February 21, 2007

In This Issue

Search the website:

Cushing's:
• Samaritan Pharma Aims At SP-6300 as New Innovative Treatment for Cushing's Syndrome
• Increased insulin-stimulated endothelin-1 release is a distinct vascular phenotype distinguishing Cushing's disease from metabolic syndrome
• Cushing's disease victim needs help for operation

Adrenal:
• Cognitive Functions in Children at Risk for Congenital Adrenal Hyperplasia Treated Prenatally with Dexamethasone
• Phoqus gets positive opinion from EU approval body for Chronocort endocrine drug (for treatment of congenital adrenal hyperplasia)
• Vaccine research continues physician's legacy

Pituitary:
• Pa study: Nose brain surgery OK for kids
• (singer Russell Watson) ‘You have a brain tumour,’ the doctor told me. ‘Quite a big one’
• Empty Sella
• Antipituitary Antibodies against Gonadotropin-Secreting Cells in Adult Male Patients with Apparently Idiopathic Hypogonadotropic Hypogonadism
• HESX1 Mutations Are an Uncommon Cause of Septooptic Dysplasia and Hypopituitarism

Cortisone / Cortisol:
• FOLLOW YOUR NOSE?
• Extra Cortisol Protects Women's Mood Under Stress
• Stress May Cause Excess Abdominal Fat In Otherwise Slender Women, Study Conducted At Yale Shows

General Health
• Unwanted hair in women
• Better act fast to minimize appearance of stretch marks
US Postage Stamps for Cushing's Awareness
Order Cushing's Awareness Silicone Bands for yourself, a family member or donate to a Cushing's patient at NIH
Upcoming Meetings: Washington, DC and Toronto ENDO 2007.


Also on the website:

Pictures from Past Meetings:
April 8, 2007, Petitions on the message boards to have April 8 be declared as Cushing's Awareness Day again this year. This date was chosen because it was Dr. Harvey Cushing's Birthday. More info here »

Pictures from the Pittsburgh, PA Christmas Dinner, December 13, 2006
Click here »

Pictures from the April 5-8, 2006 CUSH Cushing's Awareness Day Medical Forum, held in Oklahoma City, OK
Click here »

Upcoming Meetings:
June 2-5, 2007, ENDO 2007, Toronto, Canada, Metro Toronto Center.

Recent Donations:

click for fullsize graph

• In honor of:
   Dr. Jennifer Pecina
Other donors
To make a donation
Donations cover...

News:
Dr. Theodore Friedman from Charles R. Drew University, Division of Endocrinology is currently seeking patients to participate in a research study of pituitary dysfunction. More info.
• The message boards now number over 5,800 participants.
Search Tool. Use this tool to search this site, PubMed, NIH Clinical Trials or any other website. More sites to be added soon.
CUSH Cuisine! $10.00 each, including shipping.
More info »
Guest Transcripts »

Latest Media:

Sam who has been on The Mystery Diagnosis TV Show (Discovery Health) has been invited to appear on Dr. Phil taping possibly as soon as Thursday January 25th. More info as it becomes available.
Helpful Books (pituitary):
Art Russell shares the powerful story of his struggle with Cushing's Disease.
October 18, 2006 Obese from Secret Disease (ABC News) (Jaimie on the boards) Read this article »
Jun 17, 2006 Student hopes to rebound from brain surgery Rare disease caused teen to double weight in a year Read this article »
May 21, 2006 Rare disease treated at OHSU (sowens on the boards) Read this article »
May 15, 2006 Patients Fighting Cushings Disease (Rooon on the boards)
Read this article »
MedScape News

Newest Site Features:
Read the Current Newsletter »
Packing Suggestions For Surgery
Talk to Your Doctor
New Diabetes Drug Successfully Used to Treat Pituitary Tumors
New Approaches to Managing Tumors of the Pituitary Gland Offer Patients Hope.
Corticosteroid Converter.
More info on Adrenal Crisis.
Helpful Hints for dealing with Cushing's Symptoms. The first ones are here.
Add your Helpful Hints
US Cushing's Postage Stamps to promote Cushing's Awareness. See a sample here.
Cushing's Bracelets to promote Cushing's Awareness. Order the bands here.
Reviews of this site

Testing:
Midnight Salivary Cortisol Versus Urinary Free and Midnight Serum Cortisol

Videos and Webcasts:
Video: Transnasal Pituitary Surgery
Webcasts from NIH Pituitary Symposium and Endo 2004.
Videos on several topics of interest to Cushing's Patients:
Jaimie and others from the message boards on TV
• Transsphenoidal Pituitary Surgery
• Laparoscopic Bilateral Adrenalectomy (BLA)
• Transsphenoidal Pituitary Surgery
A Young Woman's Battle with a Hidden Enemy: Cushing's Disease
Top Five Webcast feature updates twice daily and highlights the most popular webcasts viewed each day.
New pages and updates

Doctors and Hospitals:
The US Helpful Hospitals list has been updated

Helpful Doctors:

New Doctors added to
US:
Riviera Beach, FL
Atlanta, GA
East Setauket, NY
Erie, PA
Astoria, OR
Portland, OR
Boston, MA
Norwalk, CT

International:
Montréal, Canada
Toronto, Ontario, Canada
Lucknow, India
Moorooka, Queensland, Australia
Budapest, Hungary

Doctors updated:
Dr. Roberto Salvatori, Johns Hopkins, Baltimore, MD
Dr William Ludlam has moved to Seattle, WA from Portland, OR.
More info here
Dr. James Neifing, Portland, OR

Newest Bios:
Add or Update your bio here
Newest bios,
listed by type of Cushing's
Eleanor
Brenda P
Kassylake
Richard's wife
Molly P
Donna
Mary P
Emily
Gerson
Denisse
Yvonne K
Jennifer I
Mari
Susan
Cathy R
Sheila Mary
Lori

Updated Bios:
Newly updated bios, listed by type of Cushing's
Judi
Ann
Elise
Jessica M
Ferol V
MaryO
Tricia Francis
Tracie

In Memory
Sue Ann Koziol (SuziQ),
CUSH Founding President

Sue was a very special friend to Cushies world-wide. We will remember her always.

• To light a candle or post a tribute for Sue, please click here »

• To read more about Sue's journey, please click here »

[Content]
Welcome to the Cushing's Help and Support Newsletters!

If it appears that the entire newsletter is not here, or you prefer to read the HTML version of this newsletter on the Internet, it is available here: http://www.cushingsonline.com/newsletters/2-21-2007.htm.

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Cushing's Awareness Day! April 8, 2007


What Can *YOU* Do to help?

Sign Amber's Petition. www.ipetitions.com/petition/CushingsDiseaseAwareness

Amber writes:
Thought I would explain what this petition can do....

First of all, it adds power and substance to our efforts to have a Nationally recognized day if we have an extensive, following.

Second, this petition and all the signatures can be printed and sent to a Senator, politician, or medical professional that may be will to take on the cause.

Third, this petition and its list of signatures are IDEAL for releasing to the press and media for coverage and will assist GREATLY in getting the word out there.

It is so simple. The petition has a place to add your name and a comment if you want. PLEASE take a moment to sign and formward it on to all the people in your address book, your friends and family.

We all get forwarded messages all the time, but this one is dear to our hearts and can make a differnce! WHATS STOPPING YOU!?

PLEASE SUPPORT OUT EFFORTS TO RAISE AWARENESS! YOUR HELP IS NEEDED AND IT IS SO EASY!

CherylF, CUSH Vice President suggests:
I contacted Senator Inhofe's (OK) office recently, and he is happy to reintroduce the Cushings Awareness Day Resolution for April 8, 2007.

Please contact your US Senator's office and ask them to support this Resolution. I'm not sure when Senator Inhofe will try and contact other senators but if you send a letter soon, and call your senator to let him know your letter is coming, and that Senator Inhofe is going to reintroduce the Resolution, it will truly help.

Last year the Resolution was introduced, but to my understanding, only one senator-another from Oklahoma was the only one to contact Senator Inhofe's (Okla) office to co-sponsor the Resolution.

If you send a letter requesting it, you might also request that a reply be sent back to you . Please try to send the letter in the next two weeks if possible.

