⁉️ Would *YOU* Do This?

I remember someone on the House TV series trying a stunt like this on the episode titled Deception.

At a betting parlor where House happens to be, a woman collapses and House makes sure she gets to the hospital. He thinks she has Cushing’s syndrome while Cameron starts to think she has Münchausen syndrome, a syndrome at which the patient creates the symptoms of a disease, guaranteeing them attention and sympathy.

Rare Case of Woman Manipulating Saliva Tests to Support Cushing’s Diagnosis

Late-night measures of cortisol levels in saliva may not be all that helpful in diagnosing Cushing’s syndrome, a group of physicians discovered upon learning that a difficult to diagnose patient had manipulated the samples.

Although this behavior is extremely rare, the research team from the University of Calgary in Canada, argued that — when a diagnosis becomes difficult — it may be advisable to confirm suspicions using another and more reliable method that can distinguish natural from synthetic glucocorticoids.

The study, Factitious ACTH- dependent, apparent hypercortisolism: the problem with late night salivary cortisol measurements collected at home,” was published in the journal Clinical Endocrinology.

The case report described a woman who was admitted to a specialist clinic after two endocrinologists had failed to diagnose what they suspected was cyclic Cushing’s syndrome.

The woman had complained of fatigue and weight gain over the past four years despite weight loss banding surgery, and declined taking steroid medications. The examination did not reveal particular Cushing’s symptoms.

Physicians started an investigation, including overnight dexamethasone suppression tests and late-night salivary cortisol tests, which indicate increased levels of cortisol likely caused by abnormal functioning of the ACTH hormone.

Imaging did not show any suspected lesions in the pituitary and adrenal gland, and all further examinations did not reveal any disease changes that might have contributed to the increased cortisol.

The woman was put on a dopamine agonist. This treatment triggered a loss of eight kilograms (almost 18 lbs) over six months, and the woman said she was satisfied with it. But two late-night cortisol measurement showed continuing high cortisol levels.

When the clinic started using a new type of analysis to measure cortisol, however, findings changed. The new test, which was more sensitive, indicated massively higher doses of cortisol in re-analyzed saliva samples compared to the older results.

The new test could detect synthetic glucosteroids, but could not indicate if synthetic steroids were responsible for the higher levels seen in the retest. So the team used a method called liquid chromatography-tandem mass spectrometry. This technique can identify specific molecules, and revealed that the women had manipulated the samples using prednisone.

The woman’s physician also paid a surprise visit to collect a new saliva sample, which turned out to have normal cortisol levels.

The woman neither denied or confirmed manipulating the samples. And the team was contacted two months later by her new physician, requesting confirmation of her Cushing’s syndrome and details on her case.

The researchers believed the woman most likely has what is known as Munchausen’s syndrome, a mental illness that leads patients to feign physical disease. A 1995 report by the National Institutes of Health showed that 0.7 percent of all people investigated for too high cortisol had this syndrome.

Despite the rarity of this case, the team argued that chemical analysis is a valuable tool for both determining sample manipulation in difficult Cushing’s syndrome cases, or a different potential problem.

They also cautioned against putting too much trust in very elevated late-night cortisol, particularly when the symptoms do not match the cortisol increase.

From https://cushingsdiseasenews.com/2017/10/05/rare-case-of-woman-manipulating-late-night-saliva-cortisol-tests-to-get-cushings-diagnosis/

 

🌈 Today is the “Birthday” of the Message Boards!

 

 

Today  is the birthday, or anniversary, of the boards starting September 30, 2000 (The rest of the site started earlier that year in July 21, 2000)

As of today, we have 72,581 members who have made 383,647 posts.

Find the message boards here: http://cushings.invisionzone.com/

 

⚠️ Message Board Issues :(

The Message Boards are currently offline. From Tech Support…

Hello,  I apologize here for the trouble, there seem to be some issues with your site after our move to the new cloud yesterday, we have our team looking into these issues now and will get back with you as soon as we can. Currently, the site is not loading the index files properly, in which we are addressing.

We will be back with you as soon as we have this corrected.

Thank you

⚠️ Yet Another Message Board Upgrade

Another message board upgrade happening right now. I’m not sure how long it will take (or what cosmetic changes need to be done afterwards.

At this moment, the links on the board to the front page are not working.  Use this instead: http://cushings.invisionzone.com/index.php?

Also, if you use Activity Streams, they’re not working, either.  I get a long error message.  The boards are only 86.62% complete as I write this.  Hopefully, the Activity Streams will fix themselves when it gets to 100%.

If you see any other issues I should be watching for – and maybe correct later – please let me know.

Patience, please!

