NIH Adrenal Clinical Trials Updated 5/5/2011

Rank	Status	Study
1	Completed	Cardiovascular Risk in Patients With Non-Functional Adrenal Incidentaloma Condition: Adrenal Cortex Neoplasms Intervention:
2	Completed Has Results	Changes in Adrenal Hormones During Adrenal Radiofrequency Ablation Condition: Adrenal Gland Neoplasms Intervention: Procedure: Radiofrequency ablation
3	Completed	Adrenal Scans With Radioiodine-Labeled Norcholesterol (NP-59) Conditions: Adrenal Gland Neoplasms;   Adrenal Malignancies;   Abnormal Hormonal Secretions;   Electrolytes Abnormalities Intervention: Other: Imaging, Adrenal acans
4	Recruiting	Trial of Vasopressin and Epinephrine to Epinephrine Only for In-Hospital Pediatric Cardiopulmonary Resuscitation Conditions: Cardiopulmonary Arrest;   Cardiac Arrest Interventions: Drug: Vasopressin;   Drug: Epinephrine
5	Completed	Adrenal Suppression and Adrenal Recovery Induced by Megestrol Acetate Condition: Adrenal Function Intervention: Drug: megestrol acetate
6	Recruiting	Test Predicting Adrenal Insufficiency in Volunteers Under Prednisone Treatment Condition: Adrenal Gland Hypofunction Interventions: Procedure: adrenal insufficiency testing;   Drug: prednisone
7	Recruiting	The Bupivacaine Dose Sparing Effect of Intrathecal Epinephrine Condition: Spinal Anesthesia Interventions: Drug: Placebo;   Drug: epinephrine 25;   Drug: Epinephrine 50;   Drug: epinephrine 100;   Drug: Epi 200
8	Recruiting	SPARTACUS: Subtyping Primary Aldosteronism: a Randomized Trial Comparing Adrenal Vein Sampling and Computed Tomography Scan. Condition: Hyperaldosteronism Intervention: Other: Ct-scan or adrenal vein sampling
9	Completed	Make up for the Epinephrine Autoinjector Condition: Anaphylaxis Intervention: Device: Epinephrine autoinjector
10	Completed	Epinephrine Inhalation Aerosol USP, a HFA-MDI Study for Assessment of Pharmacokinetics Conditions: Asthma;   Bronchospasm;   Wheezing;   Shortness of Breath Interventions: Drug: Epinephrine Inhalation Aerosol, HFA;   Drug: Epinephrine Inhalation Aerosol
11	Completed	Once-Daily Oral Modified-Release Hydrocortisone in Patients With Adrenal Insufficiency Condition: Adrenal Insufficiency Interventions: Drug: hydrocortisone (modified release), oral tablet 20 and 5 mg;   Drug: Hydrocortisone, oral tablet, 10 mg
12	Completed	Pharmacokinetics (PK) Study of Epinephrine Inhalation Aerosol in Healthy Volunteers Condition: Asthma Intervention: Drug: epinephrine inhalation aerosol
13	Completed	ED50 and ED95 of Intrathecal Bupivacaine With or Without Epinephrine for Total Knee Replacement Arthroplasty Conditions: Spinal Anesthesia;   Total Knee Replacement Arthroplasty Interventions: Drug: intrathecal bupivacaine 6 mg with 100 mcg of epinephrine;   Drug: intrathecal bupivacaine 7 mg with 100 mcg of epinephrine;   Drug: intrathecal bupivacaine 8 mg with 100 mcg of epinephrine;   Drug: intrathecal bupivacaine 9 mg with 100 mcg of epinephrine;   Drug: intrathecal bupivacaine 10 mg with 100 mcg of epinephrine;   Drug: intrathecal bupivacaine 11 mg with epinephrine 100 mcg;   Drug: intrathecal bupivacaine 6 mg with 200 mcg of epinephrine;   Drug: intrathecal bupivacaine 7 mg with 200 mcg of epinephrine;   Drug: intrathecal bupivacaine 8 mg with 200 mcg of epinephrine;   Drug: intrathecal bupivacaine 9 mg with 200 mcg of epinephrine;   Drug: intrathecal bupivacaine 10 mg with 200 mcg of epinephrine;   Drug: intrathecal bupivacaine 11 mg with 200 mcg of epinephrine
14	Active, not recruiting	Study of UK Adults With Congenital Adrenal Hyperplasia. Condition: Congenital Adrenal Hyperplasia Intervention:
15	Not yet recruiting	Intranasal Injection Versus Topical Administration of Epinephrin During Endoscopic Sinus Surgery Conditions: Hypertension;   Hypotension;   Tachycardia;   Bradycardia;   Arrhythmia Interventions: Drug: Epinephrin (Intranasal injection);   Drug: Epinephrin (Topical administration)
16	Recruiting	Adrenal Insufficiency in Septic Shock Conditions: Septic Shock;   Acute Adrenal Insufficiency Intervention: Drug: Corticosteroid
17	Recruiting	Performance of 18F-Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) in the Diagnosis of Indeterminate Adrenal Tumors on Conventional Imaging: A French Prospective Multicentric Study Condition: Adrenal Gland Neoplasms Intervention: Other: FDG-PET scan
18	Unknown †	Prospective Study on the Incidence of Adrenal Crisis in Patients With Chronic Adrenal Insufficiency Condition: Adrenal Insufficiency Intervention:
19	Completed	Dose Response Relationship for Single Doses of Corticotropin Releasing Hormone (CRH) in Normal Volunteers and in Patients With Adrenal Insufficiency Conditions: Adrenal Gland Hyperfunction;   Adrenal Gland Hypofunction;   Cushing's Syndrome;   Healthy Intervention: Drug: Ovine Corticotropin-Releasing Hormone (oCRH)
20	Recruiting	Adrenal Function in Critical Illness Condition: Adrenal Insufficiency Intervention:

