Tuesday, March 15, 2011

Book explains adrenal dysfunction

Adrenal Glands

Another dysfunction

Are You Tired and Wired?” (Hay House, $24.95, Amazon price, $16.47)

Simultaneous feelings of exhaustion and being “keyed up” characterize early adrenal dysfunction, the subject of nurse practitioner Marcelle Pick’s self-help book. The adrenal glands are responsible for providing the fight-or-flight hormones in response to stress. If they’re under-producing, that’s Addison’s disease, and if they’re overproducing, that’s Cushing’s syndrome. “But if your adrenal imbalance is less extreme — as is true for hundreds of thousands of U.S. women — your practitioner is unlikely to recognize your condition,” Pick writes. She suggests a 30-day plan to solve adrenal dysfunction, including dietary supplements, exercise, stress-reduction techniques and, the biggie, an adrenal-friendly diet with regular meal times and no processed foods.

From http://www.washingtonpost.com/national/book-explains-adrenal-dysfunction-vegan-magazine-applauds-herbivore-heroes/2011/02/24/ABKaGxV_story.html

Monday, March 14, 2011

High prevalence of subclinical hypercortisolism in patients with bilateral adrenal incidentalomas: a challenge to management

Authors: Vassiliadi, Dimitra A.; Ntali, Georgia; Vicha, Eirini; Tsagarakis, Stylianos

Source: Clinical Endocrinology, Volume 74, Number 4, April 2011 , pp. 438-444(7)


Summary Objective  The prevalence of subclinical hypercortisolism (SH) in unilateral incidentalomas (UI) has been extensively studied; however, patients with bilateral incidentalomas (BI) have not been thoroughly investigated. We therefore aimed to describe the characteristics of patients with BI compared to their unilateral counterparts. The surgical outcome in a small number of patients is reported.

Design  Observational retrospective study in a single secondary/tertiary centre. Patients  One hundred and seventy-two patients with adrenal incidentalomas (41 with BI).

Measurements  Morning cortisol (F), ACTH, dehydroepiandrosterone sulphate (DHEA-S), midnight F, 24-h urine collection for cortisol (UFC), low-dose dexamethasone suppression test (LDDST), fasting glucose, insulin, and oral glucose tolerance test (OGTT). Primarily, SH was defined as F-post-LDDST>70 nmol/l and one more abnormality; several diverse cut-offs were also examined.

Results  No difference was noted in age, body mass index, or prevalence of diabetes and impaired glucose tolerance between patients with UI and those with BI. Patients with BI had higher F-post-LDDST (119·3 ± 112·8 vs 54·3 ± 71·5 nmol/l, P < 0·001) and lower DHEA-S (1·6 ± 1·5 vs 2·5 ± 2·3 ╬╝mol/l, P = 0·003) but similar UFC, ACTH and midnight F levels, compared to UI. SH was significantly more prevalent in BI (41·5%vs 12·2%, P  < 0·001). Fourteen patients were operated on; four underwent bilateral interventions. In 10 patients, unilateral adrenalectomy on the side of the largest lesion resulted in significant improvement in F-post-LDDST (P = 0·008) and a decrease in midnight F (P = 0·015) levels.

Conclusions  Subclinical hypercortisolism is significantly more prevalent in bilateral incidentaloma patients, posing great dilemmas for its optimum management.

Document Type: Research article

DOI: 10.1111/j.1365-2265.2010.03963.x

Publication date: 2011-04-01

From http://www.ingentaconnect.com/content/bsc/cend/2011/00000074/00000004/art00005