November 8, 2006 Cushing's Help and Support/Newsletters

You eat for energy. You expend energy through work, exercise, and daily chores, burning off the calories you took in as you ate. Sometimes, you don't use enough energy to burn off all the food eaten in a day. What is left behind stays in the body, causing you to gain weight.

Weight gain is as simple as that...or so we are led to believe. While overeating is a major contributor to one's weight gain, other factors can play a role. With the many programs on the market for personalized weight loss, it is only a matter of determining which factors have led to your current size, and which products can help counteract the gain.

Let's take a look at other factors known to cause unhealthy weight gains.

Hypothyroidism

Hypothyroidism is defined by having an underactive thyroid. The thyroid is the gland located beneath the larynx (voice box) and secretes the hormones that regulate metabolism and growth. As an underactive thyroid produces less of this hormone as it would in a person with a normal thyroid, a person suffering hypothyroidism will also suffer from a low metabolism. This, in turn, may cause weight gain.

Food Allergies

Food allergies are defined as bodily reactions to the consumption of specific types of food. Symptoms may ranges from minor skin irritations to more serious medical emergencies.

Oftentimes, a person with a specific food allergy may crave that particular food when they stop eating it, not unlike a drug addict experiences withdrawl pains when trying to come clean. Falling off the wagon, so to speak, may strengthen the desire to eat more, thus causing weight gain.

Cushing's Syndrome

Cushing's syndrome is a hormonal disorder defined by the body's overproduction of the steroid cortisol. Cortisol regulates blood pressure, cardiovascular function, and the body's usage of proteins, carbohydrates, and fat stores. When the body experiences a great amount of physical or emotional stress, cortisol production increases. If you have ever wondered why you turn to the refrigerator in times of personal anxiety, it is because of this steroid. A condition like Cushing's Syndrome produces cortisol constantly, thereby increasing unecessary cravings and eventual weight gain.

Blood Sugar Imbalance

A diet consisting mainly of simple carbohydrates can lead to fluctuations in your body's blood sugar levels. As you eat things like potatoes and starches, and sweets like chocolate and pastries, your blood sugar levels rises. Your body will secrete insulin to store the sugar and stabilize these levels, but an overabundance of insulin can cause cravings for these same foods. The more bad carbs you eat, the more insulin is produced, continuing this cycle.

Hormonal and emotional imbalances in the body not only contribute to strong cravings for unhealthy foods, but may also factor into overall low metabolism. When energy is low, you are less likely to exercise and expend energy, causing a build-up of sugars and fats in your system.

Once you are able to pinpoint the reason for weight gain, you are armed with the knowledge to prevent it in the future. Whether you choose exercise, diet supplements, or another form of weight loss, consult your doctor before beginning any strenuous program.

# posted by lovingya4ever @ 1:06 AM Comments: Post a Comment

From http://www.medscape.com/viewarticle/547340

AAP Issues Guidelines for Menstrual Cycle Evaluation CME/CE

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

Complete author affiliations and disclosures, and other CME information, are available at the end of this activity.

Release Date: November 7, 2006; Valid for credit through November 7, 2007

Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians;
Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians;
Nurses - 0.3 nursing contact hours (None of these credits is in the area of pharmacology)

All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
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November 7, 2006 — Evaluation of the menstrual cycle is a viable tool to assess healthy development of teen girls' menstrual patterns, according to new guidelines published by the American Academy of Pediatrics (AAP) in the November issue of Pediatrics.

"Young patients and their parents often are unsure about what represents normal menstrual patterns, and clinicians also may be unsure about normal ranges for menstrual cycle length and amount and duration of flow through adolescence," write Jonathan D. Klein, MD, and colleagues from the AAP Committee on Adolescence and the American College of Obstetricians and Gynecologists (ACOG) Committee on Adolescent Health Care.

"It is important to be able to educate young patients and their parents regarding what to expect of a first period and about the range for normal cycle length of subsequent menses," the authors point out. "It is equally important for clinicians to have an understanding of bleeding patterns in girls and adolescents, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate young patients' conditions appropriately."

The committee recommends using the menstrual cycle as "an additional vital sign" to help evaluate normal development and exclude pathological conditions.