Rank	Status	Study
21	Recruiting	Study of Adrenal Gland Tumors Condition: Adrenal Gland Neoplasm Intervention:
22	Recruiting	The Effects of Epinephrine in Endotoxemia in Normal Volunteers Condition: Immune System Interventions: Biological: Endotoxin, Lipopolysaccharide, LPS;   Biological: Endotoxin, Lipopolysaccharide, LPS /Epinephrine
23	Unknown †	Does Topical Steroid Treatment Impair the Adrenal Function? Conditions: Hypothalamus-Pituitary-Adrenal Axis Assessement;   Topical Steroid Therapy in Chronic Skin Diseases Intervention:
24	Recruiting	Combination Local Anesthetics Condition: Perioperative Pain Interventions: Drug: 1% Lidocaine with Epinephrine;   Drug: 0.25% Bupivacaine with epinephrine;   Drug: 1% Lidocaine + 0.25% Bupivacaine with Epinephrine;   Drug: 2% Lidocaine + 0.5% Bupivacaine with epinephrine
25	Recruiting	Study Comparing Peri-articular Injection of Bupivacaine With and Without Epinephrine Condition: Osteoarthritis Interventions: Procedure: Peri-articular injection of marcaine/epinephrine;   Procedure: Peri-articular injection of marcaine alone
26	Not yet recruiting	Gluing Lacerations Utilizing Epinephrine Condition: Lacerations Intervention: Drug: LET - Lidocaine Epinephrine Tetracaine
27	Recruiting	Use of Local Analgesia With Epinephrine During Total Hip Arthroplasty (THA) Condition: Arthroplasty, Replacement, Hip Intervention: Drug: ropivacaine, physical serum and adrenalin
28	Recruiting	Relative Adrenal Insufficiency in Preterm Very Low Birth Weight Infants With Shock Condition: Adrenal Insufficiency Intervention:
29	Unknown †	Adrenal Insufficiency in Cirrhotics With Ascites. Effects of Hydrocortisone on Renal and Haemodynamic Function Condition: Cirrhosis With Ascites Interventions: Drug: hydrocortisone;   Drug: dextrose solution 5%
30	Recruiting	Bronchiolitis, Optimal Treatment in Infants and Prognosis Condition: Bronchiolitis Interventions: Drug: Racemic adrenaline;   Drug: Isotonic saline
31	Recruiting	RAD001 in Pheochromocytoma or Nonfunctioning Carcinoid Conditions: Pheochromocytoma;   Extra-Adrenal Paraganglioma;   Non-functioning Carcinoid Intervention: Drug: RAD001
32	Not yet recruiting	Hypoglycemia Associated Autonomic Failure in Type 1 DM, Q4 Condition: Type 1 Diabetes Intervention: Drug: epinephrine
33	Recruiting	Effect of Epinephrine/ Phenylephrine for Preventing the Postreperfusion Syndrome During Reperfusion in Liver Transplantation Condition: Hypotension After Reperfusion in Liver Transplantation Interventions: Drug: phenylephrine;   Drug: epinephrine;   Drug: placebo control
34	Recruiting	Safety Study Evaluating the Adrenal Suppression Potential of Product 0405 in Pediatric Subjects With Atopic Dermatitis Condition: Atopic Dermatitis Intervention: Drug: Product 0405
35	Recruiting	Merits of Continuous Paravertebral Block in the Management of Renal/Adrenal Surgery by Laparotomy Condition: Patient Scheduled for Renal and/or Adrenal Surgery Intervention: Procedure: Continuous Paravertebral block
36	Not yet recruiting	Adrenalectomy Versus Follow-up in Patients With Subclinical Cushings Syndrome Condition: Adrenal Tumour With Mild Hypercortisolism Intervention: Procedure: Adrenalectomy
37	Recruiting	Role of the Protein Osteoprotegerin in the Bone Health of Women With Congenital Adrenal Hyperplasia Condition: Adrenal Hyperplasia, Congenital Intervention:
38	Recruiting	Gene Polymorphisms Influencing Steroid Synthesis and Action Conditions: Disorders of Sex Development;   Congenital Adrenal Hyperplasia;   Congenital Adrenal Hypoplasia;   Adrenal Insufficiency;   Mineralocorticoid Deficiency;   Intersex Intervention:
39	Recruiting	Adrenal Function and Use of Intralesional Triamcinolone Acetonide 10 mg/mL (Kenalog-10) in Patients With Alopecia Areata Condition: Alopecia Areata Intervention: Drug: Triamcinolone Acetonide 10 mg/mL (Kenalog-10)
40	Recruiting	Assessment of the Efficacy of Nebulised 3% Hypertonic Saline Among Infants Aged 6 Weeks- 24 Months With Bronchiolitis Condition: Bronchiolitis Interventions: Drug: L-Epinephrine and 0.9% Normal Saline;   Drug: L-Epinephrine and 3% Hypertonic Saline

Successful treatment of Lt. Adrenocortical Tumor or Cushing's syndrome

Successful treatment of Lt. Adrenocortical Tumor or Cushing's syndrome (+ Enlarge)

Mohini Nayak the two year old female child was brought to Apollo Hospital with H/O gaining excessive weight and became obese since 1 yr. She was treated by different doctors in multiple hospitals in Bhubaneswar and Cuttack. After investigation in S.C.B. Medical College, Cuttack, it was found that the baby is suffering from Lt. Adrenocortical Tumour. Cushing Syndrome in Pediatric age group, particularly less than 2 years old child is a very rare condition, the incidence being 0.3 – 0.4 in one million child below 15yrs of age. Cushing’s syndrome may occur either due to Pituitary tumor or Adreno cortical tumor, said Dr. B N Mishra, Sr. Pediatric Surgeon, Apollo Hosipitals, Bhubaneswar. The baby had adreno cortical; tumor on left side, informed Dr. Mishra. Adrenal glands are present in our body just above and adjacent (Superiorly) to kidneys on both sides.

