Net Guide: Adrenal Disorders

//Video

Cushing’s and Obesity

This National Geographic Channel feature presents the case of Kate Meyers, a woman who struggled with obesity for 16 years, only to discover that she had two tumors on her pituitary gland that were stimulating an overproduction of cortisol. In six minutes, you’ll watch Ms. Meyers’ journey from being an active 23-year-old weighing 140 pounds, to 300 pounds at age 40, and finally recovery three months post-surgery.

Link Code: e1243311

//The Educated Patient™

Adrenoleukodystrophy

Because your patients may not have ever heard of adrenoleukodystrophy (ALD), pointing them to the FAQ page at StopALD.org is a good place for them to begin working toward an understanding of the disease, and learning what they can do to try to manage its progression. Here, the site addresses current therapies used in the treatment of ALD (bone marrow transplant, gene therapy, Lorenzo’s Oil), the differences between ALD and adrenomyeloneuropathy (AMN), what female carriers of the ALD/ AMN mutation need to know, and current research into ALD and AMN.

Link Code: e12423

Primary Aldosteronism

Per usual, the Mayo Clinic provides an excellent primer for patients being introduced to a particular disease, in this case, primary aldosteronism. The write-up includes information on symptoms, causes, complications, tests and diagnosis, treatments and drugs, home remedies, and lifestyle issues. Mayo Clinic provides additional links to outside resources, an image of the adrenal glands, and a DASH diet nutritional guide. The meat of the resource, however, is the “Basics” tab.

Link Code: e12424

Cushing’s Syndrome

Authored by Paul Margulies, MD, FACP, FACE, this guide may be a bit technical for some patients, but for those already versed in Cushing’s basics, this more advanced tutorial will be a more welcome read. In addition to a downloadable Cushing’s fact sheet, this page addresses the causes (Iatrogenic Cushing’s Syndrome, ectopic ACTH production, adrenal cortex tumors), symptoms, and diagnosis of Cushing’s Syndrome; the reasons why a Cushing’s patient should consult an endocrinologist; and the lifestyle challenges of living with cortisol excess.

Link Code: e12425

Addison’s Disease

Housed under the “Health and Money” section at Cigna.com, and authored by Healthwise, this extensive and thorough disease overview covers causes, symptoms, diagnosis, and management of Addison’s Disease in brief, as part of a topic overview, before expanding upon each in dedicated sections. The page also lists full contact information for the American Academy of Family Physicians, the Hormone Foundation, National Adrenal Disease Foundation, National Endocrine and Metabolic Diseases Information Service, and the National Organization for Rare Disorders.

Link Code: e12426

//eAbstractsControversies Surrounding the Use of Etomidate for Rapid Sequence Intubation in Patients with Suspected SepsisJournal: Annals of Pharmacotherapy (June 8, 2010)

Authors: Edwin S, Walker P

Purpose: “To evaluate the risk of adrenal insufficiency following a single dose of etomidate in patients with suspected sepsis requiring rapid sequence intubation.”

Results: A literature search “revealed seven studies that specifically evaluated clinical endpoints in septic adults receiving etomidate for induction prior to intubation.” Three “evaluated risk factors associated with adrenal insufficiency in critically ill patients [and] determined that etomidate exposure was independently associated with an inappropriate response to cosyntropin stimulation testing;” two “found no significant difference in hospital mortality rates when evaluating patients receiving induction with etomidate compared with alternative regimens; and three “found an increased risk of adrenal insufficiency in patients exposed to etomidate.” The authors note that a “majority of studies that evaluated the use of etomidate in sepsis were underpowered, leading to difficulty in establishing a causal relationship between drug-related adrenal insufficiency, morbidity, and mortality,” and that “until further studies are available, etomidate should be reserved for hemodynamically unstable patients who cannot tolerate an alternative induction agent despite the administration of fluids or vasoactive agents.”

