What Are the Adrenal Glands?

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The adrenal glands are the part of the body responsible for releasing three different classes of hormones. These hormones control many important functions in the body, such as:

  • Maintaining metabolic processes, such as managing blood sugar levels and regulating inflammation
  • Regulating the balance of salt and water
  • Controlling the “fight or flight” response to stress
  • Maintaining pregnancy
  • Initiating and controlling sexual maturation during childhood and puberty

The adrenal glands are also an important source of sex steroids, such as estrogen and testosterone.

What are adrenal gland disorders?

Adrenal gland disorders occur when the adrenal glands don’t work properly.  Sometimes, the cause is a problem in another gland that helps to regulate the adrenal gland.  In other cases, the adrenal gland itself may have the problem.  The NICHD conducts and supports research on many adrenal gland disorders.  Some examples include:

  • Cushing’s Syndrome – Cushing’s syndrome happens when a person’s body is exposed to too much of the hormone cortisol. In this syndrome, a person’s body makes more cortisol than it needs. For example, adrenal tumors can cause the body to produce too much cortisol. In some cases, children are born with a form of adrenal hyperplasia that leads to Cushing syndrome. Or, in some cases, certain medications can cause the body to make too much cortisol
  • Congenital Adrenal Hyperplasia – Congenital adrenal hyperplasia is a genetic disorder of adrenal gland deficiency.  In this disorder, the body doesn’t make enough of the hormone cortisol. The bodies of people with congenital adrenal hyperplasia may also have other hormone imbalances, such as not making enough aldosterone, but making too much androgen.
  • Pituitary Tumors – The pituitary gland is located in the brain and helps to regulate the activity of most other glands in the body, including the adrenal glands. In rare cases, benign (non-cancerous) tumors may grow on the pituitary gland, which may restrict the hormones it releases.

In some cases, tumors on the pituitary can lead to Cushing’s syndrome – this is called Cushing disease.  In other cases, the tumors reduce the adrenal gland’s release of hormones needed for the “fight or flight” response to stress.  If the body is unable to handle physiological stress—a condition called Addison’s disease—it can be fatal.

What are the treatments for adrenal gland disorders?

The treatment for adrenal gland disorders depends on the specific disorder or the specific cause of the disorder.  For example:

  • The treatment for Cushing’s syndrome depends on the cause. If the excess cortisol is caused by medication, your health care provider can change dosages or try a different medication to correct the problem.  If the Cushing’s syndrome is caused by the body making too much cortisol, treatments may include oral medication, surgery, radiation, or a combination of these treatments.
  • Congenital adrenal hyperplasia can’t be cured, but it can be treated and controlled.  People with congenital adrenal hyperplasia can take medication to help replace the hormones their bodies are not making.  Some people with congenital adrenal hyperplasia only need these medications when they are sick, but others may need to take them every day.
  • Doctors can successfully treat most pituitary tumors with microsurgery, radiation therapy, surgery, drugs, or a combination of these treatments. Surgery is currently the treatment of choice for tumors that grow rapidly, especially if they threaten or affect vision.  The treatment plan for other pituitary tumors differs according to the type and size of the tumor.

Hormone Replacement Therapy Beneficial for Postmenopausal Women

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GENEVA –  Hormone replacement therapy might be beneficial for postmenopausal women at increased heart risk, say researchers.

“Although it is commonly understood that postmenopausal women, particularly those with early menopause, have an increased risk of developing coronary artery disease and it was thought that hormone replacement therapy (HRT) would help to remedy this, some well-known clinical investigations, such as the Heart and Estrogen/progestin Replacement Study (HERS), were unable to demonstrate an improved outcome in postmenopausal women using HRT,” said Dr. Thomas Schindler, chief of nuclear cardiology at the University Hospitals of Geneva, Geneva, Switzerland.

“The exact mechanism behind this increased risk, however, remains uncertain,” he added.

Some of the factors putting women at risk are an accumulation of body fat, insulin resistance, inflammation, dyslipidemia (disruption of lipid metabolism) and increases in arterial blood pressure.

Another important factor is the deprivation of naturally occurring estrogen.

For the study, the researchers evaluated the effect of long-term hormone replacement therapy with estrogen, mostly combined with progestin, on heart vessel function in 48 postmenopausal women who had been treated for coronary risk factors, such as hypercholesterolemia (high blood cholesterol) or arterial hypertension.