FWIW – I see we have the Twitter and Facebook share boxes back. Even if you share from the boards, people on these other services will not be able to see anything other than the beginning snippet unless they are board members and they log in.

 

🖥 Cushing’s Slideshow

Cushing’s Help message board member sherryc presented this PowerPoint at pioneer Pacific College. It took a lot of work with her failing memory but she did It! She wanted to get the word out about Cushing’s and her journey with this awful disease.

She says that it took a lot of work with her failing memory but she did It! She wanted to get the word out about Cushing’s and her journey with this awful disease.

 

📺 NIH: Discovery Channel’s Documentary Series ‘First In Human’

Unprecedented Access Inside the National Institutes of Health’s Building 10
Premieres August 10

Directed by Emmy® Winner John Hoffman; Produced by McGee Media

Near the nation’s capital, on the campus of the National Institutes of Health, sits Building 10: the largest hospital in the world devoted solely to research. Inside, our country’s most brilliant scientific minds carry out some of medicine’s riskiest and most critical research, testing new treatments in people for the very first time.

With unprecedented access to the halls of Building 10, First in Human reveals for the first time how the medical breakthroughs of tomorrow make their way out of the hi-tech research laboratories and into the hands of our world’s medical professionals. The series explores the lives of the doctors, researchers, and patients who together make progress possible in this cutting-edge testing ground. Narrated by Emmy,® Golden Globe®, and Critics Choice® winning actor Jim Parsons (“The Big Bang Theory,” “Hidden Figures,”) directed by Emmy winner John Hoffman, and executive produced by Hoffman and Emmy winner Dyllan McGee, the three-part documentary series begins airing in August 10 at 9pm ET/PT exclusively on Discovery.

Because the treatments they’re testing are so new and their outcomes are entirely unknown, the doctors leading first in human trials at Building 10 can only partner with patients who have exhausted the options the medical establishment has to offer. This doctor-patient partnership is utterly unique to medicine: live or die, each of these brave “first in human” volunteers immediately becomes part of medical history. Previous trials in the building led to the development of modern chemotherapy treatments, the first treatments for HIV/AIDS, and the first successful gene therapy.

First In Human represents the first time cameras have embedded in Building 10 and followed first in human patients throughout their entire trial. This unique access is the product of Hoffman’s nearly twenty years of filmmaking in partnership with the NIH on projects such as The Alzheimer’s Project and The Weight of the Nation.

“NIH’s Building 10 has given generations hope when they need it most,” comments Rich Ross, Group President, Discovery Channel, Animal Planet, Science Channel, and Velocity.  “We are proud that the NIH has invited Discovery inside their doors for an unvarnished look at how these brave men and women work hand in hand with their doctors and technologists to seek cures to the most confounding diseases that exist.”

“Because of the very nature of first in human trials, most of the patients who enter Building 10 to enroll in them are remarkably unique: all standard care out in the world has failed them,” says Hoffman. “What was most powerful about embedding in Building 10 and following these trials was observing how the doctors and patients came to rely on each other in a true partnership to advance medicine.”

States Parsons, “I know that everyone who watches First in Human will feel the same sense of pride I did when I discovered this incredible institution that our country created. I hope viewers will share the sense of gratitude and awe that I felt when learning about the human beings who bravely put their lives in the hands of some of our most innovative scientists and doctors as they search together for the medicines and cures that give all of us fuller, longer lives. This is truly the story of how we, as human beings, function: both at an elemental level and at our most profound.”

“The NIH Clinical Center’s more than 60-year history has resulted in remarkable medical advances, from the first use of chemotherapy to treat cancer, to the development of the technique to keep the blood supply clean and safe from viruses,” said NIH Director Francis S. Collins, M.D., Ph.D. “For millions of patients around the world, it is known as the National Institutes of Hope.”

From leukemia to sickle cell disease to the rarest diseases on the planet, First in Human captures the stories of the doctors, researchers, staff, and, most importantly, the patients and families in this remarkable facility that together are pushing far into the unknown.

FIRST IN HUMAN is produced by McGee Media for Discovery Channel.  The series is directed by John Hoffman; produced by, John Hoffman, Beth Wichterich, and Michael Epstein; narrated by, Jim Parsons; executive producers Dyllan McGee, Jim Parsons, Todd Spiewak, and Eric Norsoph; producer, Jon Bardin; supervising producer, Stacia Thompson; senior editor, Adriana Pacheco; director of photography, Simon Schneider.  For Discovery Channel, supervising producer, Jon Bardin; executive producer, John Hoffman.

 

From https://corporate.discovery.com/discovery-newsroom/jim-parsons-set-to-narrate-discovery-channels-documentary-series-first-in-human-the-trials-of-building-10/