tag:blogger.com,1999:blog-8725594071580884964.post3773077477348695707..comments2024-03-19T04:06:18.999-04:00Comments on survive the journey: What's the real deal about Metabolic Syndrome?Robinhttp://www.blogger.com/profile/14910816445824791436noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-8725594071580884964.post-22950974241819484862009-03-14T01:15:00.000-04:002009-03-14T01:15:00.000-04:00Robin, don't you know by now? It is NEVER Cushing'...Robin, don't you know by now? It is NEVER Cushing's, unless you are a dog. Even when it is Cushing's, and the tumor comes out and slaps the doctor <I>and</I> the pathologist across the face, it still isn't Cushing's. It is NEVER Cushing's. Only horses and dogs and ferrets get Cushing's. I should know, I looked it up on Google. ;)~Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8725594071580884964.post-79028697956170454342009-03-10T21:44:00.000-04:002009-03-10T21:44:00.000-04:00Thanks for the comment/response, Dr. Rob. I think...Thanks for the comment/response, Dr. Rob. I think this kind of conversation is awesome, and appreciate the fact you not only allowed it on twitter but also will continue it here. I do have more information. My goal is not to tell you or anyone else what to think. My goal is to get people to see RECENT/CURRENT information. <BR/><BR/>We all win when the best interest of the patient is served. Thank you.Robinhttps://www.blogger.com/profile/14910816445824791436noreply@blogger.comtag:blogger.com,1999:blog-8725594071580884964.post-80955474734358614722009-03-10T18:48:00.000-04:002009-03-10T18:48:00.000-04:00Let me respond.Metabolic syndrome is, by definitio...Let me respond.<BR/><BR/>Metabolic syndrome is, by definition, an array of symptoms and clinical findings. It is called a syndrome because there is not clarity that there is a single disease process at work (as some of your sources stated). I won't argue that point, although there is very compelling reasons to think hyperinsulinism plays a major if not central role. I agree that this is often regarded as a disease, and not a syndrome, but from a practical standpoint it doesn't matter much to me.<BR/><BR/>Why? The purpose of identification of the syndrome is to risk-stratify a person. What really matters to me is mortality and morbidity. I treat things or test for things because they either make someone die early or cause significant harm. In this way, the term "Metabolic Syndrome"is useful. People with MS are at significantly increased risk of developing diabetes and coronary artery disease. It is very useful to identify people at risk for these serious diseases.<BR/><BR/>Besides - it sometimes scares people into changing their lifestyles enough to lose weight and eat better. In that way, it is very useful.<BR/><BR/>Regarding the correlation between the pituitary/adrenal axis (cushings) and MS, I think your evidence is interesting, but circumstantial. The fact that people with MS have an abnormal HPA axis doesn't prove cause. From what I see, it is equally likely that MS is the cause of this abnormality of the adrenocortical system, not the reverse. <BR/><BR/>The fact the two things look alike can be explained by the fact that increased cortisol levels cause insulin resistance, resulting in hyperinsulinism - which in turn makes the person look to have MS. <BR/><BR/>There probably are <I>some</I> MS patients who are actually low-level cushings. To say that <I>all</I> MS is from this cause (or even most) is really pushing your data. To prove this, one would have to reverse the process of MS by using an adreocortical antagonist - fixing the hypercortisol state and having it followed by a remission of MS. By my reading, your data didn't show this.<BR/><BR/>The bottom line for me, however, is the "so what" question. I am only marginally interested in the root causes if they don't impact my treatment or diagnosis. Aggressive risk factor reduction and lifestyle modification are the approaches in a patient in MS. The cortisol balance doesn't come into play.<BR/><BR/>Let me say, however, that the 18 year old is different. He has all sorts of red flags, as he is very unusual in his presentation. The incidence of MS in teens, although rising, is not high and so other causes must be considered - especially as his onset was somewhat rapid.<BR/><BR/>Bottom line? Maybe there is an association, but I am not convinced that it is a causal association. But how does it impact me? Not much, except that I need to keep vigilant and not assume all MS patients are the same. I need to keep my eyes open for Cushings -which I have much more since I have been interacting with your community. I have tested much more for it, and I thank you for the reminders.Dr. Robhttps://www.blogger.com/profile/01871792467587364512noreply@blogger.com