Saturday, August 3, 2013

Help PCPs Know What How to "Treat" a Cushing's Patient



verb (used with object)
to act or behave toward (a person) in some specified way: to treatsomeone with respect.
to consider or regard in a specified way, and deal with accordingly: to treat a matter as unimportant.
to deal with (a disease, patient, etc.) in order to relieve or cure.

This article is targeted to primary care physicians, often the first stop on a patient's path to diagnosis. Some patients face uninterested doctors with little medical curiosity. I did. You likely did. It is my hope that these physicians listen to their patients and begin to test for this not-so-rare-but-rarely-diagnosed disease. Primary Care Physicians must learn how to treat (1) Cushing's patients as much as they learn to treat (3) us.  This article offers guidelines for this front-line group. -- M

When to think Cushing's syndrome in type 2 diabetes

Thursday, August 1, 2013

Pituitary damage an unexpected war wound

I have noticed the news stories and court cases of enlisted soldiers beating and killing their loved ones after returning from Iraq and Afghanistan. I have often wondered if soldiers who become ultra aggressive and harm loved ones are suffering from pituitary damage, since many outside the situation describe personality changes and aggression.  The article below suggests it is probable that blast-related injuries can definitely cause pituitary dysfunction. This is just another way that soldiers of war are changed forever.

In addition, I remain sad for the stateside significant others -- mostly wives, girlfriends -- who are lost to violence at the hands of loved ones from any cause related to any war. 



[quote]"Tests revealed damage to Spires' pituitary gland. It was a rare finding in the military, but that may be because few doctors have been looking for it.

Emerging evidence suggests that pituitary problems may be going undiagnosed in victims of blast-related brain injuries, the defining wounds of the recent wars.

The symptoms often overlap, perhaps explaining why some patients do not fully recover and offering hope that hormone replacement therapy might help in some cases.

Trying to get a handle on the problem, the Pentagon last year issued guidelines to its doctors to screen for hormone irregularities when symptoms persist after concussions — the mildest and most common form of traumatic brain injury, or TBI.

The pea-sized pituitary gland secretes nine hormones that help regulate metabolism, sexual function, blood pressure and other vital processes. Housed in a bony pocket in the skull, it hangs from the base of the brain by a strand of neurons and blood vessels.

Experts long have known that serious head trauma can disrupt the blood supply and nerve connections. Over the last decade, the same damage has been documented in people who suffered concussions in car crashes and sports accidents. Only in the last few years did scientists begin to look specifically at the risk from blasts."[\endquote]