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UK FORWARD CLOSE TO FULL STRENGTH AFTER OCTOBER SURGERY By Jerry Tipton
HERALD-LEADER STAFF WRITER

"Tumor."

That diagnosis sent shockwaves through the Kentucky basketball program last fall.

Sophomore forward Sheray Thomas had been sluggish and easily fatigued. Relying on their athletic backgrounds, the coaches urged him to play harder. That didn't help.

Then a medical examination revealed the reason why Thomas got tired so quickly: A tumor was growing on his adrenal gland.

"It kind of scared me," Thomas said yesterday when asked about his initial reaction to the diagnosis.

It scared his coaches and teammates, too.

"I got scared," Chuck Hayes said. "That's very scary. Life and death, really."

Doctors removed the benign tumor -- which was tennis-ball sized, Thomas said -- in a six-hour surgery in early October.

Thomas lost about 40 pounds. UK coaches considered sitting out Thomas this season. But once his daily post-op nausea ended after about two weeks, he began the process of getting back in good enough shape to play.

"I pushed myself as hard as I could," he said. "You never realize what you have until it's gone. You want to do anything to go back out and play."

Thomas, whose rebounding and physical play off the bench fit an acute UK need, returned for a cameo role against Louisville on Dec. 18. His stints increased to six and 10 minutes against William & Mary and Campbell.

He's now well enough to not be satisfied with anything but the maximum playing time possible. In other words, he's like most other college players.

When a reporter asked if he'd expect to log eight to 10 minutes against South Carolina tonight, Thomas said his expectation was "more than that."

"I'll always say that," he added with a smile. "But that's pretty much up to the coach."

UK Coach Tubby Smith, who earlier marveled at how quickly Thomas got back into practice routines, said the player was now "full tilt."

Well, not quite full tilt, Smith added. With the physical demands of practice and games, the coach expressed doubt that Thomas will return to his playing weight of 230 pounds.

"He probably won't put that weight on until after the season," Smith said. "But he knows how to adapt and adjust to what he has to work with."

Thomas tried to adapt long before doctors discovered the tumor. He recalled feeling so weak after his senior year of high school in Upper Marlboro, Md., that he had to stay in bed for long stretches.

Thomas did not feel pain, but he noticed how quickly he got tired. "Just from shooting before practice, before stretching," he said. "I didn't feel ready to go. Something was taking away my energy, making me sweat more.

"The coaches said I wasn't going as hard as I could. Being lazy, pretty much."

Then Thomas learned of the tumor at the end of September.

Yes, he said, he wondered if he'd play basketball again.

"That was the thought in my head," Thomas said. "People were saying that. I always thought I'd come back. I was scared, but I stayed positive."

Doctors needed six hours to remove the tumor, in part, because the adrenal gland is in the back of the abdomen and requires a methodical surgical touch to reach, and because the tumor was large.

As difficult as the surgery was, the recovery period was "way worse," Thomas said. "Horrible."

Thomas grew nauseous. "Every day I was sick," he said. "It was a rough couple weeks."

The surprise of his post-op difficulties, which can be a normal effect of major surgery, probably slowed his recovery.

"A big shock," he said. "I guess I didn't ask as many questions (before surgery) as I needed to."

Now, Thomas said he feels good. He brushed off a bruised knuckle on his right ring finger.

"No injury is fun," he said, rubbing the knuckle, "but this is better than the injury I had before."

His return caused a hooray-for-Sheray reaction from teammates and coaches.

"It's unbelievable," Patrick Sparks said. "He's made big strides. People were talking of redshirting. It's given us an inspirational lift."

"I was very large. People, strangers, started to ask me, ‘When is the baby due.’"

The question was mortifying.

"From then on, I didn’t go out except to go to work," Kinne said.

Acne erupted on her normally clear skin.

Even prescription drugs had no effect.

She was now shopping for plus-size clothes.

Kinne’s hellish metamorphosis accelerated. Her face filled out and became round.

She developed a pad of fat (doctors call it a "buffalo hump") on her back at the base of her neck.

Kinne was thinking about killing herself.

Finally, her gynecologist, Dr. Vincent Pepe of Cheshire, asked Kinne what she was eating.

"He said the food didn’t account for the weight and asked me to take some tests," she said.

Kinne has six times the normal level of cortisol.

