💉 Helpful Doctors: New York

MaryO Five Star, Helpful Doctors, New York , , ,

 

Michele M (Michele), added her Helpful Doctor, Toni Murphy, to the Cushing’s MemberMap

How would you rate your Helpful Doctor? 5/5
Your Doctor’s Name Toni Murphy
Your Doctor’s Address Street Address: Harlem Road
City: West Seneca
State / Province: NY
Postal / Zip Code: 14224
What are your Doctor’s Specialties? Endocrinologist
What are your Doctor’s Hospital Affiliations? Mercy Hospital

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ℹ️ Understanding Cortisol: The Stress Hormone Explained

MaryO Basic Info , , ,

The Double-Edged Sword of Cortisol

Cortisol often receives negative attention, typically branded as the “stress hormone.” This steroid hormone plays a crucial role in the body’s ability to manage stress. However, many people remain unaware of the signs of elevated cortisol levels and what they might signify.

Recognising Elevated Cortisol Levels

You may have encountered social media trends that equate certain physical features, like facial puffiness, with high cortisol, often referred to as “cortisol face” or “moon face.” These viral portrayals have sparked curiosity and concern, but they may not paint the complete picture. Experts emphasize understanding cortisol’s broader role in health.

According to Dr. Jeannette M. Bennett, an associate professor in psychological science at the University of North Carolina at Charlotte, cortisol is vital for regulating inflammation and supporting immune function. It helps us fend off illnesses by managing the body’s responses to toxins and pathogens. This hormone also has significant effects on metabolism, blood pressure, blood sugar regulation, and the sleep-wake cycle.

As Dr. Nia Fogelman, associate research scientist at the Yale Stress Center, points out, cortisol enables the body to respond effectively to immediate dangers, providing the energy needed for fight-or-flight responses. However, certain medical conditions can lead to abnormal cortisol levels, either too high or too low, such as Cushing’s syndrome or Addison’s disease.

Identifying Symptoms of High Cortisol

Elevated cortisol levels don’t manifest through a single, obvious symptom, making them tricky to pinpoint. Nonetheless, there are several signs to watch for, including:

Sleep Disturbances**: Difficulty falling asleep or frequent awakenings can be indicative of high cortisol levels, though the relationship remains unclear.

Physical Changes**: Symptoms such as weight gain around the face and abdomen, increased hair growth, fat accumulation between the shoulders, and the appearance of purplish stretch marks may occur.

Mood Swings**: Increased irritability or overreacting to minor annoyances can signal high cortisol levels.

Food Cravings**: A strong desire for sugary, salty, and fatty foods can be a coping mechanism for underlying stress.

Persistent Fatigue**: Increased fatigue, headaches, and muscle weakness may also hint at elevated cortisol levels, particularly in the arms and thighs.

Hidden Issues**: High blood pressure, elevated blood sugar, and bone fragility are silent symptoms that require medical diagnosis.

 Understanding the Root Causes of High Cortisol

Several factors can lead to heightened cortisol levels:

Chronic Stress**: Unlike temporary stress, chronic stress can keep cortisol levels elevated long after a stressor has passed. Chronic stress may result from traumatic events or ongoing pressures in one’s personal or professional life.

*Mental Health Issues**: Conditions such as chronic alcohol abuse, depression, and anxiety can similarly elevate cortisol levels.

Cushing’s Syndrome**: This rare condition results from prolonged high cortisol levels and can lead to serious complications, including diabetes and bone loss. It may arise from high doses of corticosteroid medications or specific tumors that induce excess hormone production.

When and How to Test Cortisol Levels

Cortisol testing is not routinely done during medical check-ups, and there currently aren’t any at-home tests available to assess cortisol levels. Most healthcare providers only recommend testing for cortisol if there are symptoms indicative of conditions like Cushing’s syndrome.

If you experience symptoms linked to high cortisol, your doctor may suggest conducting tests to investigate further. Keeping track of your stressors and observable symptoms can help guide this conversation. Noticing that your symptoms worsen with increased stressors might indicate you’re not dealing with chronically elevated cortisol.

Several methods exist for testing cortisol levels, and they often involve multiple assessments due to natural fluctuations in cortisol throughout the day. These methods include:

Blood Tests**: Useful for diagnosing adrenal insufficiency and Cushing’s syndrome, but the timing of tests is crucial.

ACTH Stimulation Test**: Measures how well the adrenal glands respond to ACTH, requiring blood samples before and after an injection.