She had a very large tumor of left adrenal gland of size 10x6x3 cm size and such type of large tumors is usually malignant and rarely seen. However the biopsy does not show features of malignancy, but needs to be observed for a long time. Dr. Mishra informed that, her obesity will take time to reduce, may be six months to one year. Mohini got admitted on 12th November 2010.

Mohini comes from a very low socio-economic status. The child is the youngest of the three siblings and her parents in spite of their poverty tried their limited resources to provide the best medical treatment. Hopeless slum dwellers finally had a smile. Victory of life over death prevailed. Ashok Naik a low paid sweeper and his wife Jyotsna a domestic help sacrificed what ever little earning they did to save their youngest girl child of 2 years old, Mohini.

The girl became about 20kg within 1 year 2months. Finally parents lost all hope. Some couple of weeks back the heart touching story of the girl and her parents, featured in a local daily. The story dragged few social activists of Lions Club Bhubaneswar met the parent and resolved to take an attempt. After initial checkup, Apollo decided for operation with financial assistance from corporate houses and government of odisha.

It was risky and expensive. A group of expert doctors led by Dr. B.N. Mishra successfully operated the massive tumor after a long operation of three hours. The baby is now free of danger.

From http://www.odisha360.com/news/720/successful-treatment-of-lt-adrenocortical-tumor-or-cushings-syndrome

Long-term unemployment associated with poorer health

Patients with long-term chronic conditions, such as Cushing’s disease or Klinefelter’s syndrome, appear to be at increased risk for long-term unemployment related to their disease.

 

Researchers compared unemployment rates with re-employment rates for 130 patients (81 women) aged 65 years or younger with Addison’s disease, Cushing’s disease, craniopharyngioma or Klinefelter’s syndrome. The researchers presented the results at the Annual Society for Endocrinology BES 2010 in Manchester, England.

 

Based on telephone questionnaires, 83 patients (63.8%) were employed at the time of diagnosis. However, 79 patients (60.8%) were later unemployed, related to their long-term chronic condition.

 

Seventy-seven patients (59.2%) reported being satisfied with their current working status and ability to work. Among those unemployed, nine of 53 patients (40.8%) said they would like to work but did not feel supported.

 

Although the study was small and did not include all chronic endocrine conditions, the researchers said data show a high rate of unemployment for this patient population.

 

“Long-term unemployment is a significant problem for people with chronic diseases,” John Wass, MD, professor of endocrinology at Oxford University and consultant endocrinologist at Oxford Radcliffe Hospitals, said in a press release. “More people should consider returning to work following diagnosis, and more doctors need to encourage and support their patients in this. While a return to work may not be suitable for all patients, it can significantly improve their well-being and quality of life.”

 

Wass J. Poster #116. Presented at: The Annual Society for Endocrinology BES meeting; March 15-18, 2010; Manchester, England.

 

From http://www.endocrinetoday.com/view.aspx?rid=62296

Are doctors ever really off duty?

I found this article especially interesting.  This question was asked of a group of endos at an NIH conference a few years ago - if you saw someone on the street who looked like they had symptoms of fill-in-the disease, would you suggest that they see a doctor.  The general answer was no.  No surprise there. 

Patients, if you see someone who looks like s/he has Cushing's, give them a discrete card.

Spread The Word! Cushing's Pocket Reference

Robin Writes:

This has been a concern of mine for some time. Your post spurred me on to do something I've been meaning to do. I've designed something you can print that will fit on the business cards you can buy just about anywhere (Wal-mart included). You can also print on stiff paper and cut with a paper cutter or scissors. I've done a front and a back.

Here are the links:

• Front: This card is being presented by a person who cares.
• Back (The same for everyone)

