tag:blogger.com,1999:blog-62129419152225424082024-02-07T14:52:38.091-05:00Addison's Helpcushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.comBlogger404125tag:blogger.com,1999:blog-6212941915222542408.post-20896694287992016572017-05-07T10:45:00.000-04:002017-05-07T10:45:26.639-04:00Primary Adrenal Insufficiency (PAI)<div class="details section" style="color: #333333; font-family: Georgia, "Times New Roman", "Bitstream Charter", Times, serif; font-size: 16px;">
<time class="date-info" datetime="2017-05-05T09:18:12.000Z">05.05.2017, 05:18</time> <span class="authors-holder">by <a class="normal-link author" data-mce-href="https://figshare.com/authors/SciDoc_Publishers_International_Journal_of_Clinical_Therapeutics_and_Diagnosis_IJCTD_/4005356" href="https://figshare.com/authors/SciDoc_Publishers_International_Journal_of_Clinical_Therapeutics_and_Diagnosis_IJCTD_/4005356" rel="noopener noreferrer" target="_blank" title="SciDoc Publishers International Journal of Clinical Therapeutics and Diagnosis (IJCTD)">SciDoc Publishers International Journal of Clinical Therapeutics and Diagnosis (IJCTD)</a></span></div>
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<span class="authors-holder">Al-Jurayyan NA</span></div>
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<strong>Background:</strong> Primary adrenal insufficiency (PAI) in children is an uncommon, but potentially fatal. The current symptoms include weakness, fatigue, anorexia, abdominal pain, weight loss, orthostatic hypotension, salt craving and characterized by hyperpigmentation.</div>
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<strong>Material and Methods:</strong> This is a retrospective, hospital based-study, conducted at King Khalid University Hospital (KKUH), during the period January 1989 and December 2014. Review of medical record of patient diagnosed with primary adrenal insufficiency. The diagnosis was based on medical history, physical examination and low levels of glucocorticoids and raised adrenocorticotropic hormone (ACTH). Appropriate laboratory and radiological investigations were also reviewed.</div>
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<strong>Results:</strong> During the period under review, January 1989 and December 2014, a total of 125 patients with the diagnosis of primary adrenal insufficiency were seen. Inherited disorders like congenital adrenal hyperplasia and hypoplasia were common, 85.5%. However, variable autoimmune mediated etiologic diagnosis accounted for, 13%, were also seen. The appropriate various laboratory and radiological investigations should be planned.</div>
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<strong>Conclusion:</strong> Although, congenital adrenal hyperplasia was the commonest etiology, however, congenital adrenal hypoplasia should not be over looked. The diagnosis of PAI can be challenging in some patients, and therefore appropriate serological and radiological investigations should be done.</div>
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REFERENCES</h4>
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<li><a class="normal-link" data-mce-href="http://scidoc.org/articlepdfs/IJCTD/IJCTD-2332-2926-03-401.pdf" href="http://scidoc.org/articlepdfs/IJCTD/IJCTD-2332-2926-03-401.pdf" rel="noopener noreferrer" target="_blank">http://scidoc.org/articlepdfs/IJCTD/IJCTD-2332-2926-03-401.pdf</a></li>
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cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-54677319539064586662017-05-06T08:44:00.000-04:002017-05-06T08:44:08.841-04:00Topical Steroid Use in Psoriasis Patient Leads to Severe Adrenal Insufficiency<blockquote style="color: #333333; font-family: Georgia, "Times New Roman", "Bitstream Charter", Times, serif; font-size: 16px;">
<i>This article is written live from the American Association of Clinical Endocrinologists (AACE) 2017 Annual Meeting in Austin, TX. MPR will be reporting news on the latest findings from leading experts in endocrinology. Check back for more news from <a data-mce-href="http://www.empr.com/aace-2017/section/7524/" href="http://www.empr.com/aace-2017/section/7524/" rel="noopener noreferrer" target="_blank">AACE 2017</a>.</i></blockquote>
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At the AACE 2017 Annual Meeting, lead study author Kaitlyn Steffensmeier, MS III, of the Dayton Veterans Affairs (VA) Medical Center, Dayton, OH, presented a case study describing a patient “who developed secondary adrenal insufficiency secondary to long-term topical steroid use and who with decreased topical steroid use recovered.”</div>
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The patient was a 63-year-old white male with a 23-year history of psoriasis. For 18 years, the patient had been applying Clobetasol Propionate 0.05% topically on several areas of his body every day. Upon presentation to the endocrine clinic for evaluation of his low serum cortisol, the patient complained of a 24-pound weight gain over a 2-year period, feeling fatigued, as well as facial puffiness.</div>
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Laboratory analysis found that the patient's random serum cortisol and ACTH levels were low (0.2µg/dL and <1 .1pg="" 2mm="" a="" according="" additionally="" adrenal="" authors="" cleft="" consistent="" cyst="" gland="" hypoenhancing="" indicative="" insufficiency.="" labs="" lesion="" microadenoma.="" midline="" ml="" mri="" nbsp="" of="" p="" pituitary="" rathke="" respectively="" s="" secondary="" showed="" study="" the="" to="" versus="" were="" with="" within=""><div style="color: #333333; font-family: Georgia, "Times New Roman", "Bitstream Charter", Times, serif; font-size: 16px;">
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The patient was initiated on 10mg of hydrocortisone in the morning and 5mg in the evening and was instructed to decrease the use of his topical steroid to one time per month. For the treatment of his psoriasis, the patient was started on apremilast, a phosphodiesterase-4 enzyme (PDE4) inhibitor, and phototherapy.</div>
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After 2.5 years, the patient had a subnormal response to the cosyntropin stimulation test. However, after 3 years, a normal response with an increase in serum cortisol to 18.7µg/dL at 60 minutes was obtained; the patient was then discontinued on hydrocortisone. Additionally, a stable pituitary tumor was shown via a repeat pituitary MRI.</div>
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The study authors explained that, although secondary adrenal insufficiency is not commonly reported, “one study showed 40% of patients with abnormal cortisol response to exogenous ACTH after two weeks of topical glucocorticoids usage.” Another meta-analysis of 15 studies (n=320) revealed 4.7% of patients developing adrenal insufficiency after using topical steroids. Because of this, “clinicians need to be aware of potential side effects of prolong topical steroid use,” added the study authors.</div>
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For continuous endocrine news coverage from the AACE 2017 Annual Meeting, check back to MPR's <a data-mce-href="http://www.empr.com/aace-2017/section/7524/" href="http://www.empr.com/aace-2017/section/7524/" rel="noopener noreferrer" target="_blank">AACE page</a> for the latest updates.</div>
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From <a data-mce-href="http://www.empr.com/aace-2017/topical-steroid-psoriasis-clobestasol-propionate/article/654335/" href="http://www.empr.com/aace-2017/topical-steroid-psoriasis-clobestasol-propionate/article/654335/" rel="noopener noreferrer" target="_blank">http://www.empr.com/aace-2017/topical-steroid-psoriasis-clobestasol-propionate/article/654335/</a></div>
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cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-54726332064018718792017-04-25T09:52:00.000-04:002017-04-25T09:52:06.913-04:00Health Care Expenditure Burden High in Adrenal Insufficiency<div style="color: #333333; font-family: Georgia, "Times New Roman", "Bitstream Charter", Times, serif; font-size: 16px;">
Patients with adrenal insufficiency may accrue substantial health care costs and have more hospital stays and outpatient visits compared with healthy controls, according to findings published in the <i>Journal of the Endocrine Society.</i></div>
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<b>Candace Gunnarsson, PhD, </b>vice president of health economics and outcomes research at CTI Clinical Trial and Consulting in Cincinnati, and colleagues evaluated data from a U.S.-based payer database on 10,383 patients with adrenal insufficiency to determine the estimated annual health care burden among them.</div>
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Participants were divided into groups based on their type of adrenal insufficiency: primary adrenal insufficiency (n = 1,014), adrenal insufficiency secondary to pituitary disease (n = 8,818) or congenital adrenal hyperplasia (n = 551). A group of matched controls was also evaluated for comparison.</div>
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Total annual health care expenditures were significantly higher in the primary adrenal insufficiency group ($18,624 vs. $4,320), adrenal insufficiency secondary to pituitary disease group ($32,218 vs. $6,956) and the congenital adrenal hyperplasia group ($7,677 vs. $4,203) compared with controls. The adrenal insufficiency secondary to pituitary disease group had the highest health care expenditure estimated with an incremental health care burden of $25,262, followed by the primary adrenal insufficiency group ($14,304) and the congenital adrenal hyperplasia group ($3,474).</div>
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Compared with controls, participants with adrenal insufficiency spent eight to 10 times more days in the hospital and had up to twice as many outpatient visits per year.</div>
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“When comparing [adrenal insufficiency] patients within each cohort based on their drug regimen, patients receiving prednisone therapy vs. hydrocortisone therapy had significantly higher total annual expenditures in the [primary adrenal insufficiency] and [congenital adrenal hyperplasia] and significantly lower total expenditures in the [pituitary disease] cohort,” the researchers wrote. “Patients taking only hydrocortisone and meeting the threshold of 50% adherence were found to have lower expenditures when medication adherence was 75% or higher.” – <i>by Amber Cox</i></div>
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<b>Disclosure: </b>Gunnarsson reports being an employee of CTI Clinical Trial and Consulting. Please see the full study for a list of all other authors’ relevant financial disclosures.</div>
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From <a href="http://www.healio.com/endocrinology/adrenal/news/in-the-journals/%7B8f92bd0c-0c72-4902-beb5-663c356a61cb%7D/health-care-expenditure-burden-high-in-adrenal-insufficiency" target="_blank">http://www.healio.com/endocrinology/adrenal/news/in-the-journals/%7B8f92bd0c-0c72-4902-beb5-663c356a61cb%7D/health-care-expenditure-burden-high-in-adrenal-insufficiency</a></div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-54137145725877333162017-04-22T07:56:00.000-04:002017-04-22T07:56:31.532-04:00Lower health-related quality of life observed in patients with Addison’s disease, Cushing’s syndrome<span style="background-color: white; color: #333333; font-family: Arial, Helvetica, sans-serif; font-size: 15px;">Patients with hypothalamic-pituitary-adrenal axis dysregulations report health-related quality of life that is far lower than that of the general population, according to findings of a prospective study.</span><br />
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“In most centers, both patients with adrenal deficiency and patients with <span style="color: #255284;"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; box-sizing: border-box; font-size: 11px;">Cushing’s syndrome</span></span> are managed by the same team,” <b style="box-sizing: border-box;">Charlotte De</b><b style="box-sizing: border-box;"> </b><b style="box-sizing: border-box;">Bucy</b><b style="box-sizing: border-box;">,</b> of the Center for Rare Adrenal Diseases at Cochin Hospital in Paris, and colleagues wrote. “Despite the usual perception that both types of diseases alter quality of life, few studies have similarly investigated the impact of cortisol dysregulations on [health-related quality of life]. Such studies are important, however, to identify meaningful differences that would be important to consider to improve management and outcome.”</div>
