Hypercortisolism/ was: help with rubric

[Luise Kunkle]

Hi Irene,

perhaps this case is interesting to you and the list - and I am very
much interested in what you think.

Woman 72, hypothyroid as consequence of autoimmune thyroiditis - kept
euthyroid by thyroid hormones. No other medication except for decades
under homeopathic care, without influence on the condition nor real
effectoveness to her basic problems from the (classical) homeopathic
care.

Because of her thyroid condition she has gone to the endocrinological
clinic at the university hospital. There, by coincidence, certain lab
values were found which led to xray of the adrenals, which showed
hyperplasia of both adrenal cortexes.

Further lab work showed: cortisol in the serum 9.8 mu/grams/dl
(normal: 6.0-19.0), ACTH less than 1.0 pg/ml (normal 7.2 - 63.0).

They want to do further lab tests to find out whether she suffers from
hupercortisolism. They say that they found a basal elevated
corisol-level and completely suppressed ACTH.

Considering the lab values I do not understand the idea that the
cortisol level is elevated - but obviously the ATCH is non-existent!

Forgetting anything to do with the simillimum, I should like to know
whether you have an idea what else one could do - sarcodes? nutrition?
(she does eat quite a good diet).

I'll cross-point this in the beyondhomeopathy list and ask Suriya -
who is an endocrinologist and has posted a lot about sarcodes etc -
for her opinion also.

As I said above - I think this case is perhaps of interest to people
who read this list also. Could be that this is one of the cases you
talked about where the simillimum just has not worked over the past
decades because of the basic state - the own cortisol production
preventing action?

Regards

Luise
--
One thought to all who, free of doubt,
So definitely know what's true:
2 and 2 is 22 -
and 2 times 2 is 2:-)
==========> ICQ yinyang 96391801 <==========

[Irene de Villiers]

Luise Kunkle wrote:

This makes sense.
Firstly you can ignore the serum values for cortisol - on my list of
cushings people it is clear that those tell you nothing and the results
go all over the place - mostly low when high is expected for example -
but once in a while someone has "cyclic" cushings - where cortisol
levels fluctuate quite wildly.

(There are MANY forms of cushing's syndrome differentiated by source of
the high cortisol)

The best lab test to determine whether cortisol levels are elevated is
the 24-hour urine total cortisol test. Anything else is pretty much
guesswork.
It actually does make sense: The body has a feedback loop so that when
there is plenty of cortisol around (as here), it suppresses production
of ACTH (as here) - as ACTH otherwise would stimulate more cortisol
production in the adrenals when the body already knows there is plenty.

So the excess cortisol is due to excess production in the adrenals (from
adrenal hyperplasia) - and NOT due to excess ACTH production (as looks
more likely in Erica's presented case)
I could write a small book on nutrition and supplements yes:-))
Cortisol is catabolic and one has to rebuild daily what it breaks down
daily - no small task! Especially as it blocks enzymes for metabolizing
fat, and it increases glucose and insulin as well as turning muscle to
glucose via the liver. Plus brain damage, bone damage, tooth damage -
etc - cortisol breaks down ALL tissue types indiscriminately.
All that needs to be countered.
So a low carb, hi protein, very-high antioxiodant diet is the basis,
plus cortisol breakdown supplements and nutrients - and a lack of
cortisol aggravating foods... lots of detail though - perhaps see it on
my cushings-friends list, too long to put here?
As to sarcodes, I'd assume Thymus 4C, among others - but I have not had
a lot of luck with them and would like to know more myself.
Also a need to avoid aggravation from stress and to manage all things
that affect stress levels, growth hormone effectiveness for repair etc.
Yes I believe so. Cortisol (and prednisone - its artificial form)
destroys thymus enough so the TH-1 cytokine production is not there or
too low....resulting in a totally blocked immune system - and in my view
you need that Th-1 cytokine activity to recover.
It's akin to the feline FIP cases I see - where there is almost no
success after prednisone is used.

Namaste,
IRene

--
Irene de Villiers, B.Sc AASCA MCSSA D.I.Hom/D.Vet.Hom.
P.O. Box 4703 Spokane WA 99220.
www.angelfire.com/fl/furryboots/clickhere.html (Veterinary Homeopath.)
"Man who say it cannot be done should not interrupt one doing it."