This Topic on the Message Boards

~~~~~~~~~~~~~~~~~~

And now, the article from http://www.guardian.co.uk/lifeandstyle/2009/nov/03/doctor-diagnosis-stranger:

Are doctors ever really off duty?

Which potentially serious symptoms would prompt them to stop and advise a stranger on a bus?

By Lucy Atkins

• 
  • Lucy Atkins
  • The Guardian, Tuesday 3 November 2009
    Article history

Passengers on a London bus. Photograph: David Levene

A Spanish woman of 55, Montse Ventura, recently met the woman she refers to as her "guardian angel" on a bus in Barcelona. The stranger – an endocrinologist – urged Ventura to have tests for acromegaly, a rare disorder involving an excesss of growth hormone, caused by a pituitary gland tumour. How had the doctor made this unsolicited diagnosis on public transport? Apparently the unusual, spade-like shape of Ventura's hands was a dead giveaway.

But how many off-duty doctors would feel compelled to alert strangers to symptoms they spot? "If I was sitting next to someone on a bus with a melanoma, I'd say something or I wouldn't sleep at night," says GP Mary McCullins. "We all have a different threshold for interfering and you don't want to terrify people, but this is the one thing I'd urge a total stranger to see a doctor about." So what other symptoms might prompt a doctor to approach someone on the street?

Moon face

Cushing's syndrome is another rare hormone disorder which can be caused by a non-cancerous tumour in the pituitary gland. "A puffy, rounded 'moon face' is one of the classic signs of Cushing's," says Dr Steve Field, chair of the Royal College of GPs. "In a social situation, I wouldn't just say, 'You're dangerously ill' but I'd try to elicit information and encourage them to see a doctor."

Different-sized pupils

When one pupil is smaller than the other, perhaps with a drooping eyelid, it could be Horner's syndrome, a condition caused when a lung tumour begins eating into the nerves in the neck. This can be the first obvious sign of the cancer. "I'd encourage someone to get this checked out," says Dr Simon Smith, consultant in emergency medicine at the Oxford Radcliffe Hospitals Trust. "People often have an inkling that something's wrong, and you might spur them to get help sooner."

Clubbing fingers

Some people are born with club-shaped fingers, but if, over time, they become "drumstick-like", this could signify serious problems such as lung tumours, chronic lung infections or congenital heart disease. "Because it happens gradually, some people disregard clubbing," says Smith. "But I'd say something because it can be an important symptom in many serious illnesses."

Lumpy eyelids

Whitish yellowy lumps around the eyelids can be a sign of high cholesterol, a major factor in heart disease. Sometimes you also get a yellow circle around the iris. "I would suggest they got a cholesterol test with these symptoms," says Smith. "They can do something about it that could save their life."

Suntan in unlikely places

A person with Addison's disease, a rare but chronic condition brought about by the failure of the adrenal glands, may develop what looks like a deep tan, even in non sun-exposed areas such as the palms. Other symptoms (tiredness, dizziness) can be non-specific so the condition is often advanced by the time it is diagnosed. Addison's is treatable with lifelong steroid replacement therapy. "If someone was saying they hadn't been in the sun but had developed a tan, alarm bells would ring and I'd probably ask how they were feeling," says McCullins.

Trench mouth

Putrid smelling breath – even if the teeth look perfect – can be a sign of acute necrotising periodontitis. "I'd be able to tell when someone walks through the door," says dentist Laurie Powell. "But people become accustomed to it and don't notice." Untreated, the condition damages the bones and connective tissue in the jaw. It can also be a sign of other diseases such as diabetes or Aids.

Adrenal Blog Alert ~ 10/10/2009

survive the journey: Stars Go Blue
By Robin

Ultimately, Sam was diagnosed with Primary pigmented nodular adrenocortical disease (PPNAD), a disease which causes the adrenal glands to make too much cortisol. On April 8, 2003 (Harvey Cushing's birthday and Cushing's Awareness Day), ...

survive the journey - http://survivethejourney.blogspot.com/

Utility of Salivary Cortisol Measurements in Cushing's Syndrome and Adrenal Insufficiency

Hershel Raff PhD*

 

Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Milwaukee, WI 53215; Division of Endocrinology, Metabolism and Clinical Nutrition, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226

 

* To whom correspondence should be addressed. E-mail: hraff@mcw.edu.

 

Context. The measurement of cortisol in saliva is a simple, reproducible, and reliable test to evaluate the normal and disordered control of the hypothalamic-pituitary-adrenal (HPA) axis. There are a variety of simple methods to obtain saliva samples without stress, making this a robust test applicable to many different experimental and clinical situations.

 

Evidence Acquisition. Ovid Medline and PubMed from 1950 to present were searched using the following strategies: [<saliva or salivary>and<cortisol or hydrocortisone>and<Cushing or Cushing's>] and [<saliva or salivary>and<cortisol or hydrocortisone>and<adrenal insufficiency or hypoadrenalism or hypopituitarism or Addison's disease>]. The bibliographies of all relevant citations were evaluated for any additional appropriate citations.

 

Evidence Synthesis. Measurement of an elevated late-night (2300 h – midnight) salivary cortisol has a >90% sensitivity and specificity for the diagnosis of endogenous Cushing's syndrome. Late-night salivary cortisol measurements are also useful to monitor patients for remission and/or recurrence after pituitary surgery for Cushing's disease. Because it is a surrogate for plasma free cortisol, the measurement of salivary cortisol may be useful during an ACTH stimulation test in patients with increased plasma binding protein concentrations due to increased estrogen, or decreased plasma binding protein concentrations during critical illness. Most reference laboratories now offer salivary cortisol testing.

 

Conclusions. It is expected that the use of the measurement of salivary cortisol will become routine in the evaluation of patients with disorders of the HPA axis.

 

From http://jcem.endojournals.org/cgi/content/abstract/jc.2009-1166v1

Biopsy of adrenal masses

Posted by Thomas Repas, DO, FACP, FACE, CDE  July 6, 2009 11:52 AM

 

We received an urgent consult request this week to see a young woman with an adrenal mass.

 

She had rapid onset of weight gain, increased hunger, purple striae, increased abdominal girth and mood changes for the last three months. Her primary care provider was concerned but did not know what the explanation was. He ordered extensive testing without finding any obvious abnormality. Echocardiogram, thyroid and other laboratory studies were negative.

 

She had urinary retention and was sent to urology. Renal ultrasound was negative. The patient requested to have a CT which identified a heterogeneous 9.0-cm left adrenal mass. The patient subsequently underwent an adrenal biopsy. She tolerated the procedure well and without hemodynamic instability. However, the results were non-diagnostic. She was then sent to see me.

 

Expert guidelines advise against adrenal biopsy in the routine evaluation of adrenal masses. There are several reasons.

 

First, adrenal biopsy has not been shown to reliably distinguish between benign or malignant adrenocortical masses. If an adrenal mass is large and/or functional, then it should be resected. Adrenal biopsy does not change one’s management in either of those circumstances.

 

Second, there have been reports of adrenal carcinoma seeding along the biopsy needle track.

 

Finally, if a pheochromocytoma were inadvertently biopsied, the consequences could be catastrophic, even fatal.

 

The only situation where adrenal biopsy is useful is a patient with known or highly suspected other primary malignancy which may have metastasized to the adrenal.

 

Despite guidelines to the contrary, I continue to see adrenal masses biopsied prior to coming to see me. Often, as was the case with this woman, the adrenal biopsy occurs before biochemical evaluation has been completed. I have seen two cases with serious complications when the adrenal mass turned out to be pheochromocytoma. If I had been asked prior to the biopsy, I would have advised them not to do it and proceed with biochemical evaluation instead.

 