Pepe told her that she had Cushing’s syndrome and recommended an endocrinologist, Dr. Richard Kayne, also of Cheshire.

Kayne’s office wanted to see her immediately.

"That night, I looked up Cushing’s syndrome on the Web. It said there was a tumor on my pituitary or adrenal gland and that it might be cancer. I cried all night," she said.

When she met Kayne her anxiety was obvious.

"He said, ‘I see you’ve been looking up Cushing’s syndrome on the Internet,’ " she said.

Kayne referred Kinne to Dr. Robert Udelsman, chief of surgery at Yale-New Haven Hospital and one of a relatively small group of surgeons who treat Cushing’s syndrome.

Udelsman’s spacious office has one oil painting: a portrait of Dr. Harvey Cushing, who published a paper in 1912 on a new syndrome he had discovered.

Cushing spent the final years of his career at Yale, after "Cushing’s syndrome" had become part of the medical lexicon.

Udelsman said Cushing’s syndrome is most commonly caused by doctors prescribing prednisone, hydrocortisone and other steroids for a variety of ailments.

In these cases, the syndrome is mild and transient.

Otherwise, the syndrome can arise from one of four problems in the glucocorticoid system, Udelsman said.

When working normally, the hypothalamus produces corticotropin releasing hormone or CRH. The pituitary responds to CRH by making adrenocorticotropic hormone, or ACTH.

When ACTH reaches the adrenal glands, they produce cortisol. Cortisol-containing blood circulates back to the hypothalamus and pituitary, which respond by reducing production of CRH and ACTH, Udelsman said.

Cortisol ordinarily peaks at 8 a.m. and 10 p.m.

A tumor on the pituitary can generate too much cortisol. This condition is called Cushing’s disease. A tumor near the pituitary can do the same thing.

Or, as in Kinne’s case, a tumor, benign or cancerous, can form in the adrenal glands and pour out huge amounts of cortisol.

The result is obesity of the trunk, protein deprivation, increased fat, loss of menstruation, acne, reduced bone density, diabetes, increased blood pressure, a suppressed immune system, infections and other symptoms.

Untreated, Cushing’s syndrome often ends in death.

Treatment for all types of Cushing’s syndrome is surgery, Udelsman said.

Until recently, gaining access to the adrenal gland required major surgery, a large incision and a long recovery time.

Udelsman removed Kinne’s tumor laparoscopically, using narrow wandlike instruments inserted into the abdomen through several small incisions.

Kinne’s tumor was not cancerous.

However, continued exposure to cortisol left her pituitary atrophied and unable to make any ACTH.

In other words, she went from making too much cortisol to not being able to make any.

So Kinne had to be given cortisol. The extra weight stayed on for six months and then rapidly disappeared.

Finally, when her endocrine system came back, she had to be weaned off glucocorticoids, which normally induce euphoria.

Dr. Joseph H. Shin, director of plastic, reconstructive and aesthetic surgery at Yale, tightened her abdominal muscles and removed folds of remaining loose skin.

Kinne now weighs about 130 pounds.

"I’m very happy that I lost all that weight and look like a normal person," she said.

"I’m much more sympathetic to obese people. I know how difficult it is, not having control."

She’s working again as a paralegal at Travelers Life & Annuity in Hartford.

An unhappy four-year marriage officially ended at about the same time. The stress of her medical problems was too much for her former husband, she said.

Now she notices men glancing at her.

They pay more attention to the 132-pound "after" Kinne than to the 205-pound "before" version.

"It’s flattering. I’ve always been a flirt," she said.

But she hasn’t forgotten her other self.

"What bothered me the most was the weight gain and being mistaken for being pregnant," the new Karen Kinne said.

Abram Katz can be reached at akatz@nhregister.com or 789-5719.

January 12 - PORTLAND - It's a question scientists have debated for more than 50 years: Can a person's belief or expectation of overcoming an illness improve that person's overall health?

While this so-called "expectancy effect" may not necessarily influence the underlying cause of a disease, evidence suggests it can have an impact on a patient's health outcomes. A new, National Institutes of Health-funded research program at Oregon Health & Science University aims to find out why.

The Oregon Center for Complementary and Alternative Medicine in Neurological Disorders (ORCCAMIND) in the OHSU School of Medicine has received a three-year, $2.4 million grant from the NIH's National Center for Complementary and Alternative Medicine to develop "Complementary and Alternative Medicine: Expectancy and Outcomes," or CAMEO.