Last year we had a small Conference in OKC celebrating the passing of the Resolution, and there is some information on that conference on the CUSH website (CUSH.org) , and I believe on this one as well. We won't be having a specific conference in OKC, but ask that you bring awareness in your own states, communities as you can. Last year a TV station in OKC aired a small segment about the conference & Cushings Awareness Day, as did one in Nebraska- with Autumn as the contact person.

As the OK CUSH rep as well, I might have something for those around the OK area, a small get together if anyone is interested...more like a dinner or luncheon so we can visit each other. You can always contact me for more info if you'd like...together we can make a difference!

cheryl1957ann@sbcglobal.net
Thank you in advance, Cheryl Farrar- CUSH Vice President

Contact your Senator Print out a sample letter to send to your congress person or senator or download it in Word format.

More information here

Follow Jayne's Lead. She writes:

Of course, I'll be supporting the day and writing letters and emails and making phone calls. I hope to find us a celebrity ribbon wearer. Something else I am working on is national TV recognition with the major networks and National publications. You can email them as well on their "contact us" info. Contact the hosts of the show and the producers to mention April 8th and Cushing's Awareness.

I am going to find out information on getting money (grant) to publish magazine adds/articles for the April editions, if not this year then for next year. I know they are probably being printed, but I just thought of this idea. My local paper will run a small 2x3 ad for starting at $300. I want the whole page! I thought about having a yard sale to raise money to put in an ad, but doubt that I'd make enough. Oh Well!

Something else I thought about is getting a chain pharmacy to post cushings info for that week prior to the 8th. Medical school journal/papers can also be contacted. I know I must have emails over 100 doctors last year on the 7th (once I know that it had passed). I'll be setting up a booth at the women's Forum again this year. I hope to set up at some health expo's and at the local Hospital or at least make/pass out flyers.

US Cushing's Postage Stamps to promote Cushing's Awareness. See a sample here.

• Wear Cushing's Bracelets or T-Shirts to promote Cushing's Awareness. Order the bands here.. Cushing's Awareness T-Shirts and other products are available here: Cushie GiftStore.

Post your ideas and what you have done here: http://cushings.invisionzone.com/index.php?showtopic=19173


Last year:

For Immediate Release:                                                                   

                    April 6, 2006                                                                                                          

INHOFE DESIGNATES ‘NATIONAL
CUSHING’S SYNDROME AWARENESS DAY

More info here »


April 8, 2006, the Cushing's Understanding, Support & Help Organization (CUSH) petitioned in the USA to have April 8 be declared as Cushing's Awareness Day. This date was chosen because it was Dr. Harvey Cushing's Birthday. More info here »


The Cushing's Awareness Day Proclamation, from http://thomas.loc.gov/cgi-bin/query/z?c109:S.RES.423:

Designating April 8, 2006, as `National Cushing's Syndrome Awareness Day'. (Agreed to by Senate)

More info here »

CUSH Cookbooks are here!

The CUSH Cookbooks are only $10.00 each including shipping and handling.

Any profits will go to help bring awareness for Cushings. Thank you!

The cookbooks have about 169 recipes, so it isn't a huge cookbook, but one that includes contributions from many Cushing's message board members.

To purchase a cookbook send a check to:
CUSH
PO Box 1843
Florence, AL.
35631-1843

please indicate on your check "Cookbook" or include a note with payment.

You can also purchase cookbooks through Paypal. Please indicate that the payment is for "cookbook."

 

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Be sure that your correct mailing address is included with payment along with a contact phone number in case we have questions concerning your order.

If anyone has any questions concerning cookbook payments please contact CUSH Treasurer Cathy Gifford at CUSHOrg@aol.com

Dr. Theodore Friedman from Charles R. Drew University, Division of Endocrinology is currently seeking patients to participate in a research study of pituitary dysfunction. More info.


Updated Pages on the Website:

Testimonials http://www.cushings-help.com/testimonials.htm

I just want to say 'thank you' to all of you who have been there for me through my journey and all of you that are new and yet to arrive here...you are all very special, and don't forget it. As I have always said and always will Mary created an environment where we can share and feel empowered during this illness wub.gif ...I was very lucky when I stumbled on to a web site and found some of the very best friends in the World.
News Items:

Media:

• Sam who has been on The Mystery Diagnosis TV Show (Discovery Health) has been invited to appear on Dr. Phil taping soon. More info as it becomes available.


Cushing's:

• From http://www.samaritanpharma.com/news_02-06-07_Samaritan_Pharma_Aims_At_SP-
6300_as_New_Innovative_Treatment_for_Cushings_Syndrome.asp


Samaritan Pharma Aims At SP-6300 as New Innovative Treatment for Cushing's Syndrome
Tuesday February 6, 2007

* Files New Patent Application for SP-6300 Making Use of SP-01A's Phase II Study Data
* Drug SP-01A (HIV), SP-6300 (Cushing's) Demonstrates a Statistically Significant Ability to Normalize High Cortisol in Humans
* High Cortisol Cushing's is Caused by a Long-Term Use of Corticosteroid Medications (Normally Administered to Lupus, Asthma, and Rheumatoid Arthritis Patients)

Samaritan Pharmaceuticals Inc. (AMEX:LIV - News) a developer of innovative drugs, announced today its drug candidate SP-6300 has shown the ability to modulate excessive cortisol levels by lowering the hormone-stimulated corticosteroid formation in adrenal cells, and as a result could be a potentially new treatment for Cushing's Syndrome.

Cushing's Syndrome is a disorder of the adrenal glands leading to excess cortisol secretion. This means that there is too much cortisol hormone in the blood. Cushing's Syndrome is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. It is sometimes called "hypercortisolism,'' and an estimated 10 to 15 of every million people are affected each year.

Long-term (chronic) use of corticosteroid medications, for the treatment of conditions such as lupus, asthma, and rheumatoid arthritis, is the most common cause of Cushing's Syndrome. Patients who develop Cushing's exhibit a variety of symptoms including weight gain, fatigue, muscle weakness, diabetes, high blood pressure, depression, and osteoporosis. If left untreated, Cushing's Syndrome can lead to death.

Dr. Greeson, CEO of Samaritan Pharmaceuticals stated, "There is an urgent need to develop new therapeutic agents, with a new and different mechanism of action, for Cushing's. It is commonly held that the cause of Cushing's is related to patients taking too much corticosteroid medications. We believe the addition of SP-6300 to normally prescribed medications might allow doctors to prescribe smaller doses of corticosteroid medications; to possibly decrease corticosteroid side effects, and increase their efficacy, at the same time."

***

Samaritan Pharmaceuticals: ``We LIV...to Save Lives.''

Samaritan is a small-cap Biotech, driven to discover, develop and commercialize innovative therapeutics for AIDS, Alzheimer's, Cancer and Heart disease patients. Look at http://www.samaritanpharma.com. Please register on Website so we can notify you of upcoming conference calls, news and events.

***

The company disclaims any information that is created by an outside party and endorses only information that is communicated by its press releases, filings and Website. This news release contains forward-looking statements that reflect management's current beliefs about the potential for its drug candidates, science and technology. However, as with any biopharmaceutical under development, there are significant risks and uncertainties in the process of development and regulatory review. There are no guarantees that products will prove to be commercially successful. For additional information about the factors that affect the company's business, please read the company's latest Form 10-K/A filed November 2, 2006. The company undertakes no duty to update forward-looking statements.