Link Code: e12453

Sexual Function and Surgical Outcome in Women with Congenital Adrenal Hyperplasia Due to CYP21A2 Deficiency: Clinical Perspective and the Patients’ PerceptionJournal: Journal of Clinical Endocrinology & Metabolism (May 13, 2010)

Authors: Nordenström A, Frisén L, Falhammar H, et al

Purpose: Because little is known about how “females with congenital adrenal hyperplasia (CAH) due to a CYP21A2 deficiency…feel that the disease has affected their lives regarding surgery and psychosexual adaptation,” researchers examined “the correlation between the surgical results, the self-perceived severity of the disease, and satisfaction with sexual life and relate the results to the CYP21A2 genotype.”

Results: Excluding genital appearance, sexual function score “was higher in the patients satisfied with their sexual life,” which “was also true of the patients who were satisfied with the surgical result.” It should be noted that “there were discrepancies between the patients’ perception of the impact of the condition on their sexual life and what health professionals would assume from clinical examination. The patients in the null genotype group scored lower on sexual function and satisfaction with their sexual life and had more surgical complications, also compared with the slightly less severe I2-splice genotype group.”

Link Code: e12454

//Clinical Trials

A Phase III Trial of Lorenzo’s Oil in AdrenomyeloneuropathyStudy Type: Interventional

Age/Gender Requirements: 18 years+ (male/female)

Sponsor: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Purpose: Researchers will monitor “clinical progression of the disorder” and “determine the degree to which newly developed methods to assess spinal cord function and structure in adrenomyeloneuropathy, namely quantitative sensorimotor tests and spinal cord imaging, can act as early surrogate markers of disease progression.”

Link Code: e12463

Adrenal Insufficiency in Septic ShockStudy Type: Interventional

Age/Gender Requirements: 18 years+ (male/female)

Sponsor: The Methodist Hospital

Purpose: “Patients will be randomized to receive either hydrocortisone 50 mg IV every six hours for seven days (control) or hydrocortisone 50 mg IV every six hours until 24 hours after achievement of hemodynamic stability (MAP > 65 mm Hg off of vasopressors).” The number of hours a patient receives steroid dosing will serve as the primary outcome measure; investigators will use “the difference between daily glucose levels, insulin requirements, and length of stay in the ICU” as secondary outcome measures.

Link Code: e12464

Pilot Study Assessing Oxidative Stress in ChildrenStudy Type: Interventional

Age/Gender Requirements: Newborn-18 years (male/female)

Sponsor: Emory University

Purpose: “Since cortisol levels alone don’t always show adrenal insufficiency (AI), and children with normal hormone levels still benefit from steroids, doctors are looking for a better understanding of AI.” Emory University researchers hope to gain more insight by examining oxidative stress (OS), which “increases steroid resistance by changing glucocorticoid receptor structure and function.” They will: 1) Find out how many sick children have OS in the pediatric intensive care unit; 2) Find out the normal OS level of healthy children; 3) Decide if OS causes adrenal insufficiency.

Link Code: e12465

Pharma Focus

Hormone Therapies for Adrenal Disorders Hydrocortisone

Brand Name: Cortef

Type: Tablet; 5 mg, 10 mg, 20 mg (oral administration)

Indication: Hormone substitution or replacement in patients with Addison’s Disease

www.pfizer.com/files/products/uspi_cortef.pdf

SpironolactoneBrand Name: Aldactone, Novo-Spiroton, Aldactazide, Spiractin, Spirotone, Verospiron, Berlactone

Type: Tablet; 25 mg, 50 mg, 100 mg (oral administration)

Indication: Blocks the effects of aldosterone in patients with adrenal hyperplasia

http://hcp.lv/dhYaAm

From the Network

Rite Aid Prescription Error Results in $2.5 Million Verdict

A Montgomery County, Alabama, jury awarded a multi-million dollar settlement over a mistakenly filled prescription for rheumatoid arthritis which confined Reva Tosh to a wheelchair with Cushing’s Syndrome.

www.hcplive.com/rheumatology/articles/rite_aid_prescription_drug_error

Stress Peptide and Receptor May Have Role in Diabetes

Researchers at the Salk Institute for Biological Studies have found that the neuropeptide corticotropin releasing factor also plays a part in the pancreas, where it increases insulin secretion and promotes the division of the insulin-producing beta cells.

www.hcplive.com/endocrinology/articles/stress_peptide_receptor_diabetes_role