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Loperamide in cushings and GFR in cushings


lydia

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Effects of loperamide on the human hypothalamo-pituitary-adrenal axis in vivo and in vitro

CJ Auernhammer, GK Stalla, M Lange, A Pfeiffer and OA Muller

Department of Medicine, University of Munich, Germany.

 

Loperamide, an opiate agonist of high specificity for mu-receptors, was recently reported to suppress ACTH and cortisol levels in normal subjects, but not in patients with proven ACTH-dependent Cushing's diseasehttp://jcem.endojournals.org/cgi/content/abstract/75/2/552

 

 

and this one (Ok, my new endo prof is in this abstract too)

Patients with Cushing?s disease have a decreased GFR (glomular filtration rate in kidneys). Even if they are cured, close follow-up with strict control of cardiovascular risk factors and monitoring of GFR seems mandatory. Furthermore, the dosage of certain drugs should be adapted to the individual GFR.

http://www.eje-online.org/cgi/content/abstract/153/6/819

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Excess cortisol causes small blood vessels to overgrow. the kidney is especially reliant on those vessels to work properly. The lower GFR is not surprising. The interesting question is whether a lower GFR can lower UFC results, masking the severity of Cushings in some people. I suspect it can. The consensus guidelines only address severe kidney disease, but other studies show a linear relationship.

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Excess cortisol causes small blood vessels to overgrow. the kidney is especially reliant on those vessels to work properly. The lower GFR is not surprising. The interesting question is whether a lower GFR can lower UFC results, masking the severity of Cushings in some people. I suspect it can. The consensus guidelines only address severe kidney disease, but other studies show a linear relationship.

 

googled this and it seems you are on the target!

URINARY EXCRETION OF FREE CORTISOL IN IMPAIRED RENAL FUNCTION

P. Sederberg-Olsen, C. Binder and H. Kehlet

Total cortisol and free, non protein-bound cortisol in plasma and urinary excretion of unconjugated free cortisol were measured during iv infusion of cortisol at varying dose rates in eight patients with impaired renal function. The results showed that free urinary cortisol decreased with decreased glomerular filtration rate (GFR), also compared to free cortisol level in plasma. An increase in free cortisol in plasma had no influence on GFR. It is concluded that determination of free urinary cortisol, otherwise useful in diagnosing Cushing's syndrome, may be of less value in patients with impaired renal function.

 

 

http://www.eje-online.org/cgi/content/abstract/78/1/86

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googled this and it seems you are on the target!

URINARY EXCRETION OF FREE CORTISOL IN IMPAIRED RENAL FUNCTION

P. Sederberg-Olsen, C. Binder and H. Kehlet

Total cortisol and free, non protein-bound cortisol in plasma and urinary excretion of unconjugated free cortisol were measured during iv infusion of cortisol at varying dose rates in eight patients with impaired renal function. The results showed that free urinary cortisol decreased with decreased glomerular filtration rate (GFR), also compared to free cortisol level in plasma. An increase in free cortisol in plasma had no influence on GFR. It is concluded that determination of free urinary cortisol, otherwise useful in diagnosing Cushing's syndrome, may be of less value in patients with impaired renal function.

 

 

http://www.eje-online.org/cgi/content/abstract/78/1/86

 

 

Seems like that might be a real impediment to Cushings "declaring" itself. When the kidneys have a gag order.

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I believe GFR is also lower with hypothyroidism.

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Found other article, more info on the GFR and cushing's testing:

 

Because plasma free cortisol is filtered through the glomeruli with partial tubular reabsorption, the amount of free cortisol appearing in the urine is theoretically dependent on the glomerular filtration rate. However, the high reliability of using 24-h urinary cortisol excretion for the diagnosis of Cushing syndrome implies that urinary excretion of cortisol is relatively unaffected by renal function. In patients with confirmed Cushing disease and severe renal impairment, the urinary free cortisol excretion rate reportedly is normal despite markedly increased plasma cortisol (4)(5)(6). The relationship between glomerular filtration rate and urinary cortisol excretion has not been documented in patients with different degrees of renal impairment.

http://www.clinchem.org/cgi/content/full/50/4/757

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Found other article, more info on the GFR and cushing's testing:

 

Because plasma free cortisol is filtered through the glomeruli with partial tubular reabsorption, the amount of free cortisol appearing in the urine is theoretically dependent on the glomerular filtration rate. However, the high reliability of using 24-h urinary cortisol excretion for the diagnosis of Cushing syndrome implies that urinary excretion of cortisol is relatively unaffected by renal function. In patients with confirmed Cushing disease and severe renal impairment, the urinary free cortisol excretion rate reportedly is normal despite markedly increased plasma cortisol (4)(5)(6). The relationship between glomerular filtration rate and urinary cortisol excretion has not been documented in patients with different degrees of renal impairment.

http://www.clinchem.org/cgi/content/full/50/4/757

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Wow, thanks for finding this info Lydia. I actually asked a question here once regarding the relationship between UFC and impaired kidney function was. And, this answers it. I have had low GFR's too as well as high BUN/creatinine ratio and symptoms that I believe were kidney related. So, I am no surprised either and it confirms my suspicions. I think Dr. F. said in an interview that kidney problems would lower your UFC. But, I think he was talking people who were actually diagnosed with renal failure.

 

Thanks!

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Wow, thanks for finding this info Lydia. I actually asked a question here once regarding the relationship between UFC and impaired kidney function was. And, this answers it. I have had low GFR's too as well as high BUN/creatinine ratio and symptoms that I believe were kidney related. So, I am no surprised either and it confirms my suspicions. I think Dr. F. said in an interview that kidney problems would lower your UFC. But, I think he was talking people who were actually diagnosed with renal failure.

 

Thanks!

I had the same thoughts as you..

 

now I wonder, if GFR is still low after cushing's is gone, how do they handle that?

 

edit..oooooh, last time my endo who does the GFR research in cushing's..gave me amlodipine, ohhh, seems to make the GFR better or at least stop it from going down more.

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Loperamide, an opiate agonist of high specificity for mu-receptors, was recently reported to suppress ACTH and cortisol levels in normal subjects, but not in patients with proven ACTH-dependent Cushing's diseasehttp://jcem.endojour...stract/75/2/552

 

Pardon my ignorance, when I saw Loperamide, I automatically thought about my IMMODIUM "rescue tablet (for diarrhea)". When I looked at the generic packaging, it says "loperamide hydrochloride". Is this related in any way? I have used it numerous times during prolonged gastric distress, but don't want to be using the wrong medicine if it is adverse affecting.

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Pardon my ignorance, when I saw Loperamide, I automatically thought about my IMMODIUM "rescue tablet (for diarrhea)". When I looked at the generic packaging, it says "loperamide hydrochloride". Is this related in any way? I have used it numerous times during prolonged gastric distress, but don't want to be using the wrong medicine if it is adverse affecting.

Yes same as immodium.

It was the same immodium that sent me on a search, because my husband needed it in India and went sleeping all day and night, so I wondered if it lowered cortisol. So I googled and found the above results.

 

so yes, it must interfere with testing then big time.

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