Urine Tests**: A 24-hour urine collection can be used to screen for Cushing’s syndrome.

Saliva Tests**: These are often done at home and can help identify risk for Cushing’s syndrome.

What Constitutes Normal Cortisol Levels?

Cortisol levels are typically highest in the morning and decline throughout the day, reaching their lowest point around midnight. The interpretation of cortisol levels depends on the specific tests performed.

It is essential to discuss test results with your doctor, who can help determine if your levels fall within a healthy range or indicate potential health issues.

The Importance of Awareness

Cortisol is integral to our body’s response to stress and various essential functions. However, persistently high levels can lead to multiple health concerns, including fatigue, weight gain, and mood fluctuations. If you suspect your cortisol levels may be elevated, it is advisable to consult your physician for evaluation and possible testing.

From https://aseannow.com/topic/1347298-understanding-cortisol-the-stress-hormone-explained/

 

Dr. Friedman Has Partnered With Ulta Lab Tests to Offer Affordable, Hassle-Free Lab Testing at About One-Tenth the Cost of Going Through Insurance

MaryO Helpful Doctors , , ,

Ulta Lab Tests Overview for Dr. Friedman’s ​​​​​​​patients.

Ø  Tired of dealing with insurance or the Quest/Labcorp bureaucracy to get your labs done.

Ø  Frustrated at the slow turnaround times at Quest/Labcorp.

Ø  Dr. Friedman understands your concerns and has partnered with Ulta Lab Tests to offer affordable, hassle-free lab testing—typically at about one-tenth the cost of going through insurance, with fast turnaround times.

Ø  The Ulta Lab Tests platform is especially helpful if you are uninsured, underinsured, or have a high deductible.

Ø  Both you and Dr. Friedman will get the results in a few days.

Ø  Please note that Ulta Lab Tests does not work with insurance or handle any insurance billing or reimbursements; all services are self-pay. The only exception is that HSA and FSA cards may be used at checkout.

Patient Instructions 

1.         Change your preference for labs to Ulta Lab in Acuity and/or let Dr. Friedman know at the time of appointment you want to use Ulta Lab

2.         Go to https://www.ultalabtests.com and sign up for an account.

3.         Open the Ulta Lab Tests email from Dr. Friedman’s staff and click the link to your pre-filled cart. This will display the corresponding prices for the selected tests.

4.         Activate your patient account by entering the required demographic information.

5.         Choose a patient service center based on your ZIP code (Quest charges $12.95; “Premium Draw” fees vary).

6.         Complete payment for your order.

7.         Check your email for your order confirmation. Click the embedded link to access your Patient Portal, where you can view and download your Patient Service Center Requisition Form.

6.         Schedule your blood draw (Quest and other appointment optionscan be made through your patient portal).

7.         Review your patient instructions listed on your requisition form to view fasting and testing requirements.

8.         You will receive an email notification once your results are available. From there, you can access them in your patient portal. Dr. Friedman will also have access to your results once they are available.

9.         If you are a new patient, wait for Dr. Friedman to send you a summary of your labs. If you don’t hear from him, send us an email. If you are a follow-up patient, discuss the labs with Dr. Friedman at your next appointment

💉 Helpful Doctors: New Jersey

MaryO Five Star, Helpful Doctors, neurosurgeon, New Jersey , , , , , , , , , , , , , ,

James K. Liu, MD
Professor of Neurosurgery
Director of Skull Base and Pituitary Surgery
Rutgers University, New Jersey Medical School
RWJ Barnabas Health

Dr. James K. Liu is the Director of Cerebrovascular, Skull Base and Pituitary Surgery at the Rutgers Neurological Institute of New Jersey, and Professor of Neurological Surgery at Rutgers University, New Jersey Medical School. He is board certified by the American Board of Neurological Surgery, and has a robust pituitary tumor practice at University Hospital and Saint Barnabas Medical Center.

Dr. Liu graduated summa cum laude from UCLA with Phi Beta Kappa honors, and obtained his MD from New York Medical College with AOA honors. After completing a neurosurgery residency at the University of Utah in Salt Lake City, he was awarded the Dandy Clinical Fellowship by the Congress of Neurological Surgeons, and obtained advanced fellowship training in Skull Base, Cerebrovascular Surgery & Neuro-oncology at the Oregon Health & Science University in Portland.