[ELM]

I am very interested in information you learn regarding this. Thanks!
Erica

--- In minutus@yahoogroups.com, Luise Kunkle wrote:

[Luise Kunkle]

Hi Irene,

first: How do I get subscribed to the cushings list?

But as there does seem to be some interest on this list, I'll keep
discussing here also.

I am not so sure about the matter of ACTH being the consequence of a
high cortisol level, I tend - in this case - to think it is the other
way round, i.e. that the hyperplasia is a compensation for the low
ACTH - to try and keep the cortisol level sufficient in spite of the
low stimulating factor.

Two things make me think so:

1. The fact that BOTH adrenal cortexes are enlarged.

2. When the woman was about 18 years old, i.e. more than 50 years ago,
a doctor by some lab value diagnosed a low ACTH level and gave ACTH
supplement for some weeks or months. During that time the woman felt
great. But the doctor was leery to keep up with it - so things went
back to what they were before and pretty much stayed that way all
through her life. (Mostly tiredness, relative muscle weakness not much
responding to exercise, tendency to gain weight on
moderate eating - things like that.

The tests to be done will include the 24 - hour urine. Which is fine.
I do not know about the other two that are planned: CRH-test and 2
days later "1 mg Dexamethason suppression test" - I am going to advise
her to find out first what good the knowledge gained by those 2 latter
tests would do, i.e. what the therapeutic consequences would be.

But - does anyone know what exactly those 2 tests would mean??

Regards

Luise
--
One thought to all who, free of doubt,
So definitely know what's true:
2 and 2 is 22 -
and 2 times 2 is 2:-)
==========> ICQ yinyang 96391801 <==========

[Irene de Villiers]

Luise Kunkle wrote:

Hi Luise,
Send empty email to:
cushings-friends-subscribe@yahoogroups.com
Except the hypothalamus is the originating and master gland. It's the
one that has to do the "responding" to feedback loops - not the adrenals.

What would cause a primary loss of ACTH?
That's typical. It's quite rare for only one to be enlarged.
I wonder if THAT was caused by high cortisol as well?
But it is interesting she felt well with it - that says a lot.
Cortisol makes one feel lousy.
Did her cortisol level or the level of hyperplasia go down in that time
- if we know?
CRH (corticotropin-releasing hormone) test is less commonly used in
cushings - if it is high, then it may explain high ACTH. I know nothing
about the actual test.
Dex-suppression test (quite standard) is one I would not do if you paid me!
It's my policy to never do a test that itself is damaging to the system.
The dex suppression test involves a high dose of steroid (as if cortisol
is not enough) to "see if that suppresses the cortisol by feedback loop".
The idea is that it supposedly differentiates between a pituitary tumour
and adrenal tumour. (and takes no account of the other kinds of less
common tumours such as carcinoids or oat cell tumours)

- which IMO are more likely than usual here relevant here as she had
this a verty long time.

- I am going to advise

CRH is a clue to the origin of high ACTH (in theory - it's a newish
idea) as high CRH will cause high ACTH.

Dex suppression is used to differentiate pituitary tumour with high ACTH
from adrenal tumour/hyperplasia with too high cortisol.
If the ACTH is high they assume a pit tumour and recommend brain surgery
to remove it - and sometimes some other scary tests in between) and if
adrenal they look to see if unilateral or bilateral and remove adrenals
giving the patient Addison's disease instead among other complications
of removing adrenals.

O A Julian's repertory will differentiate ACTH versus cortisol being
high without those tests IMO (but no doctor will believe it no doubt) -
as the symptoms in the provings have at least 8 different symptoms with
ACTH high tghat are missing with only cortisol high. (ACTH high implies
cortisol also huigh.)

Namaste,
IRene
--
Irene de Villiers, B.Sc AASCA MCSSA D.I.Hom/D.Vet.Hom.
P.O. Box 4703 Spokane WA 99220.
www.angelfire.com/fl/furryboots/clickhere.html (Veterinary Homeopath.)
"Man who say it cannot be done should not interrupt one doing it."