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De Bucy and colleagues analyzed data from 343 patients with Addison’s disease or Cushing’s syndrome followed in routine practice at a single center in France between September 2007 and April 2014 (78% women; mean age, 48 years; mean length of time since diagnosis, 7.8 years; 61% married). All participants completed the short-form health survey (SF-36), a survey of health-related quality-of-life measures and the 12-item general health questionnaire (GHQ-12), a measure of psychological well-being or distress. Questionnaires were completed at baseline and at 6, 12, 24 and 36 months. Patients with Cushing’s syndrome were also assessed for cortisol status at baseline and at follow-up evaluations.</div>
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Within the cohort, 206 had Cushing’s syndrome of pituitary origin, 91 had Cushing’s syndrome of adrenal origin and 46 patients had Addison’s disease; 16% were included in the study before any treatment was initiated.</div>
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Researchers found that mean standard deviation scores for psychological and physical dimensions of the SF-36 were “well below” those of the general population, but diagnosis, cortisol status and time since treatment initiation all influenced individual scores. Cushing’s syndrome of pituitary origin was associated with worse health-related quality of life, especially for physical functioning, social functioning and mental health. In Cushing’s syndrome, health-related quality of life was generally worse during periods of hypercortisolism, but scores for these patients were lower than those of patients with Addison’s disease even during periods of <a href="http://www.healio.com/psychiatry/mood-disorders/news/online/%7B10015f80-70b4-4e25-8a8c-5d3474759588%7D/individuals-with-mood-disorders-low-cortisol-may-have-higher-risk-for-obesity-other-metabolic-disorders" id="rId9" style="background: transparent; box-sizing: border-box; color: #255284; font-size: 11px; text-decoration-line: none;" target="_new">hypocortisolism</a> or eucortisolism, according to the researchers.</div>
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“The differences were particularly large for physical functioning and role-physical subscales,” the researchers wrote.</div>
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They also found that mental health scores for patients with Cushing’s syndrome decreased during periods of hypocortisolism, whereas other adrenal conditions were associated with higher mental health scores.</div>
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More than half of patients, regardless of diagnosis and cortisol status, had psychological distress requiring attention, according to the GHQ-12 survey.</div>
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“Our findings are important for clinical practice,” the researchers wrote. “The consequences of cortisol dysregulation on [health-related quality of life] should be considered in the management of adrenal insufficiency and even more (in) Cushing’s syndrome patients, and these consequences can be long term, affecting apparently cured patients. Early information on these consequences might be helpful for patients who often perceive a poor quality of life as the result of inadequate disease control or treatment. Even if this possibility exists, knowing that adrenal diseases have long-lasting effects on [health-related quality of life] may be helpful for patients to cope with them.” – <i style="box-sizing: border-box;">by Regina Schaffer</i></div>
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<b style="box-sizing: border-box;">Disclosure: </b>L'association Surrénales supported this study. The researchers report no relevant financial disclosures.</div>
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From <a href="http://www.healio.com/endocrinology/adrenal/news/in-the-journals/%7B842655ce-e710-4476-a3c2-2909b06434ed%7D/lower-health-related-quality-of-life-observed-in-patients-with-addisons-disease-cushings-syndrome">http://www.healio.com/endocrinology/adrenal/news/in-the-journals/%7B842655ce-e710-4476-a3c2-2909b06434ed%7D/lower-health-related-quality-of-life-observed-in-patients-with-addisons-disease-cushings-syndrome</a></div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-29353511955895384262016-04-04T19:23:00.000-04:002016-04-04T19:23:03.578-04:00Action For Adrenal Disease<div class="tG QF" style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 16px; line-height: 24px;">
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Watch online Saturday April 16 at 1:00 PM eastern at <a data-mce-href="https://plus.google.com/events/cpjbd8celcbfgngp8und662s198?hl=en" href="https://plus.google.com/events/cpjbd8celcbfgngp8und662s198?hl=en" target="_blank">https://plus.google.com/events/cpjbd8celcbfgngp8und662s198?hl=en</a></div>
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Secondary Adrenal Insufficiency and Addison's Disease can be deadly, mostly because of the lack of education and awareness. We have lost too many and need to be proactive in preventing unnecessary deaths! Join us as we educate on what these diseases are, how easily they can become deadly and preventive measures we can all take to help this community. Brought to you by the National Adrenal Disease Foundation, with speakers who have personal experience with these diseases.<br /><br />Our program will include:<br /><br />Senior Administrator Nichole Klute Rushton••• of the Addison’s Disease Support Group (<a class="ot-anchor aaTEdf" data-mce-href="https://www.facebook.com/groups/addisons.support/" dir="ltr" href="https://www.facebook.com/groups/addisons.support/" rel="nofollow" target="_blank">https://www.facebook.com/groups/addisons.support/</a>) on Facebook, will speak in detail about the unfortunate adrenal insufficient patients who have tragically passed, reminding us that the danger of loss of life is a reality for every person with adrenal insufficiency who doesn’t receive the vital hormones they need<br /><br />Administrator Debby Hunter ••• of the Living With Addison's Disease Support on Facebook (<a class="ot-anchor aaTEdf" data-mce-href="https://www.facebook.com/groups/LivingWithAddisonsDisease/" dir="ltr" href="https://www.facebook.com/groups/LivingWithAddisonsDisease/" rel="nofollow" target="_blank">https://www.facebook.com/groups/LivingWithAddisonsDisease/</a>) who will give us tips on how we can approach our local emergency facilities and hospitals with information about adrenal insufficiency and its care in a crisis situation. She will also share her own personal experience with going through an adrenal crisis.<br /><br />Deputy Sheriff Chris Spires••• who will speak on life as the husband of an Addison’s disease patient, and share with us how the law enforcement community views adrenal insufficient patients<br /><br />Melanie Wong ••• National Adrenal Disease Foundation (<a class="ot-anchor aaTEdf" data-mce-href="http://www.nadf.us/" dir="ltr" href="http://www.nadf.us/" rel="nofollow" target="_blank">http://www.NADF.us</a>) Executive Director, who will speak about the recent tragic losses, and the vital importance of reminding the medical community about adrenal insufficiency, as well as NADF’s latest project to get NADF Adrenal Crisis Care posters displayed in every emergency room facility in the United States.</div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-70101673429881229242016-04-03T09:22:00.000-04:002016-04-03T09:22:57.372-04:00Adrenal Insufficiency Patients Require More Education on Adrenal Crisis<div style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 16px; line-height: 24px;">
Greater efforts to educate patients with adrenal insufficiency and their families about prevention of adrenal crisis may be necessary, according to data presented at the American Association of Clinical Endocrinologists (AACE) 24th Annual Scientific & Clinical Congress.</div>
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Additionally, the researchers, who looked at patients treated for adrenal insufficiency, found that many are not being adequately trained or equipped to deal with an adrenal crisis.</div>
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“These patients can crash and we are not doing enough to help prevent problems,” study investigator Nitika Malhotra, MD, endocrinologist in Lansing, Michigan, said. “We did this study because we think this is a big problem.”</div>
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Malhotra, who presented the study findings at the meeting, explained that patients with adrenal insufficiency are at risk for developing adrenal crisis, and it is now estimated that 8% of patients with adrenal insufficiency are hospitalized for adrenal crisis each year.</div>
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The problem, according to Malhotra, is that far too many patients are failing to receive crises prevention education. Moreover, they are not receiving emergency glucocorticoid kits.</div>
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“All of the families need to be taught and that is not happening,” Malhotra said in an interview with <i>Endocrinology Advisor</i>. “It will reduce the morbidity and mortality and the hospitalization, and it may improve the quality of life of patients too.”</div>
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For their study, Malhotra and her colleagues collected data from patients with adrenal insufficiency who were seen at a single institution between March 2009 and March 2014.</div>
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The investigators conducted a retrospective chart review and examined age, gender, causes of adrenal insufficiency, glucocorticoid dose, and monitoring for hyponatremia and hyperkalemia. They also looked at postural blood pressure, crises prevention education for glucocorticoid dose adjustments during stress, and whether patients had a Medic Alert ID or a parenteral glucocorticoid kit. </div>
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The researchers identified 85 patients (29 males and 56 females) with adrenal insufficiency. Of these patients, 33 patients had primary adrenal insufficiency (38.8%) and 52 had secondary adrenal insufficiency (61.2%). The mean age of the patients was 55.8 years.</div>
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Among the 85 patients, 23 (27%) had postural blood pressures checked — five of whom were positive (21.7%). Seventy-seven patients (90.6%) were monitored for electrolytes, and 41 patients (48.2%) were on steroid doses above 20 mg per day. </div>
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However, the researchers found that only 57 patients (67.1%) had received steroid dose adjustment instructions. In addition, only 29 patients (34.1%) had a Medic Alert ID, and only 17 patients (20%) were setup with emergency parenteral glucocorticoid kits.</div>
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Even though this study has many inherent limitations, Malhotra said, it appears that the preventive strategies for adrenal crisis in patients with adrenal insufficiency are not being consistently followed.</div>
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Patient education is paramount for achieving a successful prevention strategy for adrenal crisis, and endocrinologists have a responsibility to make sure that all patients with adrenal insufficiency have a Medic Alert ID and access to emergency glucocorticoid kits, according to Malhotra.</div>
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Furthermore, she said families should receive adequate education about parenteral steroid administration and steroid dose adjustments in stressful situations.</div>
