link]

Minim Invasive Neurosurg. 2006 Feb ;49:10-4 Endoscopic transsphenoidal treatment in recurrent and residual pituitary adenomas - first experience. A Rudnik, T Zawadzki, B Gałuszka-Ignasiak, P Bazowski, I Duda, M Wojtacha, A I Rudnik, I Krawczyk AIM OF THE STUDY:: The aim of the study has been the assessment of the endoscopic method in the surgical management of recurrent and residual pituitary adenomas, as concerns treatment efficiency, substantial complications, and its possible advantages for the operating surgeon and patient. Material and Methods: In Department of Neurosurgery, Silesian University School of Medicine in Katowice, between October 2001 and June 2004, 125 patients underwent endoscopic surgery due to pituitary adenoma. The analysis comprised 20 patients, who were operated on due to recurrent adenomas or residual tumour not completely removed during the first surgical procedure. The group of patients was composed of 9 women and 11 men. The youngest patient was 32 years of age, the oldest 79. The average age was 53.9 years. The analysed group had 14 non-functioning adenomas, 4 GH-secreting adenomas, 1 PRL-secreting adenoma and 1 ACTH-secreting adenoma. 19 of them were macroadenomas while 1 was a microadenoma. 11 of the 20 adenomas infiltrated the cavernous sinuses. The surgical procedures were performed by a stable team, composed of 2 neurosurgeons, a laryngologist and an anaesthesiologist. The surgery method was based upon the technique developed by J. and Carrau, with own modifications of the operators. A rigid neuroendoscope having the diameter of 4 mm with 0 degrees and 30 degrees optics by Storz was used. The follow-up period after surgery was between 12 and 42 months, 24.2 months on average. RESULTS: Of the 20 cases, complete recovery was achieved in 40 % of patients undergoing secondary surgical procedures. In the group of 11 patients with adenomas not infiltrating the cavernous sinuses, recovery was reported for 8 of them, that is 73 %. No fatalities occurred. 7 cases of liquorrhoea occurred during operation, requiring reconstruction and sealing of the sella by means of tissue glue and artificial dura or freeze-dried human dura. In 1 case, despite the application of post-operative lumbar drainage, rhinorrhoea occurred one month after the procedure, which required endoscopic reconstructive treatment. In the same patient, a pneumoencephalocele was observed. The average time of the repeat surgical procedure using endoscopic techniques was shorter by 18 minutes than the repeat procedure using microscopic techniques. CONCLUSIONS: The endoscopic method is a safe, hardly invasive and efficient surgical technique in the treatment of recurrent and residual pituitary adenomas. Advantages which add to its attractiveness are also reduction of the procedure duration, very good visualisation of the operative field, absence of serious complications, less pain experienced after the surgery. (I'm researching, can you tell? My house still waits on me...lol!)

An update on the overnight dexamethasone suppression test for the diagnosis of Cushing's syndrome: limitations in patients with mild and/or episodic hypercortisolism F. TC. Division of Endocrinology, Metabolism, and Molecular Medicine, Charles R. Drew University, Los Angeles, CA 90059, USA. The overnight one-mg dexamethasone suppression test has been used for many years to screen for Cushing's syndrome. This test has usually been evaluated in controls versus patients with severe hypercortisolism. Under these conditions, the overnight dexamethasone suppression test has been reported to have high sensitivity and specificity. The objective of this study was to determine the sensitivity of the one mg overnight dexamethasone suppression test in patients with mild and/or periodic Cushing's syndrome. Therefore, an overnight dexamethasone suppression test was performed in 17 consecutive patients presenting to an endocrinology clinic with signs and symptoms of hypercortisolemia who were later proven to have Cushing's syndrome. The majority of patients were found to have both mild and periodic hypercortisolism. One mg of dexamethasone was given at midnight and a plasma cortisol was measured by radioimmunoassay at 08:00 the following morning. Using a cut-off for a morning cortisol following overnight dexamethasone of > 5 microg/dL, only three of 17 patients failed to suppress to a value less than this cut-off (sensitivity 18 %). A cut-off of > 2 microg/dL gave similar sensitivity. Even with a stringent cut-off point of > 1.8 microg/dL, only seven of 17 patients failed to suppress to a value less than this cut-off point (sensitivity of 41 %). These results demonstrate that the great majority of patients with mild and/or periodic Cushing's syndrome suppress to overnight dexamethasone. Since patients with mild and/or periodic Cushing's syndrome are the patients in whom the identification of hypercortisolism is difficult, our results from this relatively small study suggest that this test should no longer be used to exclude these patients from further workup for Cushing's syndrome. PMID: 16915537 [PubMed - in process]