CAMEO's goal is to develop expectancy effect models that can be used to study cognitive and physiological changes contributing to the phenomenon, ranging from perceived self-efficacy - the belief that a person can influence his or her own health outcome - to hormonal activity and genetic changes that affect the brain's neurotransmitter systems, such as dopamine, serotonin and opioid, said Barry Oken, M.D., professor of neurology and behavioral neuroscience in the OHSU School of Medicine, and director of ORCCAMIND and CAMEO.

Researchers also hope to improve the design of clinical trials by heightening understanding of how individual differences contribute to the variability in responses to medical interventions.

Expectancy effect is considered a component of placebo effect, a long-studied medical outcome stemming from any clinically prescribed, biologically inert substance or inactive procedure for which there is no direct biological effect, including words, pills, gestures, devices and surgery. Expectancy effect is considered more broad and includes all processes and influences that may affect the brain's anticipation of a response.

"We're not talking about the patient-physician interaction, which, to some people, is considered part of placebo effect - the contact, the handholding, the bedside manners," said Oken, who wrote a chapter about placebo effect in his 2004 book, Complementary Therapies in Neurology: An Evidence-Based Approach. "We're really thinking about people's hope or expectation that they're going to get better."

One recent study, for example, showed Parkinson's disease patients who were administered a placebo experienced changes in brain chemistry similar to that caused by symptom-treating drugs levodopa annd apomorphine.

"It's really pretty remarkable," Oken said. "In Parkinson's patients, you can show dopamine release in the basal ganglia with administration" of the placebo.

CAMEO will focus on four areas: Parkinson's disease, metabolic syndromes, Alzheimer's disease and a mouse model for multiple sclerosis, Oken said. Each area is led by a two-person team that includes a conventional medicine physician and a complementary medicine practitioner. The grant allows ORCCAMIND to build on relationships it established with the National College of Naturopathic Medicine, the Oregon College of Oriental Medicine and Western States Chiropractic College in Portland.

NCCAM developmental centers, such as CAMEO, "clearly require close affiliation with CAM centers because part of the goal was to facilitate development of research infrastructure at the CAM institutions," Oken said. "So each of the four projects is linked."

Working with complementary practitioners is important because many of them have "succeeded in harnessing this effect," Oken said. "From my point of view, they have a much better handle on how to maximize this effect than conventional practitioners."

The research teams also will study factors that may contribute to clinical benefit from expectancy effect, including stress and personality traits.

One area of the brain that CAMEO will examine closely is the hypothalamic-pituitary-adrenal axis, a cluster of neuroendocrine components that includes parts of the hypothalamus, the anterior lobe of the pituitary gland, adrenal glands and hormone-transporting systems. The axis controls reactions to stress and is believed to be linked with mood disorders.

"The HPA acts as sort of a stress mediator," Oken said. "Those kinds of things might predispose a person to have a better, bigger response (to placebo) than others."

Carlo Calabrese, N.D., M.P.H., a research professor at the National College of Naturopathic Medicine and a clinical assistant professor of neurology in the OHSU School of Medicine, will serve as CAMEO's associate director.

Needle-Free Delivery Option Exclusive to Saizen(R) Available for Patients

GENEVA, Switzerland and ROCKLAND, Massachusetts, January 10 /PRNewswire-FirstCall/ -- Serono Inc., the US affiliate of Serono (virt-x: SEO and NYSE: SRA), announced today the availability of Saizen(R) [somatropin (rDNA origin) for injection] for use in the treatment of patients with adult growth hormone deficiency (AGHD), following its FDA approval.

"This new indication for Saizen(R) represents the evolution of our growth hormone portfolio and further demonstrates our commitment to the metabolic franchise," said James Sapirstein, executive vice president of Metabolic Endocrinology at Serono, Inc. "Patients with AGHD who are treated with Saizen(R) therapy can use our easy-to-use drug delivery devices such as cool.click(R), a needle-free device that is preferred by pediatric patients and is now available for use by adults taking Saizen(R)."

Adult Growth Hormone Deficiency (AGHD) can be effectively treated with Saizen(R). With the U.S. approval, patients who were growth hormone deficient during childhood and have growth hormone deficiency as an adult, may continue to use Saizen(R). In addition, adult patients who have adult onset growth hormone deficiency either alone, or associated with multiple hormone deficiencies, now have access to Saizen(R) and its line of devices.