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At her institution, Malhotra said, endocrinologists are introducing an automated electronic alert in their electronic medical records to determine if this electronic prompt will improve adherence.</div>
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Reference</h2>
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<li>Malhotra N et al. Abstract #102. Presented at: American Association of Clinical Endocrinologists (AACE) 24th Annual Scientific & Clinical Congress; May 13-17, 2015; Nashville, Tenn.</li>
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From <a data-mce-href="http://www.endocrinologyadvisor.com/aace-2015/adrenal-crisis-in-adrenal-insufficiency/article/415123/" href="http://www.endocrinologyadvisor.com/aace-2015/adrenal-crisis-in-adrenal-insufficiency/article/415123/" target="_blank">http://www.endocrinologyadvisor.com/aace-2015/adrenal-crisis-in-adrenal-insufficiency/article/415123/</a></div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-3953164987467331872016-03-19T07:00:00.000-04:002016-03-19T07:00:03.263-04:00Severe fatigue, decreased physical activity in patients with Addison’s disease<div style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 16px; line-height: 24px;">
<a data-mce-href="http://onlinelibrary.wiley.com/doi/10.1111/cen.13059/abstract?campaign=wolacceptedarticle" href="http://onlinelibrary.wiley.com/doi/10.1111/cen.13059/abstract?campaign=wolacceptedarticle" id="rId4" target="_new">van der Valk ES, et al. <i>Clin Endocrinol. </i>2016;doi:10.1111/cen.13059</a>.</div>
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Dutch adults with primary adrenal insufficiency reported abnormal or severe fatigue, reduced physical activity and significantly reduced quality of life vs. healthy controls, according to recent survey results.</div>
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In a cross-sectional study, <b>Eline S. van der Valk, MD,</b> of Amphia Hospital in Breda, the Netherlands, and colleagues also found that patients with Addison’s disease reported physical activity levels that were significantly lower than those reported by other Dutch chronically ill patients.</div>
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“The clinical relevance of the impaired [quality of life] and increased fatigue found in our study is supported by the size of the differences in scores and the restriction in physical activity in patients with [Addison’s disease], an important activity in daily life,” the researchers wrote. “Physical inactivity could be very detrimental in [Addison’s disease] because the prevalence of other cardiovascular risk factors is already increased, and it has been demonstrated that patients with [Addison’s disease] have an up to twofold increased mortality rate from [CVDs].”</div>
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Researchers analyzed survey data from 328 Dutch adults with Addison’s disease on stable glucocorticoid replacement therapy with hydrocortisone or cortisone acetate (mean age, 53 years; 223 women; mean duration of disease after diagnosis, 15.6 years). Participants attended outpatient clinics at University Medical Center Utrecht and Radboud University Nijmegen Medical Centre, or were members of the Dutch Association of Addison and Cushing Patients. They completed general and health-related quality of life (Short Form 36; Checklist Individual Strength) and physical activity questionnaires. Scores were compared with a random sample of 1,718 adults who completed a Dutch National Health Survey (controls).</div>
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Within the cohort, 53% of participants had isolated Addison’s disease; 74.1% received hydrocortisone therapy; 25.9% received cortisone acetate therapy; 87.2% received fludrocortisone therapy; and 23.2% received dehydroepiandrosterone replacement therapy.</div>
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Researchers found that 45.7% of participants with Addison’s disease met the standard of physical activity (Dutch standard of healthy physical exercise, defined as moderately intensive physical exercise for 30 minutes daily 5 days per week; “Fitnorm,” defined as 20 minutes of intensive physical exercise at least 3 days per week) vs. 67.8% of controls (<i>P < </i>.01). Researchers found 61% of participants with Addison’s disease reported abnormal fatigue, and 43% reported severe fatigue. Mean fatigue scores were significantly higher vs. controls (mean difference, 32.6; 95% CI, 24-41).</div>
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In both men and women with Addison’s disease, researchers found that quality of life scores in all component summaries were significantly decreased compared with controls, particularly in participants aged 65 years and younger. <i>– by Regina Schaffer</i></div>
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<b>Disclosure:</b> <b></b>The researchers report no relevant financial disclosures.</div>
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From <a data-mce-href="http://www.healio.com/endocrinology/adrenal/news/online/%7Ba8914384-d40e-41ab-aa1c-134d856d2edd%7D/severe-fatigue-decreased-physical-activity-in-patients-with-addisons-disease" href="http://www.healio.com/endocrinology/adrenal/news/online/%7Ba8914384-d40e-41ab-aa1c-134d856d2edd%7D/severe-fatigue-decreased-physical-activity-in-patients-with-addisons-disease" target="_blank">http://www.healio.com/endocrinology/adrenal/news/online/%7Ba8914384-d40e-41ab-aa1c-134d856d2edd%7D/severe-fatigue-decreased-physical-activity-in-patients-with-addisons-disease</a></div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-21961625329623351932015-12-09T13:05:00.001-05:002015-12-09T13:05:54.300-05:00Addison's disease may cause psychosis, say researchers<div style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 16px; line-height: 24px;">
<a data-mce-href="https://cushieblog.files.wordpress.com/2013/06/adrenal-glands.png" href="https://cushieblog.files.wordpress.com/2013/06/adrenal-glands.png" rel="attachment wp-att-1450"><img alt="adrenal-glands" class="aligncenter size-full wp-image-1450" data-mce-src="https://cushieblog.files.wordpress.com/2013/06/adrenal-glands.png" height="368" src="https://cushieblog.files.wordpress.com/2013/06/adrenal-glands.png" style="display: block; height: auto; margin-left: auto; margin-right: auto; max-width: 100%;" width="346" /></a></div>
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<a data-mce-href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508960/" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508960/" rel="nofollow" target="_blank">Research suggests</a> that chronic adrenal insufficiency, more commonly known as Addison's disease, may be responsible for psychiatric symptoms in those who suffer with it. Unfortunately, these symptoms are poorly understood and inadequately studied. In one case, a 41-year-old construction worker was admitted to a psychiatric clinic complaining of depression. He had trouble sleeping and concentrating and had lost 6 pounds due to a loss of appetite. He was placed on 20mg of fluoxetine but returned 2 weeks later complaining that the therapy did not work, and even reported hallucinating his ex-wife, who had recently died in a car accident. He returned again later 4 months later and was found to have a weak pulse, major hypotension, and hyponatremia and hyperkalemia. It was at this point that he was diagnosed with Addison's disease.</div>
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The disease was first described by Thomas Addison in the mddle of the 19th century. It involves inadequate secretion from the adrenal glands, leading to lower secretion of glucocorticoids. Its usual symptom pigmentation involves fatigue, weight loss, nausea, vomiting, weakness and abdominal pain. Among its psychiatric symptoms are psychosis and delirium.</div>
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"An array of neuropsychiatric symptoms is associated with AD. Addison is quoted as saying in 1855 that AD patients might present with “attacks of giddiness, anxiety in the face, and delirium.”1 Anglin et al1 also noted four case series published in the 1940s and 1950s that found the prevalence of neuropsychiatric symptoms in AD to be between 64 and 84 percent. Iwata et al6 reported that in some cases, the neuropsychiatric symptoms were the initial and sole presentation of AD, even though such symptoms are more common in the late course of the disease; this might lead to a patient initially being misdiagnosed, as it did in our case, and in turn, incorrectly treated. Neuropsychiatric symptoms of AD include, but are not limited to, depression, lack of energy, and sleep disturbances. During an Addisonian crisis, agitation, delirium, and, in some cases, visual and auditory hallucinations are reported.1 According to Smart,7 neuropsychiatric symptoms might also be the first presentation of an Addisonian crisis, especially in a patient who was previously symptom free while under therapy."</blockquote>
It is not clear exactly why these neuropsychiatric symptoms appear. It is possible that electrolytic and metabolic disturbances could produce these symptoms, and hyponatremia, which is its central expression, can result in brain damage. Other researchers believe that the neuropsychiatric symptoms are the effects of glucocorticoid abnormalities on the brain. Some researchers believe that unusually low amounts of the substance could produce hallucinations. <a data-mce-href="http://www.hindawi.com/journals/crips/2015/512430/" href="http://www.hindawi.com/journals/crips/2015/512430/" rel="nofollow" target="_blank">In one report</a>, Addison's disease presented as a psychotic break:<br />
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"A Caucasian 63-year-old man presented a five-month history of progressive depressive symptoms with sadness, anhedonia, asthenia, hyporexia, insomnia, limb weakness, and psychotic symptoms. He was a former heavy smoker and had been diagnosed with chronic occupational lung disease (silicosis). After a specialized psychiatric consultation, the patient started taking fluoxetine, risperidone, and nitrazepam. After a short period of time, the patient withdrew his medication by his own because of worsening of the limb weakness. The patient became severely paranoid with persecutory beliefs, delusions, an infantile speech, progressive social isolation, fear of leaving his home, periods of mental confusion and disorientation, and sporadic nausea and vomits. A few days before hospital admission, the patient almost stopped fluid intake and evolved with syncope."</blockquote>
From <a data-mce-href="http://www.examiner.com/article/addison-s-disease-may-cause-psychosis-say-researchers" href="http://www.examiner.com/article/addison-s-disease-may-cause-psychosis-say-researchers" target="_blank">http://www.examiner.com/article/addison-s-disease-may-cause-psychosis-say-researchers</a></div>
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</section>cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-11183700868698632692015-03-04T11:00:00.000-05:002015-03-04T11:00:02.365-05:00Cushing's Awareness Day Challenge 2015<div style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 16px; line-height: 24px;">
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The Cushing's Awareness Challenge is almost upon us again!</div>
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Do you blog? Want to get started?</div>
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Since April 8 is Cushing's Awareness Day, several people got their heads together to create the Fourth Annual Cushing's Awareness Blogging Challenge.</div>
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All you have to do is blog about something Cushing's related for the 30 days of April.</div>
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There will also be a logo for your blog to show show you've participated.</div>
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Please let me know the URL to your blog in the comments area of this post or <span style="background-color: white;">an </span><a data-mce-href="mailto:cushingshelp@gmail.com" href="mailto:cushingshelp@gmail.com" style="background-color: white; color: #1b57b1; text-decoration: none;" target="_blank" title="Cushing's Awareness Challenge Blog">email</a><span style="background-color: white;"> </span> and I will list it on CushieBloggers ( <a data-mce-href="http://cushie-blogger.blogspot.com/" href="http://cushie-blogger.blogspot.com/" target="_blank" title="http://cushie-blogger.blogspot.com/">http://cushie-blogger.blogspot.com/</a>)</div>