Health Tip: Cushing's Syndrome is a Hormonal Condition 05.26.06, 12:00 AM ET (HealthDay News) -- Cushing's syndrome affects as many as 15 million people each year, typically between the ages of 20 and 50. It occurs when the body's tissues have been exposed for an extended period to too much of a hormone called cortisol. According to the U.S. Endocrine and Metabolic Diseases Information Service, people with Cushing's often gain weight in the upper body, and have an abundance of fat around the neck, a round face, and thin arms and legs. Cushing's also leads to weakened bones and thin skin, which may bruise easily. Treatment options include surgery, radiation, chemotherapy or a medication regimen that prevents production of cortisol, the NIDDK says. If medications taken for other conditions are causing Cushing's, your doctor may adjust the dosage to control both problems.

Hi Judy. I don't think there is a test, yet. It will probably take a few years for them to start testing for it. I'll look around some more and see if anyone is doing it with doctor's order. Robin

Ok, Judy..I'll try. Not all Cushing's is hereditary. However, for those that do have the hereditary form, there is a gene marker, and they have found what it is. It is a mutation of the protein kinase A of chromosome 17. This doesn't mean a lot to us, but it can lead to a simple test to see if a person has this mutation and will develop Cushing's syndrome. If a family suspects they are carriers of this gene, they will be able to have a simple genetic test done to see. This will lead to earlier and better treatment for these folks. That's marvelous! It will also allow us to be tested to see if we have the gene or not. If so, we know our kids and grandkids will need to be tested. That's it in a nutshell! HA! Robin

