February 8, 2017

Cushing syndrome is a rare endocrine disorder caused by the body’s exposure to an excess of the hormone cortisol. Cortisol affects all tissues and organs in the body. These effects together are known as Cushing’s syndrome.

The disorder, which leads to a variety of symptoms and physical abnormalities, is most commonly caused by taking medications containing the hormone over a long period of time. A more rare form of the disorder occurs when the body itself produces an excessive amount of cortisol.

In 1932, a physician named Harvey Cushing described 8 patients with central body obesity, glucose intolerance, hypertension, excess hair growth, osteoporosis, kidney stones, menstrual irregularity, and emotional liability. Hence, the name Cushing’s syndrome.

What leads to Cushing’s Syndrome?

Cortisol is a powerful steroid hormone, and excess cortisol has detrimental effects on many cells throughout the body.  Keep in mind that Cushing’s syndrome is rare, occurring in only about 10 patients per one million. On the other hand, simple obesity can be associated with some of these symptoms in the absence of an adrenal tumor; this is related to the slightly different mechanism by which normally-produced steroids are metabolized by individuals who are obese. Since cortisol production by the adrenal glands is normally under the control of the pituitary, overproduction can be caused by a tumor in the pituitary or within the adrenal glands themselves.

When the adrenal glands develop a tumor, like any other endocrine gland, they usually produce excess amounts of the hormone normally produced by these cells. If the adrenal tumor is composed of cortisol-producing cells, excess cortisol will be produced. Under these conditions, the normal pituitary will sense the excess cortisol and will stop making ACTH in an attempt to slow the adrenal down. In this manner, physicians can readily distinguish whether excess cortisol is the result of a pituitary tumor or an adrenal tumor.

An estimated 10-15 per million people are affected every year.  Pituitary adenomas (Cushing’s disease) account for more than 70 percent of cases in adults and about 60-70 percent of cases in children and adolescents.  Cushing’s syndrome most commonly affects adults ages 20-50 and is more prevalent in females, accounting for about 70 percent of all cases.

Causes

Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid arthritis (iatrogenic Cushing’s syndrome), excess production of cortisol from a tumor in the adrenal gland or elsewhere in the body (ectopic Cushing’s syndrome) or a tumor of the pituitary gland secreting adrenocorticotropic hormone (ACTH) which stimulates the over-production of cortisol from the adrenal gland (Cushing’s disease).

Other causes may include –

Pituitary Adenomas – When the cause of excess cortisol is a pituitary adenoma, this is called “Cushing’s disease”. The excess ACTH produced by the pituitary tumor stimulates the adrenal to secrete excess cortisol. Adenomas are benign, or non-cancerous, tumors of the pituitary gland which can secrete increased amounts of ACTH. Women are affected 5 times as often as men.

Adrenal Tumors – Sometimes, an abnormality of the adrenal glands, most often an adrenal tumor, causes Cushing’s syndrome. The average age of onset is about 40 years. Most of these cases involve non-cancerous tumors of adrenal tissue, called adrenal adenomas, which release excess cortisol into the blood.

Ectopic ACTH Syndrome – Some benign or malignant (cancerous) tumors that arise outside the pituitary can produce ACTH, which leads to excess cortisol production by the adrenal glands. This condition is known as ectopic ACTH syndrome. The most common forms of ACTH-producing tumors are carcinoid tumors, which can be benign or malignant and small cell lung cancer, which accounts for about 25 percent of all lung cancer cases.

Adrenocortical carcinomas, or adrenal cancers, are the least common cause of Cushing’s syndrome. Cancer cells can secrete excess levels of several adrenal cortical hormones, including cortisol and adrenal androgens.

Familial Cushing’s Syndrome – Most cases of Cushing’s syndrome are not inherited. Rarely, however, some individuals have special causes of Cushing’s syndrome due to an inherited tendency to develop tumors of one or more endocrine glands. In Primary Pigmented Micronodular Adrenal Disease, children or young adults develop small cortisol-producing tumors of the adrenal glands.