Characteristics of normal menstrual cycles in young women are median age at menarche of 12.43 years; mean cycle interval of 32.2 days in the first gynecologic year; typical menstrual cycle interval of 21 to 45 days; menstrual flow length of ≤ 7 days; and menstrual product use of 3 to 6 pads or tampons per day.

Causes of menstrual irregularity may include pregnancy; endocrine causes such as poorly controlled diabetes mellitus, polycystic ovary syndrome (PCOS), Cushing disease, thyroid dysfunction, premature ovarian failure, or late-onset congenital adrenal hyperplasia; acquired conditions such as stress-related hypothalamic dysfunction, medication use, exercise-induced amenorrhea, or eating disorders including anorexia and bulimia; and tumors including ovarian or adrenal tumors and prolactinomas.

The guidelines recommend that once menstruation begins, the menstrual cycle should be evaluated along with an assessment of other vital signs, thus emphasizing the important role of menstrual patterns in reflecting overall health status. This should include asking at every visit for the first date of the patient's last menstrual period.

Other useful measures may include asking the patient to begin to chart her menses, especially if the bleeding history is vague or thought to be inaccurate. Confirming normal internal and external genital anatomy with a pelvic examination or ultrasonography can rule out significant abnormalities.

Both the AAP and ACOG recommend preventive health visits during adolescence to facilitate communication, and to establish an environment in which a patient can take responsibility for her own reproductive health while being reassured that her concerns will be addressed in a confidential setting. These visits can also provide guidance to young women and their parents concerning normal adolescent physical development.

"Young females should understand that menstruation is a normal part of development and should be instructed on use of feminine products and on what is considered normal menstrual flow," the authors write. "Ideally, both parents and clinicians can participate in this educational process.... Girls who have been educated about early menstrual patterns will experience less anxiety as development progresses."

Menstrual periods that may require evaluation are those that have not started within 3 years of thelarche; have not started by 13 years of age in the absence of signs of pubertal development; have not started by 14 years of age accompanied by signs of hirsutism; have not started by 14 years of age with a history or examination suggestive of excessive exercise or eating disorder; have not started by 14 years of age with concerns about genital outflow tract obstruction or anomaly; have not started by 15 years of age; are regular, occurring monthly, and then become markedly irregular; occur more frequently than every 21 days or less frequently than every 45 days; occur 90 days apart even for a single cycle; last for 7 days; or require frequent pad or tampon changes (soaking more than 1 every 1-2 hours).

"Clinicians who are confident in their understanding of early menstrual bleeding patterns may convey information to their patients more frequently and with less prompting; girls who have been educated about menarche and early menstrual patterns will experience less anxiety when they occur," the authors conclude. "By including an evaluation of the menstrual cycle as an additional vital sign, clinicians reinforce its importance in assessing overall health status for both patients and parents. Just as abnormal blood pressure, heart rate, or respiratory rate may be key to the diagnosis of potentially serious health conditions, identification of abnormal menstrual patterns through adolescence may permit early identification of potential health concerns for adulthood."

Pediatrics. 2006;118:2245-2250.

Learning Objectives for This Educational Activity

Upon completion of this activity, participants will be able to:

Describe normal patterns of menstruation in adolescents.
List menstrual conditions requiring further evaluation in adolescents.

Clinical Context

According to the authors of the current study, knowledge of normal patterns of menstruation in adolescents is important for patient education and for identifying deviations from normal to guide clinical evaluation. Until the mid-1950s menarche had occurred at an increasingly younger age, but there has been no decline in the age of menarche in the past 40 to 50 years. According to the authors, age at menarche varies internationally, especially in less developed countries, and 2 large studies have confirmed that higher body mass index is associated with earlier onset of puberty. Age of menarche can also be associated with other factors such as environment, poverty, nutrition, and access to care.

This position statement of the AAP and ACOG committees on adolescent health care describes the use of the menstrual cycle as a vital sign in the care of adolescent women. Both organizations recommend that adolescent women receive routine health visits and take responsibility for their own reproductive health.

