In the News: Protein in pituitary critical to women's health...

Discovery In Pituitary Of Protein That Regulates Hormones Critical To Women's Health:

University of Wisconsin-Madison researchers have solved the mystery surrounding
a 'rogue protein' that plays a role in the release of neurotransmitters and hormones in the brain.

The scientists found abundant amounts of the puzzling protein - whose main location and function were unknown until now - in a specific area of the pituitary gland. Like someone at a control knob, the protein may adjust the release of the two hormones that come almost exclusively from the posterior pituitary: oxytocin, which controls many reproductive functions, and vasopressin, which controls fluid balance.

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Wal-Mart's $4 Generic Prescription Drug List Added to Epocrates' Drug Reference Application

What does this mean for you, the patient? It means your physician should be able to readily see what drugs you can get through this program and prescribe accordingly.

Physicians will now be better equipped to help identify lower cost medication options available for their patients at Walmart, Neighborhood Market and Sam's Club pharmacies nationwide.

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Discovery of a compound strong enough to fight off some of the most deadly bacterial infections seen in human beings.

Important in many ways, including those who suffer MRSA and other hard-to-treat infections, a compound isolated while searching for a reason so many coral reefs were dying may help treat resistant infections.

Scientists isolated the compound from the thriving sponge. What they found was a compound that was originally discovered in the late 1990s by scientists searching for anticancer chemicals. Back then it was overlooked. Today, scientists think they may have hit an underwater jackpot.

"We have yet to have a failure. We have yet to find resistant bacteria. We're limited only by our imagination in what we're going to get out of the ocean for human health. It's a big world out there."

Protein That Regulates Hormones Critical To Women’s Health Found In Pituitary

Protein That Regulates Hormones Critical To Women’s Health Found In Pituitary

The scientists found abundant amounts of the puzzling protein - whose main location and function were unknown until now - in a specific area of the pituitary gland. Like someone at a control knob, the protein may adjust the release of the two hormones that come almost exclusively from the posterior pituitary: oxytocin, which controls many reproductive functions, and vasopressin, which controls fluid balance.

Is it AI or just electrolytes? Or thyroid? Or an infection?

Well, durn-it-all, I had to take an extra 5 mg of hydrocortisone again tonight. That's twice this week, and actually three times if I count last Sunday when I was flying across the country coming home. I'm trying so hard to wean off of the hydro but my body just won't let me. I don't know if it's because my pituitary still isn't making enough ACTH after my surgery 18 months ago or if it's cantankerous sometimes. Or is it my adrenal glands? Have they given up the ghost?

Between the nausea, being freezing cold in a 76 degree room, the fatigue, and the headache that comes with it, there was no way around my need for the drug I both love and hate. I fought for years to get rid of the bugger that was causing my body to be overrun with the steroid only now to be dependent on it. But I never want a repeat of a couple of episodes I've had with AI. No way, no how.

So, are my electrolytes off, or do I need more cortisol? And if I do, why? Do I have an infection? That's usually my first indication of an infection, but that's not the only reason I get AI. In fact, I'm still fighting that sinus infection and see my ENT on Wednesday. The last few times other than with sinuses, it's been UTI's. I didn't even know I had them until they got so bad and became Pyelonephritis. You know, it's all relevant and we "Cushies" tend to ignore signs others don't just because we've tolerated so much for so long. It's hard to know when one is sick outside of the endocrine disease itself.

I know, I know...time to go get some blood work done. I've been putting it off for too long. I spent the week with my daughters this past week, so really need to get on the ball and go. But, I can't go in the morning. Since I have to have the serum cortisol and ACTH done at 8 a.m. and I'm supposed to withhold my hydrocortisone for 24 hours prior...well....I blew that.

I know that my pituitary has quit making a lot of things, but the tumor did that. Surely it will make ACTH again. I hope it will, but yet, I'm afraid it will, too. The chance of a recurrence within 5 years is high, and since my tumor went into my cavernous sinus and had to be scraped off the wall there, just one cell can cause it to regrow. Most of the time I don't think about that, but every now and again....like tonight....I do.

