Adrenal Health
How to supplement the real adrenal fatigue
Results of the article suggest that longer-acting cortisol-equivalent supplementation is more beneficial than conventional therapy with multiple daily doses of hydrocortisone in adults with adrenal insufficiency. Advantages are reduced body weight, heightened immunity, less recurrent infections, and improved quality of life. A group of 89 participants were followed for 6 months. GT
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Adrenal hormones are useful in sepsis
This is a major trial evaluating the usefulness of hydrocortisone and fludrocortisone during septic shock. About 12,000 patients were followed for 30-120 days. Compared to placebo, high doses of adrenal hormone equivalents improved 90-day death rates significantly. This is a step forward in improving the care of the deadly condition. GT
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Pituitary disorders caused by cancer immunotherapy
Cancer immunotherapy is becoming more common due to its specificity and efficacy. However endocrinopathy is an undesirable byproduct. Ipilimumab, approved for melanoma, has shown to cause pituitary anomalies in 10-15% of patients. Current report reveals two cases of hypophysitis caused by a different immunotheraputic agent, atezolizumab. Unlike Ipilimumab, atezolizumab seems to have a higher inclination for corticotroph destruction leading to late-onset central adrenal insufficiency. It is important to be aware of endocrine disorders associated with cancer…
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The other aldosterone blocker, eplerenone, helps with hypertension
The aim of this review was to determine the effectiveness of eplerenone for reducing blood pressure, its side effect profile, and its impact on clinically meaningful outcomes such as mortality and morbidity. Clinicians have used eplerenone to treat high blood pressure since 2002. It is important to determine the clinical impact of all antihypertensive medications used in patients to support their continued use in essential hypertension. The eplerenone dose ranged from 25-400 mg daily. Patients…
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Aldosterone vs. renin, a cardiometabolic cat-and-mouse game
Study results are important from several aspects. It confirms prior findings that excess aldosterone increases cardiometabolic sequelae, like cardiovascular events, diabetes, atrial fibrillation and mortality, independent of high blood pressure. More importantly the study guides us on how to objectively reduce the above risks: the dose of mineralocorticoid receptor antagonists, such as spironolactone or eplerenone, could be adjusted to achieve higher plasma renin activity of ≥1 μg/L/hr. Plasma renin activity is clinically available and a good…
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Adrenal-diabetes connection
Diabetes and prediabetes are the most common endocrine conditions affecting about 38% of the US population. Adrenal tumors on the other hand are relatively rare with prevalence of < 10%. Results of the article suggest that adrenal tumors, even when “benign” or “nonfunctional”, can contribute to the development of diabetes and prediabetes. Apparently “benign” adrenal masses could be an independent risk factor for glucose dysmetabolism. Should patients with diabetes be screened for such tumors? If present,…
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Primary hyperaldosteronism amplifies cardio-metabolic anomalies
Important to diagnose primary hyperaldosteronism early as a cause of high blood pressure since patients are even at a higher risk for: stroke, coronary artery disease, atrial fibrillation, heart failure, left ventricular hypertrophy, diabetes and metabolic syndrome. Risks were evenly high for both aldosterone-producing adenoma and bilateral adrenal hyperplasia. About 13,000 patients were followed for 9 years. GT
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More options for Cushing’s disease
Cushing’s disease is a rare debilitating endocrine disorder for which few prospective interventional studies have been done. Long-acting pasireotide normalised mean urinary free cortisol concentration in about 40% of patients with Cushing’s disease at month 7 and had a similar safety profile to that of twice-daily subcutaneous pasireotide. Long-acting pasireotide is an efficacious treatment option for some patients with Cushing’s disease who have persistent or recurrent disease after initial surgery or are not surgical candidates,…
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Obstructive Sleep Apnea in Cushing’s Syndrome
Cushing’s syndrome is a rare endocrine disorder that causes chronic cortisol excess. Although its reported incidence is about 10 cases per million people each year, the true number is likely much higher when including subclinical cases. Persistent cortisol elevation affects many systems and can result in diabetes, hypertension, high triglycerides, blood clots, osteoporosis, muscle loss, and increased cardiovascular mortality.
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Prolactinoma, pheochromocytoma and MAX gene
Pheochromocytomas are rare neuroendocrine tumors. They could be adrenal vs. extra-adrenal, sporadic vs. familial, isolated vs. multifocal, or benign vs. malignant. MAX gene mutation has recently been recognized as an unusual cause of familial pheochromocytoma. This article documents the first patient with simultaneous germline MAX mutation, pituitary prolactinoma, bilateral pheochromocytoma and mild primary hyperparathyroidism. Could the germline MAX mutation be a direct cause of prolactinoma as well? GT
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Laboratory interference gives false results on various hormone measures
An important case pointing to the endocrinologist’s dilemma when facing inappropriate or discordant hormonal results. This patient had severely high levels of serum estradiol, progesterone, testosterone, and cortisol in complete absence of clinical signs and symptoms. Mass spectrometry, an expensive and poorly available analytical technique, saved the day. Mild monoclonal IgG elevation (hypergammaglobulinemia) was felt to be the interfering agent leading to falsely high hormone measures. Interference could also occur in the setting of heterophilic antibodies,…
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Atypical adrenal mass
Roughly 90% of congenital adrenal hyperplasia is categorized as “classical” due to full (70%, cortisol and aldosterone, salt-wasting) or partial (30%, cortisol alone, simple virilizing) deficiency of 21-hydroxylase. Scant or nonfunctioning 21-hydroxylase reduces cortisol synthesis. Lower background cortisol causes persistent ACTH rise, which stimulates chronic adrenal hyperplasia. This patient case uncovers that constant ACTH stimulation, besides hyperplasia, can also lead to a functional adrenal mass; characterized as a lipid rich structure (myelolipoma) with increased uptake on 18F-FDG…
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