Archive for the ‘Hormone Physician’ Category

New research was presented at ASTRO 2019, American Society for Radiation Oncology Annual Meeting, from September 15-18 in Chicago. The features below highlight some of the studies that emerged from the conference.

With survival of HPV-positive oropharyngeal cancer patients having improved remarkably over the past 2 decades, efforts are now being made to reduce long-term adverse effects of treatment in this population. Options include reducing chemotherapy, radiation, or both while hoping to maintain optimal outcomes. To test the validity of doing so, researchers assigned mostly non-smoking patients with low-risk human HPV-positive head and neck cancer to lower-dose intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy or IMRT alone. Rates of progression-free survival at 2 years were 90.5% in the combination group and 87.6% in the IMRT alone group. A pre-specified threshold for swallowing-related quality of life on the 100-point MD Anderson Dysphagia Inventory was surpassed by both groups, with scores of 85.3 in the combination group and 81.8 in the IMRT along group; these scores were down 5.6 and 6.2 points from baseline, respectively. Local recurrence rates at 2 years were 3.3% in the combination group and 9.5% in the IMRT group, while distant metastasis rates were 4.0% and 2.1%, respectively.

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Although the standard of care for early-stage favorable Hodgkins lymphoma (HL) includes radiotherapy, small studies suggests that metabolic response assessment after two cycles of chemotherapy using FDG-PET (PET-2) can predict the individual outcome and PET-2 negativity might allow reducing the overall treatment intensity. To assess whether omitting consolidating radiation therapy in patients with negative PET-2 is feasible without loss of efficacy as determined by progression-free survival (PFS), researcher randomized adults with newly diagnosed, early-stage favorable HL to standard combined modality treatment (CMT) or PET-guided treatment, whereby radiation therapy was restricted to those with a positive PET after CMT. The researchers found that omitting radiotherapy worsened disease control. Rates of 5-year PFS were 93.4% in standard therapy group and 86.1% in the de-escalation group. However, estimated 5-year overall survival rates were about the same in both groups. Among PET-2-negative and -positive patients, estimated 5-year PFS rates were 93.2% and 88.1%, respectively. In early-stage favorable HL, radiation therapy cannot be safely omitted from standard CMT without a clinically relevant loss of tumor control in patients with negative PET-2, conclude the study authors.

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Prior research has raised concerns about the cosmetic outcomes associated with partial breast irradiation (PBI), with one study finding adverse cosmetic rates to be higher in those treated with PBI than in those treated with whole breast irradiation (WBI). To compare outcomes with PBI versus WBI in women who underwent lumpectomy, researchers asked these patients and their physicians to rate the cosmetic outcomes of the procedure on the treated breast (vs the untreated breast) as excellent, good, fair, or poor at baseline, 12 months post-treatment, and 3 year post-treatment. At 3 years, reports of total satisfaction were 81% in PBI group and 86% in the WBI, while rates of somewhat dissatisfied were 1% and 2%, respectively and less than 1% in both groups were totally dissatisfied with their treatment. Treating physicians rated outcomes as comparable at 12 months but thought them to be better for WBI at 3 years, while physicians blinded to the therapy who reviewed photos of the patients breasts rated outcomes as equivalent at both 1 and 3 years.

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Prior studies suggest that the addition of high doses of radiation to immunotherapy in some cases results in a therapeutic synergy in which some tumors not targeted by radiation will shrinkthe abscopal effect. To determine if adding a high dose of radiation in just a few fractions to a single site of disease could reinvigorate the immune response in patients who progress on immunotherapy, study investigators looked for the abscopal effect in patients with non-small cell lung cancer (NSCLC) and at least two measurable tumors whose cancer progressed after pembrolizumab treatment. Among 50 patients who were immunotherapy-nave and began pembrolizumab when the trial started, 16 experienced disease progression and were treated with stereotactic body radiotherapy (SBRT) and six had progressed on anti-PD-1 therapy at the time of enrollment in the trial and were immediately treated with SBRT. Of these 22 patients, 9.52% achieved a partial response that was sustained beyond 1 year and 47.62% achieved stable disease. Patients with elevated tumor infiltrating lymphocytes scores (2 or 3 on a 0-3 scale) showed improved progression-free survival compared with patients who had lower scores (0-1), with a mean of 215 versus 59 days, respectively.