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The more people who participate, the more the word will get out about Cushing's.</div>
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<strong>Suggested topics - or add your own!</strong></div>
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<li>In what ways have Cushing's made you a better person?</li>
<li>What have you learned about the medical community since you have become sick?</li>
<li>If you had one chance to speak to an endocrinologist association meeting, what would you tell them about Cushing's patients?</li>
<li>What would you tell the friends and family of another Cushing's patient in order to garner more emotional support for your friend? challenge with Cushing's? How have you overcome challenges? Stuff like that.</li>
<li>I have Cushing's Disease....(personal synopsis)</li>
<li>How I found out I have Cushing's</li>
<li>What is Cushing's Disease/Syndrome? (Personal variation, i.e. adrenal or pituitary or ectopic, etc.)</li>
<li>My challenges with Cushing's</li>
<li>Overcoming challenges with Cushing's (could include any challenges)</li>
<li>If I could speak to an endocrinologist organization, I would tell them....</li>
<li>What would I tell others trying to be diagnosed?</li>
<li>What would I tell families of those who are sick with Cushing's?</li>
<li>Treatments I've gone through to try to be cured/treatments I may have to go through to be cured.</li>
<li>What will happen if I'm not cured?</li>
<li>I write about my health because…</li>
<li>10 Things I Couldn’t Live Without.</li>
<li>My Dream Day.</li>
<li>What I learned the hard way</li>
<li>Miracle Cure. (Write a news-style article on a miracle cure. What’s the cure? How do you get the cure? Be sure to include a disclaimer)</li>
<li>Health Madlib Poem. Go to : http://languageisavirus.com/cgi-bin/madlibs.pl#.VPGZQlPF9A8 and fill in the parts of speech and the site will generate a poem for you.</li>
<li>The Things We Forget. Visit http://thingsweforget.blogspot.com/ and make your own version of a short memo reminder. Where would you post it?</li>
<li>Give yourself, your condition, or your health focus a mascot. Is it a real person? Fictional? Mythical being? Describe them. Bonus points if you provide a visual!</li>
<li>5 Challenges & 5 Small Victories.</li>
<li>The First Time I…</li>
<li>Make a word cloud or tree with a list of words that come to mind when you think about your blog, health, or interests. Use a thesaurus to make it branch more.</li>
<li>How much money have you spent on Cushing's, or, How did Cushing's impact your life financially?</li>
<li>Why do you think Cushing's may not be as rare as doctors believe?</li>
<li>What is your theory about what causes Cushing's?</li>
<li>How has Cushing's altered the trajectory of your life? What would you have done? Who would you have been</li>
<li>What three things has Cushing's stolen from you? What do you miss the most? What can you do in your Cushing's life to still achieve any of those goals?</li>
<li>What new goals did Cushing's bring to you?</li>
<li>How do you cope?</li>
<li>What do you do to improve your quality of life as you fight Cushing's?</li>
<li>Your thoughts...?</li>
</ul>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-3314102573536798552015-02-04T14:00:00.000-05:002015-02-04T14:00:03.220-05:00Exophthalmos and Cushing's Syndrome<div style="background-color: white; color: #333333; font-family: Arial, Helvetica, Georgia, sans-serif; font-size: 13.63636302948px; line-height: 18px; padding: 10px 0px 0px;">
A woman experienced red, irritated and bulging eyes. She saw an ophthalmologist who strongly suspected Graves’ ophthalmopathy. However, the patient did not have and never had hyperthyroidism.</div>
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Indeed, she had primary hypothyroidism optimally treated with levothyroxine. Her thyroid stimulating hormone level was 1.197 uIU/mL.</div>
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An MRI of the orbits showed normal extraocular muscles without thickening, but there was mild proptosis and somewhat increased intraorbital fat content. Both thyroid-stimulating immunoglobulins as well as thyrotropin receptor antibodies were negative.</div>
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The patient presented to her primary care physician a few months later. She had experienced a 40-lb weight gain over only a few months and also had difficult-to-control blood pressure.</div>
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After failing to respond to several antihypertensive medications, her primary care physician astutely decided to evaluate for secondary causes of hypertension. A renal ultrasound was ordered to evaluate for renal artery stenosis, and the imaging identified an incidental right-sided adrenal mass. A CT confirmed a 3.4-cm right-sided adrenal mass. Her morning cortisol was slightly high at 24.7 ug/dL (4.3 – 22.4) and her adrenocorticotropic hormone was slightly low at 5 pg/mL (10-60).</div>
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At this point I saw the patient in consultation. She definitely had many of the expected clinical exam findings of Cushing’s syndrome, including increased fat deposition to her abdomen, neck, and supraclavicular areas, as well as striae. Her 24-hour urine cortisol was markedly elevated at 358 mcg/24hrs (< 45) confirming our suspicions.</div>
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She asked me, “Do you think that my eye problem could be related to this?”</div>
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“I’ve not heard of it before,” I replied, “but that doesn’t mean there can’t be a connection. Wouldn’t it be wonderful if your eyes got better after surgery?”</div>
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The patient underwent surgery to remove what fortunately turned out to be a benign adrenal adenoma.</div>
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When we saw her in follow-up 2 weeks later, her blood pressures were normal off medication and her eye symptoms had improved. I had a medical student rotating with me, so I suggested that we do a PubMed literature search.</div>
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The first article to come up was a case report titled “Exophthalmos: A Forgotten Clinical Sign of Cushing’s Syndrome.” Indeed, not only did Harvey Cushing describe this clinical finding in his original case series in 1932, but others have reported that up to 45% of patients with active Cushing’s syndrome have exophthalmos.</div>
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The cause is uncertain but is theorized to be due to increased intraorbital fat deposition. Unlike exophthalmos due to thyroid disease, the orbital muscles are relatively normal — just as they were with our patient.</div>
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Some of you may have seen exophthalmos in your Cushing’s patients; however, this was the first time I had seen it. Just because one has not heard of something, does not mean it could never happen; no one knows everything. “When in doubt, look it up” is a good habit for both attending physicians and their students.</div>
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<strong>For more information:</strong></div>
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<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608263/" style="color: #105cb6;" target="_new">Giugni AS, et al. <em>Case Rep Endocrinol.</em> 2013; 2013: 205208.</a></div>
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From <a href="http://www.healio.com/endocrinology/adrenal/news/blogs/%7B779bf3e5-e1da-459e-af27-955c9b4274a5%7D/thomas-b-repas-do-facp-face-cde/exophthalmos-and-cushings-syndrome" style="color: #105cb6;" target="_blank" title="http://www.healio.com/endocrinology/adrenal/news/blogs/%7B779bf3e5-e1da-459e-af27-955c9b4274a5%7D/thomas-b-repas-do-facp-face-cde/exophthalmos-and-cushings-syndrome">http://www.healio.com/endocrinology/adrenal/news/blogs/%7B779bf3e5-e1da-459e-af27-955c9b4274a5%7D/thomas-b-repas-do-facp-face-cde/exophthalmos-and-cushings-syndrome</a></div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-7496716719556546612014-12-17T07:02:00.000-05:002014-12-17T07:02:22.756-05:00New Jersey Ambulances Carrying Solu-Cortef<br />
The New Jersey Department of Health passed a waiver in October of last year that allows ambulances to carry Solu- Cortef, for the purposes of treating an adrenal crisis. As a result, New Jersey ambulances can be better prepared to treat adrenal insufficiency.<br />
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This news was brought to NADF by Karen Fountain of the CARES Foundation, who has been helping push state health directors to accept protocols to help treat adrenal insufficient patients during an emergency.<br />
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Adrenal insufficient people in New Jersey should contact their local EMS to make them aware of the waiver, and encourage them to carry Solu-Cortef in their ambulances.<br />
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The hope is that other states, and eventually the entire country and beyond, will start having their ambulances carry the needed medication to treat adrenal crisis.<br />
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http://www.nadf.uscushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-58020101228204511172014-06-23T20:22:00.000-04:002014-06-23T20:22:00.517-04:00Diagnosing and Treating Cortisol Excess and Deficiency<div class="conf_title_p" style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 12.800000190734863px; line-height: 19px;">
From Day 1 of the <a data-mce-href="http://www.mdlinx.com/endocrinology/conference-abstracts.cfm/33228/ZZ5BA369FDE9DE4CED82CB6A7CD5BFD1BE/?utm_source=confcoverage&utm_medium=newsletter&utm_content=conferencetitle&utm_campaign=conference-name-ICE/EN2014&nonus=0" href="http://www.mdlinx.com/endocrinology/conference-abstracts.cfm/33228/ZZ5BA369FDE9DE4CED82CB6A7CD5BFD1BE/?utm_source=confcoverage&utm_medium=newsletter&utm_content=conferencetitle&utm_campaign=conference-name-ICE/EN2014&nonus=0"><b>16th International Congress of Endocrinology and the Endocrine Society’s 96th Annual Meeting and Expo »</b></a></div>
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Chicago, IL - June 21, 2014</div>
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A phase 2 study of Chronocort®, a modified release formulation of hydrocortisone, in the treatment of adults with classic congenital adrenal hyperplasia</div>
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A Mallappa, L-A Daley, N Sinaii, C Van Ryzin, H Huatan, D Digweed, D Eckland, M Whitaker, LK Nieman, RJ Ross, DP Merke</div>
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<strong>Summary:</strong> Classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is characterized by cortisol and aldosterone deficiency and androgen excess. Current conventional glucocorticoid therapy is suboptimal as it cannot replace the normal cortisol circadian rhythm and inadequate or inappropriate suppression of adrenal androgens are common. In the preliminary results of a phase 2 study of Chronocort®, a modified release hydrocortisone capsule formulation, researchers found that Chronocort®, a novel modified release hydrocortisone capsule formulation, approximates physiological cortisol secretion, and improves biochemical control of CAH. Further analyses are underway.<br />
<strong>Methods:</strong><br />
<ul>
<li>The study objectives were to characterize pharmacokinetics and examine disease control following 6 months dose titration.</li>
<li>Serial profiling was obtained at baseline (conventional glucocorticoid) and every 2 months.</li>
<li>Twice-daily Chronocort® was initiated: 20 mg at 2300 h, 10 mg at 0700 h.</li>
<li>Dose titration was based on clinical status and optimal hormonal ranges (17OHP 300-1200 ng/dL, normal androstenedione (males: 40-150, females: 30-200 ng/dL), with androstenedione prioritized.</li>
