The Case Records of the Mayo Clinic Florida Neurosurgery featured an endoscopic transsphenoidal approach for a pituitary tumor resection.
Basic Info
Basics: Testing: Prolactin
A prolactin (PRL) test measures how much of a hormone called prolactin you have in your blood. The hormone is made in your pituitary gland, which is located just below your brain.
When women are pregnant or have just given birth, their prolactin levels increase so they can make breast milk. But it’s possible to have high prolactin levels if you’re not pregnant, and even if you’re a man.
Your doctor may order a prolactin test when you report having the following symptoms:
For women
- Irregular or no periods
- Infertility
- Breast milk discharge when you’re not pregnant or nursing
- Tenderness in your breast
- Menopausal symptoms such as hot flashes and vaginal dryness
For men
- Decreased sex drive
- Difficulty in getting an erection
- Breast tenderness or enlargement
- Breast milk production (very rare)
For both
Causes of Abnormal Prolactin Levels
Normally, men and nonpregnant women have just small traces of prolactin in their blood. When you have high levels, this could be caused by:
- Prolactinoma (a benign tumor in your pituitary gland that produces too much prolactin)
- Diseases affecting the hypothalamus(the part of the brain that controls the pituitary gland)
- Anorexia(an eating disorder)
- Drugs that are used to treat depression, psychosis, and high blood pressure
- Chest injury or irritation (for example, scars, shingles, or even a bra that’s too tight)
Also, kidney disease, liver failure, and polycystic ovarian syndrome (a hormone imbalance that affects ovaries) all can affect the body’s ability to remove prolactin.
How the Test Is Done
You don’t need to make any special preparations for a prolactin test. You will get a blood sample taken at a lab or a hospital. A lab worker will insert a needle into a vein in your arm to take out a small amount of blood.
Some people feel just a little sting. Others might feel moderate pain and see slight bruising afterwards.
After a few days, you’ll get the results of your prolactin test in the form of a number.
The normal range for prolactin in your blood are:
- Males: 2 to 18 nanograms per milliliter (ng/mL)
- Nonpregnant females: 2 to 29 ng/mL
- Pregnant females: 10 to 209 ng/mL
If Your Prolactin Levels Are High
If your value falls outside the normal range, this doesn’t automatically mean you have a problem. Sometimes the levels can be higher if you’ve eaten or were under a lot of stress when you got your blood test.
Also, what’s considered a normal range may be different depending on which lab your doctor uses.
If Your Levels Are Low
If your prolactin levels are below the normal range, this could mean your pituitary gland isn’t working at full steam. That’s known as hypopituitarism. Lower levels of prolactin usually do not need medical treatment.
Certain drugs can cause low levels of prolactin. They include:
- Dopamine (Intropin), which is given to people in shock
- Levodopa(for Parkinson’s disease)
- Ergot alkaloid derivatives(for severe headaches)
Treatment
Not all cases of high prolactin levels need to be treated.
Your treatment will depend on the diagnosis. If it turns out to be a small prolactinoma or a cause can’t be found, your doctor may recommend no treatment at all.
In some cases, your doctor may prescribe medicine to lower prolactin levels. If you have a prolactinoma, the goal is to use medicine to reduce the size of the tumor and lower the amount of prolactin.
Basics: The Role of Endocrinology in Managing Polycystic Ovary Syndrome and Diabetes
Introduction to Endocrinology
Endocrinology is a medical specialty that focuses on the diagnosis and treatment of diseases related to hormones. Endocrinologists are experts in managing and treating diseases related to the endocrine system, which includes the thyroid, pituitary, adrenal glands, and pancreas. Endocrinologists are trained to diagnose and treat conditions such as diabetes, thyroid disorders, pituitary disorders, and other conditions related to hormones. Endocrinologists also specialize in reproductive health and fertility issues, including PCOS.
Endocrinology is a complex field that requires a deep understanding of the endocrine system and its role in regulating the body’s hormones. Endocrinologists must be able to interpret laboratory tests and understand the underlying causes of endocrine disorders. They must also be able to develop individualized treatment plans to address the specific needs of each patient.
Diagnosing PCOS and Diabetes
Endocrinologists are experts in diagnosing and managing PCOS and diabetes. PCOS is a hormonal disorder that affects the ovaries, and it is characterized by irregular menstrual cycles, excess facial and body hair, and infertility. To diagnose PCOS, an endocrinologist will perform a physical exam and order laboratory tests to measure hormone levels. The endocrinologist will also ask the patient about her symptoms and family history to determine if PCOS is the cause.
Diabetes is a chronic condition that affects the body’s ability to process sugar. To diagnose diabetes, an endocrinologist will perform a physical exam and order laboratory tests to measure blood sugar levels. The endocrinologist may also order imaging tests to check for signs of diabetes-related complications.