Study Highlights

In young women, the median age of menarche is 12.43 years, the mean cycle interval is 32.2 days in the first gynecologic year, menstrual cycle duration is typically 21 to 45 days, menstrual flow length is less than 7 days, and menstrual product use is 3 to 6 pads daily.
10% of women menstruate at 11.1 years, 90% by 13.8 years, and 98% by 15.0 years.
Age of menstruation for black women is earlier (12.05 years) than for Hispanic females (12.25 years) and non-Hispanic white females (12.55 years).
Menarche typically occurs 2 to 3 years after thelarche at Tanner stage IV breast development and correlates with age of onset of puberty and breast development.
During the early years of menarche, cycles may be long because of anovulation but 90% of cycles will be within the range of 21 to 45 days.
When age at menarche is younger than 12 years, 50% of cycles are ovulatory.
When age at menarche is older, it may take 8 to 10 years for the adolescent to become fully ovulatory.
By the third year after menarche, 60% to 80% of menstrual cycles are 21 to 45 days in duration as is typical of adults.
Normal cycle length is established around the sixth gynecologic year at a chronological age of approximately 19 years.
Primary amenorrhea has been defined as no menarche by 16 years.
Secondary amenorrhea is defined as absence of menses for 6 months but since the 95th percentile for cycle length is 90 days, the guidelines advise evaluation after 90 days of amenorrhea.
Irregular menses may be caused by pregnancy, endocrine disorders, PCOS, hyperprolactinemia, adrenal and ovarian tumors, drug effects, stress, significant weight loss, or substantial change in eating or sleep habits.
Mean blood loss per menstrual period is 30 mL and chronic blood loss of more than 80 mL is associated with anemia.
Most adolescent women report changing pads 3 to 6 times daily; flow requiring a change of pad every 1 to 2 hours is considered excessive.
Acute menorrhagia is most commonly associated with anovulation.
The most common hematologic problem causing acute menorrhagia is von Willebrand disease; other conditions such as hepatic failure and malignancy are less common. In the general population, the prevalence of von Willebrand disease is 1%, but as many as 1 in 6 girls presenting to the emergency department with acute menorrhagia may have von Willebrand disease.
Menstrual conditions that may require evaluation include the following:
- No menses within 3 years of thelarche.
- No menses by 13 years with no pubertal development.
- No menses by age 14 years with hirsutism.
- No menses by 14 years with excessive exercise or weight loss.
- No menses by 14 years with suggestion of genital tract obstruction.
- No menses by 15 years.
- Change from regular to irregular menses.
- Menses more frequently than every 21 days or less frequently than every 45 days.
- Menses 90 or more days apart.
- Menses lasting more than 7 days.
- Pad changes more than once very 1 to 2 hours.

Pearls for Practice

The median age of menarche is 12.43 years, mean menstrual cycle duration is 21 to 45 days, mean cycle interval is 32.2 days in the first gynecologic year, menstrual flow duration is less than 7 days, and menstrual product use is 3 to 6 pads daily.
Investigation of menses is recommended for menorrhagia, amenorrhea, and irregular menses in adolescent women with previously regular menses.

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Laurie Barclay, MD
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Desiree Lie, MD, MSEd
Clinical Professor of Family Medicine; Director, Division of Faculty Development, University of California, Irvine School of Medicine, Irvine, California

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Medscape Medical News 2006. ©2006 Medscape

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Adrenal:

From http://jcem.endojournals.org/cgi/content/abstract/91/11/4205

Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-1645

The Journal of Clinical Endocrinology & Metabolism Vol. 91, No. 11 4205-4214
Copyright © 2006 by The Endocrine Society

EXTENSIVE CLINICAL EXPERIENCE

Nonclassical 21-Hydroxylase Deficiency

Maria I. New

Department of Pediatrics, Mount Sinai School of Medicine, New York, New York 10029

Address all correspondence and requests for reprints to: Dr. Maria I. New, Director, Adrenal Steroid Disorders Program, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1198, New York, New York 10029. E-mail: maria.new@mssm.edu.

Context: Nonclassical congenital adrenal hyperplasia (CAH) owing to steroid 21-hydroxylase deficiency (NC21OHD) is the most frequent of all autosomal recessive genetic diseases, occurring in one in 100 persons in the heterogeneous New York City population.NC21OHD occurs with increased frequency in certain ethnic groups,such as Ashkenazi Jews, in whom one in 27 express the disease. NC21OHD is underdiagnosed in both male and female patients with hyperandrogenic symptoms because hormonal abnormalities in NC21OHD are only mild to moderate, not severe as in the classical form of CAH. Unlike classical CAH, NC21OHD is not associated with ambiguous genitalia of the newborn female.