Contact:
Samaritan Pharmaceuticals, Inc.
Richard Brown
(702) 735-7001


• Fromhttp://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2265.2007.02774.x

Clinical Endocrinology

OnlineEarly Articles

To cite this article: Emanuela Setola, Marco Losa, Roberto Lanzi, Pietro Lucotti, Lucilla D. Monti, Tristana Castrignanò, Elena Galluccio, Massimo Giovanelli, PierMarco Piatti

Increased insulin-stimulated endothelin-1 release is a distinct vascular phenotype distinguishing Cushing's disease from metabolic syndrome Clinical Endocrinology (OnlineEarly Articles).
doi:10.1111/j.1365-2265.2007.02774.x

* Emanuela Setola* *Diabetology, Endocrinology and Metabolic Disease Unit,
*Marco Losa‡ ‡Pituitary Unit, Department of Neurosurgery, Scientific Institute San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy,
*Roberto Lanzi
**Diabetology, Endocrinology and Metabolic Disease Unit,
*Pietro Lucotti
**Diabetology, Endocrinology and Metabolic Disease Unit,
*Lucilla D. Monti† †Core Laboratory, Diabetology, Endocrinology and Metabolic Disease Unit,
*Tristana Castrignanò‡ ‡Pituitary Unit, Department of Neurosurgery, Scientific Institute San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy,
*Elena Galluccio† †Core Laboratory, Diabetology, Endocrinology and Metabolic Disease Unit and
*Massimo Giovanelli‡ ‡Pituitary Unit, Department of Neurosurgery, Scientific Institute San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy and
*PierMarco Piatti
**Diabetology, Endocrinology and Metabolic Disease Unit

*Diabetology, Endocrinology and Metabolic Disease Unit, †Core Laboratory, Diabetology, Endocrinology and Metabolic Disease Unit and ‡Pituitary Unit, Department of Neurosurgery, Scientific Institute San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy

Correspondence: PierMarco Piatti, Diabetology, Endocrinology and Metabolic Disease Unit, Scientific Institute San Raffaele, Università Vita-Salute San Raffaele, Via Olgettina 60, Milan, Italy. Tel.: +39 02 26432619; Fax: +39 02 26433839; E-mail: piermarco.piatti@hsr.it

Summary

Objective Although much is known about the anti-inflammatory effects of an acute corticosteroid therapy, little is known about the effects on chronic hypercortisolism on endothelial dysfunction and proinflammatory alterations in patients with Cushing's disease (CD).

Patients and methods We studied 9 patients with CD, 10 patients with metabolic syndrome and 27 normal controls. The tests consisted of an intravenous bolus of 0·1 U/kg insulin combined with a euglycaemic clamp technique with an arterialized forearm and assessment of the training parameters deep-venous balance of forearm glucose uptake (as an index of insulin sensitivity); NOx (nitric oxide end-products), c-GMP (second messenger of nitric oxide) and endothelin-1 release, as indices of endothelial function and proinflammatory systemic markers.

Results Forearm glucose uptake incremental area was significantly lower in Cushing's disease and in the metabolic syndrome than in controls, suggesting a state of severe insulin resistance. Compared to controls and to the metabolic syndrome, basal and insulin-stimulated NOx release incremental areas were significantly reduced in Cushing's disease, while forearm c-GMP release was similarly decreased in CD and metabolic syndrome. By contrast, endothelin-1 incremental areas after insulin bolus were significantly higher in CD than in controls and the metabolic syndrome, in the presence of increased TNF-alpha, IL-6 and CRP levels. Forearm glucose uptake incremental area significantly correlated with NOx incremental area, forearm c-GMP release incremental area, TNF-alpha levels and ET-1 incremental area.

Conclusions In patients with CD, supraphysiological insulin levels are not able to overcome the insulin resistance due to chronic hypercortisolism. Furthermore, an increased proatherogenic risk profile is characterized by decreased nitric oxide synthesis and activity, enhanced endothelin-1 levels and increased proinflammatory markers.
• From http://www.stabroeknews.com/index.pl/article_general_news?id=56513496

StabroekNews
Cushing's disease victim needs help for operation
Tuesday, February 6th 2007


Maureen Mohabir before being diagnosed with Cushing's disease and after

Five years ago Maureen Mohabir noticed that her stomach had started to swell for no apparent reason; not long after her feet also started to swell.

Mohabir visited many different doctors in an attempt to find out what was wrong with her. While some doctors told her that they had no idea what was wrong with her others diagnosed kidney problems and prescribed different medication which she took but got no relief. Her body continued to swell and additional problems, such as depression and haemorrhaging started.

Prior to the swelling of her body, which now includes her neck; Mohabir was considered to be a "busy body" and always took care of herself. Today, the 42-year-old mother of two grown children, who resides in Linden, finds it difficult to even take care of her personal needs. The disease has affected her once perfect eyesight and she has since had to wear glasses.

After years of seeking the truth about what ailed her, she visited a doctor who diagnosed her with a rare disease called Cushing's disease. The doctor was able to pinpoint what was wrong with her because she had seen someone else out of Guyana with the same disease.

Mohabir travelled to Trinidad for confirmation of the diagnosis which was done as she had all the symptoms of the disease.

The woman's brother, Anthony Mohabir, recently told Stabroek News that his sister is in dire need of an operation, which has to be done in Trinidad. But because she has had to make several trips to Trinidad for tests and follow-up doctor's visits the family has no way of finding the US$12,000 needed for the operation that would remove the adrenal gland, found at the top of the kidney. The operation is expected to be done by Dr Dilip Dan in Trinidad and the family is appealing to the public for assistance in raising the funds for the surgery, which should be done in another two weeks.

They have since approached the Region Ten Welfare & Women's Affairs Committee and a telethon is expected to be held shortly in the mining town. A bank account, #516-773-9, has been set up by the committee at Republic Bank in the name of the Regional Women's Affairs Committee. Persons wishing to assist the woman can deposit money in the account or they can contact the family on telephone numbers, 444-4214 or 617-1158. Valerie Sharpe of the women's welfare committee can also be contacted on telephone numbers; 444-6058 or 4440-3048.

Cushing's disease is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. Sometimes called "hypercortisolism," it is relatively rare and most commonly affects adults aged 20 to 50. An estimated 10 to 15 of every million people are affected each year.

Symptoms of the disease vary, but most people have upper body obesity, rounded face, increased fat around the neck, and thinning arms and legs.

Other symptoms appear in the skin, which becomes fragile and thin. It bruises easily and heals poorly. Purplish pink stretch marks may appear on the abdomen, thighs, buttocks, arms and breasts. The bones are weakened and routine activities such as bending, lifting or rising from a chair may lead to backaches, rib and spinal column fractures. Most of the symptoms are being experienced by the woman.

Most people have severe fatigue, weak muscles, high blood pressure and high blood sugar. Irritability, anxiety and depression are common.

Women usually have excess hair growth on their faces, necks, chests, abdomens, and thighs. Their menstrual periods may become irregular or stop. Men have decreased fertility with diminished or absent desire for sex.

Adrenal:

• From http://jcem.endojournals.org/cgi/content/abstract/92/2/542

Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-1340

The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 2 542-548
Copyright © 2007 by The Endocrine Society

Cognitive Functions in Children at Risk for Congenital Adrenal Hyperplasia Treated Prenatally with Dexamethasone

Tatja Hirvikoski, Anna Nordenström, Torun Lindholm, Frank Lindblad, E. Martin Ritzén, Anna Wedell and Svetlana Lajic

Departments of Psychiatry (T.H.), Molecular Medicine and Surgery (T.H., A.N., A.W., S.L.), Clinical Sciences (A.N.), Public Health Sciences/National Institute for Psychosocial Medicine (F.L.), and Woman and Child Health (E.M.R.), Karolinska Institutet, 171 76 Stockholm, Sweden; and the Department of Psychology (T.L.), Stockholm University, 106 91 Stockholm, Sweden

Address all correspondence and requests for reprints to: Dr. Svetlana Lajic, Department of Molecular Medicine and Surgery, Center for Molecular Medicine L8:02, Karolinska Institutet/Karolinska University Hospital, 171 76 Stockholm, Sweden. E-mail: Svetlana.Lajic@ki.se.

Context and Objective: In Sweden, from 1985 through 1995, 40 fetuses at risk for congenital adrenal hyperplasia (CAH) were treated with dexamethasone (DEX) to prevent virilization of affected females. We report long-term effects on neuropsychological functions and scholastic performance of this controversial treatment.

Design and Patients: Prenatally treated children, 7 to 17 yr old, were assessed with standardized neuropsychological tests (A Developmental Neuropsychological Assessment and Wechsler Intelligence Scales for Children) and child-completed questionnaires measuring self-perceived scholastic competence (Self-Perception Profile for Children). A parent-completed questionnaire (Child Behavior Checklist/4–18 School Scale) was used to evaluate whether the treatment had any impact on the children’s school performance. In addition, a child-completed questionnaire measuring social anxiety (The Social Anxiety Scale for Children–Revised) was completed by the prenatally treated children aged 8 to 17 yr (n = 21) and age- and sex-matched controls (n = 26).

