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Submit your recipes
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Iatrogenic
Cushing’s Syndrome with Osteoporosis and
Secondary Adrenal Failure in Human
Immunodeficiency Virus-Infected Patients
Receiving Inhaled Corticosteroids and Ritonavir-Boosted
Protease Inhibitors: Six Cases
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|
| News! |
Submit your recipes for a CUSH
Cookbook!
It's
time to gather up your favorite
recipes, the ones you'd like to
share with others, and send them to
Cheryl Farrar for entry in our
cookbook, CUSH Cuisine.
For questions or comments, please
visit this topic on the message
boards:
http://cushings.invisionzone.com/index.php?
showtopic=13732&pid=112309&st=0#entry112309
Cheryl's Address is:
Cheryl Farrar
2725 Cambridge Ct.
Oklahoma City, OK 73116
You can also email to her at:
cheryl1957ann@sbcglobal.net
The link to the form for the recipes
is:
Recipe Collection or fill out
the info below.
Please note: We are allowed 2
lines with 35 characters each so
we'd like to publish everyone's
board names along with their real
names and state or country.
Thanks!
(Please type or print clearly and
proofread before you send it to
Cheryl)
Category: 1. Appetizers/Beverages
2. Soups/Salads
3. Veggies & Side dishes
4. Main Dishes
5. Breads/Rolls
6. Desserts
7. Cookies & Candy
8. This & That
Category: ______________________
Recipe Title:__________________
Submitted by: _________________
phone # _______________________
State/country__________________
e-mail _______________________
Ingredients: (Use abbreviations: pt.
qt. pkg. env. c. tsp. T. oz. lb.
gal. doz sm. med. lg.)
________________________________________
________________________________________
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_________________________________________
Up to 10 recipes per person please,
all recipes may not be used if we
receive several of same type.
We
are going to try to have recipes
submitted by Nov 1st, if at all
possible so that we can get them
typed and to the publisher by mid
January to get the best
discounts....but it all depends on
you! |
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available in August in the
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The stamps come in sheets of 20. This
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Cushing's
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I want to thank the
people who generously
contributed so that NIH
visitors could get Cushie
wrist bands. I delivered
the first of them this summer to Myra B, Lisa J
and to the chaplain on
their floor. He came in
while I was waiting for
Myra, and was new to NIH and
new to Cushing's. I
figured he could learn a
lot from the included
pamphlets and maybe
understand his patients a
little better as he talks
with them each day.
I also left a
"package" with
Myra to give to another
Cushie on their floor who
I hadn't met but both
Lisa and Myra knew.
So, I distributed the
first 4 of the Cushie
bands...so far, and I
thank you for your
generosity in doing this
for them.
In addition to the
awareness bands, each bag
includes a CUSH brochure,
my own brochure (the same
as I send out with the
regular awareness bands),
and a Cushings-Help
business card.
Each of the brochures includes the
name of the person who
donated the bands, so
that the patients will
know that there's another
patient out there who did
this for them.
Thanks again - you made
several Cushies smile! More
information here.
Order here.
| News: |
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Submit a Story or Article
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|
|
Iatrogenic Cushing’s Syndrome |
from:
http://jcem.endojournals.org/cgi/content/abstract/90/7/4394
The Journal of
Clinical Endocrinology & Metabolism
Vol. 90, No. 7 4394-4398
Copyright © 2005 by The Endocrine
Society
CLINICAL CASE SEMINAR
Iatrogenic Cushing’s Syndrome with
Osteoporosis and Secondary Adrenal
Failure in Human Immunodeficiency
Virus-Infected Patients Receiving
Inhaled Corticosteroids and Ritonavir-Boosted
Protease Inhibitors: Six Cases
Katherine Samaras,
Sarah Pett, Andrew Gowers,
Marilyn McMurchie and
David A. Cooper
Department of Endocrinology (K.S.),
St. Vincent’s Hospital and St.
