I have a theory about why half of us can?t get diagnosed and

[Guest Handiman]

I have a theory about why half of us can?t get diagnosed and the other half can!

Before I go into this theory, I just want everybody to remember that I am neither a Doctor nor a med student or even in any of the medical professions. I am just a 35 y.o. man that is in the middle of the biggest battle he has ever fought, The Battle For Life! I have been told in the past that if you have a battle to fight, I am one of the Handiest-Men to have on your side. I don?t do anything halfway, and I always see the fight to the very end! (Thus the name Handiman)

My Theory: (part one)

I think the problem that some of us are having is that we are looking for a diagnosis of Cushing?s and half of us don?t have Cushing?s! Please don?t roll your eyes and blow me off, I know it is not what you want to hear but it is true! The fight we are having is not whether or not we have Cushing?s, but it is whether we have a hormonal imbalance in our bodies or not! This is where my theory about the hypothalamic-pituitary-adrenal (HPA) axis comes in! We all should know by now that the HPA axis has something to do with the hypothalamic, pituitary, adrenals and the common link they have to make an axis. The common link they have is that when something goes wrong with one of them, it causes a chain reaction in the other two glands. Meaning that if you have something wrong with one of them, you have something wrong with all of them. Quote, ?The adrenal glands can produce too much of one or more hormones. Changes in the adrenal glands themselves or overstimulation by the pituitary gland may be the cause. The symptoms and treatment depend on which hormones--androgenic steroids, corticosteroids, or aldosterone--are being overproduced.?

I think the problem that we are running into is that Cushing?s is an overproduction of hormones and not an underproduction of hormones. But in theory, they can have the same symptoms. For example: A pituitary tumor that is secreting hormones could, in theory, have the same symptoms as a nonscreting tumor that is putting pressure on the pituitary gland and causing a hormone deficiency. It all boils down to the fact that both of them are considered to be a hormonal imbalance in the HPA axis!

Just to leave you with an example, growth hormone deficiency can cause: increased cardiovascular deaths, abnormal body fat & distribution, dehydration, reduced bone density, impaired physical/performance/psychosocial defects, depression & social isolation, insomnia & poor sleep patterns, skin thinning, reduced healing, chronic lung disorders, increased neurologic disorders, increased mental confusion, decreased thymus gland function, decreased immune system function, and vital organ shrinkage. (You can read more about it at http://www.usdoctor.com/gh.htm) Doesn?t most if not all of these symptoms sound a lot like Cushing?s Syndrome/Disease?

I recently read in an article called, Clinically Nonfunctioning Pituitary Adenomas: Characterization and Diagnosis (It can be found at: http://neurosurgery.mgh.harvard. edu/e-f-933.htm) that said: The majority of patients with pituitary adenomas present with signs and symptoms reflecting excess hormone production. Approximately 25-30% of patients with pituitary tumors don?t have classical hyper-secretory syndromes such as acromegaly or Cushing's disease. These tumors are referred to as clinically nonfunctioning adenomas. Patients often present with signs of mass effects, including headaches and symptoms of pituitary insufficiency. In addition, compression of the optic chiasm frequently results in temporal field deficits.

I think the problem that we are experiencing was best put my Dr. Allan D. Marks in his article: Disorders of Hypothalamic-Pituitary Function - Pituitary Tumors; (which can be found at http://blue.temple.edu/~pathphys/endocrine...othalamus.html) He writes, ?General Concepts, Overactivity of endocrine glands can be caused by hyperplasia, adenomas or carcinomas in the gland; Underactivity of endocrine glands can be caused by destruction (autoimmune, infection, tumor), decreased stimulation (hypopituitarism), surgical removal of that gland; Stimulation tests are used to diagnose hypofunctioning endocrine disorders, while suppression tests are used to diagnose hyperfunctioning disorders; As a rule, hyperfunctioning glands cannot be suppressed, while normal glands suppress; Exceptions to above: pituitary Cushings can be suppressed by high dose dexamethasone and prolactinomas can be suppressed with dopamine agonists?; In laymen?s terms, that means that for a diagnosis of Cushing?s syndrome/disease the doctor/Endo use is a number of suppression tests, but on the other hand, to get diagnose a of hormonal deficiency, the doctor/Endo will use a number of stimulation tests.

My Theory: (part two)

The second problem, in my opinion, that we all run into is that there is an unwritten law between your PCP and the Specialist (Endo). That law says,

?Hey we all can make a lot of money from this patient, but when I send him/her to you ($), I will also tell you what to check for, you check that and only that, but if you think he/she needs more test you send Him/her back to me ($) and then I will send him/her back to you($) for more test and we will keep doing this ($$$$), but if you get greedy and run test without sending him/her back to me ($), you will never get another dime patient) from me ($), GOT IT!?

So, some how we have to get around this dilemma! The first thing I would tell you to do is talk to your PCP and ask him/her to send you for an endocrine evaluation period!!! But most PCP will send you to the Endo for an endocrine evaluation for Cushing?s Syndrome. So, in turn the Endo can only do what the PCP says and give you the suppression tests and not stimulation tests. Now I ask you, How many people on this board have had stimulation tests done, much less even know what one is? Another problem that we often run into is that PCP?s don?t know anything about a hormone imbalance! Just for the record, most Endo?s don?t know that much about them either! Thus is why the second thing I would tell you is to call The Hormone Foundation (1-800-HORMONE) and get a list of all of the Endo?s in your state and find one that specializes in pituitary functions and non-functions.

The Handiman, MD, Ph.D. (Mentally Deranged, Pretty Handi Dude)

I just wanted my theory to be over here, also!

I hope that is Okay!

(Edited by Handiman at 2:46 am on June 27, 2001)

[MAYELA]

You’re so funny!! I have my own theories too!!