Why would my pituitary start making ACTH and not the GH or TSH I need? Oh, I've read all the research and supposition that goes with a pituitary tumor and the hormones it affects. But think about it. The pituitary has a posterior and anterior section. It also leads into the hypothalamus. The anterior section is responsible for the majority of the hormones, and those are the hormones I'm missing. All of them. TSH, GH, FSH, LH, etc. So, why would I not produce them but still produce ACTH? Yeah, you see why I'd worry if I did produce enough ACTH? Why won't I produce all the other ones?

Oh, I know, as we get older there are a lot of other things that happen in our bodies that cause the GH and estrogen to fall. And I know there are feedback mechanisms that fail, too. In fact, the hypothalamus directs a lot of the action with the anterior pituitary, including GH production.

The hypothalamus is a very small portion of the brain, but wow, is it ever busy! I'll have to do a piece on it sometime. In fact, there is some new research involving the hypothalamus and obesity. It's very interesting. If the hypothalums is damaged, a lot of the hormone production of the body goes haywire or stops. You can read more about it in Testing 101: An introduction. So, is my hypothalamus damaged? Ok, y'all....I know some of you are saying "she's dain bramaged for sure!" ;) Yeah, yeah.... I'm just curious!

So, I'm still cold, my nausea has abated to a tolerable level, and my headache is tolerable, too. Maybe I can sleep again. At least my polar fleece blanket will feel good tonight!

It's not just apples and oranges.....

Oh, I know you've heard it before. "She's just depressed." As if anyone can be "just" depressed. And it's said like it's all just a mental thing. (Around here you'd hear that pronounced "thang". It sorta works with this topic.)

Well, the problem is, with those of us who have had our pituitaries sliced and diced after they were first suppressed with a "tumah" of varying proportions, it isn't "just depression". In the article "Apathy and Pituitary Disease: It Has Nothing to Do with Depression" the authors make some very valid points.

Of course, when I read the following, I just about got depressed. After all, they are describing me!

Patients who are diagnosed with pituitary disease experience many physical changes that have been well documented in the literature. These patients may have significant fluctuations in their weight as well as changes in their physical appearance, as seen in patients with adrenocorticotropic hormone-producing adenomas (ACTHomas), prolactinomas, and growth hormone-producing adenomas (GHomas). They may also experience changes in their sexual and reproductive functioning, such as amenorrhea, impotence, and impaired orgasm. Many patients with pituitary disease develop comorbid medical illnesses as a result of their pituitary dysfunction. The development of diabetes mellitus, hypertension, and coronary artery disease are a few examples.

They go on to talk about the problems of "lethargy, increased sleepiness, cyclic mood instability, impaired cognitive function (i.e., deficits in concentration and memory), and personality change" which occur with Cushing's Disease. Although I'm skipping a lot, basically they studied numerous patients who had pituitary surgery, and summarized with "apathy is an emerging concept in neuropsychiatry, and major depressive disorder and chronic fatigue syndrome are important syndromes from which apathy must be differentiated.... these patients with pituitary disease appeared to be suffering from depression, given their constricted affect. However, when asked about their mood, all stated that they were not depressed but, instead, stated that they had chronic fatigue and lack of motivation." Apathy, not depression, was a major factor in the quality of life for these patients.

The pituitary gland is a very tiny gland, actually, at the base of the brain. It is often described as "pea-sized" or "lima-bean" shaped. It is divided, basically, into anterior and posterior sections. Each part of the pituitary is responsible for multiple hormones.

Since adenomas (tumors) of the pituitary are typically measured in millimeters, it becomes obvious that size does not matter here. Adenomas under 10 mm in diameter are called microadenomas, while those 10 mm and larger are termed macroadenomas. In other words, one centimeter is LARGE in the pituitary world. Placement, size, and cell type(s) all vary so greatly that there really is not one, or two, or even three standard outcomes with these tumors.