Vincent’s Clinic; Immunology and
Infectious Diseases Unit (S.P., D.A.C.),
St. Vincent’s Hospital; National
Centre for HIV Epidemiology and
Clinical Research (S.P., D.A.C.),
University of New South Wales; and
Holdsworth House General Practice
(A.G.), Darlinghurst, New South Wales
2010, Australia; and 407 Doctors
General Practice (M.M.), Surry Hills,
New South Wales 2010, Australia
Address all
correspondence and requests for
reprints to: Dr. Katherine Samaras,
MBBS, FRACP, Ph.D., Diabetes and
Obesity Group, Garvan Institute of
Medical Research, 384 Victoria Street,
Darlinghurst, New South Wales, 2010,
Australia. E-mail:
k.samaras@garvan.org.au
.
Ritonavir, a protease
inhibitor (PI), is a potent inhibitor
of cytochrome P450 3A4. This
pharmacological effect, even at
low doses ( 200
mg/d), is used to "boost" levels of
other PIs in the treatment
of HIV infection and facilitate once
or twice daily dosing with
reduced pill burden. Six patients with
preexisting HIV-lipodystrophy
developed symptomatic Cushing’s
syndrome when treated with
inhaled fluticasone at varying doses
for asthma while
concurrently treated with low-dose
ritonavir-boosted PI
antiretroviral therapy (ART) regimens
for HIV infection. There
was evidence of adrenal suppression in
all patients on stimulation
studies. After the withdrawal of
inhaled fluticasone, four patients
became symptomatic of
hypocortisolism, and three required
oral corticosteroid support
for several months. Other
complications included
evidence of osteoporosis (n = 3),
crush fractures (n = 1),
and exacerbation of preexisting type 2
diabetes mellitus (n = 1).
In part, the diagnosis of fluticasone-induced
Cushing’s syndrome was
delayed because all patients had
preexisting body
composition changes of ART-associated
lipodystrophy, masking the
Cushing’s features. Practitioners
should be aware of the
impact on the adrenal axis of
coadministration of PI-based
ART regimens with inhaled
corticosteroids and the potential
for exacerbating or even
inducing other metabolic conditions,
such as osteoporosis or
diabetes.
|
|
Cushing’s Syndrome Statistics |
from:
http://www.wrongdiagnosis.com/c/cushings_syndrome/stats-country.htm
Statistics by Country for Cushing's
syndrome
|
About these extrapolations of
prevalence and incidence
statistics for Cushing's syndrome:
These statistics are calculated
extrapolations of various
prevalence or incidence rates
against the populations of a
particular country or region. The
statistics used for
prevalence/incidence of Cushing's
syndrome are typically based on
US, UK, Canadian or Australian
statistics. This extrapolation
calculation is automated and does
not take into account any genetic,
cultural, environmental, social,
racial or other differences across
the various countries and regions
for which the extrapolated
Cushing's syndrome statistics
below refer to. As such, these
extrapolations may be highly
inaccurate (especially for
developing or third-world
countries) and only give a general
indication (or even a meaningless
indication) as to the actual
prevalence or incidence of
Cushing's syndrome in that region.
About prevalence and incidence
statistics in general for
Cushing's syndrome: The word