Main Outcome Measures: The hyperandrogenic symptoms include advanced bone age, early pubic hair, precocious puberty, tall stature, and early arrest of growth in children; infertility, cystic acne, and short stature in both adult males and females; hirsutism, frontal balding, polycystic ovaries, and irregular menstrual periods in females; and testicular adrenal rest tissue in males.

Conclusions: The signs and symptoms of hyperandrogenism are reversed with dexamethasone treatment.

From http://www.dallasnews.com/sharedcontent/dws/fea/healthyliving2/
stories/DN-NSL_health_1029liv.ART.State.Edition1.3e8526f.html

We're human. We break.
And the doctors fixing us are only human, too
12:25 PM CST on Sunday, November 5, 2006
By EMILY L. HAUSER

I drove by it again today, the hospital where they saved my life.

Finding myself in its orbit, I felt once again (as I always do) that someone was walking over my grave, right then and there, as I waited for the light.

Two and a half years ago, I had what is misleadingly called an adrenalectomy – misleading because my adrenal gland wasn't the problem. It was the grapefruit-size tumor on top of it that had doctors in a tizzy.

I had a thing so rare that experts can't agree how rare it is. In medical circles, it makes me something of a celebrity, though: "Oh, you're the one with the pheo!"

My pheo (short for pheochromocytoma) had been growing for five to 10 years by the time it was discovered (hence the size). It had spent that time diligently pumping out a toxic elixir of hormones that my body neither needed nor wanted, no doubt causing the loss of libido I learned to live with, frequent sleep difficulties and a bout with what some doctors finally dubbed chronic fatigue syndrome, for lack of a better explanation.

It led to serious complications in the two pregnancies I carried to term, and it may have caused a miscarriage.

It certainly stood behind the hypertension headaches I got now and then, soul-crushing pain that would instantly, without warning, pin me to the ground, grind me up and then, many endless minutes later, spit me out. The pheo was diagnosed when, after a long absence, these headaches returned, 10 to a day.

Had it ruptured at any time, I likely would have died. In fact, undetected pheos often burst when the patient is having surgery for something else, such as the two C-sections I had to have because of what the pheo was doing to me. If it had ruptured as I was being sectioned, my babies could have died, too.

No fewer than seven doctors were consulted regarding the supposed chronic fatigue; the headaches were considered by five midwives and four doctors. Among the many diagnoses I received were: menstrual hormonal imbalance, reactive airway disease, mini-migraines, preeclampsia, and, my personal favorite, female stress (for which I was offered, as if in a time warp, tranquilizers). Not one of these professionals ever considered the possibility of a pheo.

There's an expression I've heard people in medicine use: "When you hear hoofbeats, think horses, not zebras." Look for reasonable explanations before you consider the crazy ones. Only, here's the thing: I was a zebra.

And I think this is why, two and a half years later, I still can't let it go. I'm fine, the surgery was a success, the tumor wasn't malignant (although I have a hard time considering it benign) and my babies and I are strong and healthy and happy.

But in a quiet corner of my heart, it feels as if my children and I brushed helplessly against our mortality. That I can't trust my body to send out decipherable signals, that I can't trust medical professionals to read them, that I can't know, can't possibly know, what godawful horror is cooking in my body.

Most days, I don't think about it much. I may pause as I catch a glimpse of the 11-inch scar that bisects me; I frequently bemoan the damage the surgery inflicted on my abdominal muscles. For the most part, though, there's work to do and little bodies to bathe, and life is really very sweet.

But when I drive past that hospital, where they took the damned tumor out, a desperate powerlessness and a deep sense of grief flood over and through me. I shudder as my hands grip the wheel. I strain to see the window from which I gazed at the road during my week of recovery. I often cry. I'm teaching my children to move through the world with a quiet faith in the benevolent nature of things, but I don't believe it.

I wonder whether survivors of humanity's many other bizarre and unexpected conditions feel like this, or whether they get over it. Whether they stop feeling somehow enveloped in bubble wrap, awaiting the next disaster. I begin to understand how some become defined by their freakish illnesses, launching national awareness campaigns as if their dance with death is anything more than a blip on the medical horizon. As if yelling about it will give them some control.

I can draw no sensible conclusions, have reached no understanding, other than the most banal: We are fragile, and doctors, it seems, are human. We fall apart, and they make mistakes.

I know that some people find freedom in these sorts of truths.