Main Category: Genetics News Article Date: 13 Jun 2006 - 0:00am (PDT) Two Seville-based scientists of the Molecular Genetics Laboratory of Virgen Macarena Hospital have discovered the gene responsible for the hereditary Cushing's syndrome, a disease that is the result of an increase of the blood cortisol level, a hormone produced by the adrenal glands; patients suffer a serious of symptoms such as obesity, marks in their face, chest and shoulders, sometimes with an infection and an increased quantity of urine and excessive thirst (which may indicate the excess of glucose in the blood), among others. According to the work carried out by doctors of the University Hospital, the fault is in the gene of the protein kinase A of chromosome 17. The mutation increases the quantity of cortisol in the blood anomalously, which shows the first symptoms when boys and girls reach puberty. ?Generally, they begin to put on weight without a justified cause, their blood pressure increases, they have menstruation disorders and violet stretch marks can appear in their breasts, hips and legs', said Alfonso Gentil, assistant lecturer of the Endocrinology Department of Virgen Macarena Hospital. This research work describes the mutation found in 12 families in France, the USA and Spain, and connects for first time the Cushing's syndrome with a specific genetic anomaly. That's why this disease can be eventually diagnosed in molecular genetics laboratories on a prenatal basis or before it becomes clinically apparent, as it will be possible to identify what relatives of a patient are disease carriers. This research was carried out at the Molecular Genetics Laboratory of Virgen Macarena Hospital, in Seville, and led by Dr. Miguel Lucas, from a study made in the Endocrinology and Nutrition Department by Dr. Gentil. It consisted on genetically assessing nine members of a family, where two of them -an 18-year-old girl and her aunt, in the 40's- were already diagnosed and surgically treated to eliminate the syndrome. The clinical trials consisted of extracting the DNA from the blood in order to check the segregation and link to gene of the protein kinase A and after that, determinate the sequence. When the results were ready, the researchers of Virgen Macarena Hospital contacted Constantine Stratakis, a prestigious pathologist of Bethesda University, in Maryland, USA, who after learning of the Seville family case, put the Seville doctors in contact with the Cochin Institute of Paris in order to publish the work in the May edition of the international journal ?Journal Clinical Endocrinology and Metabolism' . About the ANDALUC?A INVESTIGA Andalusia's I+D+I public system includes over 18,000 researchers and more than 1,700 research groups. Together with Madrid and Catalu?a, Andalusia has a great potential, with 14% of the nation's total scientific output. This privileged position has been possible thanks both to the regional government's financial support to the I+D+I and the aid of the private sector. Last January 9, the Andalusian Programme for the Spreading of Scientific Knowledge created the news agency InnovaPress in Spanish, with the aim of providing prompt information about scientific developments in the region. The project follows the European Commission's guidelines for the creation of a major scientific news agency that will enhance the spread of such information, and will serve as a new tool for the EU's economic reforms set out in Lisbon, as debated in Brussels last December 2004. Now, from April 3rd, InnovaPress will also be available in English, in an attempt to spread scientific developments and results to mass media, researchers, and universities. The Andalusian Programme for the Spreading of Scientific Knowledge is sponsored by the Andalusian Ministry of Innovation, Science and Enterprise. This is a pioneering project in Europe, which has managed to gather research, higher education and knowledge-based industry, I.T.s, and entreprenurial, industrial and energy policies. With the interaction of all these agents in mind, the Andalusian Ministry of Innovation, Science and Enterprise intends to create a major social alliance that will enable an ?innovation explosion? in Andalusia as exclusive guarantee of progress and welfare development. In this vein, the Andalusian Regional Government has increased its investment in I+D+I by 37% with regard to the previous year, when investment was also increased by 32%. This shows the government's commitment to double investment in this area in the course of the present term of office. Some of the actions carried out by the regional government include a brand new Multi-annual Plan for University Infrastructure Investment for the period 2006-2010, with a total budget of 480 million Euros for the ten Andalusian public universities. With this new Plan, investment in university infrastructure and equipmentmte agents in mind,ry policiesm groups. is increased by 32% with regard to the previous five-year period. Also, within five years, the Plan will match all investment made in the last 12 years (1994-2005), which amounted to 504 million Euros. Also, a new system of incentives has been established for Research Groups and Excellence Projects, reaching a total of 87 million Euros, which means an increase of 79 million with regard to the previous official announcement made by the regional government before the new system was in force. In the new system, 12 million Euros have been allocated as incentives to the work of 1731 research groups, and 30 million more have made it possible to start 219 excellence projects dealing with Life Sciences, Food and Agriculture, Information Technologies, etc. Through InnovaPress, the Andalusian Programme for the Spreading of Scientific Knowledge will channel this new sustainable economic and social model, based on the creation of social welfare, respect for the environment and equal opportunities, within the major framework of the second modernisation of Andalusia. ANDALUC?A INVESTIGA Consejer?a de Innovaci?n, Ciencia y Empresa c/ Albert Einstein s/n http://www.andaluciainvestiga.com info@andaluciainvestiga.com