<li>Chronocort® cortisol pharmacokinetic profile was the primary endpoint.</li>
<li>Secondary endpoints included biomarkers of disease control.</li>
</ul>
<strong>Results:</strong><br />
<ul>
<li>A total of 16 adults (8 females; age 29 ±13 years) with classic CAH (12 salt-wasting, 4 simple virilizing) participated.</li>
<li>Conventional therapy varied (5 dexamethasone, 7 prednisone, 4 hydrocortisone).</li>
<li>Chronocort® cortisol pharmacokinetic profile approximated physiological cortisol secretion.</li>
<li>Ten patients required Chronocort® dose adjustments (decrease in 8, increase in 2; mean hydrocortisone equivalent dose conventional vs 6 months: 16.1 ± 6.4 vs 14.7 ± 6.4 mg/m2).</li>
<li>Serial androstenedione levels were in the normal range in 8 (50%) of patients on conventional therapy compared with 12 (75%) on Chronocort® at 6 months.</li>
<li>The majority of patients on Chronocort® achieved 17O HP levels within the normal range, rather than within the mildly elevated range currently used for management.</li>
<li>At 6 months, Chronocort® resulted in lower 24-hr (<em>P</em>=0.02), morning (0700-1500; <em>P</em>=0.008), and afternoon (1500-2300; <em>P</em>=0.03) area-under-the-curve androstenedione compared with conventional therapy.</li>
<li>No serious adverse events occurred.</li>
<li>Common adverse events were headache, fatigue, early awakening, and anemia.</li>
<li>Three patients had unexpected carpal tunnel syndrome, which resolved with wrist splints.</li>
</ul>
From <a data-mce-href="http://www.mdlinx.com/endocrinology/conference-abstract.cfm/ZZ5BA369FDE9DE4CED82CB6A7CD5BFD1BE/16521/?utm_source=confcoveragenl&utm_medium=newsletter&utm_content=abstract-list&utm_campaign=abstract-ICE/EN2014&nonus=0#" href="http://www.mdlinx.com/endocrinology/conference-abstract.cfm/ZZ5BA369FDE9DE4CED82CB6A7CD5BFD1BE/16521/?utm_source=confcoveragenl&utm_medium=newsletter&utm_content=abstract-list&utm_campaign=abstract-ICE/EN2014&nonus=0#" target="_blank" title="MDLinx">http://www.mdlinx.com/endocrinology/conference-abstract.cfm/ZZ5BA369FDE9DE4CED82CB6A7CD5BFD1BE/16521/?utm_source=confcoveragenl&utm_medium=newsletter&utm_content=abstract-list&utm_campaign=abstract-ICE/EN2014&nonus=0#</a></div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-69905390199072250302013-11-30T13:00:00.000-05:002013-11-30T13:00:05.513-05:00ARMC5 Mutations in Macronodular Adrenal Hyperplasia with Cushing's Syndrome<div style="padding: 10px 0px 0px;">
<a href="http://cushieblog.files.wordpress.com/2013/11/adrenal-hyperplasia.jpg" style="color: #105cb6;" target="_parent"><img alt="adrenal-hyperplasia" class="aligncenter size-large wp-image-1840" height="234" originalh="234" originalw="468" scale="1.5" src-orig="http://cushieblog.files.wordpress.com/2013/11/adrenal-hyperplasia.jpg?w=468&h=234" src="http://cushieblog.files.wordpress.com/2013/11/adrenal-hyperplasia.jpg?w=714&h=363" style="background-color: white; background-position: initial initial; background-repeat: initial initial; border: 1px solid rgb(221, 221, 221); display: block; margin-left: auto; margin-right: auto; padding: 4px;" width="468" /></a></div>
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Guillaume Assié, M.D., Ph.D., Rossella Libé, M.D., Stéphanie Espiard, M.D., Marthe Rizk-Rabin, Ph.D., Anne Guimier, M.D., Windy Luscap, M.Sc., Olivia Barreau, M.D., Lucile Lefèvre, M.Sc., Mathilde Sibony, M.D., Laurence Guignat, M.D., Stéphanie Rodriguez, M.Sc., Karine Perlemoine, B.S., Fernande René-Corail, B.S., Franck Letourneur, Ph.D., Bilal Trabulsi, M.D., Alix Poussier, M.D., Nathalie Chabbert-Buffet, M.D., Ph.D., Françoise Borson-Chazot, M.D., Ph.D., Lionel Groussin, M.D., Ph.D., Xavier Bertagna, M.D., Constantine A. Stratakis, M.D., Ph.D., Bruno Ragazzon, Ph.D., and Jérôme Bertherat, M.D., Ph.D.</div>
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N Engl J Med 2013; 369:2105-2114 <a href="http://www.nejm.org/toc/nejm/369/22/" style="color: #105cb6;" target="_parent">November 28, 2013</a> DOI: 10.1056/NEJMoa1304603</div>
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BACKGROUND</h3>
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Corticotropin-independent macronodular adrenal hyperplasia may be an incidental finding or it may be identified during evaluation for Cushing’s syndrome. Reports of familial cases and the involvement of both adrenal glands suggest a genetic origin of this condition.</div>
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METHODS</h3>
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We genotyped blood and tumor DNA obtained from 33 patients with corticotropin-independent macronodular adrenal hyperplasia (12 men and 21 women who were 30 to 73 years of age), using single-nucleotide polymorphism arrays, microsatellite markers, and whole-genome and Sanger sequencing. The effects of armadillo repeat containing 5 (<em>ARMC5</em>) inactivation and overexpression were tested in cell-culture models.</div>
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RESULTS</h3>
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The most frequent somatic chromosome alteration was loss of heterozygosity at 16p (in 8 of 33 patients for whom data were available [24%]). The most frequent mutation identified by means of whole-genome sequencing was in <em>ARMC5,</em> located at 16p11.2. <em>ARMC5 </em>mutations were detected in tumors obtained from 18 of 33 patients (55%). In all cases, both alleles of <em>ARMC5 </em>carried mutations: one germline and the other somatic. In 4 patients with a germline <em>ARMC5</em> mutation, different nodules from the affected adrenals harbored different secondary <em>ARMC5</em> alterations. Transcriptome-based classification of corticotropin-independent macronodular adrenal hyperplasia indicated that <em>ARMC5</em> mutations influenced gene expression, since all cases with mutations clustered together. <em>ARMC5</em> inactivation decreased steroidogenesis in vitro, and its overexpression altered cell survival.</div>
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CONCLUSIONS</h3>
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Some cases of corticotropin-independent macronodular adrenal hyperplasia appear to be genetic, most often with inactivating mutations of <em>ARMC5,</em> a putative tumor-suppressor gene. Genetic testing for this condition, which often has a long and insidious prediagnostic course, might result in earlier identification and better management. (Funded by Agence Nationale de la Recherche and others.)</div>
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Supported in part by grants from Agence Nationale de la Recherche (ANR-10-Blan-1136), Corticomedullosurrénale Tumeur Endocrine Network (Programme Hospitalier de Recherche Clinique grant AOM95201), Assistance Publique–Hôpitaux de Paris (Clinical Research Center Grant Genhyper P061006), Institut National du Cancer (Recherche Translationelle 2009-RT-02), the Seventh Framework Program of the European Commission (F2-2010-259735), INSERM (Contrat d’Interface, to Dr. Assié), the Conny-Maeva Charitable Foundation, and the intramural program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.</div>
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<a href="http://www.nejm.org/doi/suppl/10.1056/NEJMoa1304603/suppl_file/nejmoa1304603_disclosures.pdf" style="color: #105cb6;" target="_parent">Disclosure forms</a> provided by the authors are available with the full text of this article at NEJM.org.</div>
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Drs. Assié, Libé, Espiard, Rizk-Rabin, Ragazzon, and Bertherat contributed equally to this article.</div>
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We thank Drs. J. Chelly and M. Delpech of the cell bank of Cochin Hospital and Dr. B. Terris of the tumor bank of Cochin Hospital for their help in sample collection; Dr. E. Clauser of the oncogenetic unit of Cochin Hospital for help in microsatellite analysis; Drs. J. Guibourdenche and E. Clauser of the hormone biology unit of Cochin Hospital for cortisol assays; Drs. F. Tissier and Pierre Colin for pathological analysis; Anne Audebourg for technical assistance; J. Metral and A. de Reynies of the Cartes d’Identité des Tumeurs program of Ligue Nationale contre le Cancer for help in genomics studies and fruitful discussions; Dr. P. Nietschke of the bioinformatics platforms of Paris Descartes University for helpful discussions; all the members of the Genomics and Signaling of Endocrine Tumors team and of the genomic platform of Cochin Institute for their help in these studies; and the patients and their families, as well as the physicians and staff involved in patient care, for their active participation.</div>
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SOURCE INFORMATION</h3>
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From INSERM Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin (G.A., R.L., S.E., M.R.-R., A.G., W.L., O.B., L.L., S.R., K.P., F.R.-C., F.L., L. Groussin, X.B., B.R., J.B.), Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité (G.A., S.E., A.G., O.B., L.L., M.S., K.P., F.R.-C., L. Groussin, X.B., J.B.), Department of Endocrinology, Referral Center for Rare Adrenal Diseases (G.A., R.L., O.B., L. Guignat, L. Groussin, X.B., J.B.), and Department of Pathology (M.S.), Assistance Publique–Hôpitaux de Paris, Hôpital Cochin, and Unit of Endocrinology, Department of Obstetrics and Gynecology, Hôpital Tenon (N.C.-B.) — all in Paris; Unit of Endocrinology, Centre Hospitalier du Centre Bretagne, Site de Kério, Noyal-Pontivy (B.T.), Unit of Endocrinology, Hôtel Dieu du Creusot, Le Creusot (A.P.), and Department of Endocrinology Lyon-Est, Groupement Hospitalier Est, Bron (F.B.-C.) — all in France; and the Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics and the Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (C.A.S.).</div>
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Address reprint requests to Dr. Bertherat at Service des Maladies Endocriniennes et Métaboliques, Centre de Référence des Maladies Rares de la Surrénale, Hôpital Cochin, 27 rue du Faubourg St. Jacques, 75014 Paris, France, or at <a href="mailto:jerome.bertherat@cch.aphp.fr" style="color: #105cb6;" target="_parent">jerome.bertherat@cch.aphp.fr</a>.</div>
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<h6 class="zemanta-related-title" style="font-family: Arial, Helvetica, Georgia, sans-serif; font-size: 1em; margin: 0px; padding: 9px 0px 0px;">
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<li class="zemanta-article-ul-li"><a href="http://cushieblog.com/2013/11/28/are-you-carrying-adrenal-cushings-syndrome-without-knowing-it/" style="color: #105cb6;" target="_parent">Are you carrying adrenal Cushing’s syndrome without knowing it?</a>(cushieblog.com)</li>
<li class="zemanta-article-ul-li"><a href="http://www.2minutemedicine.com/armc5-mutation-identified-in-patients-with-macronodular-adrenal-hyperplasia/" style="color: #105cb6;" target="_parent">ARMC5 mutation identified in patients with macronodular adrenal hyperplasia</a>(2minutemedicine.com)</li>
</ul>
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cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-35290364096278970722013-11-28T10:43:00.000-05:002013-11-28T10:43:00.326-05:00Happy Thanksgiving!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIqttt-SLhUO-vC81HZrCjLG8iHI63cgguezQ01sIACLNYUIqJ2qWFcp1_DJh75HtMZ-Ag-kh-NaQeELN4PHZvKCvie-QU55wLOw3dh79xN3AzMBom0gBAZZ0tCmJIiYLoN2BKCqG8Q6JP/s1600/thanksgiving.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIqttt-SLhUO-vC81HZrCjLG8iHI63cgguezQ01sIACLNYUIqJ2qWFcp1_DJh75HtMZ-Ag-kh-NaQeELN4PHZvKCvie-QU55wLOw3dh79xN3AzMBom0gBAZZ0tCmJIiYLoN2BKCqG8Q6JP/s1600/thanksgiving.gif" /></a></div>
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<br />
Have a safe and Happy Thanksgiving!cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com1tag:blogger.com,1999:blog-6212941915222542408.post-63608923232085118942013-11-07T19:00:00.000-05:002013-11-07T19:00:00.022-05:00Perspectives on the management of adrenal insufficiency<div class="auths" style="background-color: white; font-family: arial, helvetica, clean, sans-serif; font-size: 0.923em;">