But, to me, as I draw alongside the site of my salvation, they feel like nothing so much as a prison. We are fragile, and I hate it.

Emily L. Hauser is a freelance writer living near Chicago.

E-mail healthyliving@dallasnews.com

Pituitary:

From http://www.marketwire.com/mw/release_html_b1?release_id=176989

Ambrilia Announces Positive Results of a Pivotal Human Pharmacokinetic Study of its New Prolonged Release Formulation of Octreotide

MONTREAL, QUEBEC -- (MARKET WIRE) -- 10/26/2006 -- Ambrilia Biopharma Inc. (TSX: AMB), a biopharmaceutical company developing innovative therapeutics in the fields of oncology and infectious diseases, announced today positive results of a pivotal pharmacokinetic (PK) study of its lead specialty generic, Octreotide, for the treatment of acromegaly.

The data generated in a controlled study in healthy volunteers performed in a FDA (U.S. Food and Drug Administration) approved clinical centre show that Ambrilia's formulation has a bioavailability which is superior to that of Sandostatin LAR® at the same dose. Sandostatin LAR®'s data sheet recommends injections of the product every four weeks. Ambrilia's product bioavailability will allow for longer time intervals between injections, which could improve patient compliance, and reduce the discomfort and costs associated with injections. In addition, the study supports the better stability and ease of use of Ambrilia's patented formulation, as compared to Sandostatin LAR®.

"We are very happy to report these positive PK results for our lead specialty generic Octreotide as this represents a significant event in its development program," said Hans J. Mader, President and Chief Executive Officer of Ambrilia. "This allows us to advance Octreotide's program as planned with the initiation of the clinical studies in acromegaly patients before year end," he concluded.

This PK study will be part of the international file designed to obtain registration of Ambrilia's Octreotide worldwide. The Company is currently setting up small clinical studies of its formulation in acromegalics, as scheduled in the development plan of the product. Completion of these studies is expected sometime around mid 2007. Filing for approval in Europe and then North America by Ambrilia's licensees will follow shortly thereafter.

ABOUT OCTREOTIDE, SANDOSTATIN®LAR AND ACROMEGALY

Ambrilia's lead specialty generic is a prolonged release formulation of Octreotide. The original product is commercialized as Sandostatin®LAR (octreotide acetate for injectable suspension, a registered trademark of Novartis Pharmaceuticals Corporation) and is owned by Novartis. Octreotide is used for the treatment of a rare disease called acromegaly caused by a tumor of the pituitary gland, and for certain rare digestive tumors.

Acromegaly is a rare and serious chronic condition related to a permanent hypersecretion of growth hormone (GH) by the pituitary gland, generally of tumoral origin. This causes an excessive production of Insulin-like Growth Factor 1 (IGF-1), a hormone secreted from the liver and other tissues. Excessive production of IGF-1 and GH translates into uncontrolled growth of various organs, and debilitating symptoms. Control of the GH and IGF-1 levels by Sandostatin® LAR results in normalizing such excessive growth and symptoms. Medical treatment has an important role to play in the management of patients with acromegaly. It is a life long treatment, with few, mild side effects.

ABOUT AMBRILIA BIOPHARMA

Ambrilia Biopharma Inc. (TSX: AMB) is a biopharmaceutical company developing innovative and proprietary early- to mid-stage therapeutics in the fields of oncology and infectious diseases. Ambrilia's product portfolio includes an anti-cancer therapeutic peptide (PCK3145), a novel anti-cancer therapy (TVT-Dox), two oncology specialty generics (Octreotide, Goserelin), the first of which is late-stage and value-added, and promising anti-HIV treatments (PPL-100, Anti-HIV Peptides, Integrase Inhibitor Program). Exclusive worldwide rights to PPL-100 and its related compounds have been granted to Merck & Co., Inc. in return for milestone payments that could total up to $US 232 million. Ambrilia's head office, research and development and manufacturing facilities are located in Montreal with a regional office in France. For more information, please visit the Company's web site: www.ambrilia.com

Ambrilia's forward-looking statements

This press release contains forward-looking statements that reflect the Company's current expectation regarding future events. The forward-looking statements involve risks and uncertainties. Actual events could differ materially from those projected herein and depend on a number of factors including, but not limited to, changing market conditions, successful and timely completion of clinical studies, uncertainties related to the regulatory approval process, establishment of corporate alliances and other risks detailed from time to time in the Company's filings. Such statements are also based on various assumptions, including the successful and timely completion of clinical studies on Ambrilia's products demonstrating efficacy and safety for human use, their successful commercialization within the forecasted timelines and the attainment of the forecasted milestone payments and other revenues. While Ambrilia anticipates that subsequent events and developments may cause Ambrilia's views to change, Ambrilia specifically disclaims any obligation to update these forward-looking statements.