Dr. Liu is renowned for his comprehensive treatment of complex brain tumors and skull base lesions, including pituitary tumors, acoustic neuromas, meningiomas, craniopharyngiomas, chordomas, and jugular foramen tumors. His robust clinical practice encompasses both traditional open and minimally invasive endoscopic endonasal skull base approaches. He also specializes in microsurgery of cerebrovascular diseases including aneurysms, arteriovenous malformations (AVMs), cavernous malformations, and carotid artery stenosis. He also has expertise in cerebrovascular bypass procedures for moya moya disease, carotid artery occlusion, vertebral artery occlusion, complex aneurysms and skull base tumors, as well as endoscopic-assisted microvascular decompression for trigeminal neuralgia and hemifacial spasm.

As one of the most active researchers in his field, Dr. Liu has published extensively with over 250 peer-reviewed publications and 25 textbook chapters. He has taught many hands-on cadaver dissection courses in skull base surgery and has lectured extensively nationally and internationally throughout North America, Latin America, Europe, and Asia. Dr. Liu’s research is focused on the development of innovative and novel skull base and endoscopic techniques, quantitative surgical neuroanatomy, microsurgical and microvascular anastomosis skills training, virtual surgical simulation, pituitary tumor biology, and clinical outcomes after skull base and cerebrovascular surgery.

Dr. Liu is an active member of the American Association of Neurological Surgeons, Congress of Neurological Surgeons, North American Skull Base Society, Pituitary Network Association, The Facial Pain (Trigeminal Neuralgia) Association, AANS/CNS Cerebrovascular Section, Tumor Section. He serves on the medical advisory board of the Acoustic Neuroma Association of New Jersey, and is the current Secretary-Treasurer of the International Meningioma Society.

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💉 Helpful Doctors: Arizona

MaryO Arizona, Five Star , ,

Donna’s Doctor. She said on the message boards

“I Went to my Endo appt yesterday (prepared) I had a list of all of my symptoms and a few photos of me to show the dramatic changes that my body has gone through over a short period of time. Without my prompting, He is sure that I have Cushings. …The endo walked in the room, introduced himself, took a good look at me and my pictures and asked me if I had ever heard of Cushings? He told me that I was in good hands and that he would set me up with a great neurosurgeon.”

Dr. Alexander Zwart. He is located in Tucson Arizona.

Tucson Endocrine Associates.

5910 N La Cholla Blvd.

Tucson Arizona, 85741.

(520) 297-0404

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Helpful Doctors: Dr. Fernandez-Miranda

MaryO Helpful Doctors , , , , , , , ,

This month the spotlight focuses on Dr. Juan Carlos Fernandez-Miranda, a Professor of Neurosurgery and the Surgical Director of Brain Tumor, Skull Base and Pituitary Centers at Stanford University. Dr. Fernandez-Miranda did a neurosurgery residency at La Paz University Hospital in Madrid, Spain. He completed a fellowship in microsurgical neuroanatomy at the University of Florida. He did clinical training in cerebrovascular surgery at the University of Virginia, and in endoscopic endonasal and open skull base surgery at University of Pittsburgh Medical Center (UPMC). He joined the faculty at Stanford earlier this year. He was kind enough to answer some questions from the PNA. His answers are below:

What inspired you to choose your career path?

When I was a young kid, about 10-11 years old, I got sick with a skin rash and high fever; the family doctor visited our home, carefully examined me, and based on a number of clues, he determined I got a very rare bacterial infection known as scarlet fever; a few days of antibiotic medication and I was back to normal. I now realized that I was fascinated by the wisdom, expertise, and detective attitude of the physician, and this personal event was (I now know) key to my future decision to become a doctor.

As I started medical school, I became deeply interested in the structure of the brain and how it explains brain and perhaps even mind function. I realized that the closest I could get to know the brain was actually as a surgeon operating on it.

I became a neurosurgery resident, and I immediately felt that entering into a patient’s brain, skull base, or pituitary gland was a huge privilege and a unique experience that will require my entire devotion and attention. I learned from my mentors the importance of precise knowledge of surgical neuroanatomy to perform gentle, accurate, and safe surgery. After residency training, I decided to spend 2 entire years in the lab – fully dedicated to mastering the understanding of the complex tridimensional surgical neuroanatomy required to safely and efficiently navigate the brain and skull base. These years, under the guidance of legendary neurosurgeon Albert Rhoton, served as the basis of everything I have accomplished thus far.