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Men should be offered hormone therapy while undergoing salvage radiotherapy (SRT) following prostate cancer surgery and subsequent biochemical recurrence, according to current treatment guideline recommendations. However, such therapy has been associated with adverse events but no overall survival benefit in those treated with early SRT. Thus, researchers conducted a secondary analysis of the study on which the guideline recommendation is based to determine if a patients pre-SRT PSA level could serve as a prognostic and predictive biomarker of benefit or harm from anti-androgen therapy. While overall survival was significantly improved in men with a PSA greater than 1.5 ng/mL following hormone therapy, those with a PSA level below 1.5 ng/mL experienced no significant overall survival benefit. In fact, men with PSA levels of 0.6 ng/mL were nearly twice as likely to die from non-cancer causes with the addition of hormone therapy, and between three and four time more likely to experience a combination of severe cardiac events and neurologic issues.

Continued here:
Conference Highlights: ASTRO 2019 - Physician's Weekly

There's nothing more frustrating than waiting month after month for those two pink lines to pop up. Struggling with infertility can be a heartbreaking experience, but in many cases, the solution may be more simple than you realize.

One of the things that can affect your chances of getting pregnant is an imbalance of hormones. Now, you can take matters into your own hands by using an at-home hormone test to find out if your hormone levels are the source of the problem.

Here, experts give you a better understanding of the key hormones that can affect your fertility and explain how to have your levels tested.

While it's true that we have tons of different hormones coursing through our bodies, only a few come into play when we're trying to conceive. Below, we've listed some of the key fertility hormones you'll want to get familiar with if you suspect a hormone imbalance might be affecting your ability to get pregnant. The good news is, a hormone test will give you insight into these important hormones.

FSH is of the most important hormones for fertility, FSH or follicle-stimulating hormone is responsible for maintaining cycle regularity and producing healthy eggs.

LHor luteinizing hormone, may sound familiar; it's the hormone that's measured in at-home ovulation predictor kits (OPKs). LH is the hormone that tells your body to release an egg that's ready to be fertilized.

AMH, also called anti-Mullerian hormone, is responsible for maintaining the immature eggs your body has. If you come across a hormone test that measures your ovarian reserve, or how many eggs you have left, it's measuring AMH.

Progesteroneis a key player both in preparing the body for pregnancy and for helping a new pregnancy to continue. Often when a woman suffers repeated miscarriages, plummeting progesterone levels are the culprit.

Prolactin If you're thinking that this hormone is the one that handles milk production, you're correct! But it's also a key player in ensuring your cycle stays regular, which is essential when trying to conceive.

T3 and T4 Many women don't realize this, but these thyroid hormones have a major influence on the ability to get pregnant. In fact, Dr. Elena Villanueva with Modern Holistic Health, says, "The thyroid gland, female reproductive organs, and adrenal glands are intricately connected. If there is an issue with either the thyroid or the adrenals, becoming pregnant can be a challenge. The good news is a hormonal imbalance test for thyroid or adrenal dysfunction can reveal issues that can be easily fixed in most cases. Many women find that when their thyroid is brought back into healthy hormone range they easily become pregnant."

First, it's important to know that if your hormones are out of whack, it's not your fault, and you're not doing anything wrong.

"For better or worse, there are very few things we can do lifestyle-wise that negatively (or positively) impact hormone production and balance," says Dr. Emily Jungheim, a board certified reproductive endocrinologist and fertility expert at the Women & Infants Center in St. Louis, Missouri. "One lifestyle factor that can be important though is obesity. Extreme athletes can also have issues as low body fat can impact a woman's menstrual cycles and ovulation."

Medical conditions affecting the thyroid and adrenal glands can also affect hormones. In fact, the thyroid is so important to sustaining a healthy pregnancy that it's considered one of the biggest causes of hormone imbalance in women. Another is PCOS, which stands for Polycystic Ovary Syndrome. PCOS is a condition that affects between 6% and 12% of women of childbearing age, according to theCDC. It's characterized by irregular cycles, excess male-pattern hair growth, and infertility.