'prevalence' of Cushing's syndrome
usually means the estimated
population of people who are
managing Cushing's syndrome at any
given time (i.e. people with
Cushing's syndrome). The term
'incidence' of Cushing's syndrome
means the annual diagnosis rate,
or the number of new cases of
Cushing's syndrome diagnosed each
year (i.e. getting Cushing's
syndrome). Hence, these two
statistics types can differ: a
short disease like
flu can have high annual
incidence but low prevalence, but
a life-long disease like
diabetes has a low annual
incidence but high prevalence. For
more information see
about prevalence and incidence
statistics. |
Prevalence of Cushing's syndrome:
2-5 per million (NIDCD); 10 per
million; 10-15 per million
Prevalance Rate for Cushing's
syndrome: approx 1 in 500,000 or
0.00% or 543 people in USA [about
data]
Extrapolation of Prevalence Rate of
Cushing's syndrome to Countries and
Regions: The following table
attempts to extrapolate the above
prevalence rate for Cushing's syndrome
to the populations of various
countries and regions. As discussed
above, these prevalence extrapolations
for Cushing's syndrome are only
estimates and may have limited
relevance to the actual prevalence of
Cushing's syndrome in any region:
|
Country/Region |
Extrapolated Prevalence
|
Population Estimated Used
|
|
Cushing's syndrome in North
America (Extrapolated Statistics)
|
|
USA |
587 |
293,655,4051
|
|
Canada |
65 |
32,507,8742
|
|
Cushing's syndrome in
Europe (Extrapolated
Statistics) |
|
Austria |
16 |
8,174,7622 |
|
Belgium |
20 |
10,348,2762
|
|
Britain (United
Kingdom) |
120 |
60,270,708 for UK2
|
|
Czech Republic |
2 |
1,0246,1782
|
|
Denmark |
10 |
5,413,3922 |
|
Finland |
10 |
5,214,5122 |
|
France |
120 |
60,424,2132
|
|
Greece |
21 |
10,647,5292
|
|
Germany |
164 |
82,424,6092
|
|
Iceland |
0 |
293,9662 |
|
Hungary |
20 |
10,032,3752
|
|
Liechtenstein |
0 |
33,4362 |
|
Ireland |
7 |
3,969,5582 |
|
Italy |
116 |
58,057,4772
|
|
Luxembourg |
0 |
462,6902 |
|
Monaco |
0 |
32,2702 |
|
Netherlands (Holland) |
32 |
16,318,1992
|
|
Poland |
77 |
38,626,3492
|
|
Portugal |
21 |
10,524,1452
|
|
Spain |
80 |
40,280,7802
|
|
Sweden |
17 |
8,986,4002 |
|
Switzerland |
14 |
7,450,8672 |
|
United Kingdom |
120 |
60,270,7082
|
|
Wales |
5 |
2,918,0002 |
|
Cushing's syndrome in the Balkans
(Extrapolated Statistics)
|
|
Albania |
7 |
3,544,8082 |
|
Bosnia and Herzegovina
|
0 |
407,6082 |
|
Croatia |
8 |
4,496,8692 |
|
Macedonia |
4 |
2,040,0852 |
|
Serbia and Montenegro |
21 |
10,825,9002
|
|
Cushing's syndrome in
Asia (Extrapolated Statistics)
|
|
Bangladesh |
282 |
141,340,4762
|
|
Bhutan |
4 |
2,185,5692 |
|
China |
2,597 |
1,298,847,6242
|
|
East Timor |
2 |
1,019,2522 |
|
Hong Kong s.a.r. |
13 |
6,855,1252 |
|
India |
2,130 |
1,065,070,6072
|
|
Indonesia |
476 |
238,452,9522
|
|
Japan |
254 |
127,333,0022
|
|
Laos |
12 |
6,068,1172 |
|
Macau s.a.r. |
0 |
445,2862 |
|
Malaysia |
47 |
23,522,4822
|
|
Mongolia |
5 |
2,751,3142 |
|
Philippines |
172 |
86,241,6972
|
|
Papua New Guinea |
10 |
5,420,2802 |
|
Vietnam |
165 |
82,662,8002
|
|
Singapore |
8 |
4,353,8932 |
|
Pakistan |
318 |
159,196,3362
|
|
North Korea |
45 |
22,697,5532
|
|