This woman clearly has Cushing’s syndrome. Her adrenocorticotropic hormone was undetectable, and her 24-hour urine-free cortisol was one of the highest I have ever seen: 1,095 ug/24 hours (upper limits of normal 45). There was no evidence of pheochromocytoma or hyperaldosteronism but dehydroepiandrosterone sulfate was elevated. The rapid onset of symptoms, large tumor size, imaging characteristics and evidence of secretion of more than one adrenal hormone concern me greatly for adrenocortical carcinoma. She will be undergoing surgical resection next week.

 

I know this is a recurring theme in my posts, but I will make this observation yet again: Why is it that the endocrinologist is so often the last subspecialist to see a patient, including the patient with obvious endocrine disease?

For more information:

• Mazzaglia PJ. Arch Surg. 2009;144(5):465-470.
• Mansmann G. Endocr Rev. 2004;25:309-340.
• NIH Statement on management of the clinically inapparent adrenal mass. 2002 Feb 4-6;19(2):1-23. http://consensus.nih.gov/2002/2002AdrenalIncidentalomasos021PDF.pdf

From http://www.endocrinetoday.com/comments.aspx?rid=41362

Froedtert, medical college open specialty clinic

Froedtert & The Medical College of Wisconsin have opened a new clinic specializing in endocrine and metabolic conditions such as diabetes, obesity and thyroid disorders.

 

The clinic, located in the St. Francis Medical Arts Pavilion, 2025 W. Oklahoma Ave., opened in April.

 

Medical College endocrinologists Dr. Bradley Javorsky and Dr. Ty Carroll practice at the clinic from 1 p.m. to 5 p.m. Wednesdays and 8 a.m. to noon Thursdays.

 

Both physicians treat medical conditions including adrenal and pituitary gland disorders, cholesterol and lipid issues, Cushing’s disease, diabetes, hypoglycemia, osteoporosis, polycystic ovarian syndrome, obesity, thyroid disorders and thyroid cancer.

“Endocrine and metabolic disorders are usually complex, chronic conditions that should be carefully managed,” said Dr. James Findling, a Medical College endocrinologist and professor who heads the college’s community division of endocrinology. “Our new clinic gives residents of Milwaukee’s southern communities easy access to this specialized expertise.”

 

From http://www.bizjournals.com/milwaukee/stories/2009/07/06/daily5.html

Adrenal Testing and Treatment

In the first two newsletters in this series, we discussed the following:
• The endocrine system and how it is composed of glands throughout the body that  release hormones (chemical messengers) into the bloodstream or the fluid surrounding cells. These hormones activate receptors and either alter the cell's existing proteins or instruct the cell in the building of new proteins that create actions in the body.

• The importance of the hypothalamus and the pituitary gland and how these two glands control the two adrenal glands--the HPA axis as it is called, and control the thyroid; 

• Each adrenal gland has two parts, the adrenal cortex and the adrenal medulla and the purpose of each;

• The symptoms of adrenal problems and how many of them are similar to symptoms created by problems in the thyroid and other endocrine glands;

• The primary purpose of the adrenal glands, and the entire endocrine system, is to keep the body in a balanced condition called homeostasis;

• The purpose of cortisol and the problems created when cortisol levels are too high or too low;

• How the adrenals can create hypoglycemia, where blood sugar levels are lower than normal;

• How the adrenals affect fatigue, insomnia and obesity;

• How the adrenals affect proper hydration of the body.

Here are links to the first two articles in the series. (http://media.novusdetox.com/dependence.php?include=139775, http://media.novusdetox.com/dependence.php?include=139840)

   In this newsletter we will look at the tests used to determine adrenal problems and the most common treatments.

TESTS
   If you go to most doctors and say that you are suffering from insomnia, fatigue, hypoglycemia, weight gain and other symptoms of adrenal problems and ask for an adrenal test, most doctors will likely tell you that you need to just take this or that pill and go on a diet.  This is always true of Radio Medicine Doctors because they just want to turn up the volume and drown out the symptoms and not treat the cause.
   If you persist and demand that they test your adrenals, then they likely will do tests to determine if you have Addison's disease or Cushing's syndrome—diseases where you either have the lowest or highest amounts of cortisol. 
   First, we will look at the worst cases of adrenal problems and then the more common adrenal problems that affect the majority of us to a greater or lesser extent.

ADDISON'S DISEASE
   Addison's disease occurs when the adrenal glands do not produce enough cortisol and, in some cases, aldosterone. This disease is also called adrenal insufficiency, hypoadrenia (“hypo”=low and “ism” =condition of) or hypocortisolism.
According to the National Institute of Health:
• Addison's disease affects about 1 in 100,000 people;

• Adrenal insufficiency occurs when at least 90 percent of the adrenal cortex has been destroyed and no cortisol is being produced.

ADDISON'S DISEASE TESTS
   Two of the common tests used to diagnose Addison's disease are:
• ACTH Stimulation Test - where ACTH is released by the pituitary gland to signal the adrenals to produce more cortisol.  The ACTH Test usually measures the levels of  blood cortisol, urine cortisol before and after a synthetic form of ACTH is given by injection.  If the adrenals are functioning properly, there is an increase in blood and urine cortisol levels and the amount of the increase tells doctors about the extent of the adrenal problem.
• CRH Stimulation Test - if the ACTH test is abnormal, a CRH (cortisol releasing hormone from the hypothalamus) stimulation test is used to determine the cause of adrenal insufficiency.  Synthetic CRH is injected intravenously and blood cortisol is measured before and 30, 60, 90, and 120 minutes after the injection. If there is no ACTH response, this indicates the problem may be the pituitary gland.  If there is a delayed ACTH response, the hypothalamus may be the cause.

ADDISON'S DISEASE TREATMENT
   Treatment of Addison's disease requires replacement of the missing cortisol or replacement of the missing aldosterone. 

CUSHING’S SYNDROME
   Cushing’s syndrome or hypercortisolism (“hyper”=high and “ism” =condition of) is diagnosed when there is a high level of cortisol for a long period of time.   According to the National Institute of Health, Cushing’s syndrome is relatively rare and most commonly affects:
• Adults aged 20 to 50;
• People who are obese and have type 2 diabetes.
   Because of the dangerous effects of elevated cortisol levels, this is why people who take prednisone (a synthetic form of cortisone that is used in the treatment of rheumatoid arthritis and other inflammatory diseases) or any other form of cortisol should carefully monitor their cortisol levels. 

CUSHING’S SYNDROME TESTS
   Some of the common tests used to diagnose Cushing’s syndrome are:
• 24-hour urinary free cortisol test where urine is collected over a 24 hour period and tested for cortisol;

• Measurement of midnight plasma cortisol where blood tests to show the level of cortisol at night (when it should be lower at midnight)

• Late-night salivary cortisol where a saliva test is used to determine the level of cortisol at night;

• Giving high or low doses of synthetic cortisol and then checking the urine to see  if there is a drop in blood and urine cortisol levels;

• CRH stimulation test described above.

Cushing’s Syndrome Treatment
   While the treatment will depend on the cause for the high cortisol levels, some of the traditional options are:
• Surgery;
• Radiation
• Chemotherapy;
• Cortisol-inhibiting drugs.

ADRENAL FATIGUE
   As we have learned, your adrenals can be causing problems but you do not have Addison's disease or Cushing's syndrome.  Therefore, if you don't have either disease, most doctors don't really address adrenal fatigue—where your adrenals are just not working properly. What if you are experiencing some or all of these symptoms:
• Fatigue
• Have trouble sleeping
• Anxiety
• Sudden weight gain
• Libido is lessened
• Salt cravings

THE SOLUTION--ALTERNATIVE MEDICINE DOCTORS