Other causes of hormone imbalance include the following:

If you've been trying to conceive for more than a few months and you're otherwise healthy, it may be time to consider your hormone levels. Below is a list of symptoms that may indicate a hormone imbalance, courtesy of Dr. Villanueva.

If you've realized by now that fertility isn't exactly a one-size-fits-all thing, you're right! Each woman is different, which can make it tough to determine when it's time to take action. But in general, Dr. Jungheim suggests that if you haven't conceived after 6-12 months of trying (it's fine it keep it to only 6 months if you're over 35), your cycles are totally irregular and unpredictable, or if you have symptoms of PCOS or a thyroid condition, it's wise to get checked.

Another scenario where hormone testing totally makes sense? If you're planning to have your eggs frozen for later use. "An AMH level can be helpful in understanding how many oocytes one might expect to get during a banking cycle or during IVF," she says.

There are two basic methods: you can have your doctor order the tests and have your blood drawn at a lab, or you can try an at-home hormone testing kit. More and more women are turning to at-home testing solutions as a way to kick-start their fertility journey.

It used to be that in order to get a hormone blood test, couples would first have to endure months of not getting pregnant, then schedule a visit to a reproductive endocrinologist. Now, at-home hormone tests for women are allowing couples to take back control and present their findings to their doctor as a first step in determining whether they're dealing with an easily solvable hormone imbalance or something more serious.

Hormones can be measured in blood, hair, urine or saliva, and each at-home hormone test functions a little differently. There are benefits and drawbacks to each method; while a hormone blood test is the traditional method, saliva hormone testing is becoming a widely accepted way of testing, since it gives a better average over time by collecting several different samples of spit in a single day (gross, we know).

If you decide to try an at-home test, it's a good idea to discuss your findings with your own doctor, especially if anything unusual pops up. Not only will they want to add the information to your medical history, but they may want to perform their own tests to confirm. Due to the nature of their profession, doctors are natural skeptics of any at-home test.

"There are a number of at-home hormone tests. Some are reliable and some are not, but all should be confirmed and interpreted with a medical provider if someone is concerned about an underlying medical condition or if someone is struggling with fertility," says Dr. Jungheim. That's why we recommend using at-home hormone tests in conjunction with your doctor's care rather than in lieu of it.

Here are a few of the top hormone level tests you can buy to measure your hormones in the comfort of your own home:

Proovis an at-home hormone test that uses urine to detect levels of progesterone in the bloodstream. In a typical cycle, progesterone is a hormone that's released immediately after ovulation; it's critical for a healthy pregnancy to occur.

Everlywell hormone test for women measures many of the fertility hormones mentioned above, like estradiol, FSH, AMH and LH with a simple finger prick in the comfort of your home. Results are promptly reviewed by a board-certified physician.

Modern Fertility uses a simple but effective private dashboard to deliver results, this hormone test measures different hormones based on whether and what type of birth control you use. Testing can be performed at home or in a designated lab.

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Could a Hormonal Imbalance Be Affecting Your Fertility? Here's What You Need to Know - Yahoo Lifestyle

Hormones are natural substances made by our glands in our body and the network of glands that make hormones is termed as endocrine systems. These hormones are carried through bloodstream and act as a messenger between one part to another part of our body. Hormone therapy is one of the major modalities of medical treatment for cancers which involves manipulation of the endocrine systems through exogenous administration of steroid hormones or drugs inhibiting or interrupting activities of specific hormones. Surgical removal of certain endocrine organs for instance oophorectomy can also be employed as a part of hormone therapy. In hormone therapy physician generally start with hormone receptor test that let caregivers to measure amount of cancer proteins or hormone receptors within a cancer tissue. By estimating the amount of hormones such as estrogen or progesterone the test either can be positive or negative. A positive test indicates growth of cancer cells with the help of hormones. In such cases physician divert the hormone therapy by blocking the interaction of hormones with the hormone receptor. Alternatively, in case of negative hormone receptor test which signifies null effect of hormones in growth and development of cancer cells other effective treatments can be rendered to cure cancer.