They were divided into groups according to HRT. The first group comprised 18 women who were on HRT at baseline and at follow-up positron emission tomography (PET) assessment of coronary endothelial function (the inner lining of the coronary vessels).

The second group comprised 18 women who were not on HRT; and group 3 comprised 12 women who were on HRT at baseline, but not at follow-up PET exam.

“Given that preventive medical treatment of coronary risk factors, such as statins (cholesterol-lowering agents) or angiotensin-coverting enzyme inhibitors, usually improves coronary endothelial function, it is not known whether HRT, which commonly promotes the release of endothelial-derived NO in postmenopausal women with already medically treated coronary risk factors, might still exert an additional protective effect on the function of the coronary endothelium and, thus, the development of coronary artery disease,” said Schindler.

Applying PET, the researchers found that HRT widely maintained coronary endothelial function, while those postmenopausal women without HRT experienced a worsening in the endothelium function.

In addition, postmenopausal women who gave up HRT during the observational period demonstrated the most severe drop in the coronary endothelial function.

Steroid Hormone Deficiency May be Behind Cardiovascular Disease

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Steroid Hormone Deficiency May be Behind Cardiovascular Disease

BOSTON – The deficiency of steroid hormones called androgens, such as testosterone, may be behind cardiovascular disease, according to a study.

Published in the Journal of Andrology, a report on the study underscores the fact that a number of studies have linked androgen deficiency to an increased mortality in men.

Testosterone (T) is an anabolic hormone with a wide range of beneficial effects on men’s health.

However, according to Boston University School of Medicine (BUSM) researchers, the therapeutic role of T in men’s health remains a hotly debated issue for a number of reasons, including the purported risk of prostate cancer.

Working in collaboration with researchers from Lahey Clinic Northshore, Peabody, Massachusetts, they evaluated several relevant articles pertinent to androgen deficiency and vascular disease, and determined that a relationship did exist between androgen deficiency and CVD.

“In view of the emerging evidence suggesting that androgen deficiency is a risk factor for CVD, androgen replacement therapy could potentially reduce CVD risk in hypogonadal men. It should be emphasized, however, that androgen replacement therapy should be done with very thorough and careful monitoring for prostate diseases,” said lead author Dr. Abdulmaged M. Traish, a professor of biochemistry and urology as well as the director of Laboratories for Sexual Medicine, Institute for Sexual Medicine at BUSM.

To further elucidate the role of androgen deficiency in vascular disease, the researchers recommend large, long-term, double-blind, randomised, placebo-controlled clinical trials be carried out.

“Although challenges might lie ahead regarding how data from such clinical trials are to be properly interpreted and whether long-term safety can be established with T supplementation, these findings warrant definite investigation into the beneficial role that androgens might have in preventing cardiovascular risk in androgen-deficient men,” added Traish.

PLEASE NOTE OTHER POSTS ON “HORMONES” AND “BIO IDENTICAL HORMONES”

Introducing – DHEA

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Other names: dehydroepiandrosterone, dehydroepiandrosterone sulfate

Dehydroepiandrosterone (DHEA) is a steroid hormone that’s produced by the adrenal glands. The body converts DHEA to male and female sex hormones, such as estrogen and testosterone.

DHEA levels typically peak by the time people are in their 20s and decline with age, which is why there has been considerable interest in DHEA and its role in aging. In fact, DHEA supplements have been touted as an anti-aging hormone because lower levels of DHEA have been reported in some people with type 2 diabetes, breast cancer, heart disease, osteoporosis, AIDS, adrenal insufficiency, kidney disease and anorexia. Certain medications may also deplete DHEA, such as corticosteroids, insulin, opiates and danazol.

DHEA is manufactured naturally in the body, but DHEA supplements can also be made in a laboratory from a substance called diosgenin, found in soybeans and wild yam. Wild yam cream and supplements are often promoted as being a natural source of DHEA, but the body can’t convert wild yam to DHEA on its own — the conversion must be done in a laboratory.

DHEA supplements were taken off the U.S. market in 1985 because of concerns about false claims regarding its benefits. It became available only by prescription but was reintroduced as a nutritional supplement after the Dietary Supplement Health and Education Act was passed in 1994.