   As we have advised in previous newsletters, it is recommended that you find a doctor who will actually spend the time to find out the physiological cause of your symptoms and treat them.  Since the symptoms listed above can be caused by problems with other glands, the doctor will likely have you do a complete set of tests on your most important hormones. 

SALIVA CORTISOL TEST
   This test measures the cortisol levels at least four times during the day, because cortisol levels are supposed to be highest in the morning and start declining until about midnight and then start rising again.  The person uses a small tube to collect the saliva, marks the time and then at set times during the rest of the day and evening the person again spits in a new tube and marks the time.  If the person is feeling more fatigued at certain times of the day, then some doctors will also have the saliva test done when they feel fatigued.  The saliva samples are then sent to a lab and the cortisol levels for the testing period are shown. 
   Using this information, the doctor can then advise you as to whether you have adrenal fatigue.

TREATMENT OF ADRENAL FATIGUE
   While many doctors are quick to prescribe drugs to address any type of adrenal problem, most alternative medicine doctors will try to use a non-pharmaceutical approach.  Here are some of the things that are outlined in Adrenal Fatigue by Dr. James Wilson:
• Do relaxation exercises
• Adjust your sleeping hours
• Physical exercise
• Change your eating times and habits
   ◦ 40% raw or lightly cooked vegetables
   ◦ 30% whole grains
   ◦ 15% beans, seeds and nuts
   ◦ 10% animal foods
   ◦ 5% fruits
• Supplements
   ◦ Vitamin C
   ◦ Magnesium (particularly if you crave chocolate)
   ◦ Vitamin E
   ◦ B vitamins
   ◦ Calcium
   ◦ Fiber
   ◦ Certain herbs

DR. BRENT AGIN'S TREATMENT FOR ADRENAL FATIGUE
   Dr. Agin is  Novus Medical Detox Center's medical director.   In addition to advising on diet changes and on many of the things recommended by Dr. Wilson, Dr. Agin has developed injectable (intra-muscular) vitamins, minerals and herbs that will help provide the support that the adrenals need to recover.  Dr. Agin believes that injecting these supplements directly will ensure that more is actually converted and used by the body.  The following are the supplements that Dr. Agin's research has indicated are needed to help the adrenals recover:
Vitamin C – 2,000-4,000 mg per day (supports the adrenals and improves immune function)
B-Complex - which includes the following:
• B5 - (Pantothenic acid) 1,000-1,500 mg per day
• B6 -  50-100 mg daily
• B3 - 75-125 mg daily
• B12 - 200-400 mcg daily
Minerals:
• Chromium
Herbal support:
• Licorice Root   (not the candy!)- This is well known for supporting the adrenals. It has calming properties along with an ability to increase endurance and energy. It can be taken as a tea, capsule or liquid(in rare cases if large amounts are ingested it can increase the blood pressure).

• Ashwaganda Root- This is considered an adaptogen.  An adaptogen is an herb that  will help normalize cortisol levels. If there is too much cortisol, it will lower the level, if the level is too low, it will help to increase it.

• Siberian Ginseng- This root helps to uphold and revive adrenal function along with increasing the body’s resistance to stress and normalizing the metabolism. It has antidepressant properties and promotes calmness and a sense of well being.  It has  been shown to stimulate antibodies to help fight off viruses and harmful bacteria. It also aids in the absorption of B vitamins.  (This root usually helps to normalize blood pressure, but if someone has very high blood pressure, then it would still be best to avoid it.)

• Ginkgo- When the adrenals are under a lot of stress, there is an increase in the number of free radicals and if not neutralized, then there is increased risk to the immune system. Ginkgo is a powerful antioxidant along with other supplements that are believed to help counteract the free radicals.
   In some cases, Dr. Agin will prescribe additional injectable supplements.  The shots are painless and easy to give to yourself.  If you are interested in more data about Dr. Agin's injectable products, please email us.

CONCLUSION
   At Novus Medical Detox Center, we are very proud that we help people who have become dependent or addicted to substances like OxyContin, methadone, Vicodin, Percocet, heroin, and psychoactive drugs like Xanax and Zoloft and to people who have become addicted to alcohol. 
   Please call us if we can help someone that you know.
NOTE: This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine, health care diagnosis or treatment, or (iii) the creation of a physician patient or clinical relationship.  If you have or suspect that you have a medical problem or that this information may be useful to you or others, please consult with your health care provider before applying any information from our articles to your personal situation or to the personal situation of others.
FAIR USE NOTICE: This may contain copyrighted (C) material the use of which has not always been specifically authorized by the copyright owner. Such material is made available for educational purposes, to advance understanding of human rights, democracy, scientific, moral, ethical, and social justice issues, etc. It is believed that this constitutes a 'fair use' of any such copyrighted material as provided for in Title 17 U.S.C.
Section 107 of the US Copyright Law. This material is distributed without profit.

Technorati Tags: adrenal glands, endocrine system, fatigue, addison's disease, cushing's syndrome, cortisol,

From http://media.novusdetox.com/dependence.php?include=139924

Have an appointment with the doctor? Tips show what to ask

Good general info for anyone of any age, no matter what symptoms or disease you may have.

 

by John Beale

Good communication between patients and their health-care practitioners is essential for good care. To help older adults better communicate with their health-care providers, the American Geriatrics Society's Foundation for Health in Aging has released a new, easily understandable tip sheet.

 

The tip sheet, "How to Talk to Your Healthcare Practitioner: Tips on Improving Patient-Practitioner Communication," outlines steps older adults and their caregivers can take before, during and after a visit to a practitioner. These steps help ensure practitioners, older patients and their caregivers get the information they need. The tip sheet is available online at: http://www.healthinaging.org/public_education/communication_tips.php.

 

Before visiting a health-care provider, the tip sheet advises older people to, among other things, make a list of any symptoms or health problems they have, as well as past health problems, any treatments they've undergone and any adverse reactions to treatments they have had.

 

Bring medications

It also encourages older adults to put the medications, supplements and other remedies they're taking in a bag and bring it to their appointment. That way, their practitioner can see what they're taking and at what doses - important information, since medications may interact and some may affect medical test results.

 

The tip sheet also advises older adults who don't speak English as a first language to consider looking for a practitioner who speaks their native tongue, bring along a bilingual buddy to translate or call the office and request a translator ahead of time.

 

The tip sheet encourages older patients and their caregivers to answer all questions frankly, to request explanations when needed and to ask follow-up questions, such as "Are there any risks associated with this treatment?" and "Are there any alternative treatments?"

 

Understanding is vital

It also suggests patients and caregivers repeat back what their providers tell them about their health and treatments to ensure they've understood correctly.

 

After an appointment, the tip sheet advises older patients to contact their practitioner's office if they don't feel better, if they have an adverse reaction to a medication or other treatment or if they realize they've forgotten to mention something important that's relevant to their health.

 

Other easy-to-read health tip sheets for older adults and their caregivers cover such topics as cold and immunizations, falls prevention, emergency planning, and joint replacement surgery for older people.

 

Anyone who does not have online capability may call the Office for the Aging at 845-486-2555 for tip sheet copies.

 

From http://www.poughkeepsiejournal.com/article/20090629/COLUMNISTS06/906290301/1005/LIFE