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A hormone therapy can be rendered either before or after a primary treatment. In case it is rendered before the primary treatment it is medically termed as neoadjuvant treatment which kills. Neoadjuvant treatments help to kill cancer cells and contribute to the effectiveness of the primary therapy. If hormone therapy is given after the primary cancer treatment, it is called adjuvant treatment. Adjuvant therapy is given to improve the chance of a cure. Now a day hormone therapy is widely used in treating breast and prostate cancer. In breast cancer the female hormone estrogen are primarily responsible for stimulating the growth and development of breast cancer cell in majority of cases. Recently in 2014, aromatase inhibitors such as Arimidex and Femara have been approved for treating breast cancers through hormone therapy. Apart from these FDA approved Zoladex Lupron can also be used in curing breast cancers through hormone therapy. In case of prostate cancer a variety of medications can be used as hormone therapy. Male hormones, such as testosterone, stimulate prostate cancer to grow. Hormone therapy is given to help stop hormone production and to block the activity of the male hormones. Some of the antiandrogens used as inhibitors of prostate cancer cell growth encompass flutamide, enzalutamide, bicalutamide, and nilutamide among others. some of the other cancers to which hormone therapy is gaining acceptance now a day include womb cancer, kidney cancer, ovarian cancer among others.

Major drivers to global cancer hormone therapy include rising incidences of cancer across globe. Statistically according to WHO cancer accounts for 8.2 million deaths in 2012 and it is estimated that annual cancer cases is expected to rise from 14 million in 2012 to 22 million by 2022. Rising awareness among physician and patients towards alternative cancer therapy processes such as target therapy, immunotherapy or hormone therapy is likely to uplift the market in forthcoming years. Side-effects associated with hormone therapy are major restraints to growth and acceptance of therapy. Some of the common side-effects associated with hormone therapy for cancer include nausea, vaginal spotting, irregular menstrual periods, skin rashes, loss of appetite, vaginal dryness, impotence and male breast enlargement among others.

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Prominent companies operating the global cancer hormone therapy market include AstraZeneca plc, Novartis International AG, Merck & co., QuatRx Pharmaceuticals and Pfizer, Inc. among others.This research report analyzes this market on the basis of its market segments, major geographies, and current market trends. This report provides comprehensive analysis of Market growth drivers Factors limiting market growth Current market trends Market structure Market projections for upcoming years

This report is a complete study of current trends in the market, industry growth drivers, and restraints. It provides market projections for the coming years. It includes analysis of recent developments in technology, Porters five force model analysis and detailed profiles of top industry players. The report also includes a review of micro and macro factors essential for the existing market players and new entrants along with detailed value chain analysis.

Reasons for Buying this Report This report provides pin-point analysis for changing competitive dynamics It provides a forward looking perspective on different factors driving or restraining market growth It provides a six-year forecast assessed on the basis of how the market is predicted to grow It helps in understanding the key product segments and their future It provides pin point analysis of changing competition dynamics and keeps you ahead of competitors It helps in making informed business decisions by having complete insights of market and by making in-depth analysis of market segments It provides distinctive graphics and exemplified SWOT analysis of major market segments

Note: Although care has been taken to maintain the highest levels of accuracy in TMRs reports, recent market/vendor-specific changes may take time to reflect in the analysis.

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Cancer Hormone Therapy Market 2019 By Demand Services, Developments, Advancements, Application, Platforms Types, Industry Growth Drivers and...

CHICAGO Women with breast cancer who want to take advantage of the more convenient course of partial breast irradiation (PBI) can now rest assured they are not going to have worse cosmetic outcomes by foregoing whole breast irradiation (WBI). This is the conclusion from the final report from the pivotal phase 3 trial (RTOG 0413) that compared the two approaches.

"I think this trial has confirmed the ASTRO consensus statement" that describes the patient population that is suitable for PBI, commented lead author Julia White, MD, professor of radiation oncology at the Ohio State University Comprehensive Cancer Center.