General Health:

From http://www.keepmecurrent.com/Business/story.cfm?storyID=26537

Endocrinology clinic coming to Bridgton (Maine) Hospital
By Bridgton Hospital

BRIDGTON (Oct 27, 2006): The clinics at Bridgton Hospital will welcome an endocrinology specialist, Maylene Claire I. Peralta, for local patients, beginning Nov. 10. The clinic will be offered the second Friday of each month, from 9 a.m.–3 p.m.

Peralta is a member of Central Maine Endocrinology, which provides specialty care for patients 15 years of age or older who are living with such health issues as diabetes, thyroid disease, cholesterol disorders, pituitary disease, reproductive disorders, adrenal tumors, hyperparathyroidism, obesity, and metabolic bone disorders, including osteoporosis.

A graduate of the University of the Philippines in Quezon City, Philippines, she earned her medical degree from the University of the Philippines College of Medicine in Manila. She completed an internship at the University of the Philippines-Philippine General Hospital in Manila, and served an internship and residency in internal medicine at the State University of New York Health Science Center at Brooklyn.

In 2002 she completed a fellowship in endocrinology and metabolism at Loyola University Chicago Medical Center in Maywood, Ill. She has authored and published articles on diabetes, thyroid and bone disorders, and has presented research abstracts at various professional meetings.

Peralta is certified in endocrinology and metabolism by the American Board of Internal Medicine, and is a member of the American Association of Clinical Endocrinologists and The Endocrine Society.

Appointments for the Bridgton Hospital clinic can be scheduled by calling 795-7520.

http://apnews1.iwon.com//article/20061028/D8L1T9500.html

From Ethics Rules Send NIH Scientists Packing
Oct 28, 6:06 PM (ET)

By RITA BEAMISH

(AP) National Institute of Health Director Ellias Zerhouni appears before the Senate Appropriations...

Nearly 40 percent of the scientists conducting hands-on research at the National Institutes of Health say they are looking for other jobs or are considering doing so to escape new ethics rules that have curtailed their opportunity to earn outside income.

Most scientists say the ethics crackdown is too severe, and nearly three-quarters of them believe it will hinder the government's ability to attract and keep medical researchers, according to a survey commissioned by the government's premier medical research agency.

The tightened rules were put in place last year after NIH found dozens of scientists had run afoul of existing restrictions on private consulting deals that had enriched them with money from drug and biotechnology companies.

Outside income from such companies is now banned. NIH also is placing greater restrictions and disclosure requirements on employees' financial holdings.

"Of course we are concerned when any employees are saying they might consider leaving as a result of a change of policy," said Dr. Raynard Kington, the agency's principal deputy director. But he said in a telephone interview Friday that the survey results are muddy because they combine both those actively seeking to leave and those thinking about it.

NIH Director Elias Zerhouni, in a letter Thursday to the staff, said the survey "does suggest concerns about the impact of the regulations on recruitment and retention." But he added, "At this time we do not anticipate revisions in the regulations."

About 8,000 NIH employees, or about half the work force, responded to the Internet-based survey.

Employee job satisfaction was high overall, the survey found. But 39 percent of the scientists researching disease and cures - known as tenure and tenure-track scientists - said they actively were seeking new work or considering leaving NIH because of the rules.

Overall, 3,336 NIH scientists responded to the survey, including 512 tenure and tenure-track researchers.

Among all NIH scientists, only 18 percent said they were trying to leave or considering it. Those who are not in the tenure group typically do not conduct research themselves and instead manage outside research conducted with NIH money by universities and other nonfederal entities. They are less likely to have private consulting opportunities.

One-third of all NIH scientists said they believed the new rules will hurt NIH's ability to fulfill its mission, and most said the old rules could have been enforced better rather than tightened.

NIH officials said they now want to question former and potential employees to see how the changes influenced their decisions.