~~~

How to Talk to Your Healthcare Practitioner: Tips on Improving Patient-Practitioner Communication

The list mentioned in the article from http://www.healthinaging.org/public_education/communication_tips.php

 

Good communication between you and your healthcare practitioners -- the physicians, nurse practitioners, nurses, physician assistants and other healthcare professionals you see -- is essential to good care.

 

It's important that you give your practitioner the information about yourself and your health that he or she needs to provide quality care. And it's important that he or she explain what you need to do to stay as healthy as possible, in a way that you understand.

 

Here's what experts with the American Geriatrics Society's Foundation for Health in Aging (FHA), suggest:

 

Before your appointment

Make a list Visiting a healthcare professional can be stressful -- particularly if you're not feeling well -- and stress can make it harder to remember what you need to tell and ask your practitioner. So make a list and bring it to your appointment. Write down any health problems you have had or do have, and any surgery or other treatments you've undergone. Write down the names of any medications you've taken that have caused unpleasant or dangerous side effects. If you're sick, write down all of your symptoms.

 

And don't forget to write down any questions about your health that you might have. You can find comprehensive lists of questions that older adults should consider asking their healthcare practitioners - organized by subject - on "Aging in the Know" (www.healthinaging.org/agingintheknow/questions_trial.asp), the FHA's free senior health website.