Why Do People Use DHEA Supplements

DHEA is used as an “anti-aging” hormone and for conditions in which DHEA levels have been found to be low, however, there are very few large, well-designed human studies showing that it’s effective.

    * Aging

      The gradual decline in the body’s DHEA levels correlate with loss of muscle mass, decreased bone density, and a decline in immune function. A study by Mayo Clinic researchers, published in the New England Journal of Medicine, looked at the effect of DHEA supplements on markers of aging, such as muscle mass, muscle strength, fat mass, peak endurance and glucose tolerance in older men and women.

      The study involved 87 men and 57 women. At the end of the two-year study, participants showed no significant change in any of the markers. It’s one of the largest and longest studies on DHEA and human aging to date.

    * Depression

      Clinical trials examining the effect of DHEA for depression suggest that DHEA temporarily improves symptoms of depression compared to a placebo. For example, a study sponsored by the National Institute of Mental Health investigated the use of DHEA by 46 people between the ages of 40 and 65 with major or minor depression. They took DHEA for six weeks (90 mg a day for three weeks followed by 450 mg a day for three weeks) or a placebo.

      Twenty three people improved while taking DHEA, compared to 13 who responded while taking the placebo. After six weeks, 14 out of 15 people taking the placebo were still depressed, compared to eight out of 14 people taking DHEA.

      Studies on lasting mood changes, however, have had inconsistent results. More research is needed before DHEA should be used for depression, however, because the long-term effects aren’t known.

    * Menopause

      One small study found that 25 mg a day of DHEA may reduce symptoms of menopause. Levels of other hormones were affected, however, which may have adverse effects.

    * Obesity

      In animal studies, DHEA has shown some promise in reducing genetic or diet-induced obesity. A study funded by the National Institutes of Health looked at the effect of DHEA (50 mg a day) compared to a placebo for weight loss in 56 overweight adults between the ages of 65 and 78. At the end of the six month study, people taking DHEA lost an average of two pounds compared to the people taking the placebo, who gained just over one pound.

      Although overall weight loss was minimal, results were more promising when fat loss around the abdomen was assessed. After six months, women taking DHEA lost 10% of their abdominal fat and men lost 7%.

      A large study involving 942 men in the Massachusetts Male Aging Study looked at men between the ages of 40 and 70, first in 1987 to 1989 and then again in 1995 to 1997. Researchers found that fat around the abdomen (called central obesity) was associated with lower DHEA levels.

      Although these are promising preliminary results, until we have more research on the safety and effectiveness of DHEA, researchers recommend trying other, more proven methods for weight loss.

    * Osteoporosis

      Supplementation with DHEA has been studied to increase bone density. It is usually taken by mouth or applied as a cream to the inner thigh. DHEA hasn’t been found to be helpful for younger women and men. Some evidence sugests it might be helpful for osteoporosis in older women. More research is needed.

    * Sexual Dysfunction

      Studies on the use of DHEA for erectile dysfunction in men and sexual function in men and women have been inconsistent. A one-year study involving 280 men and women found that 50 mg a day of DHEA improved libido in women over 70 but not in younger women or men. Other studies have been mixed — most have been too small to be meaningful or the treatment duration has been too short.

    * Systemic Lupus Erythematosus

      Scientific evidence indicates that DHEA may enhance mental function and increase bone mass in women with systemic lupus erythematosus (SLE), an autoimmune disease affecting connective tissue. In fact, synthetic DHEA called prasterone (Prestara) is under investigation for the treatment of this condition and the prevention of loss of bone mineral density. The FDA has granted orphan drug status for the prevention of loss of bone mineral density in SLE patients taking corticosteroids.

    * Adrenal Insufficiency

      Adrenal insufficiency is a condition involving low levels of adrenal gland hormones. Several studies suggest DHEA supplements may improve well-being, quality of life, and sex drive in people with adrenal insufficiency. In 2003, prasterone (Fidelin) received orphan drug status for adrenal insufficiency. Adrenal insufficiency can only be diagnosed by a doctor. It can be a medical emergency and should be properly diagnosed and treated by a qualified health professional.

    * Other Conditions DHEA has also been explored for many other conditions, such as:

      Alzheimer’s disease

      Chronic fatigue syndrome

      Crohn’s disease

      Heart disease

      Schizophrenia

      Sjogren’s syndrome

DHEA Side Effects and Safety

DHEA is a hormone, so it should only be used under the supervision of a qualified health practitioner. Pregnant or nursing women or children should not use DHEA. There have been no studies on the long-term safety of DHEA.