Saizen(R) can be administered using a needle-free device, cool.click(R), the only FDA approved needle-free device for the administration of growth hormone. It can also be administered with a recently launched autoinjector pen device, one.click(R), or by traditional needle and syringe. Serono's portfolio of innovative devices gives patients the choice they want in growth hormone delivery.

Patients can learn more about Saizen(R) and Serono's growth hormone delivery devices by talking with their physician, or by calling Serono Connections for Growth(R) toll-free at 1-800-582-7989. The full prescribing information for Saizen(R) can be found online at http://www.seronousa.com.

About Adult Growth Hormone Deficiency (AGHD)

Growth hormone deficiency can be a significant problem for adults even though they no longer get taller. AGHD is recognized as a specific clinical syndrome with numerous physiological consequences, with effects on:
- Changes in body composition, including central obesity;
- Lipids in the blood;
- Muscle strength;
- Bone composition;
- Exercise capacity and energy;
- Cardiovascular risk; and
- Psychological well-being (social isolation and depression).

There are also studies indicating that patients with AGHD have an increased risk of mortality from cardiovascular disease, possibly attributable to their growth hormone (GH) deficiency.

GH deficiency in adults can result from a pituitary or peri-pituitary tumor or as a direct result of the surgery/radiation used to manage these conditions. Less commonly, GH deficiency in adults arises from a deficiency acquired in childhood.

About Saizen(R)

Saizen(R) [somatropin (rDNA origin) for injection] is a human growth hormone produced by recombinant DNA technology. The recommended dose for adults at the start of therapy is .005 mg/kg daily. The dosage may be increased to not more than .01 mg/kg daily after four weeks depending upon the patient's tolerance of treatment.

Saizen(R) is indicated for the long-term treatment of children with growth failure due to inadequate secretion of endogenous growth hormone. It is indicated for replacement of endogenous growth hormone in adults with growth hormone deficiency that meets the criteria of adult onset or childhood onset.

In patients with AGHD, the most common adverse events with associated growth hormone therapy are joint and muscle pain, edema, carpal tunnel syndrome, and tingling.

Growth hormone should be used with caution in patients with insulin resistance, glucose intolerance, diabetes, hypothyroidism, intracranial hypertension, and in women who are pregnant or nursing. GH should not be used in patients with Prader-Willi syndrome who are severely obese or have severe respiratory impairment; in the presence of active neoplasia; and in patients with proliferative or preproliferative diabetic retinopathy; or in patients hospitalized with acute critical illnesses.

Full prescribing information for Saizen(R), including important safety information, is available at http://www.seronousa.com.

NEW YORK (Reuters Health) Dec 30 -Case reports and evidence from small series have suggested that aneurysmal subarachnoid hemorrhage might be associated with neuroendocrine dysfunction.

In the December issue of Stroke, Greek researchers now report that in a larger population with long-term follow-up, endocrine abnormalities are indeed common in patients who survive these events.

Dr. Ioanna Dimopoulou and colleagues at the National & Kapodistrian University of Athens performed endocrine assessments in 30 patients who had suffered aneurysmal subarachnoid hemorrhage between 12 and 24 months earlier.

The investigators report that 14 of the 30 patients had isolated or combined abnormalities. These included low insulin-like growth factor 1 levels compatible with growth hormone deficiency in 37%, hypogonadism in 13%, cortisol hyporesponsiveness to the low-dose corticotropin stimulation test in 10% and subclinical hypothyroidism in 7%.

The presence of endocrine abnormalities was not correlated either with severity of the hemorrhage or with functional outcome. In fact, the authors note that long-term functional evaluations showed that most patients "had mainly recovered."

They point out, however, that follow-up studies of subarachnoid hemorrhage survivors generally report relatively high rates of functional limitations and other problems, even in patients with good neurological recovery.

Thus the team concludes that given the high rate endocrine dysfunction, in particular, growth hormone and gonadal abnormalities, "screening of pituitary function is recommended in patients surviving subarachnoid hemorrhage."

Stroke 2004; 35:2884-2889.

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January 28, 2005, Pituitary Update Conference For Patients And Physicians. More info here.

June 4-7, 2005, ENDO 2005, San Diego. Mainly for physicians, but patients may attend. More info here.

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