Many adenomas/tumors suppress the pituitary so it cannot produce multiple hormones while the tumor overproduces one or more hormones. (Another topic for another day.) The point I'm trying to make is that we know what happens to the body with just one hormone problem. Think in terms of multiples and it obvious that what is seen as depression is often a by-product of pituitary malfunction.

Growth Hormone (GH) is a powerful brain hormone that is believed to play an important role in stimulating and controlling areas of the brain that regulate moods and emotions. It is not just important in growth. Certain chemicals in the brain, called neurotransmitters are dependent on the effects of GH to help them carry their messages between brain centers. If GH is not available, these functions may not occur appropriately and the result can be uncontrolled changes in psychological functioning. It can cause anxiety, depression or worry for no apparent reason when this happens, and this may cause changes in behavior or decline in social functioning. Negative and sad feeling often dominate the deficient person's mood, and positive or joyful feelings can be dampened. An affected individual could feel unable to enjoy life and lack the motivation to make change in their circumstance.

I am GH deficient. I have probably been GH deficient (as well as thyroid deficient) for over 20 years, and maybe 30 years. Since I don't have access to any records that far back, it's hard to tell. When I had the Arginine GHRH Stimulation test at the University of North Carolina back in the spring, I only stimmed to 0.13 ng/ml. I started out at 0.02 ng/ml. When normal is around 10 ng/ml, that's mighty low. I have been on GH (Genotropin) for about 2 months and can tell a huge difference in my attitude and fortitude. Ok...I now have 'tude!! Seriously, I have less apathy, much more social presence, and I'm not hiding in my den so much. I see a return of the "old Robin" in many ways. Yes, less apathy.

Back to the apples and oranges....depression is not the same as apathy. Sliced or diced.....still two different fruits.

A horse of a different color

Or should I say zebra? In med school, potential doctors are told ""When you hear hoofbeats, think horses, not zebras". Well, what about those of us who are zebras? What does that say to those who don't fit any mold of illness or have multiple illnesses which paint stripes?

As I said earlier, my primary care doctor sees horses, but every now and then she does notice a stripe. The thing is, she tries to get rid of the stripe instead of looking at what caused it. And she's not alone. Frankly, I'm wondering if there really are any horses out there? Ok...ok....I guess there are. Maybe.

Diabetes, you say, is a horse. Nope.... Did you know that endocrine disease can cause it? And that it is just a secondary symptom? You didn't know that? Don't worry. Most endocrinologists don't seem to, either. Thankfully, I never had that particular stripe.

Ok, how about thyroid function/disease? Nope, not that one either. It's actually a stripe in the zebra of endocrine disease, especially a pituitary tumor. Secondary/central hypothyroidism is linked to a pituitary tumor suppressing the pituitary, and hyperthyroidism can be linked to a TSH producing tumor.

Low hormones? Oh, that must be early menopause or pre-menopause with females, right? Wrong. Just stripes of another color in the zebra of pituitary tumors.

How about high hormones? Well, guess what? Do I need to say it? More stripes...... Pituitary adenomas are famous for growth hormone and ACTH overproduction.

PCOS and metabolic syndrome are often the horses with which a Cushing's patient is diagnosed. Too often, it's just too easy to camouflage the stripes with those diagnoses.

Oh, and my favorite. Obesity. "You need to eat less and get more exercise." How many people do you know who want to be extremely overweight? Those doctors who don't listen, ignore the stripes (some literal ones called striae) and keep repeating that mantra need a A Swift Kick in the ASP. They don't know that fat is an endocrine organ. They also don't know it is actually possible to literally starve while remaining obese.

I do not know the answers. I do know there is a problem. Instead of heading to the dude ranch, maybe med schools ought to take their future doctors on a safari.