Results: Of 40 DEX-treated children, 26 (median age, 11 yr) participated in the study. Thirty-five sex- and age-matched healthy children were controls. There were no between-group differences concerning psychometric intelligence, measures of cerebral lateralization, memory encoding, and long-term memory. Short-term treated, CAH-unaffected children performed poorer than the control group on a test assessing verbal working memory (P = 0.003), and they rated lower on a questionnaire assessing self-perception of scholastic competence (P = 0.003). This group also showed increased self-rated social anxiety assessed by The Social Anxiety Scale for Children–Revised (P = 0.026). Prenatally treated, CAH-affected children performed poorer than controls on tests measuring verbal processing speed, although this difference disappeared when controlling for the child’s full-scale IQ.

Conclusions: This study indicates that prenatal DEX treatment is associated with previously not described long-term effects on verbal working memory and on certain aspects of self-perception that could be related to poorer verbal working memory. These findings may thus question future DEX treatment of congenital adrenal hyperplasia. Therefore, we encourage additional retrospective studies of larger cohorts to either confirm or challenge the present findings.


• From http://www.hemscott.com/news/latest-news/item.do?newsId=39386997634520

Phoqus gets positive opinion from EU approval body for Chronocort endocrine drug (for treatment of congenital adrenal hyperplasia)

LONDON (AFX) - Phoqus Group PLC said is application for Orphan Drug status for its Chronocort endocrine drug has received a positive opinion from the Orphan Medicinal products body of the European Agency for the Evaluation of Medicinal Products (EMEA).

Following formal European Commission approval, this will lead to an orphan drug status -- which means 10 years market exclusivity after the grant of a marketing authorisation -- for Chronocort, which the company said is the first circadian endocrine treatment for adrenal insufficiency.

Chronocort has already got orphan drug status in the treatment of congenital adrenal hyperplasia following a licensing deal with Diurnal, a portfolio company of Biofusion PLC.
• From http://www.cushingdaily.com/features/cnhinsfamily_story_044092222.html?keyword=topstory

February 13, 2007 09:22 am

(Adrenal) Vaccine research continues physician's legacy By Susan Redden
THE JOPLIN GLOBE (JOPLIN, Mo.)

CARTHAGE, Mo. — A year after his death, physician Alan Clark’s legacy continues to raise concerns about a mercury-containing additive in some vaccines.

Money contributed to a memorial fund established by Clark’s wife, Lujene, is underwriting research on the impact of thimerosal, a vaccine preservative that the couple believed caused their son, Devon, to develop a form of autism.

Alan Clark, an emergency-room physician for 30 years who had worked at Freeman Health System and St. John’s Regional Health Center in Springfield, died Feb. 7, 2006, of complications from lung cancer. He had never smoked.

On Jan. 24 — Alan Clark’s 56th birthday — Lujene Clark was in Jefferson City for a state-sponsored symposium titled “Mercury in Medicine: Separating Science From Fiction.”

The host was state Sen. John Loudon, R-Chesterfield, sponsor of a bill passed two years ago that will allow no more than trace amounts of thimerosal to be used in vaccines administered to pregnant women and to children younger than 3 starting in April. Clark was among those who testified on behalf of the ban.

“When the bill was being debated, one of the things they agreed to was doing an educational symposium,” she said.

Speakers from both sides addressed the issue, then met with lawmakers and their staffs.

Clark also has lobbied recently in Nebraska, where lawmakers are considering legislation to ban thimerosal in some vaccines.

But most exciting, Clark said, is the start of a new research project that studies the effects of thimerosal on the adrenal system. Money to underwrite the work is coming from contributions made in Alan Clark’s memory.

“People were so generous, and there’s nothing Alan would have liked more,” she said.

She said discussions she had with her late husband were the genesis of the idea, which she pitched to potential researchers at an autism conference in Chicago. She said most of the work is being done at the University of Rochester in New York, though there are other “collaborators.”

“Mercury does have a big effect on the adrenal system, and you’ll find children with autism-spectrum diseases also have a disruption of the pituitary and thyroid, and elevated testosterone levels,” Clark said. “We think testosterone makes mercury more toxic, and that’s why autism affects more boys than girls.”

The Clarks began a campaign against the use of thimerosal in vaccines after their son, then 5 years old, developed a form of autism after receiving a flu shot in the wake of a series of childhood vaccines.

The couple did their own investigation, then met with other doctors and researchers before coming to that conclusion. Clark said tests on Devon at the time showed his blood had elevated levels of mercury.

“The diagnosis was Asperger’s, but he was mercury-poisoned,” she said.

Devon at one time was taking six or seven medications a day for Asperger syndrome and asthma. After the Clarks switched the treatment to vitamins, minerals and an infrared sauna chelation therapy to remove the heavy metals — including mercury — from his body, illnesses and behaviors associated with his autism began to diminish. Now, he no longer is diagnosed as having a form of autism, his mother said.

The couple also formed NoMercury, an organization to raise concerns about the issue, and began lobbying on behalf of bills to remove the substance from all vaccines, especially childhood inoculations.

While the substance has been removed from most childhood vaccines, it still is in some flu and tetanus shots that children can receive, Clark said.

Susan Redden writes for The Joplin (Mo.) Globe.

CDC stance

The federal Centers for Disease Control and Prevention, which sets national vaccine requirements, has rejected any link between thimerosal and autism-spectrum disorders.

The CDC contends that the best scientific studies have not borne out that connection. Scientists are putting more focus on possible genetic causes, according to a recent Stanford University study.

Pituitary:

• From http://www.chron.com/disp/story.mpl/ap/health/4538773.html

Feb. 8, 2007, 7:16PM
Pa study: Nose brain surgery OK for kids

By JENNIFER C. YATES Associated Press Writer
© 2007 The Associated Press

PITTSBURGH — A surgery in which adults' brain tumors are removed through the nose can also be effective in children, many of whom have no other medical options available, according to a review of cases published this month.

Doctors at Children's Hospital of Pittsburgh in conjunction with the University of Pittsburgh Medical Center reviewed the cases of their first 25 pediatric patients to have the surgery, known as the expanded endonasal approach.

The surgery was successful in all cases, with patients who ranged in age from 3 to 18. None suffered neurological damage, vascular injury or central nervous system infection, the doctors said.

"What we learned from this study is the potential is unlimited," said Dr. Amin Kassam, interim chair of the Department of Neurological Surgery at the University of Pittsburgh Medical Center.

The results were published in the February issue of the Journal of Neurosurgery: Pediatrics. The surgeries reviewed were done from 1999 to 2005 and, so far, Pittsburgh doctors have performed more than 50 similar surgeries on children.

For years, doctors have been doing minimally invasive surgeries that require small incisions and the use of tiny cameras that allow doctors to see into the body. The practice of going through the nose for surgery is also common with pituitary disorders and among ear, nose and throat doctors.

Alan R. Cohen, chief of pediatrics at Cleveland's Rainbow Babies & Children's Hospital, said that doctors from Pittsburgh expanded on that technology to apply it to children with brain tumors and other kinds of congenital and vascular malformations.

Without this technique, the only other option would be going in through a patient's skull and brain, a much more complicated procedure with greater risks, he said.

"The less invasive you can be, the quicker the recovery for the patients," said Cohen, cautioning that the surgery still has risks including leakage of cerebral spinal fluid.

Kassam said that when they first began to apply adult techniques to children, they had to learn more about children's bodies and create smaller instruments.

"When we started, these weren't views we were used to seeing," Kassam said.

He said using the technique on children is especially advantageous because through-the-skull surgery can have long-term effects for a growing child.

Rhonda Firek's daughter, RaeAnn, was one of the first children to undergo the procedure in Pittsburgh. At just 11 months old, RaeAnn began having nosebleeds that worsened until doctors eventually diagnosed the cause: a bundle of veins in her head that had malformed before birth.

There was little doctors could do, because RaeAnn could bleed to death during surgery or a particularly horrible nosebleed. Doctors decided her only hope might be expanded endonasal surgery.