Symptoms

  • Weight gain – particularly around the gut or mid-section
  • “Moon face” – a rounded shape of the face that develops from a specific pattern of fat distribution.
  • Easy bruising – the arms and legs are frequently covered with multiple bruises.
  • “Buffalo hump” – a mound of fat at the base of the back of the neck.
  • Abnormal hair growth – women with Cushing’s syndrome may develop more hair growth on the face or near the belly button.
  • Edema (leg swelling) – due to excess fluid buildup in the lower legs and feet.
  • Stretch marks (purple striae) – most common around the sides and lower abdomen, these may have a pink, red, or purple color.
  • Hypertension (high blood pressure)
  • Diabetes (high blood sugar levels)
  • Mood changes – many patients feel “hyper”, others may experience sudden emotional ups and downs or be quick to anger.
  • Thinning of the skin – the skin may develop a shiny, paper-thin quality and may rip or tear easily.
  • Ruddy complexion (plethora) – a reddening of the face or cheeks.
  • Muscle weakness – the arms and legs may become skinny like twigs from muscle wasting.
  • Menstrual disturbances – a woman’s period may be irregular or stop altogether.

Patients who have too much cortisol but do not have any clear signs or symptoms of hypercortisolism are said to have “subclinical Cushing’s.”

Complications

  • Bone loss (osteoporosis), which can result in unusual bone fractures, such as rib fractures and fractures of the bones in the feet
  • High blood pressure (hypertension)
  • Diabetes
  • Frequent or unusual infections
  • Loss of muscle mass and strength

Treatment

Tumour of the pituitary gland – The tumour is surgically removed. Other options include radiation therapy and drug therapy to shrink the tumour and stop it from producing hormones. Various hormone replacements may be required after pituitary surgery.

Tumour of the adrenal gland – The tumour is surgically removed. Replacement hormone therapy may be necessary for a short while.

ACTHproducing tumours – Treatment includes surgery to remove the tumour, followed possibly by chemotherapy, immunotherapy and radiation therapy. Medication can reduce the ability of the adrenal glands to make cortisol.

MEN1 – Radiation therapy and surgery are used to remove the tumours and associated glands. Ongoing hormone replacement therapy is needed after surgery.

Glucocorticoid hormone therapy – Induced Iatrogenic Cushing’s syndrome – symptoms will gradually resolve if treatment can be reduced or stopped, which depends on the activity of the disorder. Treatment should never be stopped suddenly because of the possibility of adrenal suppression.

Alternative Treatment

Stop exposing the brain and head to strong magnetic or sound vibrations.

DHEA – DHEA may help to protect against the overproduction of cortisol from the adrenal glands and enhance the immune system. This is an important factor since too much cortisol accelerates aging and causes immune system disorders. Studies show that DHEA deficiency may actually debilitate immune status

Vitamin C – Studies show that vitamin C and aspirin can attenuate and influence cortisol, inducing an anti-inflammatory response to prolonged exercise and stress. Vitamin C has been shown to reduce the elevation of cortisol in response to heavy exercise.

Melatonin – Melatonin is secreted by the pineal gland and functions to regulate circadian rhythm and induce sleep. Melatonin circadian secretion in patients with pituitary- or adrenal-dependent Cushing’s syndrome was shown to be significantly lower compared to healthy control groups.

Phosphatidylserine (PS) – Phosphatidylserine is a phospholipid that is a structural component of the biological membranes in animals and plants. In studies, supplemental PS has been shown to improve mood and blunt the release of cortisol in response to physical stress.

Antioxidants – Antioxidants may improve immune functioning. Choosing a wide variety of low-potassium fruits and vegetables may help.

Fiber – A high-fiber diet can help maintain normal blood glucose levels.

Refined starches – Eliminating refined starches, following a consistent carbohydrate diet, and eating five or six small meals a day may help decrease carbohydrate cravings that typically occur with Cushing’s syndrome.

Dandelion – Helps normalize adrenal function. It is also an excellent tonic for the liver and kidneys. Dandelion reduces inflammation in the body and also contains vitamins and minerals necessary for hair growth.