I found this by accident, but thought it pertinent and interesting. Cleveland Clinic Reports Experience with Laparoscopic Radical Adrenalectomy Written by Michael J. Metro, MD Monday, 31 January 2005 BERKELEY, CA (UroToday Inc.) - Laparoscopic adrenalectomy has become the gold standard approach for benign surgical adrenal disorders such as aldosteronoma, Cushing's disease and pheochromocytoma. BERKELEY, CA (UroToday Inc.) - Laparoscopic adrenalectomy has become the gold standard approach for benign surgical adrenal disorders such as aldosteronoma, Cushing's disease and pheochromocytoma. However, laparoscopic adrenalectomy for solitary metastasis or primary adrenal cancer remains a matter of considerable debate. Adrenal cancer rightfully confers the possibility of carcinomatosis or port site metastasis, as noted in initial published case reports. Given the controversial nature of this topic, the group at Cleveland Clinic headed by Dr. Inderbir Gill reviewed their single center experience with laparoscopic adrenalectomies for malignancy. Their results are reported in the February, 2005 issue of the Journal of Urology. Their cohort comprised 31 patients (33 adrenalectomies) with preoperative suspicion of a solitary metastasis to the adrenal gland, and those who were incidentally found to have primary adrenal malignancy. Selection criteria for the laparoscopic approach on pre-operative CT were an adrenal mass of 10 cm or less without evidence of peri-adrenal infiltration, caval thrombus or bulky locoregional adenopathy. A closer look at the study population revealed a mean age of 59.8 years. Mean tumor size was 5 cm. The laparoscopic approach was transperitoneal in 17 cases, retroperitoneal in 15 and transthoracic in 1. Pathology reports indicated a diagnosis of adrenal metastasis in 26 patients; with the primary cancer being renal cell carcinoma (RCC) in 13 patients, colonic metastasis in 5, and lung metastasis in 4 patients. Six patients had primary adrenocortical carcinoma (ACC). Surgical margins of the adrenalectomy specimen were negative for cancer in 19 cases (56%), indeterminate in 2 (6%) and positive in 1 (3%). The pathology report made no mention of margin status in 11 patients (33%). Analysis revealed a current median follow-up of 26 months. Overall, 15 patients (48%) died and 16 (52%) were alive. Of these 13 (42%) had no evidence of disease. Local recurrence was noted in 7 patients including 3 with metastatic RCC, 2 with metastatic colon cancer and 2 with primary ACC. Surgical margins had been positive in one patient with a local recurrence. One patient with bilateral metastatic adrenal masses from RCC developed carcinomatosis 7 months postoperatively. They noted no port site metastases. Survival was similar in patients with tumors less than 5 cm vs. 5 cm or greater. Survival was not associated with patient age, tumor size, operative time or surgical approach. Survival was compromised in patients who developed local recurrences, with a median survival of 17 months. In conclusion, their study shows that laparoscopic radical adrenalectomy can be performed with acceptable outcomes in carefully selected patients with a small, organ confined, solitary adrenal metastasis or primary adrenal carcinoma. The results of this group from Cleveland Clinic compare favorably with a contemporary open series from Memorial Sloan Kettering Cancer Center. J Urol. 2005 Feb; 173(2):519-25

Mary, I think that would be great!!! I have more to add, when I get some time. If we'll use this topic to add them, then you can put them on your site as you get the time and energy. How are you doing? Lots of soft hugs!!! Can I do anything to help from this end? Robin

I thought maybe we could all share our bookmarks between this topic and the previous one I started. This one is for links and the other for journal/research articles. That way we could all find them when we need them. The Cyclical Cushing's Journal/Research links are here National Cancer Institute Wake Forest University Baptist Medical Center Pituitary Tumor Center Tuft's Open Courseware (The information on Thyrotroph (TSH) Adenomas was new to me!) Harvard Major Diagnostic Advance: Bilateral Inferior Petrosal Sinus Sampling in Cushing's Syndrome NIH information on Cushing's

http://jcem.endojournals.org/cgi/content/full/88/12/5593 http://www.gimbe.org/eventi/AME2001/Boscar..._Intern_Med.pdf http://www.ncbi.nlm.nih.gov/entrez/query.f...4&dopt=Abstract http://jcem.endojournals.org/cgi/content/abstract/60/2/328 http://www.eje-online.org/cgi/content/abstract/133/3/317 http://goodhormonehealth.com/patel-periodic-publ.pdf http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_DocSum http://content.karger.com/ProdukteDB/produ...ArtikelNr=23431 http://www.endotext.org/neuroendo/neuroendo7/neuroendo7.htm http://www.ohsupituitary.com/pros/cme.asp

LOL...I didn't have the nerve to put the actual title of the article.... Hi, Jade! How are you? Robin