"I was planning her funeral in my mind because these previous few years they were telling me they couldn't remove it," said Firek, of Baldwin.

After three surgeries, RaeAnn's condition was controlled. Now 9, RaeAnn is a happy third-grader. She has lost sight in one eye and still suffers nosebleeds from time to time, but otherwise is fairly healthy.

"We didn't have an option. Eventually, she was going to have an option that was so severe that she would bleed to death," her mother said. "She would have died at some point, I know it."


• From http://www.timesonline.co.uk/tol/life_and_style/health/features/article1399498.ece

From The Times
February 19, 2007

‘You have a brain tumour,’ the doctor told me. ‘Quite a big one’

On the eve of his 40th birthday, the singer Russell Watson discovered he had a brain tumour. After an operation to remove it, he’s battling back with a new album and tour.

Interview by Jane Wheatley

One cool morning last October, Russell Watson sat in a neurologist’s consulting room at the Cedars Sinai Medical Centre in Los Angeles waiting for the man to speak. He could hardly see the doctor’s face: his vision had diminished to a narrow tunnel and he had an excruciating headache.

“You have a tumour,” said the doctor. “Quite a big one.”

There would be a four-day wait for an MRI scan to reveal the precise size and location of the tumour. Watson had come to LA to record a new album: the studio was ready, the musicians were waiting, but he was sick, frightened and in permanent pain. How could he think of work?

Watson smiles — a tight little smile, almost a grimace: “I thought this record would be my last, my legacy,” he says. “Since an early age I’d had an in-built premonition, a vision that I wouldn’t make 40. For the previous seven years I’d had a recurring nightmare in which my head exploded. And here I was with a brain tumour on the eve of my 40th birthday; I thought, ‘This is it, I was right, I knew it’.”

Fortunately for Watson and his many fans, his visionary powers turned out to be faulty: he made the record, had the tumour removed and lived to tell the tale. As he sits opposite me on a sofa in a Manchester hotel suite, it is apparent that the experience has been, if not humbling, then profoundly moving: “It changed my priorities,” he says. “Made me appreciate the importance of relationships, of friends and family and, most of all, my two daughters. My fear for them if I died — that was the worst part.”

In his seven years as an international singing star and self-styled “people’s tenor”, the Russell Watson story has been well documented in interviews, tabloid gossip columns and in the pages of Hello! , so let’s just summarise: Salford lad, welder, married with a baby, gives up work to try his luck as a singer round the northern clubs; after lean years, hiding from bailiff, ducking and weaving, he is heard singing Puccini’s Nessun Dorma in a working men’s club and is invited to perform it at Old Trafford before Manchester United’s last Premiership match of the season in 1999, when they clinched the title.

Fame spreads, his crossover albums of Italian arias and pop classics conquer charts on both sides of Atlantic and Watson “the Voice” is courted by popes, princes and the Beckhams. Casualties along the way include his marriage, his engagement to a receptionist from New York and his relationship with a former manager, who claimed that he had been dumped.

Then, two years ago, Watson began having headaches — “like a knife being pressed into the bridge of my nose” — and consulted a specialist who told him there was nothing to worry about: he was suffering from stress and should find ways of relaxing. When his peripheral vision began to be affected late last year, he visited another specialist who also told him he was suffering from stress: “I said the only thing that’s stressing me is this pain in my head.”

On the flight to LA to record his new album, Watson told his producer that he was experiencing terrible pressure inside his skull. “When we landed, he suggested a game of tennis to clear my head,” recalls Watson. “I couldn’t see the ball.”

Four days later, the MRI scan revealed a tumour the size of two golf balls: “Like a figure of eight,” says Watson, “one filling the frontal cavity of my skull, the other forced through into the top of my nose.” Watson went back to his hotel and phoned his best friend, the Colonel (a nickname dating from early club days when Watson sang Elvis songs and his friend dubbed him the King). “I asked him to make sure that the kids got everything.”

He flew home and booked in for surgery at St George’s Hospital, South London: “My mates were saying, you’re so fit, so strong and healthy, you will sail through it,” says Watson. “I was thinking, if that surgeon’s knife slips inside my skull, fitness is irrele-vant.” It made him feel lonely, he says, surrounded by their determined optimism: “Even though I knew they probably went home and said, “F***ing hell, poor bastard.” He spent the evening before the operation with his daughters, Rebecca, 12, and six-year-old Hannah: “I thought I was saying good-bye.”

Was there anyone to lean on, to be truthful with — a girlfriend? “Well I’m not in a relationship,” he says, “So no. My rock and support was the Colonel and his wife Lynne. I stayed with them for three weeks after surgery; Lynne doted on me like a mother.”

He could barely walk, he says, and the tumour had affected his pituitary gland, which controls hormone levels: “My mood swings went from ecstatic to suicidal.” he says. “I remember one night standing on the balcony, full of dark thoughts and self-pity, thinking ‘God, this is f***ing terrible, why me?’ I went back to bed, couldn’t sleep, got up again. I thought I’d had enough. If it hadn’t been for the girls . . .”

Watson’s energy levels were at rock bottom and he didn’t leave the house for two months: “I couldn’t deal with more than one person at a time or with multitasking and I cried easily,” he confesses, his cheerful chappie face looking bleak for a moment. “The best thing I can say now, three months later, is that where I was getting a hell of a lot of really bad days, now the good days outnumber the bad.”

In two weeks he will embark on a 22-city concert tour to promote the new album — lush covers of classic love songs and not an aria to be heard. He has been shunned by critics in the past who said his untrained tenor voice was just not up to operatic standards: did this influence the new direction? “Doesn’t bother me,” he says. “Seven years ago classical crossover didn’t exist — putting Italian lyrics to pop songs in a big ballsy way. Now every bugger’s doing it. I’ve transcended all that bickering and bitching.”

Now he has a new lease on life, what are his career ambitions? “Longevity, that’s the most important thing,” he says. “I want to be a musical force for a good long while.” But above everything else, he insists, the reprieve taught him to cherish his relationship with his daughters. “It put everything into perspective.”

Russell Watson’s new album, That’s Life, is out on March 5.
• From http://www.southcoasttoday.com/daily/02-07/02-19-07/03advice.htm

Empty Sella
Paul G. Donohue, M.D. To Your Good Health

DEAR DR. DONOHUE: Several years ago I had an MRI of my sinuses. The doctor told me I had an empty sella. I learned that meant my pituitary gland had shrunk. Can you give me information on what bearing this has on my health?
-- M.H.

You can join the ranks of many people who have had an MRI scan of the skull for some completely different reason and then were told they had an empty sella.

The sella is a saddle-shaped bone in which the pituitary gland sits. The pituitary gland, at the base of the brain, is a small gland, only about two-fifths of an inch in all dimensions. It is, however, a giant gland in its many responsibilities. It's the body's master endocrine gland.

When an MRI doesn't show the pituitary gland in the sella, a person is said to have an empty sella. If people with an empty sella have no symptoms and no signs of endocrine gland deficiencies, the conclusion is that there is a thin rim of pituitary gland left that can't be seen on the MRI but that fills all the gland's functions.

For most people, an empty sella has no bearing on their health.

Readers may write to Dr. Donohue or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
• Fromhttp://jcem.endojournals.org/cgi/content/abstract/92/2/604

Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-1216

The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 2 604-607
Antipituitary Antibodies against Gonadotropin-Secreting Cells in Adult Male Patients with Apparently Idiopathic Hypogonadotropic Hypogonadism
Annamaria De Bellis1, Antonio Agostino Sinisi1, Marisa Conte, Concetta Coronella, Giuseppe Bellastella, Dario Esposito, Daniela Pasquali, Giuseppe Ruocco, Antonio Bizzarro and Antonio Bellastella

Chair of Endocrinology (A.D.B., A.A.S., G.B., D.E., D.P., G.R., A.Be.) and Chair of Immunology (M.C., C.C., A.Bi.), Department of Clinical and Experimental Medicine and Surgery "F. Magrassi, A. Lanzara," Second University of Naples, 80131 Naples, Italy

Address all correspondence and requests for reprints to: Annamaria De Bellis, Cattedra di Endocrinologia, Seconda Università di Napoli, Via S. Pansini, 5, 80131 Napoli, Italy. E-mail: annamaria.debellis@unina2.it.