Treating PCOS and Diabetes
Once the endocrinologist has diagnosed PCOS or diabetes, they will develop an individualized treatment plan to address the patient’s specific needs. For PCOS, the endocrinologist may recommend lifestyle changes such as weight loss, exercise, and dietary changes to help manage symptoms. The endocrinologist may also prescribe medications to regulate hormone levels and improve fertility.
For diabetes, the endocrinologist may recommend lifestyle changes such as weight loss, exercise, and dietary changes to help manage blood sugar levels. The endocrinologist may also prescribe medications to help regulate blood sugar levels. In addition, the endocrinologist may recommend regular check-ups to monitor the patient’s progress and to adjust the treatment plan if needed.
Conclusion
Endocrinology plays an important role in managing PCOS and diabetes. Endocrinologists are experts in diagnosing and treating these conditions, and they are trained to develop individualized treatment plans that address the specific needs of each patient. By working with an endocrinologist, patients can get the help they need to manage their PCOS or diabetes and achieve their health goals.
Endocrinology is a complex field that requires a deep understanding of the endocrine system and its role in regulating the body’s hormones. An endocrinologist can help patients with PCOS and diabetes manage their conditions and achieve their health goals. By working with an endocrinologist, patients can get the help they need to manage their PCOS or diabetes and achieve their health goals.
Basics: Diagnostic Procedures in Suspected Adrenocortical Carcinoma
Patients with suspected adrenocortical carcinoma (ACC) may also undergo additional tests to identify excess sex steroids and steroid precursors, mineralocorticoids and glucocorticoids.
Table 2 provides a summary of the tests recommended by the European Society of Endocrinology in collaboration with the European Network for the Study of Adrenal Tumors in patients with suspected ACC.10
Table 2. Diagnostic work-up in patients with suspected or proven adrenocortical carcinoma. Reproduced from Fassnacht et al., 2018,10 with permission under a Creative Commons Attribution 4.0 International License.
ACTH: adrenocorticotropic hormone; DHEA-S: dehydroepiandrosterone sulphate; CT: computed tomography; FDG-PET: 18F-fluorodeoxyglucose positron emission tomography; MRI: magnetic resonance imaging.
- Click image to enlarge
Basics: Pseudo-Cushing’s syndrome
Pseudo-Cushing’s syndrome is when symptoms are similar to those of Cushing’s syndrome, but further tests show that the syndrome is not present.
Common causes include consuming too much alcohol, obesity, persistently high blood glucose levels, pregnancy, and depression.
Basics: What Causes Abnormal Cortisol Levels?
Cortisol isn’t bad; you need it to help regulate your responses to life. Regulation involves a very complex interplay of feedback loops between the hypothalamus, pituitary gland, and adrenal glands, says Dr. Singh.
“In general, cortisol levels tend to peak in the late morning and gradually decline throughout the day,” he explains. “When a stressful event occurs, the increased cortisol will work alongside our ‘fight or flight’ mechanisms to either upregulate or downregulate bodily functions. [Affected systems include] the central nervous system, cardiovascular system, gastrointestinal system, or immune system.”
In addition to normal processes that trigger or suppress cortisol release, levels can also be affected by different medical conditions, Dr. Singh says. For example, if someone has abnormally high levels of cortisol, this is called Cushing’s syndrome, which is typically caused by a tumor affecting any of the glands that take part in the process of cortisol production.
When people suffer from abnormally low levels of cortisol, it’s called Addison’s disease. It generally occurs due to adrenal gland dysfunction, but could also be the result of abnormal functioning of any of the other glands in the cortisol production process.
Finally, if you use corticosteroid medications such as prednisone or dexamethasone, prolonged use will result in excessive cortisol production, Dr. Singh says.
“If the medication is not adequately tapered down when discontinued, the body’s ability to create cortisol can become permanently impaired,” he says.
From https://www.yahoo.com/lifestyle/manage-pesky-stress-hormone-cortisol-184900397.html
📚 Merck Manuals: Answering Common Questions About Cushing Syndrome
MaryO’Note: Cushing’s Disease is a subset of Cushing’s Syndrome and is caused by pituitary issues.
High cortisol – and its deleterious effects on the body – may be a more commonly recognized phrase in today’s healthcare lexicon. Still, doctors say there is a need for more awareness of a rare and potentially life-threatening condition involving cortisol, known as Cushing’s Syndrome
In a new editorial from MerckManuals.com, Ashley B. Grossman, MD, University of Oxford; Fellow, Green-Templeton College, addresses common patient questions around Cushing syndrome.
1. What causes Cushing syndrome?
Adrenal glands release hormones that help control blood pressure, heart rate, balance of water and salt, response to stress, and more, says Grossman. Cushing syndrome occurs when these glands release too much of the hormone cortisol, or you are taking a hormone like cortisol.