South Korea |
96 |
48,233,7602
|
|
Sri Lanka |
39 |
19,905,1652
|
|
Taiwan |
45 |
22,749,8382
|
|
Thailand |
129 |
64,865,5232
|
|
Cushing's syndrome in Eastern
Europe (Extrapolated Statistics)
|
|
Azerbaijan |
15 |
7,868,3852 |
|
Belarus |
20 |
10,310,5202
|
|
Bulgaria |
15 |
7,517,9732 |
|
Estonia |
2 |
1,341,6642 |
|
Georgia |
9 |
4,693,8922 |
|
Kazakhstan |
30 |
15,143,7042
|
|
Latvia |
4 |
2,306,3062 |
|
Lithuania |
7 |
3,607,8992 |
|
Romania |
44 |
22,355,5512
|
|
Russia |
287 |
143,974,0592
|
|
Slovakia |
10 |
5,423,5672 |
|
Slovenia |
4 |
2,011,473 2
|
|
Tajikistan |
14 |
7,011,556 2
|
|
Ukraine |
95 |
47,732,0792
|
|
Uzbekistan |
52 |
26,410,4162
|
|
Cushing's syndrome in Australasia
and Southern Pacific (Extrapolated
Statistics) |
|
Australia |
39 |
19,913,1442
|
|
New Zealand |
7 |
3,993,8172 |
|
Cushing's syndrome in the Middle
East (Extrapolated Statistics)
|
|
Afghanistan |
57 |
28,513,6772
|
|
Egypt |
152 |
76,117,4212
|
|
Gaza strip |
2 |
1,324,9912 |
|
Iran |
135 |
67,503,2052
|
|
Iraq |
50 |
25,374,6912
|
|
Israel |
12 |
6,199,0082 |
|
Jordan |
11 |
5,611,2022 |
|
Kuwait |
4 |
2,257,5492 |
|
Lebanon |
7 |
3,777,2182 |
|
Libya |
11 |
5,631,5852 |
|
Saudi Arabia |
51 |
25,795,9382
|
|
Syria |
36 |
18,016,8742
|
|
Turkey |
137 |
68,893,9182
|
|
United Arab Emirates
|
5 |
2,523,9152 |
|
West Bank |
4 |
2,311,2042 |
|
Yemen |
40 |
20,024,8672
|
|
Cushing's syndrome in
South America (Extrapolated
Statistics) |
|
Belize |
0 |
272,9452 |
|
Brazil |
368 |
184,101,1092
|
|
Chile |
31 |
15,823,9572
|
|
Colombia |
84 |
42,310,7752
|
|
Guatemala |
28 |
14,280,5962
|
|
Mexico |
209 |
104,959,5942
|
|
Nicaragua |
10 |
5,359,7592 |
|
Paraguay |
12 |
6,191,3682 |
|
Peru |
55 |
27,544,3052
|
|
Puerto Rico |
7 |
3,897,9602 |
|
Venezuela |
50 |
25,017,3872
|
|
Cushing's syndrome in
Africa (Extrapolated
Statistics) |
|
Angola |
21 |
10,978,5522
|
|
Botswana |
3 |
1,639,2312 |
|
Central African Republic
|
7 |
3,742,4822 |
|
Chad |
19 |
9,538,5442 |
|
Congo Brazzaville |
5 |
2,998,0402 |
|
Congo kinshasa |
116 |
58,317,0302
|
|
Ethiopia |
142 |
71,336,5712
|
|
Ghana |
41 |
20,757,0322
|
|
Kenya |
65 |
32,982,1092
|
|
Liberia |
6 |
3,390,6352 |
|
Niger |
22 |
11,360,5382
|
|
Nigeria |
35 |
12,5750,3562
|
|
Rwanda |
16 |
8,238,6732 |
|
Senegal |
21 |
10,852,1472
|
|
Sierra leone |
11 |
5,883,8892 |
|
Somalia |
16 |
8,304,6012 |
|
Sudan |
78 |
39,148,1622
|
|
South Africa |
88 |
44,448,4702
|
|
Swaziland |
2 |
1,169,2412 |
|
Tanzania |
72 |
36,070,7992
|
|
Uganda |
52 |
26,390,2582
|
|
Zambia |
22 |
11,025,6902
|
|
Zimbabwe |
7 |
1,2671,8602
|
Incidence (annual) of Cushing's
syndrome: estimated 10 to 15 per
million people develop Cushing’s
syndrome each year in the US (NIDDK,
NIH, 2002)
Incidence Rate for Cushing's
syndrome: approx 1 in 100,000 or
0.00% or 2,720 people in USA [about
data]
Extrapolation of Incidence Rate for
Cushing's syndrome to Countries and
Regions: The following table
attempts to extrapolate the above
incidence rate for Cushing's syndrome
to the populations of various
countries and regions. As discussed
above, these incidence extrapolations
for Cushing's syndrome are only
estimates and may have limited