One of the more common side effects of DHEA supplements is acne. Other side effects include abdominal pain, hair loss, insomnia, nasal congestion, fatigue, oily skin, rapid or irregular heartbeats, or heart palpitations.

DHEA supplements may alter liver function, so people with liver disease shouldn’t use DHEA. People with mood disorders such as depression should only use DHEA under the supervision of their health-care provider, as DHEA supplementation may worsen mood. High levels of the body’s natural DHEA has been associated with psychotic disorders, so people with or at risk for psychotic disorders shouldn’t use DHEA unless under the supervision of their health-care provider.

Since DHEA supplements may influence the production of male and female hormones, acne, greasy skin, facial hair growth, hair loss, weight gain around the waist, a deepening of the voice and other signs of masculinization may occur in women. Men may develop high blood pressure, male pattern baldness, aggressiveness, breast enlargement (gynecomastia), breast tenderness and shrinkage of the testicles.

DHEA supplements may also affect the levels of other hormones, such as insulin and thyroid hormone, and affect cholesterol levels. People with diabetes or hyperglycemia, high cholesterol, thyroid disorders, Cushing’s disease or other hormonal disorders should be particularly cautious.

DHEA supplements may alter the levels estrogen and testosterone, which can theoretically increase the risk of hormone-sensitive cancers such as breast, prostate and ovarian cancer. It’s also not known whether DHEA supplements may inhibit the body’s ability to make DHEA.

People taking DHEA supplements may be more likely to develop blood clots, so people with clotting disorders, heart disease and those with a history of stroke should avoid DHEA supplements.

Possible Drug Interactions

Theoretically, DHEA supplements may interfere with the effectiveness of antipsychotic drugs, such as chlorpromazine (Thorazine), fluphenazine (Prolixin) and prochlorperazine (Compazine).

DHEA supplements may increase the effects of the following medications:

    * AZT (Zidovudine) — HIV medication

    * Barbiturates — medications for sleep disorders

    * Cisplatic — cancer medication

    * Estrogen and oral contraceptives

    * Testosterone

    * Benzodiazepines, such as triazolam (Halcion), alprazolam and dizaepam for anxiety and sleeping disorders

DHEA may interact in unpredicatable ways with the following drugs:

    * Corticosteroids, such as prednisone, beclomethasone (Beconase, Vancenase), dexamethasone, hydrocortisone, prescribed for inflammatory conditions such as arthritis, asthma and skin infections.

    * Insulin

    * Lithium

    * Prescription drugs that are broken down by the same liver enzymes, such as: allergy medication such as fexofenadine (Allegra), antifungal drugs such as itraconazole (Sporanox) and ketoconazole (Nizoral), cancer medications such as etoposide (VePesid), paclitaxel (Taxol), vinblastine, or vincristine, cholesterol medications, such as lovastatin, and oral contraceptives.

Obese Kids Aged 12 Early Signs of Heart Disease

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BARCELONA — Overweight and obese kids as young as 12 are showing early signs of heart disease, warn Spanish researchers.

During a study, scientists in Barcelona analysed 80 obese and overweight kids with an average age of 12 and compared them with 60 lean youngsters.

They found that larger kids had higher cholesterol and blood pressure, as well as more signs of pre-diabetes.

The researchers are now looking into “endothelial dysfunction” – a thickening of the arteries associated with heart problems.

By studying how easily the forearm relaxes, scientists are able to monitor the degree of the dysfunction.

They discovered the overweight and obese children had a similar level of the condition to adults with chronic heart disease.

“Endothelium-dependent relaxation of forearm arteries is already impaired by the same as in adults with chronic heart failure, and this in our 12-year old obese children,” the Scotsman quoted the researchers as saying.

“Primary or secondary prevention strategies starting early in childhood should aim at reversing current increase in childhood obesity.

“These strategies can be initiated at home and in preschool institutions, schools or after-school care services to influence diet and physical activity in the entire children population. However, further research needs to explore the most effective strategies to prevent and treat obesity.

“Already in early childhood, overweight and obesity are associated with the risk factors for the development of cardiovascular diseases like diabetes, high blood pressure or high cholesterol levels,” they added.

The findings were presented at European Society of Cardiology. (ANI)