<a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Grossman%20A%5BAuthor%5D&cauthor=true&cauthor_uid=24031090" style="border-bottom-width: 0px; color: #660066;">Grossman A</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Johannsson%20G%5BAuthor%5D&cauthor=true&cauthor_uid=24031090" style="border-bottom-width: 0px; color: #660066;">Johannsson G</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Quinkler%20M%5BAuthor%5D&cauthor=true&cauthor_uid=24031090" style="border-bottom-width: 0px; color: #660066;">Quinkler M</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Zelissen%20P%5BAuthor%5D&cauthor=true&cauthor_uid=24031090" style="border-bottom-width: 0px; color: #660066;">Zelissen P</a>.</div>
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Source</h3>
<div style="margin-bottom: 0.5em; margin-top: 0.5em;">
Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Headington, Oxford OX3 7EJ, UK.</div>
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Abstract</h3>
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BACKGROUND:</h4>
<div style="margin-bottom: 0.5em;">
Conventional glucocorticoid (GC) replacement for patients with adrenal insufficiency (AI) is inadequate. Patients with AI continue to have increased mortality and morbidity and compromised quality of life despite treatment and monitoring.</div>
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OBJECTIVES:</h4>
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i) To review current management of AI and the unmet medical need based on literature and treatment experience and ii) to offer practical advice for managing AI in specific clinical situations.</div>
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METHODS:</h4>
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The review considers the most urgent questions endocrinologists face in managing AI and presents generalised patient cases with suggested strategies for treatment.</div>
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RESULTS:</h4>
<div style="margin-bottom: 0.5em;">
Optimisation and individualisation of GC replacement remain a challenge because available therapies do not mimic physiological cortisol patterns. While increased mortality and morbidity appear related to inadequate GC replacement, there are no objective measures to guide dose selection and optimisation. Physicians must rely on experience to recognise the clinical signs, which are not unique to AI, of inadequate treatment. The increased demand for corticosteroids during periods of stress can result in a life-threatening adrenal crisis (AC) in a patient with AI. Education is paramount for patients and their caregivers to anticipate, recognise and provide proper early treatment to prevent or reduce the occurrence of ACs.</div>
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CONCLUSIONS:</h4>
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This review highlights and offers suggestions to address the challenges endocrinologists encounter in treating patients with AI. New preparations are being developed to better mimic normal physiological cortisol levels with convenient, once-daily dosing which may improve treatment outcomes.</div>
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<dt style="display: inline; margin-bottom: 0px; margin-left: 0px !important; margin-right: 0px; margin-top: 0px; padding: 0px; white-space: nowrap;">PMID:</dt>
<dd style="display: inline; margin: 0px; padding: 0px; white-space: nowrap;">24031090</dd> <dd style="display: inline; margin: 0px; padding: 0px; white-space: nowrap;">[PubMed - in process] </dd><dd style="display: inline; margin: 0px; padding: 0px; white-space: nowrap;"></dd>
<dt style="display: inline; margin-bottom: 0px; margin-left: 0.5em !important; margin-right: 0px; margin-top: 0px; padding: 0px; white-space: nowrap;">PMCID:</dt>
<dd style="display: inline; margin: 0px; padding: 0px; white-space: nowrap;">PMC3805018</dd><dd style="display: inline; margin: 0px; padding: 0px; white-space: nowrap;"> [Available on 2013/12/1]</dd></dl>
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<dl class="rprtid" style="display: inline; font-size: 0.8465em; line-height: 1.4em; margin: 0px 15px 0px 0px;"><dd style="display: inline; margin: 0px; padding: 0px; white-space: nowrap;"><span style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 14.399999618530273px; line-height: 16.799999237060547px; white-space: normal;"><br /></span></dd></dl>
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<dl class="rprtid" style="display: inline; font-size: 0.8465em; line-height: 1.4em; margin: 0px 15px 0px 0px;"><dd style="display: inline; margin: 0px; padding: 0px; white-space: nowrap;"><span style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 14.399999618530273px; line-height: 16.799999237060547px; white-space: normal;">From </span><span style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 14.399999618530273px; line-height: 16.799999237060547px; white-space: normal;"></span><a data-mce-href="http://www.mdlinx.com/endocrinology/newsl-article.cfm/4829245/ZZ4747461521296427210947/?news_id=2364&newsdt=110713&subspec_id=1509&utm_source=Focus-On&utm_medium=newsletter&utm_content=Top-New-Article&utm_campaign=article-section" href="http://www.mdlinx.com/endocrinology/newsl-article.cfm/4829245/ZZ4747461521296427210947/?news_id=2364&newsdt=110713&subspec_id=1509&utm_source=Focus-On&utm_medium=newsletter&utm_content=Top-New-Article&utm_campaign=article-section" style="font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 14.399999618530273px; line-height: 16.799999237060547px; white-space: normal;" target="_blank" title="MDLinx">http://www.mdlinx.com/endocrinology/newsl-article.cfm/4829245/ZZ4747461521296427210947/?news_id=2364&newsdt=110713&subspec_id=1509&utm_source=Focus-On&utm_medium=newsletter&utm_content=Top-New-Article&utm_campaign=article-section</a></dd></dl>
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cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-66956477181115894332013-10-24T18:00:00.000-04:002013-10-24T18:00:02.319-04:00Video: What ifFrom <a class="g-hovercard yt-uix-sessionlink yt-user-name " data-name="watch" data-sessionlink="feature=watch&ei=izVpUsHlC4T7gAKfmYAQ" data-ytid="UCpDw5FGNc26vrDcfafR3oCA" dir="ltr" href="http://www.youtube.com/channel/UCpDw5FGNc26vrDcfafR3oCA?feature=watch" style="border: 0px; color: #333333; cursor: pointer; display: inline-block; margin: 0px 0px 0px 10px; padding: 0px; text-decoration: none;">Adrenal Insufficiency United</a><br />
<br />
A video about Adrenal Insufficiency and the need for emergency protocols.<br />
<br />
An injection which costs about $10 could save a life.<br />
<br />
Please help us make sure it's available to all who need it.<br />
<br />
http://youtu.be/yKPnNNM_dIwcushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-53404920311077934302013-08-03T16:00:00.000-04:002013-08-03T16:00:04.460-04:00FDA Puts Strict Limits on Oral Ketoconazole Use<div style="color: #333333; font-family: 'Open Sans', sans-serif; font-size: 13px; line-height: 19px;">
By <a data-mce-href="mailto:j.gever@medpagetoday.com" href="mailto:j.gever@medpagetoday.com" style="color: #3c2bb6;">John Gever</a>, Deputy Managing Editor, MedPage Today</div>
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SILVER SPRING, Md. -- Oral ketoconazole (Nizoral) should never be used as first-line therapy for any type of fungal infection because of the risk of liver toxicity and interactions with other drugs, the FDA said Friday.</div>
<div style="color: #333333; font-family: 'Open Sans', sans-serif; font-size: 13px; line-height: 19px;">
The agency ordered a series of label changes and a new medication guide for patients that emphasize the risks, which also include adrenal insufficiency. It noted that the restrictions apply only to the oral formulation, not topical versions.</div>
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Late Thursday, the chief advisory body for the FDA's European counterpart went further. The EU's Committee on Medicinal Products for Human Use (CHMP) recommended that member nations pull oral ketoconazole from their markets entirely.</div>
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Both the FDA and the CHMP cited studies indicating high risks of severe, acute liver injury in patients taking the drug. Studies using the FDA's adverse event reporting system and a similar database in the U.K. indicated that liver toxicity was more common with oral ketoconazole than with other anti-fungals in the azole class.</div>
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The FDA also said that oral ketoconazole "is one of the most potent inhibitors" of the CYP3A4 enzyme. This effect can lead to sometimes life-threatening interactions with other drugs metabolized by CYP3A4, and also to adrenal insufficiency, since the enzyme also catalyzes release of adrenal steroid hormones.</div>
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"This accounts for clinically important endocrinologic abnormalities observed in some patients (particularly when the drug is administered at high dosages), including gynecomastia in men and menstrual irregularities in women," the FDA said.</div>
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The only indication for oral ketoconazole still supported by the FDA is for use in life-threatening mycoses in patients who cannot tolerate other anti-fungal medications or when such medications are unavailable.</div>
<div style="color: #333333; font-family: 'Open Sans', sans-serif; font-size: 13px; line-height: 19px;">
In such instances, the FDA said, physicians should assess liver function before starting the drug. It is contraindicated in patients with pre-existing liver disease, and patients should be instructed not to drink alcohol or use other potentially hepatotoxic drugs.</div>
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<br /></div>
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Adrenal function should also be monitored in patients using the drug.</div>
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<br /></div>
<div style="color: #333333; font-family: 'Open Sans', sans-serif; font-size: 13px; line-height: 19px;">
The CHMP also indicated the topical formulations of ketoconazole should stay on the market, but it found no basis for keeping the oral form available for any purpose.</div>
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"Taking into account the increased rate of liver injury and the availability of alternative anti-fungal treatments, the CHMP concluded that the benefits did not outweigh the risks," the panel indicated in a statement.</div>
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It recommended that physicians stop prescribing oral ketoconazole and that they should review alternatives in patients currently receiving the drug. The committee also said that patients now taking oral ketoconazole "make a non-urgent appointment" with their physicians to discuss their treatment.</div>
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From <a data-mce-href="http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/40710?isalert=1&uun=g366689d167R5360099u&utm_source=breaking-news&utm_medium=email&utm_campaign=breaking-news&xid=NL_breakingnews_2013-07-26" href="http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/40710?isalert=1&uun=g366689d167R5360099u&utm_source=breaking-news&utm_medium=email&utm_campaign=breaking-news&xid=NL_breakingnews_2013-07-26" style="color: #3c2bb6;" target="_blank" title="MedPage Today">MedPage Today</a></div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-43292916561494511902013-07-16T13:09:00.001-04:002013-07-16T13:09:38.356-04:00Laparoscopic Bilateral Transperitoneal Adrenalectomy For Cushing Syndrome<h2 style="font-size: 16px; margin: 0px; padding: 9px 0px 0px;">
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 07/16/2013 Clinical Article</h2>
<div style="background-color: white; color: #333333; font-family: Arial, Helvetica, Georgia, sans-serif; line-height: 18px;">
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<span style="font-size: x-small;">Aggarwal S et al. –</span></div>
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<span style="font-size: x-small;">Laparoscopic adrenalectomy is well established for treatment of adrenal lesions. However, bilateral adrenalectomy for Cushing syndrome is a challenging and time–consuming operation.</span></div>