relevance to the actual incidence of
Cushing's syndrome in any region:
|
Country/Region |
Extrapolated Incidence
|
Population Estimated Used
|
|
Cushing's syndrome in North
America (Extrapolated Statistics)
|
|
USA |
2,936 |
293,655,4051
|
|
Canada |
325 |
32,507,8742
|
|
Cushing's syndrome in
Europe (Extrapolated
Statistics) |
|
Austria |
81 |
8,174,7622 |
|
Belgium |
103 |
10,348,2762
|
|
Britain (United
Kingdom) |
602 |
60,270,708 for UK2
|
|
Czech Republic |
12 |
1,0246,1782
|
|
Denmark |
54 |
5,413,3922 |
|
Finland |
52 |
5,214,5122 |
|
France |
604 |
60,424,2132
|
|
Greece |
106 |
10,647,5292
|
|
Germany |
824 |
82,424,6092
|
|
Iceland |
2 |
293,9662 |
|
Hungary |
100 |
10,032,3752
|
|
Liechtenstein |
0 |
33,4362 |
|
Ireland |
39 |
3,969,5582 |
|
Italy |
580 |
58,057,4772
|
|
Luxembourg |
4 |
462,6902 |
|
Monaco |
0 |
32,2702 |
|
Netherlands (Holland) |
163 |
16,318,1992
|
|
Poland |
386 |
38,626,3492
|
|
Portugal |
105 |
10,524,1452
|
|
Spain |
402 |
40,280,7802
|
|
Sweden |
89 |
8,986,4002 |
|
Switzerland |
74 |
7,450,8672 |
|
United Kingdom |
602 |
60,270,7082
|
|
Wales |
29 |
2,918,0002 |
|
Cushing's syndrome in the Balkans
(Extrapolated Statistics)
|
|
Albania |
35 |
3,544,8082 |
|
Bosnia and Herzegovina
|
4 |
407,6082 |
|
Croatia |
44 |
4,496,8692 |
|
Macedonia |
20 |
2,040,0852 |
|
Serbia and Montenegro |
108 |
10,825,9002
|
|
Cushing's syndrome in
Asia (Extrapolated Statistics)
|
|
Bangladesh |
1,413 |
141,340,4762
|
|
Bhutan |
21 |
2,185,5692 |
|
China |
12,988 |
1,298,847,6242
|
|
East Timor |
10 |
1,019,2522 |
|
Hong Kong s.a.r. |
68 |
6,855,1252 |
|
India |
10,650 |
1,065,070,6072
|
|
Indonesia |
2,384 |
238,452,9522
|
|
Japan |
1,273 |
127,333,0022
|
|
Laos |
60 |
6,068,1172 |
|
Macau s.a.r. |
4 |
445,2862 |
|
Malaysia |
235 |
23,522,4822
|
|
Mongolia |
27 |
2,751,3142 |
|
Philippines |
862 |
86,241,6972
|
|
Papua New Guinea |
54 |
5,420,2802 |
|
Vietnam |
826 |
82,662,8002
|
|
Singapore |
43 |
4,353,8932 |
|
Pakistan |
1,591 |
159,196,3362
|
|
North Korea |
226 |
22,697,5532
|
|
South Korea |
482 |
48,233,7602
|
|
Sri Lanka |
199 |
19,905,1652
|
|
Taiwan |
227 |
22,749,8382
|
|
Thailand |
648 |
64,865,5232
|
|
Cushing's syndrome in Eastern
Europe (Extrapolated Statistics)
|
|
Azerbaijan |
78 |
7,868,3852 |
|
Belarus |
103 |
10,310,5202
|
|
Bulgaria |
75 |
7,517,9732 |
|
Estonia |
13 |
1,341,6642 |
|
Georgia |
46 |
4,693,8922 |
|
Kazakhstan |
151 |
15,143,7042
|
|
Latvia |
23 |
2,306,3062 |
|
Lithuania |
36 |
3,607,8992 |
|
Romania |
223 |
22,355,5512
|
|
Russia |
1,439 |
143,974,0592
|
|
Slovakia |
54 |
5,423,5672 |
|
Slovenia |
20 |
2,011,473 2
|
|
Tajikistan |
70 |
7,011,556 2
|
|
Ukraine |
477 |
47,732,0792
|
|
Uzbekistan |
264 |
26,410,4162
|
|
Cushing's syndrome in Australasia
and Southern Pacific (Extrapolated
Statistics) |
|
Australia |
199 |
19,913,1442
|
|
New Zealand |
39 |
3,993,8172 |
|
Cushing's syndrome in the Middle
East (Extrapolated Statistics)
|
|
Afghanistan |
285 |
28,513,6772
|
|
Egypt |
761 |
76,117,4212
|
|
Gaza strip |
13 |
1,324,9912 |
|
Iran |
675 |
67,503,2052
|
|
Iraq |
253 |
25,374,6912
|
|
Israel |
61 |
6,199,0082 |
|
Jordan |
56 |
5,611,2022 |
|
Kuwait |
22 |
2,257,5492 |
|
Lebanon |
37 |
3,777,2182 |