"A good population for PBI includes women over the age of 50 who have stage 1 breast cancer that is hormone sensitive, who take endocrine therapy for it, as well as ductal carcinoma in situ (DCIS) patients whose tumors are less than 2.5 cm in size," she said.

"These patients, who represent probably around 30,000 women a year, need to know that PBI is a good alternative for their cancer outcome and now, I don't think concern about cosmetic outcomes should be a barrier," she added.

White was speaking here at a press briefing at the American Society for Radiation Oncology (ASTRO) annual meeting, where she presented the final report from this trial.

The NRG Oncology/NSABP B39-RTOG 0413 study involved more than 4000 women with stage 0, I, or II breast cancer who had undergone a lumpectomy and were randomly assigned to either WBI or PBI.

WBI was administered at a dose of 50 Gy at 2.0 Gy/fraction or 50.4 Gy at 1.8 Gy/fraction to the whole breast, followed by an optional boost to 60 Gy for 5 to 6 weeks.

Women assigned to the PBI arm received 10 fractions, twice a day, for 5 to 8 days at a dose of 34 Gy in 3.4 Gy fractions. PBI was delivered via interstitial brachytherapy or by mammosite balloon catheter or in a dose of 38.5 Gy in 3.85 Gy delivered in 3-dimensional conformal radiotherapy.

Previously reported oncological outcomes from this trial showed that breast recurrence rates after PBI were within 1% of breast recurrence rates after WBI.

"The really good news was that 95% of all women had no recurrence out to 10 years," White added, "and the risk for distant metastases after each procedure was also pretty close at between 1% to 2% between the two approaches," she said.

At the ASTRO meeting, White presented results from a quality of life substudy that showed that cosmetic outcomes were equivalent between WBI and PBI as well.

In the substudy involving 900 women, breast cosmesis was assessed by the patients themselves, as well as by the accruing-site physician and by central review of digital photos by physicians blinded to the randomized treatment arm. Digital photos of the breasts were collected at baseline, and at 1 and 3 years after patients received either WBI or PBI.

The goal of the current substudy was to see if PBI induced changes in breast appearance that were equivalent to those induced by WBI as assessed by the 3 separate groups using the Global Cosmetic Score (GCS).

"Patients were stratified by chemotherapy use and no-chemotherapy use," the investigators noted. Just under half (47%) of the group had received chemotherapy.

Based on the patients' own assessment, changes in cosmetic outcomes at 36 months were equivalent for women who received WBI or PBI based on GCS scores in both chemotherapy recipients and nonchemotherapy recipients at 0.06 vs 0.04, respectively.

When the two groups were combined, change in cosmetic outcomes at 36 months were again equivalent at a GCS of 0.045, as White reported.

Judged by accruing-site physicians, change in the GCS again at 36 months was not quite equivalent in chemotherapy receipts who received PBI compared with WBI, and the same was true in nonchemotherapy recipients. In both groups, cosmetic outcomes were judged to be slightly worse following PBI compared with WBI, White reported.

However, when the two groups were combined, GCS changes were equivalent between PBI and WBI at a change in GCS score of 0.045, she observed.

When the digital photos were assessed by central reviewers, cosmetic outcomes were not equivalent among chemotherapy users, where PBI was deemed to be inferior to WBI.

However, the reverse was true for patients who did not undergo chemotherapy, among whom cosmetic outcomes in breasts treated with WBI were judged to be worse than they were for breasts treated with PBI.

Again, however, when the two groups were combined, cosmetic outcomes as assessed by central reviewers were felt to be equivalent for PBI and WBI, at a change in GCS of 0.028.

White also noted that there were no significant differences in mean changes in GCS as assessed by both patients and by digital photos reviewers at each time point that cosmesis was assessed during the study interval.

The only differences observed between mean changes in GCS at each time point of assessment were seen among accruing-site physicians who, at 36 months, rated changes in cosmetic outcomes at 0.43 for breasts treated with PBI vs 0.17 for breasts treated with WBI, which was statistically significant (P = .001).

On the other hand, patient satisfaction with cosmetic outcomes in those who had received chemotherapy, those who had not received chemotherapy, and the combination of the two groups were all equivalent between those who had undergone WBI and those who had received PBI.