 

Reference –

http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/basics/complications/con-20032115

http://www.emedicinehealth.com/cushing_syndrome/page5_em.htm#medical_treatment

http://familydoctor.org/familydoctor/en/diseases-conditions/cushings-syndrome/treatment.html

http://pituitary.mgh.harvard.edu/CushingsSyndrome.htm#Causes

http://www.medicinenet.com/cushings_syndrome/article.htm

http://csrf.net/

http://www.endocrineweb.com/conditions/cushings-syndrome/diseases-adrenal-cortex-cushings-syndrome

http://patient.info/health/cushings-syndrome-leaflet

http://www.nadf.us/adrenal-diseases/cushings-syndrome/

http://www.nhs.uk/conditions/Cushings-syndrome/Pages/Introduction.aspx

https://www.nlm.nih.gov/medlineplus/ency/article/000410.htm

http://emedicine.medscape.com/article/117365-overview

http://www.whitakerwellness.com/health-concerns/respiratory-system-diseases/chronic-cough/

 

 

February 8, 2017

Adrenal insufficiency, also known as Addison’s disease, is a rare endocrine, or hormonal disorder that affects 1 in 10,000 people. It occurs in all age groups and afflicts men and women equally.  It occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases, the hormone aldosterone. Hence, the disease is sometimes called chronic adrenal insufficiency, or hypocortisolism.

What are Adrenal Glands?

The adrenal glands are located at the top of the kidneys, one on each side of the body. It produces the steroid hormones that are essential for life; cortisol and aldosterone. Cortisol mobilizes nutrients, enables the body to fight inflammation, stimulates the liver to produce blood sugar and also helps control the amount of water in the body. Aldosterone regulates salt and water levels which affect blood volume and blood pressure. The adrenal glands also produce sex hormones known as adrenal androgens; the most important of these is a hormone called DHEA.

Adrenal Insufficiency is caused by failure of the adrenal glands to produce sufficient or any amount of cortisol and aldosterone. Prolonged lack of cortisol leads to severe fatigue, chronic exhaustion, depression, loss of appetite and weight loss. Lack of aldosterone leads to a drop in blood pressure. Loss of DHEA production by the adrenals results in loss of hair in pubic and underarm areas and also potentially reduced sex drive and low energy levels in women affected by adrenal insufficiency. A specific dark pigmentation of the skin is also sometimes observed, particularly in areas where the clothes rub against the skin and in areas exposed to increased xrddi98ck8riction, such as the creases of the hands.de

Cortisol is important for life and its production by the adrenal glands is especial\lly important at times when the body experiences intense ‘stress’, such as surgery, trauma or serious infection. If the adrenal glands cannot produce enough cortisol, the body might not be able to cope with this kind of major stress, which can be life-threatening.

Types of Adrenal Insufficiency

  • Primary insufficiency (Addison’s disease) – There is an inability of the adrenal glands to produce enough steroid hormones. The most common cause for this in the developed world is autoimmune disease.
  • Secondary insufficiency – there is inadequate pituitary or hypothalamic stimulation of the adrenal glands.

Causes

Adrenal Insufficiency is most often caused by autoimmune disease where the body’s immune system mounts an attack against its own adrenal cells. However, it can also be caused by infection, most importantly by tuberculosis. Sometimes both adrenal glands are surgically removed for various reasons; this is called a bilateral adrenalectomy and is another cause of primary adrenal insufficiency.

  • Autoimmune Factor – Up to 80 percent of Adrenal insufficiency cases are caused by an autoimmune disorder, which is when the body’s immune system attacks the body’s own cells and organs. In autoimmune Addison’s, which mainly occurs in middle-aged females, the immune system gradually destroys the adrenal cortex—the outer layer of the adrenal glands.
  • Genetic Factor – The inborn causes of adrenal insufficiency which are caused by spelling errors in the genetic code. This includes the disruption of hormone production in the adrenals by different variants of congenital adrenal hyperplasia (CAH). In CAH, there is a spelling error in the gene responsible for the production of the protein that helps to generate cortisol in the adrenal; as a result cortisol and often also aldosterone levels are low. Another inborn cause of adrenal insufficiency is a condition called X-linked adrenoleukodystophy (ALD) or adrenomyeloneuropathy (AMN) that affects boys and men and can cause both adrenal insufficiency and neurological symptoms.
  • Infections – Tuberculosis (TB), an infection that can destroy the adrenal glands, accounts for 10 to 15 percent of adrenal insufficiency cases in developed countries. When primary adrenal insufficiency was first identified by Dr. Thomas Addison in 1849, TB was the most common cause of the disease.
  • Other Causes – Less common causes of Addison’s disease are
    • Cancer cells in the adrenal glands
    • Amyloidosis, a serious, though rare, group of diseases that occurs when abnormal proteins, called amyloids, build up in the blood and are deposited in tissues and organs
    • Surgical removal of the adrenal glands
    • Bleeding into the adrenal glands
    • Medication-related causes, such as from anti-fungal medications and the anesthetic etomidate, which may be used when a person undergoes an emergency intubation—the placement of a flexible, plastic tube through the mouth and into the trachea, or windpipe, to assist with breathing.