Context: Hypogonadotropic hypogonadism (HH) can occur at any stage of life as an isolated congenital or acquired abnormality or within a more generalized pituitary or hypothalamic impairment. However, the defect in patients with idiopathic HH is still unknown.

Objective: The aim of this study was to investigate the prevalence of antipituitary antibodies (APA) in a group of HH patients with or without Kallmann’s syndrome and to characterize their pituitary target.

Design: We conducted a cross-sectional cohort study.

Setting: The study was performed at the Endocrinology Unit of the Second University of Naples.

Patients: Twenty-one HH patients with normal sense of smell (group 1), 10 patients with Kallmann’s syndrome (group 2), 13 patients with HH associated with other pituitary hormone deficiencies (group 3), and 50 normal controls were studied.

Main Outcome Measures: APA were evaluated in patients and in controls by indirect immunofluorescence. Moreover, a magnetic resonance imaging (MRI) of the hypothalamic-pituitary region was performed in all three groups of patients.

Results: APA were detected at high titer in eight out of 21 patients in group 1 (38%) and in five of 13 in group 3 (38.4%), and at low titers in two out of 10 in group 2 (20%) and in three of 50 controls (6%). In patients of group 1, APA immunostained selectively gonadotropin-secreting cells, whereas in those of group 3, they immunostained other pituitary hormone-secreting cells also. None of patients in group 1 showed alterations on MRI, whereas all patients in group 2 showed aplasia/hypoplasia of the olfactory bulbs/tracts and/or of olfactory sulci. Among the five APA-positive patients in group 3, three had normal MRI, one had findings of empty sella, and one had findings of autoimmune hypophysitis.

Conclusions: Our results suggest that some apparently idiopathic cases of HH, both isolated and associated with other pituitary impairment, can be caused by an early autoimmune process involving the gonadotrophs at pituitary level. Future longitudinal studies are needed to clarify the natural history of this process and the possible effect of early corticosteroid therapy.
• From http://jcem.endojournals.org/cgi/content/abstract/92/2/691

The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 2 691-697
Copyright © 2007 by The Endocrine Society
HESX1 Mutations Are an Uncommon Cause of Septooptic Dysplasia and Hypopituitarism
David E. G. McNay, James P. Turton, Daniel Kelberman, Kathryn S. Woods, Raja Brauner, Anastasios Papadimitriou, Eberhard Keller, Alexandra Keller, Nele Haufs, Heiko Krude, Stephen M. Shalet and Mehul T. Dattani

Biochemistry, Endocrinology, and Metabolism Unit (D.E.G.M., J.P.T., D.K., K.S.W., M.T.D.), Institute of Child Health, London WC1N 1EH, United Kingdom; Université Paris-Descartes, Assistance Publique Hopitaux de Paris, Hôpital Bicêtre (R.B.), 94275 Le Kremlin Bicêtre, France; Third Department of Pediatrics (A.P.), University of Athens School of Medicine, Athens, Greece; Hospital for Children and Adolescents (E.K., A.K.), University of Leipzig, Leipzig, Germany; Charite (N.H., H.K.), Institute of Experimental Pediatric Endocrinology, Augustenburgerplatz 1, D-13353 Berlin, Germany; and Department of Endocrinology (S.M.S.), Christie Hospital National Health Service Trust, Manchester, United Kingdom

Address all correspondence and requests for reprints to: Mehul T. Dattani, Biochemistry, Endocrinology, and Metabolism Unit, Institute of Child Health, London WC1N 1EH, United Kingdom. E-mail: m.dattani@ich.ucl.ac.uk.

Context: Mutations in the transcription factor HESX1 have previously been described in association with septooptic dysplasia (SOD) as well as isolated defects of the hypothalamic-pituitary axis.

Objective: Given that previous screening was carried out by SSCP detection alone and limited to coding regions, we performed an in-depth genetic analysis of HESX1 to establish the true contribution of HESX1 genetic defects to the etiology of hypopituitarism.

Design: Nonfamilial patients (724) with either SOD (n = 314) or isolated pituitary dysfunction, optic nerve hypoplasia, or midline neurological abnormalities (n = 410) originally screened by SSCP were rescreened by heteroduplex detection for mutations in the coding and regulatory regions of HESX1. In addition, direct sequencing of HESX1 was performed in 126 patients with familial hypopituitarism from 66 unrelated families and in 11 patients born to consanguineous parents.

Patients: All patients studied had at least one of the three classical features associated with SOD (optic nerve hypoplasia, hypopituitarism, midline forebrain defects).

Results: Novel sequence changes identified included a functionally significant heterozygous mutation at a highly conserved residue (E149K) in a patient with isolated GH deficiency and digital abnormalities. The overall incidence of coding region mutations within the cohort was less than 1%.

Conclusions: Mutations within HESX1 are a rare cause of SOD and hypopituitarism. However, the large number of familial patients with SOD in whom no mutations were identified is suggestive of an etiological role for other genetic factors. Furthermore, we have found that within our cohort SOD is associated with a reduced maternal age compared with isolated defects of the hypothalamopituitary axis.

Cortisone / Cortisol:

• From http://www.sciencefriday.com/news/020907/news0209071.html

FOLLOW YOUR NOSE?

Male presenter brings vials of AND and yeast into the smell-proof room for the subjects to sniff. Credit: Claire Wyart

Attention men: Before you wipe your brow, you should know that a man's sweat can change a woman's body chemistry. Androstadienone (AND) is a testosterone-derived molecule found in the sweat of all men. Women have it too but in lower concentrations. Researchers found that AND in men elevates cortisol levels in women, according to a study published in the Journal of Neuroscience this week.

Cortisol is a hormone associated with physiological arousal—which translates to a measure of awakeness (but not specifically sexual arousal). "You have a peak of cortisol after you wake up, and then it goes down during the day," explains Claire Wyart, a post doctoral researcher at the University of California, Berkeley and lead-author on the study.

Wyart and her colleagues placed women in a smell-proof room, (such a room can be created, she says), and sent vials of pure AND and vials of yeast into the room for women to sniff. Yeast was used because on the pleasant-to-smell scale, AND and yeast rank about the same, according to Wyart. The scientists then incrementally measured the cortisol levels in the women's saliva, as well as other physiological responses, post sniffing.

After twenty sniffs of pure AND, cortisol levels increased significantly in the sniffers' saliva. Yeast didn't elevate cortisol. These results were consistent with previous studies that showed AND exposure can improve a woman's self-reported mood, alter her heart rate, breathing rate, body temperature, blood pressure and other parameters associated with general arousal. But this study, also demonstrated that AND can change a woman's hormone levels.

But before you start sniffing around for a good man, Wyart warns, many questions remain about how smelling the pure stuff from a jar in a laboratory relates to a real life sweat-sniffing situation. Wyart says: "We have no clue about how this relates to the natural stimulation we are exposed to, when you're actually smelling someone."

-Flora Lichtman


• From http://www.sciencedaily.com/releases/2007/02/070211200649.htm

Source: American Psychological Association
Date: February 12, 2007

Extra Cortisol Protects Women's Mood Under Stress

Science Daily — German researchers have found additional evidence that the stress hormone cortisol can have positive effects in certain situations. Although chronic stress, which brings long-term elevations of cortisol in the bloodstream, can weaken the immune system and induce depression, this new study adds to mounting evidence that cortisol given near in time to a physical or psychological stress may lessen the stressor's emotional impact. Psychologists are especially interested in what this means for preventing and treating post-traumatic stress disorder. The findings appear in the February issue of Behavioral Neuroscience, which is published by the American Psychological Association (APA).

Psychologists Serkan Het, MSc, and Oliver Wolf, PhD, of the University of Bielefeld, enlisted 44 healthy women for a double-blind study, in which neither researchers or participants knew the condition to which the women were assigned. One hour before a psychosocial stress test, participants were given either a 30 mg. dose of oral cortisol or a placebo. That 30 mg. dose is considered high, translating to a severe stressor. Experimenters tracked participant mood through self report, and measured their cortisol levels with a simple swab check of their saliva, before and after the psychosocial stress test.