"I think this is the link we were waiting for," White observed.

White noted that an earlier, similarly designed study referred to as the RAPID trial again demonstrated that the accelerated PBI regimen used in the trial was noninferior to WBI in preventing local recurrence, but there was an increase in late normal tissue toxicity and cosmetic outcomes were judged to be worse with PBI than with WBI.

"Thus, there was concern that women would have to sacrifice the appearance of their breast to undergo more convenient radiation," White said.

"But from our analysis, we feel pretty confident that from a patient perspective, there was no difference between treatment arms, and that one arm did not cause more change [in cosmetic outcomes] than the other," she concluded.

Commenting on the findings, Wendy Woodward, MD, professor of radiation oncology, MD Anderson Cancer Center in Houston, Texas, told the press briefing that the outstanding question at the time the RTOG 0413 trial was designed was whether there would be a similar detriment in cosmetic outcomes following PBI as was shown in the RAPID trial.

"Looking at the data very granularly, it is patient satisfaction and patient-reported outcomes that really matter and in this trial, [and these assessments] were completely equivalent," Woodward said.

"So I think this study is a cornerstone for highlighting that PBI is now standard of care for eligible patients and, ultimately, we will see these papers published and we will see practice change as PBI becomes a standard-of-care option," she concluded.

White disclosed travel expenses from IBA and Qfix. Woodward declared she has served as a consultant for Global Health International.

American Society for Radiation Oncology (ASTRO) 2019 Annual Meeting: Abstract #5. Presented September 16, 2019.

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Cosmetic Outcomes Equal After Partial vs Whole Breast Radiation - Medscape

A few weeks ago, a patient came to me complaining of nausea, muscle weakness and fatigue. Her urine was tea-colored despite drinking loads of water. A middle-aged woman, she seemed worried she had cancer or some deadly disease.

Her lab tests revealed significant liver dysfunction. But her symptoms were not due to liver cancer, hepatitis or other disease. It turned out she had liver toxicity from a green tea supplement that she'd heard was a "natural" way to lose weight.

When she stopped taking the supplement at my suggestion, her liver tests gradually normalized and she felt better over the course of a few weeks

I've seen the green tea issue in patients before and often witness the real-life pitfalls of eschewing traditional medicine, science and facts in favor of supplements, herbs and cleanses in the name of "natural" healing.

In an effort to be healthy, patients can easily become ensnared in the potential dangers of alternative medicine or homeopathy.

Let's be clear: Nature has a lot to offer patients.

The Greek physician Hippocrates is said to have reported on the use of St. Johnswort, a flowering plant, for mood disturbances in the 5th century BC Digoxin, a well-studied medicine used to treat heart failure, is derived from the foxglove plant.

Parkinson's patients are often commonly treated with the medication L-dopa, which comes from the plant Mucuna pruriens. Moreover, research repeatedly shows that consuming fruits and vegetables, getting adequate sleep and regular exercise, and spending time outdoors have myriad health benefits.

But nature isn't always so well-intended.

Spoiler alert: Arsenic, cyanide, asbestos and snake venom derive from nature. Refined sugar, a naturally occurring substance and one that lives in most Americans' pantries, is in large part responsible for our country's obesity epidemic. Simply because a substance comes from nature does not mean it is good for us.

An important key to health is using nature appropriately.

And in the case of my patient, she was able to lose weight when we made a clear plan to alter her basic human behaviors. Before she started taking the green tea extract, she was skipping breakfast, drinking the equivalent of two Venti coffees before noon, eating takeout meals for lunch, washing down her late-night dinner with two glasses of wine, sleeping restlessly, and spending too much time sitting and indoors.

Green tea extract was never going to be the quick fix that she - and other patients I have seen - had hoped. It may be attractive as a natural cure for extra body fat, but this promise has not been shown in any studies, according to the National Center for Complementary and Integrative Health at the National Institutes of Health.

The key to helping my patient was pretty basic: looking at her lifestyle, her stress, and creating some structure and accountability for important lifestyle changes.