This typically has one of two causes:
- a tumor in the adrenal glands or cancer in another part of the body
- taking a corticosteroid medicine for a long time
2. What are the symptoms of Cushing syndrome?
Cortisol is an essential hormone in the body. Having too much can cause many changes, including increases in blood sugar and cholesterol. Corticosteroids also alter the amount and distribution of body fat, says Grossman.
Other symptoms of Cushing syndrome include:
- Large round face (called a “moon face”)
- Large amounts of belly fat and fat at the top of your back (often called a “buffalo hump”)
- Thin skin that bruises easily and heals slowly
- Purple streaks that look like stretch marks on your chest and belly
- Getting tired easily
- Sometimes, extra face and body hair
- In females, sometimes sudden hair loss from their head
Cushing syndrome can be life-threatening, says Grossman. Very high cortisol will lower your potassium level, which can cause heart problems.
3. What can I expect at a doctor’s appointment for Cushing syndrome?
For patients not taking high levels of steroids, Cushing syndrome is rare, and many symptoms can have other causes. At the same time, the physical changes can be a good indicator of Cushing syndrome, says Grossman.
If you’re experiencing these symptoms, it’s a good idea to see your primary care doctor right away. Bring some photos of yourself from a few years ago so doctors can see how your body may have changed. Doctors will also ask about anything that could increase steroid levels, such as using creams with steroids or inhaled steroids, as well as recreational drug use.
Once a patient is diagnosed with Cushing syndrome, it’s important to see a specialist for further guidance and treatment, says Grossman. Treatment will depend on whether the problem is in the adrenal glands, the pituitary gland, or elsewhere.
4. Is it safe to take steroids?
Steroids can be a game-changing treatment for many patients, but they do have a risk of side effects, says Grossman. They need to be taken as prescribed. Doctors never stop the use of corticosteroids abruptly if people have been taking them for more than two or three weeks. Instead, doctors gradually reduce (or taper) the dose over weeks and sometimes months.
To read more of Grossman’s insights on Cushing syndrome, visit this editorial on MerckManuals.com.
About The Merck Manuals and MSD Manuals
First published in 1899 as a small reference book for physicians and pharmacists, The Merck Manual grew in size and scope to become one of the world’s most widely used comprehensive medical resources for professionals and consumers. As The Manual evolved, it continually expanded the reach and depth of its offerings to reflect the mission of providing the best medical information to a wide cross-section of users, including medical professionals and students, veterinarians and veterinary students, and consumers. In 2015, The Manuals kicked off Global Medical Knowledge 2020, a global initiative with the goal to make the best current medical information accessible by up to three billion professionals and patients around the world by 2020. The Manuals achieved that goal, and today its medical information is available in nearly 250 countries and in 14 languages. It’s continuing its ambitious mission through outreach, education and creating new reliable medical resources. For access to thousands of medical topics with images, videos and a constantly expanding set of resources, visit MerckManuals.com or MSDManuals.com and connect with us on social media: For Consumers in the U.S. and its territories: X (formerly Twitter) and Facebook. For Professionals in the U.S. and its territories: X (formerly Twitter) and Facebook
About Merck
At Merck, known as MSD outside of the United States and Canada, we are unified around our purpose: We use the power of leading-edge science to save and improve lives around the world. For more than 130 years, we have brought hope to humanity through the development of important medicines and vaccines. We aspire to be the premier research-intensive biopharmaceutical company in the world – and today, we are at the forefront of research to deliver innovative health solutions that advance the prevention and treatment of diseases in people and animals. We foster a diverse and inclusive global workforce and operate responsibly every day to enable a safe, sustainable and healthy future for all people and communities. For more information, visit www.merck.com and connect with us on X (formerly Twitter) , Facebook, Instagram, YouTube and LinkedIn.
View original content to download multimedia: https://www.prnewswire.com/news-releases/merck-manuals-answering-common-questions-about-cushing-syndrome-302422038.html
SOURCE The Merck Manuals
ℹ️ Cushing Syndrome and Hormone Disorders
MaryO’Note: This is really basic information. Maybe News 9 should have checked with a doctor who has actually been diagnosed with Cushing’s or at least tested for it!
~~~~~~~~~~~~~~~~~~~~~~~
In our Daily Dose, a viewer is asking about hormone problems that can cause your face to become round. Dr. Lacy Anderson joined News 9 to explain how some hormone disorders, like Cushing syndrome work.
Cushing’s syndrome is a rare disorder caused by the body making too much cortisol over a long period of time. It can be caused by a tumor of the adrenal gland, which makes cortisol, or it can be caused by a tumor of the pituitary gland, which controls the adrenal gland.