Kington highlighted a finding that nearly nine in 10 scientists reported they still intend to work at NIH a year from now. Despite rumblings of low morale, he said the scientists' job satisfaction rate of 81 percent reflects one of the government's most positive work forces.

Officials also emphasized employees' belief that the new rules will boost the agency's credibility with the public. Seventy-three percent of the employees who responded agreed with that, the survey found.

"We have to monitor closely and we'll continue do that, and if we show through our evaluations objective evidence of an impact on our ability to recruit and retain the smartest staff, scientific and nonscientific, that we can, then we will be the first ones to make the case for modifying the rules, but we're not there yet," Kington said.

One NIH administrator who left over the ethics rules said the agency's changes were handled poorly.

"Dedicated public servants were harassed right out of NIH. That's a disservice to us all," said Edward Maibach, the former associate director of the biggest NIH component, the National Cancer Institute. He is now director of Public Health Communication at the George Washington University. Maibach said he left the NCI nearly two years ago because new financial disclosure requirements invaded his privacy.

The changes are "a dramatic backlash," to earlier policies encouraging outside work by NIH scientists to speed practical application of scientific advances, he said.

Arthur Caplan, medical ethics chairman at the University of Pennsylvania, said tighter rules were needed but "we still haven't figured out exactly how to manage conflict of interest."

"To have a large number of the senior scientists unhappy spells trouble. You don't want them to retire or leave," he said.

"The leaders of the NIH and in Congress have to think a bit harder about giving a tiny bit of breathing room so that NIH scientists are not sent into a monastery from which they can't ever come out in the name of scientific integrity."

---

On the Web:

NIH survey: http://www.nih.gov/about/ethics/evaluationslides.pdf

Memo on survey results: http://www.nih.gov/about/ethics/10262006COImemo.htm

New Feature! Add your Helpful Hints for Dealing with Cushing's to the website and the email Newsletters.

Newest Bios:
To add or edit your bio, http://cushings-info.com/tinc?key=ryQTnONX&formname=Bio
Ectopic Patients
Lisa G	Lisa G had ectopic Cushing's caused by a lung tumor. She had surgery in September, 1987 but her symptoms are back now. She has now been diagnosed with an Ectopic tumor. She had a BLA in Sept 2005.	Vancouver. WA
Not Yet Diagnosed Patients
Cassie (Cassie)	After Cassie broke her leg she was given prednisone. She had also been taking Depakote as a mood stabilizer. Her last thyroid test came back with unusual results so she is seeing an endocrinologist.	Ashtabula, OH
Tina	Tina has had cancer of the uterus but it was caught early. She had an hysterectomy in 2003 and a Mini Stroke in 2004.	Lebanon, PA
Traci	Traci is not yet diagnosed but has many Cushing's symptoms	Canonsburg, PA
Pituitary Patients
Cathy (CATHY)	Cathy had a large pituitary tumor removed 8 months ago. She still has several problems post-op, like memory loss and vision problems. She wonders if this is normal after surgery.	Vancouver Island, British Columbia, Canada
Cathy Tia	Cathy had the left side of her pituitary gland removed and a BLA. Cathy has been through 2 cycles of IVF fertility treatment and the second one worked. She had a baby girl.	New Zealand
Elise (Elise T)	Elise has had hormone problems since puberty. An MRI was done which showed a 3x5x5 mm micro adenoma on her pituitary gland. She has also been diagnosed with PCOS and Raynaud's Phenomenon.	Dallas, TX
Erella G	Erella had her second transphenoidal surgery in 2004 for a pituitary tumour, in Toronto. The CBC did a one hour documentary about her first surgery. She is wondering about some of her symptoms and whether anyone else had something similar occur.	Toronto, Canada
Jessica	Jessica finished her nursing program in 2002. She was recently diagnosed with pituitary Cushing's but they have not yet found the tumor. She hopes to have surgery soon.	Cathedral City/Palm Springs CA
Lovisa (Lovisa)	Lovisa had pituitary surgery last year. It took her eight years to find out that she had Cushing's. During her college years, she learned that she suffered from PCOS.	Sweden
MaryO	MaryO updated her bio after her most recent endo visit	Fairfax, VA
Sherry C	Sherry C is now diagnosed. Her first pituitary surgery was March 23, 2006. Her second pituitary surgery, did not work and she is now scheduled for a BLA November 7, 2006	Silverton, OR
To add or edit your bio, http://cushings-info.com/tinc?key=ryQTnONX&formname=Bio

Newest Helpful Doctors:
To add your helpful doctor, http://cushings-info.com/tinc?key=ryQTnONX&formname=Doctors

• If you've been diagnosed with Cushing's, please participate in the Cushing's Register

The information you provide will be used to create a register and will be shared with the medical world. It would not be used for other purposes without your expressed permission. Note: This information will not be sold or shared with other companies.