While she wasn't able to eat like Gwyneth Paltrow would recommend (who can eat Pinterest-perfect meals like that as a mere mortal?), my patient took my advice to heart that she begin eating breakfast, packing healthy leftovers for lunch at work, cutting back the wine to weekends only, and getting more exercise on weekends.

As a result, she started sleeping better and feeling more energetic. Eventually, the weight started coming off, too.

Particular patients seem to be more susceptible to the lure of "naturopathic" medicine or homeopathy. Patients who have vague symptoms that do not fit tidily into a box, for example, are often the ones combing the Internet for answers to their health woes and spending hundreds of dollars on unproven and insufficiently regulated supplements and herbs.

According to the 2012 National Health Interview Survey (NHIS), which included a comprehensive poll on the use of complementary health approaches by Americans, 17.7 percent of American adults had used a dietary supplement other than vitamins and minerals in the past year.

That number is probably larger now: The total sales of herbal and dietary supplements in the United States were estimated to be more than US$8 billion in 2017, the 15th consecutive year of sales growth, according to a market research report. And women were more likely than men to use these products as well as people with more education.

Scientific data is often not the reason patients are drawn to herbal or "natural" supplements, Harvard School of Public Health researchers said. Of supplements users surveyed in 2001, 72 percent said they would continue using supplements despite a negative government scientific study. Patients reported getting much information about herbs from family, friends, advertisements and the Internet.

My patients often consider herbal remedies to be free of side effects, but many "natural" products can lead to toxicity and can dangerously interact with prescription medications.

Compounding the problem is that herbal and dietary supplements are not subject to the same strict regulatory standards as prescription drugs. On its website, NIH's Office of Dietary Supplements says the products "are not required to be reviewed by the FDA for their safety before they are marketed because they are presumed to be safe based on their history of use by humans."

Last year, another patient came in to see me complaining of fatigue, joint pains and abdominal bloating. She had seen a naturopath for these symptoms, who told her she had "chronic Lyme" disease and gave her multiple rounds of antibiotics and a bag full of daily herbal supplements. She said she didn't feel any better.

When we met, she told me she was certain she had Lyme disease that wasn't being adequately treated. In fact, the antibiotics she had been given had only worsened her abdominal issues and caused a new problem: an intestinal infection that causes bad diarrhea.

After 10 days of appropriate antibiotic treatment, her diarrhea was gone but she was back to her tired and achy self. At my recommendation, she stopped the supplements, and her fatigue abated somewhat.

When we discussed her situation further, she revealed to me she suffered from a love-hate relationship with sugar.

Like many of my patients, when she was stressed out she binged on sugar. For most people, ingesting sugar provides a quick hit of the pleasure hormone dopamine, and for some people that rush of dopamine and the accompanying instantaneous boost of energy can become addicting.

The problem is that a high sugar load causes a surge in the hormone insulin, which then results in a sudden drop in blood sugar - which can promote fatigue, weakness and irritability, among other symptoms.

If consumed in excess over time, such dietary sugar can cause abdominal distress, bloating and joint aches. This is what was probably causing my patient's symptoms.

So we made a plan for her to not only cut back on sugar but also fill her diet with healthy stuff to get ahead of hunger and avoid binges. I also recommended she work with a therapist to deal with stress-eating. Her joint aches went away and her energy improved after about two weeks, and she continues to see a therapist for stress-eating issues.

Food - and added support to use it properly - was the fix.

Symptoms such as fatigue, headaches, joint pains and irregular bowel movements are some of the most common complaints I see in my office. They can be challenging for physicians to figure out, largely because they require careful and attentive listening by the doctor.

And since more than 40 percent of patients do not tell their doctors about their use of complementary or alternative medicine (including 25 percent who takesupplements and/or herbs), physicians can be bewildered when trying to pin down a root cause for a patient's complaints.

Indeed, these patients are not easily diagnosed after a single lab test - and they are not easily fixed with a supplement.

Occasionally, it takes time with the patient, careful attention to the patient's story, and asking the right questions to get to the bottom of the problem. Often, the solution is right under our nose.