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<span style="font-size: x-small;">The authors report their experience of laparoscopic bilateral adrenalectomy for this disease in 19 patients. Laparoscopic bilateral adrenalectomy for Cushing syndrome is feasible and safe. It confers all the advantages of minimally invasive approach such as less postoperative pain, shorter hospitalization, lesser wound complications, and faster recovery.</span></div>
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<span style="font-size: x-small;">The advantages of the laparoscopic approach have led to an earlier referral for bilateral adrenalectomy by endocrinologist in patients with failed pituitary surgery.</span></div>
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This article is available on <a href="http://www.mdlinx.com/endocrinology/news-article-exit-page.cfm/4682172" style="color: #105cb6;" target="_blank" title="PubMed">PubMed</a></div>
</div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-5780638521809462032013-07-04T16:17:00.000-04:002013-07-04T16:17:00.128-04:00Cushing’s Syndrome is Hazardous to Your Health<div style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 13px; line-height: 19px;">
<a data-mce-href="http://cushieblog.files.wordpress.com/2013/07/morbidity.png" href="http://cushieblog.files.wordpress.com/2013/07/morbidity.png"><img alt="morbidity" class="aligncenter size-full wp-image-1546" data-mce-src="http://cushieblog.files.wordpress.com/2013/07/morbidity.png" height="237" src="http://cushieblog.files.wordpress.com/2013/07/morbidity.png" style="border: 0px; cursor: default; display: block; margin-left: auto; margin-right: auto;" width="388" /></a></div>
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People with Cushing’s syndrome, even when treated, have higher morbidity and mortality rates that comparable controls. That is the conclusion of a <a data-mce-href="http://jcem.endojournals.org/content/98/6/2277.abstract" href="http://jcem.endojournals.org/content/98/6/2277.abstract" target="_blank">new study published</a> in the June issue of the Journal of Clinical Endocrinology Metabolism. The study by Olaf Dekkers et al, examined data records from the Danish National Registry of Patients and the Danish Civil Registration System of 343 patients with benign Cushing’s syndrome of adrenal or pituitary origin (i.e., Cushing’s disease) and a matched population comparison cohort (n=34,300). Due to the lengthy delay of many patients being diagnosed with Cushing’s syndrome, morbidity was investigated in the 3 years before diagnosis while morbidity and mortality were assessed during complete follow-up after diagnosis and treatment.</div>
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The study found that mortality was twice as high in Cushing’s syndrome patients (HR 2.3, 95% CI 1.8-2.9) compared with controls over a mean follow-up period of 12.1 years. Furthermore, patients with Cushing’s syndrome were at increased risk for:</div>
<ul style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 13px; line-height: 19px;">
<li>venous thromboembolism (HR 2.6, 95% CI 1.5-4.7)</li>
<li>myocardial infarction (HR 3.7, 95% CI 2.4-5.5)</li>
<li>stroke (HR 2.0, 95% CI 1.3-3.2)</li>
<li>peptic ulcers (HR 2.0, 95% CI 1.1-3.6)</li>
<li>fractures (HR 1.4, 95% CI 1.0-1.9)</li>
<li>infections (HR 4.9, 95% CI 3.7-6.4).</li>
</ul>
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The study also found that this increased multimorbidity risk was present before diagnosis indicating that it was due to cortisol overproduction rather than treatment.</div>
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Many of the Cushing’s syndrome patients underwent surgery to remove the benign tumor. For this group, the investigators performed a sensitivity analysis of the long-term mortality and cardiovascular risk in this subgroup (n=186) considered to be cured after operation (adrenal surgery and patients with pituitary surgery in combination with a diagnosis of hypopituitarism in the first 6 months after operation). The risk estimates for mortality (HR 2.31, 95% CI 1.62-3.28), venous thromboembolism (HR 2.03, 95% CI 0.75-5.48), stroke (HR 1.91, 95% CI 0.90-4.05), and acute myocardial infarction (HR 4.38, 95% CI 2.31-8.28) were also increased in this subgroup one year after the operation.</div>
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The standard treatment for endogenous Cushing’s syndrome is surgery. This past year, <a data-mce-href="http://www.accessdata.fda.gov/scripts/opdlisting/oopd/OOPD_Results_2.cfm?Index_Number=288709" href="http://www.accessdata.fda.gov/scripts/opdlisting/oopd/OOPD_Results_2.cfm?Index_Number=288709" target="_blank">Signifor</a> (pasireotide) was approved for treatment of adults patients with Cushing’s disease for whom pituitary surgery is not an option or has not been curative. Cushing’s disease, which accounts for the majority of Cushing’s syndrome patients, is defined as the presence of an ACTH producing tumor on the pituitary grand. In the study by Dekker’s et al, the percentage of patients with Cushing’s disease is not known. We look forward to reexamination of this dataset in a few years following the introduction of more treatment options for Cushing’s disease as well as an analysis that explores the differences in mortality/morbidity rates in the different subsets of patients that make of Cushing’s syndrome (Cushing’s disease, ectopic Cushing’s syndrome, Exogenous Cyshing’s syndrome).</div>
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<strong>References</strong></div>
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Dekkers OM, Horvath-Pujo, Jorgensen JOL, et al, Multisystem morbidity and mortality in Cushing’s syndrome: a cohort study. <em>J Clin Endocrinol Metab 2013 </em>98(6): 2277–2284. <a data-mce-href="http://jcem.endojournals.org/content/98/6/2277.abstract" href="http://jcem.endojournals.org/content/98/6/2277.abstract" target="_blank">doi: 10.1210/jc.2012-3582</a></div>
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- See more at: <a data-mce-href="http://www.raredr.com/medicine/articles/cushing%E2%80%99s-syndrome-hazardous-your-health-0" href="http://www.raredr.com/medicine/articles/cushing%E2%80%99s-syndrome-hazardous-your-health-0" target="_blank" title="RareDr.com">http://www.raredr.com/medicine/articles/cushing%E2%80%99s-syndrome-hazardous-your-health-0</a></div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-86583586752386427502013-06-23T17:00:00.000-04:002013-06-23T17:00:03.912-04:00An Adrenal Crisis Survey<span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 12.800000190734863px; line-height: 13.600000381469727px;">This Survey is to gather information for the </span><span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 13px; line-height: 13.59375px;">Adrenal Insufficiency Awareness Organization's</span><span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 12.800000190734863px; line-height: 13.600000381469727px;"> grant project to create educational materials for ER personnel. </span><br />
<span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 12.800000190734863px; line-height: 13.600000381469727px;"><br /></span>
<span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 12.800000190734863px; line-height: 13.600000381469727px;">The survey is for those of you who have been to the ER during an impending or full blown Adrenal Crisis. (you may fill it out for a child or yourself) </span><br />
<span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 12.800000190734863px; line-height: 13.600000381469727px;"><br /></span>
<span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 12.800000190734863px; line-height: 13.600000381469727px;">Your help is appreciated! </span><br />
<span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 12.800000190734863px; line-height: 13.600000381469727px;"><br /></span>
<span style="background-color: white; color: #333333; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 12.800000190734863px; line-height: 13.600000381469727px;">At the end of the survey you will have the chance to enter for a chance to win an Adrenal Insufficiency Awareness Pin.</span><br />
<br />
<a href="http://www.facebook.com/l.php?u=https%3A%2F%2Fwww.surveymonkey.com%2Fs%2FERcare&h=HAQEdrQrQAQHRFG7bT1_OYyYcQOuh01LOhPvzPcsVjHF_Sw&s=1" rel="nofollow nofollow" style="background-color: white; color: #3b5998; cursor: pointer; font-family: 'lucida grande', tahoma, verdana, arial, sans-serif; font-size: 12.800000190734863px; line-height: 13.600000381469727px; text-decoration: none;" target="_blank">https://www.surveymonkey.com/<wbr></wbr><span class="word_break" style="display: inline-block;"></span>s/ERcare</a>cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-47116268021353751762013-06-23T08:27:00.000-04:002013-06-23T08:27:26.881-04:00Adrenal Glands<div style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 13px; line-height: 19px;">
<strong><a data-mce-href="http://cushieblog.files.wordpress.com/2013/06/adrenal-glands.png" href="http://cushieblog.files.wordpress.com/2013/06/adrenal-glands.png"><img alt="adrenal-glands" class="aligncenter size-medium wp-image-1450" data-mce-src="http://cushieblog.files.wordpress.com/2013/06/adrenal-glands.png?w=282" height="300" src="http://cushieblog.files.wordpress.com/2013/06/adrenal-glands.png?w=282" style="border: 0px; cursor: default; display: block; margin-left: auto; margin-right: auto;" width="282" /></a>Anatomy of the adrenal glands:</strong></div>
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Adrenal glands, which are also called suprarenal glands, are small, triangular glands located on top of both kidneys. An adrenal gland is made of two parts: the outer region is called the adrenal cortex and the inner region is called the adrenal medulla.</div>
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<strong>Function of the adrenal glands:</strong></div>
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The adrenal glands work interactively with the hypothalamus and pituitary gland in the following process:</div>
<ul style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 13px; line-height: 19px;">
<li>the hypothalamus produces corticotropin-releasing hormones, which stimulate the pituitary gland.</li>
<li>the pituitary gland, in turn, produces corticotropin hormones, which stimulate the adrenal glands to produce corticosteroid hormones.</li>
</ul>
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Both parts of the adrenal glands -- the adrenal cortex and the adrenal medulla -- perform very separate functions.</div>
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<strong>What is the adrenal cortex?</strong></div>
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The adrenal cortex, the outer portion of the adrenal gland, secretes hormones that have an effect on the body's metabolism, on chemicals in the blood, and on certain body characteristics. The adrenal cortex secretes corticosteroids and other hormones directly into the bloodstream. The hormones produced by the adrenal cortex include:</div>
<ul style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 13px; line-height: 19px;">
<li><strong>corticosteroid hormones</strong><ul>
<li><strong>hydrocortisone hormone</strong> - this hormone, also known as cortisol, controls the body's use of fats, proteins, and carbohydrates.</li>
<li><strong>corticosterone</strong> - this hormone, together with hydrocortisone hormones, suppresses inflammatory reactions in the body and also affects the immune system.</li>
</ul>
</li>
<li><strong>aldosterone hormone</strong> - this hormone inhibits the level of sodium excreted into the urine, maintaining blood volume and blood pressure.</li>
<li><strong>androgenic steroids</strong> <strong>(androgen hormones) </strong>- these hormones have minimal effect on the development of male characteristics.</li>
</ul>
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<strong>What is the adrenal medulla?</strong></div>
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The adrenal medulla, the inner part of the adrenal gland, is not essential to life, but helps a person in coping with physical and emotional stress. The adrenal medulla secretes the following hormones:</div>
<ul style="color: #333333; font-family: Georgia, 'Times New Roman', 'Bitstream Charter', Times, serif; font-size: 13px; line-height: 19px;">