Lynne Clemens, President of CUSH Org is be the person responsible for the creation of this register. You do not have to be a member of CUSH to fill out this questionnaire, as long as you are a Cushing’s patient. We do not believe that the world has an accurate accounting of Cushing’s patients. The only way to authenticate accuracy is with actual numbers. Your help will be appreciated. Thank you.

Fundraising:

The Cushing's Store

for all kinds of Cushing's Labeled clothing, US Postage Stamps, coffee mugs, totebags and much more. Great for your endo or Secret Someone.

Order Cushing's Awareness Wrist Bands here.

Remember iGive.com...

... all year round.

iGive.com allows online stores to donate a percentage of their profit to running these Cushing's Support sites: the message boards at http://cushings.invisionzone.com/index.php, http://www.cushings-help.com, http://www.CUSH.org, http://www.cushings-support.com and http://www.cushingsonline.com.

See the list of participating merchants

===> FREE $5 DONATIONS! <===
Each new member who joins iGive
and shops will earn an additional $5 for the Cushing's Support sites! That's on
top of the standard donations from shopping (up to 26%
of each purchase benefits Cushing's Help and Support!).
Only one hitch: supporters must shop within 45 days of joining to get
the bonus. With over 600 stores now at iGive.com, we have
something for everyone!

Thank you so much for your support.

Upcoming Conventions, Meetings and Seminars:

November 18, 2006, Australian Pituitary Foundation, Seminar at St. Vincents Hospital, Melbourne, Australia, Time 1.00pm-4.00pm

If you wish to attend RSVP: by the 13th November to pituitary@bigpond.com.au
attention: Catherine Wormald. More info on the message boards

December Dec 13, 2006, Pittsburg, PA, More info on the message boards

December Dec 13, 2006, UCLA Bi-monthly Pituitary Patient Support Group, more info and directions here

December 7-10, 2006, "December in the Desert 2006" Conference, Rancho Mirage, California.
More info here

June 2-5, 2007, ENDO 2007, Toronto, Canada, Metro Toronto Center. More info as it becomes available.

More upcoming local meetings are listed here

Online Chats:

Please join us in the Chat Room TONIGHT at 9 PM Eastern. Click to access through the message boards

If you are not yet a member of the message boards, please use this page: http://cushings.invisionzone.com/chatroom.htm

This room is always open, and has convenient links so that you can get needed information while you're chatting.

I hope to see you tonight!

Expression of Serotonin₇ Receptor and Coupling of Ectopic Receptors to Protein Kinase A and Ionic Currents in Adrenocorticotropin-Independent Macronodular Adrenal Hyperplasia Causing Cushing’s Syndrome

Tuesday, November 07, 2006

What Causes Weight Gain

Credits Available

Learning Objectives for This Educational Activity

Clinical Context

Study Highlights

Pearls for Practice

Instructions for Participation and Credit

Target Audience

Goal

Accreditation Statements

Authors and Disclosures

News Author

CME Author

Nonclassical 21-Hydroxylase Deficiency

Expression of Serotonin7 Receptor and Coupling of Ectopic Receptors to Protein Kinase A and Ionic Currents in Adrenocorticotropin-Independent Macronodular Adrenal Hyperplasia Causing Cushing’s Syndrome

Tuesday, November 07, 2006

What Causes Weight Gain

Credits Available

Learning Objectives for This Educational Activity

Clinical Context

Study Highlights

Pearls for Practice

Instructions for Participation and Credit

Target Audience

Goal

Accreditation Statements

Authors and Disclosures

News Author

CME Author

Nonclassical 21-Hydroxylase Deficiency

Expression of Serotonin₇ Receptor and Coupling of Ectopic Receptors to Protein Kinase A and Ionic Currents in Adrenocorticotropin-Independent Macronodular Adrenal Hyperplasia Causing Cushing’s Syndrome