I was then fortunate to continue my clinical training at University of Virginia with several giants of neurosurgery, and I was greatly influenced by the meticulous approach of Dr. Ed Oldfield’s pituitary surgeries, particularly for Cushing’s disease. It was such a joy to watch his precise extracapsular tumor resections. At the same time, I had become totally enchanted by the endoscopic endonasal operations that Dr. Amin Kassam was performing at University of Pittsburgh, and after many requests he finally accepted me for specialized training with him and his team. That was a life changing event for me, as my career was about to be centered in the development and refinement of endoscopic endonasal skull base and pituitary surgery.

What is the primary focus of your work/research?

My primary clinical focus is the treatment of patients with pituitary, skull base, and brain tumors. I have particular technical expertise in endoscopic endonasal surgery for pituitary tumors and other skull base lesions, such as craniopharyngiomas, meningiomas, and chordomas, with an accumulated surgical experience of more than 1,000 cases. My clinical practice includes a full range of minimally invasive approaches, in addition to complex open skull base and brain surgery.

My research interests lie in the study of surgical neuroanatomy and the application of innovative techniques into the operating room that aim to improve surgical safety and effectiveness. As an example, along with my fellows, we have recently provided a new compartmental classification of the cavernous sinus that may help improve resection rates of pituitary tumors that invade the cavernous sinus, while preserving cranial nerve function. We have also described the structure of the medial wall of the cavernous sinus and the ligaments that anchor it to the carotid artery, and we have implemented an innovative surgical technique to selectively remove the medial wall of the cavernous sinus; this is extraordinarily important to achieve complete remission in certain functional tumors causing Cushing’s disease or acromegaly, and our results have proven not only the efficacy of this novel technique, but its safety when appropriately performed.

What do you consider to be the future of your field?

There is no doubt that the field is already moving towards multidisciplinary super-specialization, promoting the creation of Pituitary Centers of Excellence that provide dedicated clinical care, research, and education. This favorable trend will facilitate the development of more effective surgical and medical treatments. Pituitary tumors should only be treated by fellowship-trained neurosurgeons in this field at high-volume surgical centers.

In spite of the multiple advances in the treatment of pituitary tumors, we are still in need of further improvement at all levels. From the surgical point of view, the future is on developing better visualization tools and mini-robotic instruments that will allow more effective and less invasive operations. From the imaging point of view, I believe functional imaging, such as PET-MRI, may improve the diagnosis and localization of hormonally active microadenomas with “negative” MRI studies. The future will hopefully bring newer and more effective medical therapies for active and even inactive pituitary tumors.

What should patients know about your field/what deserves more recognition/awareness?

I think the most important message for current and future patients is to make sure they seek the best team around to treat their disease. It is important to emphasize the team approach, because experience, knowledge, and collaboration is critical to obtaining the best outcome. This extends to all members of the team, including not only the neurosurgeon and the endocrinologist, but also ENT, neuro-ophthalmologist, radiation therapist, neuroradiologist, and neuropathologist.

What would you like to convey about yourself to your patients?

I strive to offer my patients the best possible treatment, that combines ultimate surgical and technological applications with compassionate care. I believe in teamwork and I am privileged to work with such a stellar team at Stanford. I have dedicated my life to becoming the best possible surgeon for my patients.

Why did you get involved with the PNA and what is the extent of your involvement?

I have always been fascinated by the diagnosis and treatment of pituitary tumors and pituitary diseases, and I feel extremely fortunate to dedicate a large portion of my practice to helping pituitary patients. My motivations perfectly align with the PNA goals, and this is the main reason I got involved. I have contributed to the education and counseling of patients through the PNA and I hope to continue to do so for the years to come.

Adapted from https://pituitary.org/highlights-enewsletter-child/spotlight-dr-fernandez-miranda/

💉 Helpful Doctors: Pennsylvania

MaryO Four Star, Helpful Doctors, Pennsylvania , ,

 

Dr. Julia Kharlip
Hospital of University of Pennsylvania
Spruce St
Philadelphia, PA

Endocrinologist specializing in Cushing’s

 

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👥 Interview: False Positives for Adrenal Insufficiency

MaryO Interviews, Meetings and Conferences , , , , , ,

– AI false positives pose serious danger to patients; cutoff changes recommended

by Scott Harris , Contributing Writer, MedPage Today November 15, 2021

This Reading Room is a collaboration between MedPage Today® and:

Medpage Today

For adrenal insufficiency (AI), reducing false positives means more than reducing resource utilization. Treatments like glucocorticoid replacement therapy can cause serious harm in people who do not actually have AI.

Research published in the Journal of the Endocrine Society makes multiple findings that report authors say could help bring down false positive rates for AI. This retrospective study ultimately analyzed 6,531 medical records from the Imperial College Healthcare NHS Trust in the United Kingdom.