|
Libya |
56 |
5,631,5852 |
|
Saudi Arabia |
257 |
25,795,9382
|
|
Syria |
180 |
18,016,8742
|
|
Turkey |
688 |
68,893,9182
|
|
United Arab Emirates
|
25 |
2,523,9152 |
|
West Bank |
23 |
2,311,2042 |
|
Yemen |
200 |
20,024,8672
|
|
Cushing's syndrome in
South America (Extrapolated
Statistics) |
|
Belize |
2 |
272,9452 |
|
Brazil |
1,841 |
184,101,1092
|
|
Chile |
158 |
15,823,9572
|
|
Colombia |
423 |
42,310,7752
|
|
Guatemala |
142 |
14,280,5962
|
|
Mexico |
1,049 |
104,959,5942
|
|
Nicaragua |
53 |
5,359,7592 |
|
Paraguay |
61 |
6,191,3682 |
|
Peru |
275 |
27,544,3052
|
|
Puerto Rico |
38 |
3,897,9602 |
|
Venezuela |
250 |
25,017,3872
|
|
Cushing's syndrome in
Africa (Extrapolated
Statistics) |
|
Angola |
109 |
10,978,5522
|
|
Botswana |
16 |
1,639,2312 |
|
Central African Republic
|
37 |
3,742,4822 |
|
Chad |
95 |
9,538,5442 |
|
Congo Brazzaville |
29 |
2,998,0402 |
|
Congo kinshasa |
583 |
58,317,0302
|
|
Ethiopia |
713 |
71,336,5712
|
|
Ghana |
207 |
20,757,0322
|
|
Kenya |
329 |
32,982,1092
|
|
Liberia |
33 |
3,390,6352 |
|
Niger |
113 |
11,360,5382
|
|
Nigeria |
177 |
12,5750,3562
|
|
Rwanda |
82 |
8,238,6732 |
|
Senegal |
108 |
10,852,1472
|
|
Sierra leone |
58 |
5,883,8892 |
|
Somalia |
83 |
8,304,6012 |
|
Sudan |
391 |
39,148,1622
|
|
South Africa |
444 |
44,448,4702
|
|
Swaziland |
11 |
1,169,2412 |
|
Tanzania |
360 |
36,070,7992
|
|
Uganda |
263 |
26,390,2582
|
|
Zambia |
110 |
11,025,6902
|
|
Zimbabwe |
36 |
1,2671,8602
|
Footnotes:
1. US Census Bureau, Population
Estimates, 2004
2. US Census Bureau, International
Data Base, 2004
|
• If you've been
diagnosed with Cushing's,
please participate in the
Cushing's
Register »
The
information you provide
will be used to create a
register and will be
shared with the medical
world. It would not be
used for other purposes
without your expressed
permission. Note:
This information will not
be sold or shared with
other companies.
Lynne
Clemens, Secretary of CUSH
Org is be the
person responsible for
the creation of this
register. If you have any
questions you may contact
her at lynnecush@comcast.net. You do
not have to be a member
of CUSH to fill out this
questionnaire, as long as
you are a Cushing’s
patient. We do not
believe that the world
has an accurate
accounting of
Cushing’s patients.
The only way to
authenticate accuracy is
with actual numbers. Your
help will be appreciated.
Thank you."
|
| Fundraising: |
|
CUSH can always use
funds to help us all, by
spreading the word and helping
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|
| Upcoming
Conventions, Meetings and
Seminars: |
|
October 2005, Washington DC Metro Area,
Third Thursdays,
More info here »
October 21-22, 2005,
CUSH Meetings, Brighton, MI,
More info here »
October 29, 2005,
Nashville, TN,
More info here »
June
24-27, 2006, ENDO 2006, Boston Convention &
Exhibit Center. More info as it becomes
available.
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ENDO 2007,
Toronto, Canada, Metro Toronto Center.
More info as it becomes available.
More
upcoming local meetings are
listed here »
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~~~~~~~~~~~
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