Pituitary Gland and Adrenal Insufficiency – Another important cause of adrenal insufficiency is disease affecting the pituitary gland, an endocrine gland located behind the nose at the bottom of the brain.

Environmental Factors

  • Nutritional Deficiencies are a common cause. The need for nutrients is much greater during Adrenal insufficiency. Carbohydrates, when excessive in the diet, stress the adrenals. Diets low in protein may also create deficiencies. Inadequate or poor quality water affects oxygenation of the tissues. Most diets are low in nutrients required by the adrenals. These include B-complex vitamins, vitamins A, C and E, manganese, zinc, chromium, selenium and other trace elements. The reasons for this begin with how food is grown. Most food is grown on depleted soils. Processing and refining further deplete nutrients. Habits such as eating in the car or while on the run further diminish the value derived from food. Also, allergic reactions to foods such as wheat and dairy products can damage the intestines and reduce the absorption of nutrients.
  • Toxic metals and chemicals often play a large role in adrenal burnout. Everyone is exposed to thousands of chemicals in the air, the water and the food. Other sources are dental materials and skin contact with chemicals. Over-the-counter and prescribed medications add to the body’s toxic load. Most people do not realize that antibiotics and many other drugs accumulate to some extent in the liver and other organs. Toxins may also be generated within the body due to impaired digestion. When food is not properly digested, it either ferments or rots in the intestines, producing many harmful substances that are absorbed into the body. A healthy body has the ability to eliminate many toxins on a daily basis. However, as adrenal weakness develops the body’s ability to eliminate all toxins decreases. This produces a vicious cycle in which weaker adrenals impairs the elimination of all poisons, which then further weakens the adrenals.
  • Stimulants damage the adrenal glands. They whip the adrenals. Caffeine, sugar and alcohol are among the most common stimulants.

Symptoms

The most common symptoms of adrenal insufficiency are

  • Chronic, or long lasting, fatigue
  • Muscle weakness
  • Loss of appetite
  • Weight loss
  • Abdominal pain

Other symptoms of adrenal insufficiency can include

  • Nausea
  • Vomiting
  • Diarrhea
  • Low blood pressure that drops further when a person stands up, causing dizziness or fainting
  • Irritability and depression
  • Craving salty foods
  • Hypoglycemia, or low blood sugar
  • Headache
  • Sweating
  • Irregular or absent menstrual periods
  • In women, loss of interest in sex
  • Hyperpigmentation, or darkening of the skin

Adrenal Crisis

Sudden, severe worsening of adrenal insufficiency symptoms is called adrenal crisis. If the person has adrenal insufficiency. In most cases, symptoms of adrenal insufficiency become serious enough that people seek medical treatment before an adrenal crisis occurs. However, sometimes symptoms appear for the first time during an adrenal crisis. Symptoms of adrenal crisis include –

  • Sudden, severe pain in the lower back, abdomen, or legs
  • Severe vomiting and diarrhea
  • Dehydration
  • Low blood pressure
  • Loss of consciousness

If not treated, an adrenal crisis can cause death.

Treatment

Conventional –

  • Adrenal insufficiency is treated by replacing, or substituting, the hormones that the adrenal glands are not making. The dose of each medication is adjusted to meet the needs of the patient.
  • Cortisol is replaced with a corticosteroid, such as hydrocortisone, prednisone, or dexamethasone, taken orally one to three times each day, depending on which medication is chosen.
  • If aldosterone is also deficient, it is replaced with oral doses of a mineralocorticoid hormone, called fludrocortisone acetate (Florinef).
  • Standard therapy involves immediate IV injections of corticosteroids and large volumes of IV saline solution with dextrose, a type of sugar, in cases of adrenal crisis that involves – low blood pressure, low blood glucose, low blood sodium, and high blood levels of potassium can be life threatening.
  • Replacement therapy for DHEA in adolescent girls who have secondary adrenal insufficiency and low levels of DHEA can improve pubic hair development and psychological stress.