Sirazum Choudhury, MBBS, an endocrinologist-researcher with the trust, served as a co-author of the report. He discussed the study with MedPage Today. The exchange has been edited for length and clarity.

This study ultimately addressed two related but distinct questions. What was the first?

Choudhury: Initially the path we were following had to do with when cortisol levels are tested.

Cortisol levels follow a diurnal pattern; levels are highest in the morning and then decline to almost nothing overnight. This means we ought to be measuring the level in the morning. But there are logistical issues to doing so. In many hospitals, we end up taking measurements of cortisol in the afternoon. That creates a dilemma, because if it comes back low, there’s an issue as to what we ought to do with the result.

Here at Imperial, we call out results of <100 nmol/L among those taken in the afternoon. Patients and doctors then have to deal with these abnormal results, when in fact they may not actually be abnormal. We may be investigating individuals who should really not be investigated.

So the first aim of our study was to try and ascertain whether we could bring that down to a lower level and in doing so stop erroneously capturing people who are actually fine.

What was the second aim of the study?

Choudhury: As we went through tens of thousands of data sets, we realized we could answer more than that one simple question. So the next part of the study became: if an individual is identified as suspicious for AI, what’s the best way to prove this diagnosis?

We do this with different tests like short Synacthen Tests (SST), all with different cutoff points. Obviously, we want to get the testing right, because if you falsely label a person as having AI, the upshot is that treatments will interfere with their cortisol access and they will not do well. Simply put, we would be shortening their life.

So, our second goal was to look at all the SSTs we’ve done at the center and track them to see whether we could do better with the benchmarks.

What did you find?

Choudhury: When you look at the data, you see that you can bring those benchmarks down and potentially create a more accurate test.

First, we can be quite sure that a patient who is tested in the afternoon and whose cortisol level is >234 does not have AI. If their level is <53.5 then further investigation is needed

There were similar findings for SSTs, which in our case were processed using a platform made by Abbott. For this platform, we concluded that the existing cut-offs should be dropped down to 367 at 30 minutes or 419 at about 60 minutes.

Did anything surprise you about the study or its findings?

Choudhury: If you look at the literature, the number of individuals who fail at 30 minutes but pass at 60 minutes is around 5%. But I was very surprised to see that our number at Imperial was about 20%.

This is a key issue because, as I mentioned, if individuals are wrongly labelled adrenally insufficient, you’re shortening their life. It’s scary to think about the number of people who might have been given steroids and treated for AI when they didn’t have the condition.

What do you see as the next steps?

Choudhury: I see centers unifying their cutoffs for SST results and making sure we’re all consistent in the way we treat these results.

From a research perspective, on the testing we’re obviously talking about one specific platform with Abbott, so research needs to be done on SST analyzers from other manufacturers to work out what their specific cutoffs should be.

Read the study here and expert commentary on the clinical implications here.

The study authors did not disclose any relevant relationship with industry.

💉 Helpful Doctors: California

MaryO Cushing’s Help, Five Star, Helpful Doctors, North Carolina , , , , , , , ,

Dr. Daniel Kelly, a board certified neurosurgeon, is Director of the Pacific Neuroscience Institute and Professor of Neurosurgery at the John Wayne Cancer Institute.

Considered to be one of the best neurosurgeons in the US and a multiple recipient of the Patients’ Choice Award, Dr. Kelly is internationally recognized in the field of minimally invasive keyhole surgery for brain, pituitary and skull base tumors.

He has one of the world’s largest series in endonasal surgery with over 2000 procedures performed including over 800 endonasal endoscopic surgeries, and over 2000 craniotomies for brain and skull base tumors. His current surgical practice encompasses the full spectrum of brain and skull base tumors, both benign and malignant, treated with minimally invasive and conventional approaches.

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❓Can You Help?

MaryO Can You Help? , , , , , , ,

I’m on my second round of GH (I had to stop the first time due to cancer). I’ve been on Omnitrope since 2006 and the threads inside my pen must have worn down – I’m having a lot of trouble injecting it now.

I insert the needle and have to balance on the edge of the countertop in the bathroom and sort of lean in. Has anyone else had to replace the pen? I told my insurance company who sends the actual drug and they said “not us”. I don’t know if my endo has to prescribe another “starter kit” or what.

I did find a website that will sell me a new one for $200 but I’d rather not buy one that way. I found nothing on the Novartis website about this, either :(

Anyone?

Please respond here or on the message boards.

Thanks!