Participants were asked to give five-minute oral presentations as if interviewing for their dream job, focusing on their personal strengths and weaknesses. For the next five minutes, they had to count backwards by 17s from a very high number; every time they made a mistake, they had to start over. During both tasks, participants faced a "committee" of one man and one woman, both of whom acted cold and reserved without actually being unfriendly or rude. To heighten discomfort over being evaluated, participants spoke into microphones and knew they were being videotaped.

Het and Wolf measured mood five times using two self-report questionnaires, 15 and 45 minutes participants arrived at the lab, and 1, 45, and 60 minutes after the stress test. Afterwards, the cortisol-treated women developed, on average, less negative mood states as a result of the stress-producing activity when compared with placebo-treated women. The high dose of cortisol seems to have worked as a buffer.

Wolf says that whereas chronically elevated cortisol levels can be damaging to both mood and immunity, a short spike in cortisol levels may be protective. He comments, "The difference between acute cortisol elevations and chronic cortisol hyperactivity appears to be important."

Prior research has suggested that low-dose treatment with cortisol can offer relief from the core symptoms of post-traumatic stress disorder. In addition, in patients with social phobia exposed to a social stress situation, pre-treatment with cortisol has reduced anxiety. This new study in healthy participants adds to the growing body of evidence that cortisol may be a useful clinical tool. Says Wolf, "Our study suggests that when it comes to the negative effects of stress on the emotions, an anticipatory rise in cortisol levels prior to a stressor might help someone to cope with the stressor more efficiently. This might have implications for treating and preventing post-traumatic stress and other anxiety disorders."

Article: "Mood Changes in Response to Psychosocial Stress in Healthy Young Women: Effects of Pretreatment with Cortisol," Serkan Het, MSc, and Oliver T. Wolf, PhD, University of Bielefeld; Behavioral Neuroscience, Vol. 121, No. 1.

Note: This story has been adapted from a news release issued by American Psychological Association.
• From http://www.sciencedaily.com/releases/2000/11/001120072314.htm

Stress May Cause Excess Abdominal Fat In Otherwise Slender Women, Study Conducted At Yale Shows

Science Daily — Non-overweight women who are vulnerable to the effects of stress are more likely to have excess abdominal fat, and have higher levels of the stress hormone cortisol, a study conducted at Yale suggests.

While past studies have examined cortisol response in overweight women, this is the first study to show that lean women with abdominal fat have exaggerated responses to cortisol. Abdominal fat is related to worse health, including greater risk of heart disease and diabetes.

"We also found that women with greater abdominal fat had more negative moods and higher levels of life stress," said Elissa S. Epel, Ph.D., lead investigator on the study she conducted while at Yale's psychology department. "Greater exposure to life stress or psychological vulnerability to stress may explain their enhanced cortisol reactivity. In turn, their cortisol exposure may have led them to accumulate greater abdominal fat."

Published in the September/October issue of Psychosomatic Medicine, the study looked at pre-menopausal, non-overweight women, and overweight women who stored fat either centrallyat the waist vs. peripherallyat the hips, and examined their stress responses over three consecutive days.

Cortisol affects fat distribution by causing fat to be stored centrallyaround the organs. Cortisol exposure can increase visceral fatthe fat surrounding the organsin animals. People with diseases associated with extreme exposure to cortisol, such as severe recurrent depression and Cushing's disease also have excessive amounts of visceral fat.

"Everyone is exposed to stress, but some people may secrete more cortisol than others, and may secrete cortisol each time they face the same stressor," Epel adds. "We predicted that reacting to the same stressors consistently by secreting cortisol would be related to greater visceral fat."

After the first exposure to stress, women with greater abdominal fat felt more threatened by the study's stressful tasks, performed more poorly on them, and secreted more cortisol. They also reported more life stress. By the third exposure to stress, the lean women with abdominal fat still consistently secreted more cortisol in response to stressful lab tasks, compared to women with peripheral fat.

"It is possible that greater exposure to stressful conditions or psychological vulnerability to stress has led them to overreact to stressors in their daily lives, so they have had greater lifetime exposure to cortisol," Epel said. "Cortisol, in turn may have caused them to accumulate abdominal fat. Genetics, however, also play a role in shaping reactivity to stress, as well as body shape."

Lifestyle and age may also influence levels of abdominal fat. Smoking, alcohol and lack of exercise all contribute to greater abdominal fat. Postmenopausal women tend to carry fat at their abdomen, due to changes in sex hormones. Epel said a healthy lifestyle, including getting enough sleep, exercise and relaxation, may reduce cortisol levels.

"These relationships likely apply to men as well," Epel said. "However, excess weight on men is almost always stored at the abdomen. On the contrary, in pre-menopausal women, excess weight is more often stored at the hips. Therefore, for women, it is possible that stress may influence body shape more than for men, leading to abdominal fat instead of lower body fat accumulation."

Elissa Epel's research team at Yale included Kelly D. Brownell, Ph.D., Jeannette R. Ickovics, Ph.D., Jennifer Bell, and Grace Castellazzo. Other researchers included Bruce McEwen, Ph.D. of the Rockefeller University; Teresa Seeman, Ph.D., of the University of California, Los Angeles; and Karen Mathews, Ph.D. of the University of Pittsburgh.

The study was funded by the MaCarthur Foundation Research Network on Socioeconomic Status and Health.

Note: This story has been adapted from a news release issued by Yale University.

Source: Yale University

General Health:

• From http://www.theithacajournal.com/apps/pbcs.dll/article?AID=/20070208/LIFESTYLE18/702080302/1025

Health Watch: Unwanted hair in women
A team of licensed cosmetologist and endocrinologist may provide the best results

By Jolie Massicci and Adam Law
Special to The Journal

Women face many challenges with their appearance but one of the most troublesome and recurring is unwanted hair. Unwanted hair can range from a few extra hairs on the breast or issuing from moles on the face, to a full beard. There are many cultural and ethnic differences in the perception of this hair and moreover what may be seen as unwanted hair in one society may be seen as desirable in another. Making this even more complex, some women experiencing excessive bodily hair actually have an underlying disorder of the hormone system in which there is an imbalance between male sex hormones (androgens) and female sex hormones (estrogens). Taking care of unwanted hair can be a simple matter of weekly leg shaving or intermittent tweezing hairs from the face. Other women have an exuberant growth of hair on their face that no amount of waxing or tweezing can take care of. Shaving may be too demoralizing or ineffective as it leaves unsightly stubble. It is important to recognize that the optimal approach to these more severely affected women with this common problem is through the combined efforts of cosmetologist and a medical team. Primary care physicians, gynecologists, dermatologists and endocrinologists may be part of this team. Endocrinology is a medical subspecialty whose focus is the disturbance of hormone function and of the organs that secrete them. A coordinated team approach is the most effective way to help women with this distressing problem.

Cosmetology has come a long way from the bad old days when phenol-containing depilatory creams were used to remove unwanted hair and in the process damaged the skin, or painful hair extraction techniques. Electrolysis is a widely used and effective approach. It has the advantage of being readily available in most communities and it also takes care of all but the most severe cases of excess and unwanted facial and bodily hair. However, its effects are relatively short lived and repeated treatments are often necessary making it costly and inconvenient. In recent years advances in technology have led to new approaches that are being moved from the dermatology clinic to the repertoire of licensed cosmetologists. Laser hair removal is one such approach.

Laser hair removal is a gentle, non-invasive, long-lasting solution for unwanted hair. Moreover, laser hair removal has been proven to create a permanent reduction in the number of re-growing hairs following each treatment.

The treatment involves the gentle cooling of the skin surface while pulses of light are selectively absorbed by the pigment in the hair. The absorbed light heats the hair structures, which damages the existing hair and destroys the re-growth potential of the follicle-all without damaging the surrounding normal tissue.

Flexible settings of the laser allow for customized hair removal treatment according to the particular body area to be treated and hair and skin type of the individual patient for the safest and best possible results.

Laser hair removal, when performed by a licensed professional, is safe, effective and permanently reduces unwanted hair. The procedure is fast, and there are few, if any, side effects. However, because hair grows in stages, multiple treatments are usually required to achieve optimal results.