 

Bring your medications, vitamins, and other remedies to your appointment Before leaving for your visit, put all of the prescription drugs, over-the-counter medications, herbs, vitamins, and other supplements you take in a bag. Take them with you and show them to your healthcare practitioner. This way, he or she will know exactly what you're taking, when, and at what doses. This is important because some drugs, herbs and supplements can interact with medications your practitioner might prescribe. They might also affect the results of certain medical tests.

 

Pack paper Bring paper or a notebook to your appointment so you can write down what your healthcare professional tells you. If you have trouble remembering later on, you can look at your notes.

 

Consider asking a buddy along A family member or close friend who goes with you when you see your healthcare professional can offer your practitioner information that you might forget or overlook. He or she can also help you remember what your healthcare practitioner says. If you want to discuss something with your practitioner alone, you can always ask your relative or friend to leave the room while you do so.

 

Call ahead to request a translator if necessary If English is not your first language, you might seek out a healthcare practitioner who speaks your native language. Other options include bringing a bilingual buddy with you to your appointment, or calling your practitioner's office ahead of time and asking if staff can supply a translator.

 

During your appointment

Answer questions honestly It's essential that you answer all of the questions your healthcare practitioner asks you, even if he or she asks about topics that might make you uncomfortable, such as mental health problems, drinking, and sex. There's nothing to be embarrassed about. Your practitioner needs complete information to provide proper care. And everything you tell him or her is confidential.

 

Ask questions If you don't understand what your healthcare professional tells you during your visit, ask him or her to explain it. You need to -- and have a right to -- understand what your practitioner says. It's particularly important that you understand any treatments he or she recommends. You should ask if there are any risks associated with treatments, and if there are any alternatives.

 

Mention any cultural or religious traditions that might affect your care If your healthcare practitioner recommends that you eat foods that your religion prohibits, for example, or if you need to fast at certain time of the year, tell him or her.

 

Repeat back After your healthcare professional explains what you should do to stay healthy, or to treat a health problem, repeat this back to him or her using your own words. You might start by saying, "So, you're telling me that I should…." If you've misunderstood his or her advice, your practitioner will realize this, and clarify.

 

Ask for written instructions If your healthcare practitioner puts his or her advice in writing, you can refer to the written instructions at any time.

 

After your appointment

Call your practitioner's office if you don't feel better, have a bad reaction to medications, or realize you forgot to mention something If you don't feel better after your visit, or seem to be having a bad reaction to medication your healthcare professional prescribed, call his or her office immediately. You should also call if you realize, after leaving the office, that you neglected to ask a question or provide information about your health, or didn't understand what your healthcare practitioner said. Ask to speak with your practitioner as soon as he or she is available or ask to speak to another healthcare professional in the office who can help you.

 

Communication between you and your healthcare practitioner is an ongoing process. The simple tips above can help improve communication. Improved communication means better understanding, diagnosis and treatment.

Adrenal Alerts, June 10, 2009

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Adrenal: Cushings in the neonatal period occurs, but has not been reported past the first year. Some cases of neonatal Cushings resolve spontaneously 1. check adrenal reserve in resolved cases of neonatal Cushings ...
Lauren Our Brave Little Hero - http://laurenourbravelittlehero.blogspot.com/

 

Cushing's Moxie: Melissa's Battle with Cushing's Disease: JFK had ...
By Cushie Melissa
President John F. Kennedy suffered from Addison's disease, or adrenal insufficiency. The John F. Kennedy Presidential Library includes a four-page summary of his condition and how he handled it as he ran several campaigns. ...
Cushing's Moxie: Melissa's Battle... - http://cushingsmoxie.blogspot.com/

Addison's / Adrenal Alerts 2/15/2009

Cushing's & Cancer: Hair, Hair, Go Away!
By MaryO
Addison's Alert. 3 days ago. Repairing the Healthcare System · More Medicaid: Is This What We Want For Our Healthcare System?: Part 2. 4 days ago. Kidney Cancer Bloggers · 100000 Mile Overhall is now complete! 2 weeks ago ...
Cushing's & Cancer - http://cushingshelp.blogspot.com/

Happy Valentine's Day Leslie... ~ Should Have Seen It...
By Steve
It has brought me down. It has taken most of what I own. I am in debt. Yet, I still see the good in life. Take a look at life through my eyes. There is something wonderful to see everyday, if we stop to look. HOME; CUSHING'S; ADDISON'S ...
Should Have Seen It... - http://www.shouldhaveseenit.com/

Addison's Alert

Full Circle... ~ Should Have Seen It...
By Steve
I have been tested, diagnosed, treated and cured of Cushing's Disease. Addison's Disease now replaces the old because of the BLA. While I have come full circle, we know that Cushing's Disease took years to damage body and mind. ...
Should Have Seen It... - http://www.shouldhaveseenit.com/

Adrenal Alerts

Cushie Blogger: Adrenal, Cushing's Alerts
By MaryO
5 weeks ago. Addison's Help · Adrenal Alerts - Medical Blog » Blog Archive » Adrenal Crisis Too rapid withdrawal of exogenous steroid may precipitate adrenal crisis, or sudden stress may induce cortis... 2 hours ago ...
Cushie Blogger - http://cushie-blogger.blogspot.com/

Addison's Help: Adrenal Alerts
By MaryO
Cushing's & Cancer: Medical PBL: Examination of a Cushing's By MaryO. In 2006, I was also diagnosed with kidney cancer (renal cell carcinoma). My left kidney and adrenal gland were removed. Having an adrenal gland removed complicates my ...
Addison's Help - http://addisonshelp.blogspot.com/