Alternative Treatment

  • Vitamins & Minerals – There are a number of vitamins and minerals that Adrenal insufficiency sufferers tend to be lacking. There are other valuable supplements (vitamin D, vitamin E and others) but I will keep this section as simple as possible. It is important to note that not all of these will be appropriate for each individual.
  • Vitamin B12, B6 and B5 – These important B vitamins play an important role in cell metabolism. Improving your metabolic pathways boosts your energy levels and is a great way to reduce the fatigue often felt during AI. B5 helps to produce co-enzyme A, which contributes to cellular respiration and the breakdown of fats, proteins and carbohydrates. B6 acts in several of the pathways that are used to create adrenal hormones. And B12 helps with energy production, cell repair and the maintenance of our red blood cells.
  • Vitamin C – This powerful antioxidant vitamin is directly involved in the production of cortisol in your adrenals. So besides the other health benefits it carries (boosting your immune system, protecting from free radicals), vitamin C is also an essential building block for the recovery of your adrenal glands.
  • Magnesium – Studies suggest that 75% of Americans are deficient in magnesium. In very simple terms, magnesium helps to maintain energy flow, so you can see that deficiency might be a problem.
  • Probiotic – By improving the digestion, probiotics enable the body to extract more of the nutrients present in the foods that is eaten. This allows the body to get more of the essential vitamins and minerals that are needed to maintain the energy levels and produce the hormones that aree needed. Additionally, they support the immune system and prevent regular illness from weakening our adrenals further.
  • Licorice Root – This is an herb that has long been used to stimulate hormone production, maintain energy levels and increase endurance. It is a great choice for many individuals with AI, as it helps the cortisol to circulate for longer, but there is one significant drawback.
  • Maca Root – Research has shown maca to have beneficial effects on cortisol regulation and blood sugar. It also allows for more efficient uptake of hormones into the cells, increasing their effectiveness. If somone suffers from Adrenal Insufficiency and have low hormone levels, maca helps the body to make the most of those low hormone levels.
  • Omega 3 – Most of the people are deficient in Omega-3 fatty acids, although the body tends to have an adequate supply of Omega-6. This imbalance can lead to increased inflammation, which requires an increase in cortisol production to manage. Taking a good Omega-3 supplement can reduce inflammation throughout the body and relieve the workload placed on your adrenals.
  • Acetyl–L–Carnitine – This supplement is particularly useful for boosting metabolism and increasing energy levels. Acetyl-L-Carnitine increases the production of certain neurotransmitters in which people are often deficient, and it helps to move fatty acids into the mitochondria where the body needs them to produce energy.
  • CoQ10 – The body produces CoQ10 and uses it to produce energy for growing and maintaining the cells. Some find that it increases endurance and improves recovery time after exercise. Good food sources include beef, sardines and various organ meats, but if you are not getting enough from food then supplementation might be an excellent choice.
  • DRibrose – This supplement is another way to sustain higher energy levels throughout the day without placing any stress on your adrenal glands. D-Ribose is actually a form of sugar, but it won’t spike the blood sugar like glucose or other sweeteners. Instead, it goes directly to forming ATP, the molecule that facilitates the transfer of energy between the cells. Tissues in the heart and muscles respond particularly well to D-Ribose supplementation, and many AI sufferers find it gives a useful boost to their energy levels.
  • Ashwagandha – Known as an adaptogenic herb, ashwagandha regulates various systems in the body. If cortisol is too high, it acts to lower it, And if cortisol is too low, it acts to raise it.

 

Reference –

http://www.drugs.com/condition/adrenal-insufficiency.html

http://www.drugs.com/condition/adrenal-insufficiency.html

http://www.drugs.com/condition/adrenal-insufficiency.html

http://www.drugs.com/condition/adrenal-insufficiency.html

http://www.drugs.com/condition/adrenal-insufficiency.html

http://www.drugs.com/condition/adrenal-insufficiency.html

http://www.drugs.com/condition/adrenal-insufficiency.html

http://www.drugs.com/condition/adrenal-insufficiency.html

http://www.drugs.com/condition/adrenal-insufficiency.html