The procedure is tolerated well and can be performed in the convenience of a comfortable salon setting. Following treatment, patients can typically return to work and resume all regular activities.

Medical research in the field of endocrinology has given rise to an understanding of the causes of excessive bodily hair in women - a condition termed “hirsuitism”.

The most common medical condition giving rise to hirsuitism is the polycystic ovarian syndrome (PCOS). Women with this condition often have irregular or absent menstrual periods at puberty lasting throughout the reproductive years. In their early teenage years girls with this problem developed distressing amount of male distribution bodily hair and oily skin with. In this condition the ovaries produce excessive testosterone, measured easily in a blood test. Half the women with PCOS are overweight or obese. This excessive body fat is characteristically distributed in the abdomen. The cause of PCOS remains a medical mystery. Endocrinologists have found that one of the main mechanisms that gives rise to PCOS is insulin resistance. This is the lack of responsiveness of insulin target tissues, such as muscle and liver, to the usual actions of insulin. In response to this insulin resistance the insulin producing cells of the pancreas produce large amounts of insulin in order to maintain blood glucose levels in the normal range. Excess concentrations of insulin stimulates the ovaries to produce inappropriate amounts of testosterone, in turn giving rise to an abnormal menstrual periods, unwanted bodily hair, and acne. Many women with this condition go on to develop gestational diabetes, type 2 diabetes mellitus later in life and it is thought also to be an important risk factor for heart attacks and strokes. Specific treatment of PCOS includes sustainable weight loss, a diet lower in carbohydrates and daily aerobic exercise. Medications reducing insulin resistance, such as metformin, pioglitazone and rosiglitazone also have a role.

There are many other less common causes of hirsutism. Some women have an inherited disorder of the adrenal gland that is called congenital adrenal hyperplasia. At its most severe form babies are born with ambiguous genitalia (little girls look superficially like little boys) and also with severe problems retaining salt and water, resulting in shock and critical illness in newborn infants. However there is another form of this condition that is less severe and reveals itself either in late childhood or at puberty with a dense growth of unwanted hair in the male distribution and oily skin with acne. This can be diagnosed by blood tests for adrenal androgens (DHEAS) and precursors of cortisol synthesis (17 alpha hydroxyprogesterone). Specific medical treatment involves the use of a small daily dose of synthetic steroids (hydrocortisone, prednisone or dexamethasone) to suppress the excess secretion of adrenal androgens in this condition. This is a highly effective treatment.

Some women have a mutation of the enzyme that activates testosterone at the hair follicle itself causing stimulation of male distribution hair growth. Many other women with unwanted bodily hair never have the cause discovered despite many tests. This is termed idiopathic hirsutism (a medical term used when the cause is unknown). Other rare conditions causing hirsuitism include ovarian, adrenal and pituitary tumors.

Once thick, terminal hairs have established themselves in unwanted places they are difficult to treat with medication. However, medication can prevent new thick hairs forming in the first place and also reduce their rate of growth, making treatments with electrolysis and laser hair removal more effective and less frequent. Oral contraceptive pills are the first line of treatment as they reduce the production of testosterone from the ovaries and they also increase the amount of estrogen in the circulation. This changes the balance of estrogens to androgens favorably affects unwanted hair growth. In those women who are taking oral contraceptive pills it is also possible to use an anti-androgenic medication. The most widely of medication of this class used currently in the USA is Spironolactone. This is a potassium-sparing diuretic that caused breast formation (gynecomastia) when used in men with heart failure. Other stronger anti-androgens are being used experimentally, but are at present not used widely in the USA. Anti-androgens should be stopped when women wish to conceive as they can cause male fetuses to be feminized.

Finally there is a cream that has been developed for use in women with unwanted hair called Eflornithine. This is applied directly to the areas affected by unwanted hair. Our experience with this medication has been disappointing and few women ask for refills of this prescription.

As you can see from our discussion above, the best treatment plan for women with more severe unwanted hair is a team approach of patients, licensed cosmetologists and physicians. Cosmetic specialists can use a large repertoire of techniques depending upon the severity and persistence of the unwanted hair. This can start with low technology approaches such as waxing and tweezing for milder cases, more established techniques such as electrolysis and also the use of laser hair removal for more prolonged effectiveness. The medical profession has an important role in the team. Excessive body hair can indicate an underlying an important medical problem. Primary care providers, dermatologists, gynaecologists and endocrinologists are all involved in the evaluation and treatment of these women. Endocrinologist have come to play an important role in the diagnosis and treatment of difficult to treat cases.


From http://www.chicagotribune.com/features/health/chi-0702180397feb18,1,1023163.story

FROM THE MAYO CLINIC
Better act fast to minimize appearance of stretch marks
Tribune Media Services


February 18, 2007

Q. Are there any effective non-surgical treatments for stretch marks?

--Chicago

A. With many medical problems, doctors counsel a wait-and-see attitude in order to avoid interventions that may be painful, inconvenient and possibly unnecessary. The problem just might go away by itself.

This is not the case with stretch marks, for which time is of the essence. They are most responsive to treatment before they are six weeks old. Even then, therapy might best be described as "mildly effective." Not every patient responds, and any improvement often is marginal.

Stretch marks develop in a variety of circumstances. Some involve a physical stretching of the skin (such as seen in weight lifters), substantial weight gain or adolescent growth spurts; areas of skin get stretched to the point that collagen and elastin fibers break down. Other cases involve hormonal effects, such as from chronic steroid use or Cushing's syndrome. Sometimes, as in pregnancy, there is both the physical component (stretching of the skin) as well as hormonal change.

Either way, a stretch mark is skin that has lost its elasticity, and the resulting scarlike tissue is shiny, depressed, flaccid and thin compared with surrounding normal tissue. At first, the stretch mark may be pink, red or purple; later, it will fade to a color closer to the individual's natural skin tone, though it will plainly be lighter. Its texture, however, will be unchanged.

One way to reduce the likelihood of a stretch mark's occurrence is to maintain a normal weight, which of course has numerous other benefits. And even though it is inevitable that a pregnant woman will put on some weight over a relatively brief time, she can work with her obstetrician to minimize that gain by maintaining a proper diet and pursuing a suitable exercise program.

Research has shown that tretinoin cream (Retin-A, Renova) may improve the appearance of stretch marks that are less than six weeks old, though it should never be used during pregnancy, as it might harm the fetus. Tretinoin, when it works, helps to rebuild collagen, rendering the stretch mark more similar in appearance to one's normal skin. Once the mark is fairly well established, it tends not to respond to this treatment.

Another option, which also is best used when the stretch mark is new but still has some effectiveness when it's older, is pulsed dye laser therapy. Used at wavelengths of light that are non-ablative (will not remove any skin), the treatment remodels the dermis (the layer of skin just beneath the surface layer, the epidermis) by stimulating the growth of fibroblasts, cells that help produce the elastic tissues collagen and elastin.

Two leading options for older stretch marks are microdermabrasion and excimer laser therapy. Microdermabrasion uses mineral crystals blown onto the target tissue. This "polishing" gently removes the skin's topmost layer, which, when effective, results in new growth that is more elastic.

The excimer laser, an altogether different system from the pulsed dye laser, does nothing for collagen or elastin growth. Instead, its aim is repigmentation by stimulating melanin production. If it works, the old scar is rendered similar in color to the surrounding skin, and therefore less visible.

Some individuals with stretch marks are content to live with them and therefore seek no treatment. But for people who find them unsightly and unacceptable, help is available. They should work with a dermatologist or plastic surgeon to choose the most appropriate treatment. Factors to consider include age of the stretch mark, convenience of treatment (therapies differ in length and frequency of sessions) and cost (being cosmetic, these options are usually not covered by health plans). Patients also need to be advised that treatment will, at best, be only partially effective. But for lots of people, that may be enough.

--P. Kim Phillips, MD, dermatology, Mayo Clinic, Rochester, Minn.

----------

Medical Edge From Mayo Clinic is an educational resource and doesn't replace regular medical care.

To submit a question, write to: medicaledge@mayo.edu, or Medical Edge From Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, NY 14207.

Copyright © 2007, Chicago Tribune

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