Cushing’s syndrome can cause a rounded face, known as a moon face. It can cause weight gain and fat deposits on the upper back, known as a buffalo hump. It can also cause stretch marks on the abdomen. It can cause high blood pressure, and high blood sugar, and increase the risk of cataracts and osteoporosis. Occasionally, Cushing’s syndrome can be caused by long-term, high-dose steroid use.
For pituitary or adrenal tumors, surgery can cure this condition. I’ve had several patients wanting me to check their cortisol levels recently, so this condition may have hit social media feeds, but I’ve never diagnosed Cushing’s syndrome because it’s so rare. I can usually take one look at my patients and reassure them that they don’t have Cushing’s syndrome.
Stay healthy and take care!
A video is included in the article at https://www.news9.com/story/6658b8f860ad19ad44c6da8f/daily-dose:-cushing-syndrome–hormones-disorders
ℹ️ Understanding Cortisol: The Stress Hormone Explained
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/
ℹ️ Basics: Pituitary Tumors and Headaches
Headaches are a common complaint in patients with pituitary tumors. Although many patients presumably have headaches which are unrelated to their pituitary tumor, there are several important direct and indirect mechanisms by which pituitary tumors may elicit or exacerbate headaches. Pituitary tumors may directly provoke headaches by eroding laterally into the cavernous sinus, which contains the first and second divisions of the trigeminal nerve, by involvement of the dural lining of the sella or diaphragma sella (which are innervated by the trigeminal nerve), or via sinusitis, particularly after transsphenoidal surgery. Headache pain in these situations is typically characterized by steady, bifrontal or unilateral frontal aching (ipsilateral to tumor). In some instances, pain is localized in the midface (either because of involvement of the second division of the trigeminal or secondary to sinusitis).
In contrast to the insidious, subacute development of headaches in most patients with pituitary tumors, patients with pituitary apoplexy may experience acute, severe headaches, perhaps associated with signs and symptoms of meningeal irritation (stiff neck, photophobia), CSF pleocytosis or occulomotor paresis. Routine CT scans of the head occasionally skip the sella, hence the presence of blood or a mass within the sella may not be detected and patients can be misdiagnosed with meningitis or aneurysm. Because pituitary apoplexy represents a neurosurgical emergency, MRI should be used in patients with symptoms suggestive of this disorder. A subacute form of pituitary apoplexy has also been reported. Patients with subacute pituitary apoplexy experience severe and/or frequent headaches over weeks to months and have heme products within the sella on MRI scans.
In most instances, headaches are not attributable to direct effects of the pituitary tumor and indirect causes must be considered. Generally, indirect effects of pituitary tumors are caused by reduced secretion of pituitary hormones and are manifested by promotion of “vascular” headaches (e.g., migraine). The major exception to this rule relates to the potential for acromegalic patients to develop headaches secondary to cervical osteoarthritis. Vascular headaches may be exacerbated in association with disruption of normal menstrual cyclicity and impaired gonadal steroid secretion (e.g., from hyperprolactinemia or gonadotropin deficiency). Hyperprolactinemia, hypothyroidism and hyperthyroidism may also have direct effects, independent of gonadal hormones. Headaches are common in acromegaly, and in the majority of cases the etiology is not well understood.
Finally, drug management of pituitary tumors may inadvertently impact headaches. Octreotide results in extremely rapid headache improvement with patients with acromegaly. The rapid time course suggests it is not due to lowering of GH levels. Octreotide also has a dramatic beneficial effect on migraine and may be producing relief of headache by vascular mechanisms. Occasionally severe headaches surface in acromegalic patients after reduction or discontinuation of octreotide, as a “withdrawal” phenomenon.|
Bromocriptine or other dopamine agonists occasionally trigger severe headaches. When this occurs, it is important to recognize that bromocriptine has been reported as a cause of pituitary apoplexy, and it may be necessary to perform an MRI or CT to rule out infarction or hemorrhage within the pituitary. Once it is established that the patient is not infarcting the pituitary, it is generally safe to treat the headaches symptomatically (not with an ASA containing drug) and consider alternative therapies for the prolactinoma if the problem remains severe.
Pituitary tumor patients with vascular headaches are generally quite responsive to standard prophylactic migraine drugs (e.g., tricyclic antidepressants, verapamil and beta-blockers). It is best to begin therapy with very low-dose medication (e.g., 10 mg of amitriptyline at bedtime) and resist the impulse to escalate the dose rapidly to higher levels. Often patients have an excellent response to 10-30 mg of a tricyclic antidepressant, although it may take up to six or more weeks to reach the ultimate benefit. The choice of tricyclic antidepressant should be based upon the desired side effects (e.g., either more sedation or less sedation) The newer, serotonin-selective antidepressants are generally less effective for headaches than tricyclics, although some patients do respond nicely to these agents. In some cases it may be necessary to use combination therapy (e.g., verapamil plus a tricyclic).