<li><strong>epinephrine</strong> <strong>(also called adrenaline) - </strong>this hormone increases the heart rate and force of heart contractions, facilitates blood flow to the muscles and brain, causes relaxation of smooth muscles, helps with conversion of glycogen to glucose in the liver, and other activities.</li>
<li><strong>norepinephrine (also called noradrenaline) - </strong>this hormone has little effect on smooth muscle, metabolic processes, and cardiac output, but has strong vasoconstrictive effects, thus increasing blood pressure.</li>
</ul>
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From: <a data-mce-href="http://umm.edu/programs/diabetes/health/endocrinology-health-guide/adrenal-glands" href="http://umm.edu/programs/diabetes/health/endocrinology-health-guide/adrenal-glands" target="_blank" title="University of Maryland Center for Diabetes and Endocrinology ">University of Maryland Center for Diabetes and Endocrinology</a></div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-48352377883363136012013-05-11T10:26:00.000-04:002013-05-11T10:26:00.460-04:00Ask your Member of Congress to join the Rare Disease Congressional Caucus<br />
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<br class="Apple-interchange-newline" />Help us strengthen the rare disease community's voice on Capitol Hill! Please take 3 minutes to ask your Member of Congress to join the Rare Disease Caucus at <a href="http://bit.ly/RareAlert"><span class="s1">http://bit.ly/RareAlert</span></a>.</div>
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It's easy - the Action Center has a draft letter that will automatically be sent to your Member of Congress - just put in your name and address & click send. We also encourage you to personalize the letter to share information about your specific disease. If your Congress Member is already on the Caucus, the letter will automatically populate as a thank you letter instead - these are just as important to send!</div>
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<br /></div>
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It can take up to 10 letters from constituents for a Member to respond so please share this Action Alert with your friends, family & colleagues. Join our Facebook event & invite your friends: <a href="http://on.fb.me/17Mlpjg"><span class="s1">http://on.fb.me/17Mlpjg</span></a> </div>
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<br /></div>
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The Rare Disease Congressional Caucus will help bring public and Congressional awareness to the unique needs of the rare disease community – patients, physicians, scientists, and industry, and create opportunities to address roadblocks in access to and development of crucial treatments. The Caucus will give a permanent voice to the rare disease community on Capitol Hill. Working together, we can find solutions that turn hope into treatments.</div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-1307020483994498272013-03-29T09:58:00.000-04:002013-03-29T09:58:00.888-04:00Multisystem Morbidity and Mortality in Cushings Syndrome: a Cohort Study<br />
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<span class="subTitle" style="color: #666666; font-size: 12px; margin: 0px; padding: 0px;">Journal of Clinical Endocrinology and Metabolism, 03/28/2013 <span style="color: black;"> Clinical Article</span></span></h1>
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Dekkers O.M. et al.– To examine the risks for mortality, cardiovascular disease, fractures, peptic ulcers, and infections in CS patients before and after treatment.Cushing’s syndrome (CS) is associated with hypercoagulability, insulin resistance, hypertension, bone loss, and immunosuppression. To date, no adequately large cohort study has been performed to assess the multisystem effects of CS. It was concluded that despite the apparently benign character of the disease, CS is associated with clearly increased mortality and multisystem morbidity, even before diagnosis and treatment.</div>
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<b>Methods</b></div>
<ul>
<li style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 14px; margin-bottom: 10px; margin-top: 5px; padding: 0px;">The study used Cox–regression, and computed hazard ratios (HR) with 95% confidence intervals (95% CI).</li>
<li style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 14px; margin-bottom: 10px; margin-top: 5px; padding: 0px;">Morbidity was investigated in the three years before diagnosis; morbidity and mortality was assessed during complete follow–up after diagnosis and treatment.</li>
</ul>
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<b>Results</b></div>
<ul>
<li style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 14px; margin-bottom: 10px; margin-top: 5px; padding: 0px;">343 CS patients and 34,300 controls were included. Mortality was twice as high in CS patients (HR 2.3, 95%CI 1.8–2.9) compared with controls.</li>
<li style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 14px; margin-bottom: 10px; margin-top: 5px; padding: 0px;">Patients with CS were at increased risk for venous thromboembolism (HR 2.6, 95%CI 1.5–4.7), myocardial infarction (HR 3.7, 95%CI 2.4–5.5), stroke (HR 2.0, 95%CI 1.3–3.2), peptic ulcers (HR 2.0, 95%CI 1.1–3.6), fractures (HR 1.4, 95%CI 1.0–1.9), and infections (HR 4.9, 95%CI 3.7–6.4).</li>
<li style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 14px; margin-bottom: 10px; margin-top: 5px; padding: 0px;">This increased multi–morbidity risk was present before diagnosis. Mortality and risk of myocardial infarction remained elevated during long–term follow–up.</li>
<li style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 14px; margin-bottom: 10px; margin-top: 5px; padding: 0px;">Mortality and risks for AMI, VTE, stroke and infections were similarly increased in adrenal and pituitary CS.</li>
</ul>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: 12px; line-height: 14px;">From <a href="http://www.mdlinx.com/internal-medicine/newsl-article.cfm/4536397/ZZ4747461521296427210947/?news_id=466&newsdt=032813&utm_source=Newsletter&utm_medium=DailyNL&utm_content=General-Article&utm_campaign=Article-Section" target="_blank">MDLinx</a></span></span></div>
</div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-3589355196361062292013-03-21T09:00:00.000-04:002013-03-21T09:00:00.390-04:00For Cushing's Awareness Challenge Bloggers<br />
Cushie bloggers - who would like to share your post on April 8 (Cushing's Awareness Day) with our friends at Adrenal Insufficiency United, on their blog?<br />
<br />
Also, they are interested in sharing others of our posts from April. Please let me know if I have your permission to share your blog post(s) with them. I won't without your permission.<br />
<br />
Thanks!<br />
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0tag:blogger.com,1999:blog-6212941915222542408.post-73887192162421475552013-03-16T07:12:00.000-04:002013-03-16T07:12:00.394-04:00Cushing's Awareness Blogging Challenge 2013<br />
Do you blog? Want to get started?<br />
<br />
Since April 8 is Cushing's Awareness Day, several people got their heads together to create the Second Annual Cushing's Awareness Blogging Challenge.<br />
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All you have to do is blog about something Cushing's related for the 30 days of April.<br />
<br />
Robin designed this year's version of our "official logo" to put on your blogs.<br />
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<div style="text-align: center;">
<a href="http://www.cushie.info/blog/?attachment_id=866" rel="attachment wp-att-866"><img alt="Cushing's Awareness Challenge 2013" class="size-full wp-image-866 aligncenter" src="http://www.cushie.info/blog/wp-content/uploads/2013/03/challenge-2013b.jpg" height="239" width="360" /></a></div>
<div style="text-align: center;">
<a href="http://www.cushie.info/blog/?attachment_id=867" rel="attachment wp-att-867"><img alt="challenge-2013nb" class="aligncenter size-full wp-image-867" src="http://www.cushie.info/blog/wp-content/uploads/2013/03/challenge-2013nb.jpg" height="233" width="360" /></a> </div>
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If your blog wants you to upload an image from your desktop, right-click on the image above and choose "save-as". Remember where you saved it to! </div>
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To link to the image with the yellow border, use this URL: http://www.cushings-help.com/images/challenge-2013b.jpg </div>
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<div>
To link to the image without a border, use this URL: http://www.cushings-help.com/images/challenge-2013nb.jpg </div>
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In all cases, the URL for the site is http://www.cushings-help.com </div>
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Please let me know the URL to your blog in the comments area of this post or and I will list it on CushieBloggers ( <a href="http://cushie-blogger.blogspot.com/" target="_blank" title="Cushie-Bloggers.com">http://cushie-blogger.blogspot.com/ </a>) </div>
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The more people who participate, the more the word will get out about Cushing's. </div>
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<strong>Suggested topics - or add your own!</strong><br />
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In what ways have Cushing's made you a better person?<br />
What have you learned about the medical community since you have become sick?<br />
If you had one chance to speak to an endocrinologist association meeting, what would you tell them about Cushing's patients?<br />
What would you tell the friends and family of another Cushing's patient in order to garner more emotional support for your friend?<br />
Challenges with Cushing's? How have you overcome challenges? Stuff like that.<br />
I have Cushing's Disease....(personal synopsis)<br />
How I found out I have Cushing's<br />
What is Cushing's Disease/Syndrome? (Personal variation, i.e. adrenal or pituitary or ectopic, etc.)<br />
My challenges with Cushing's<br />
Overcoming challenges with Cushing's (could include any challenges)<br />
If I could speak to an endocrinologist organization, I would tell them...<br />
. What would I tell others trying to be diagnosed? What would I tell families of those who are sick with Cushing's?<br />
Treatments I've gone through to try to be cured/treatments I may have to go through to be cured.<br />
What will happen if I'm not cured?<br />
I write about my health because...<br />
10 Things I Couldn’t Live Without.<br />
My Dream Day.<br />
What I learned the hard way<br />
Miracle Cure. (Write a news-style article on a miracle cure. What’s the cure? How do you get the cure? Be sure to include a disclaimer)<br />
Health Madlib Poem. Go to http://languageisavirus.com/cgi-bin/madlibs.pl and fill in the parts of speech and the site will generate a poem for you.<br />
The Things We Forget. Visit http://thingsweforget.blogspot.com/ and make your own version of a short memo reminder. Where would you post it?<br />
Give yourself, your condition, or your health focus a mascot. Is it a real person? Fictional? Mythical being? Describe them. Bonus points if you provide a visual!<br />
5 Challenges and 5 Small Victories.<br />
The First Time I...<br />
Make a word cloud or tree with a list of words that come to mind when you think about your blog, health, or interests. Use a thesaurus to make it branch more.<br />
How much money have you spent on Cushing's, or, How did Cushing's impact your life financially?<br />
Why do you think Cushing's may not be as rare as doctors believe?<br />
What is your theory about what causes Cushing's?<br />
How has Cushing's altered the trajectory of your life? What would you have done? Who would you have been?<br />
What three things has Cushing's stolen from you? What do you miss the most? What can you do in your Cushing's life to still achieve any of those goals? What new goals did Cushing's bring to you?<br />
How do you cope?<br />
What do you do to improve your quality of life as you fight Cushing's?<br />
Your thoughts...?</div>
cushiehttp://www.blogger.com/profile/03457151536101769306noreply@blogger.com0