Nature is indeed wonderful, but it doesn't always come in a pill.

Lucy McBride is an internist based in the District.

2019 The Washington Post

This article was originally published by The Washington Post.

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A Doctor Explains The True Risk of 'Natural' Treatments Like Green Tea Supplements - ScienceAlert

How many times has your doctor said, we will get some blood tests and you are handed a piece of paper that looks like a foreign language or a menu from another country. Often we blindly take the paper order go to the lab and let them take tubes of blood out of us, with many concerned that all their blood will be gone.

I thought we would take a few minutes and discuss common blood tests, what to expect, what tests should you have, and what is new and exciting in blood testing.

First a little trivia for you, the average sized adult has about 1.5 gallons of blood in their body, that comes out to 12 pints of blood. Blood is made from within our bones, the kidney will actually secrete a hormone to tell the body it is time to make more blood. The average age of a blood cell is 120 days after which point it is removed from circulation by the spleen. The spleen acts a recycling plant by keeping the important parts of the red blood cell to be used again. For those of you who donate blood, the blood you donate is totally replaced in your body within 4- 8 weeks. For a simple blood draw of a few tubes of blood, that blood is replaced within days and makes no impact on your total blood volume.

When we say blood, it is often used as a generic word. Our blood actually is a lot more than red blood cells. It can be broken down to red blood cells, white blood cells, plasma and platelets. Each portion of our blood has important roles. Red blood cells carry oxygen to the body and return carbon dioxide to the lungs, White blood cells fight infections and act as a major portion of our immune system, platelets stop bleeding from advancing and plasma carries other factors needed to clot blood. When the blood is clotted we are left with serum which contains, lipids, electrolytes, hormones, proteins and antibodies to list a few.

You may notice when the tech is drawing your blood that they are using tubes with different color tops. The reason for this is that the tubes are treated with chemicals to make sure that the component you are measuring will be accurate. For example, if the tube has no chemicals in the tube, the blood will clot as it should, however if we are looking at components that allow the blood to clot we dont want them all used up, or if we want to count red blood cells we cant count them if they are all clotted and clumped together. So next time you have blood drawn watch as they change tubes and look for the different colors. You will now know why they do that.

So when you hear you are going to have blood tests it is important to understand exactly what they are testing for. The tests are done for many reasons and are specific for the indication being tested for. For example if we are concerned about an infection we will often do a White Blood cell count. We do this because when the body is under stress from an infection it will produce more white Blood cells to help fight the infection, so our WBC count will go up and give the doctor an idea as to how severe the bacterial infection is. What is unique is that viral infections actually cause the WBC count to drop in many cases as the virus impacts the production of WBCs for a short time.

Doctors will order blood tests that give them specific information to a condition that they are concerned about. What about when you are having a physical and the doctor orders basic tests, what are they looking for? The doctor at this time is looking at your body as a whole and not honing in on any specific disorder. In these cases he is essentially doing the same as your car dealer does with their multipoint inspection.

Lets go over the most common tests your doctor may order and what the doctor is checking with each.

1.Comprehensive metabolic Panel- this is a panel of tests that may include close to 30 different tests. These tests will give a snapshot of your kidney function, your liver function, your gall bladder function, your nutritional status, diabetes and your cholesterol. They can do all of these tests out of a simple tube of blood. They will ask you to fast for this as some portions of your cholesterol as well as your blood sugar will be impacted with any recent food intake.2.Complete blood count- this test will look at your White Blood cells, including the number of WBCs as well as what type of white blood cells. Red Blood cells are counted as well including both number of red blood cells but also sizes of the red blood cells. It will also look at how many platelets we have, which is important for blood clotting. These tests are not only signals of general health but also for leukemia, anemia and iron deficiency.3.Lipid Panel- this test looks at our cholesterol and takes it beyond just a total value for our cholesterol. The test breaks it down into our good cholesterol- HDL, our bad Cholesterol LDL and our very bad cholesterol- VLDL. HDL is good cholesterol as it removes harmful material from our blood. The bad cholesterols are bad because they need to blockage in our arteries.4.Hemoglobin A1c- we discussed how eating can impact your blood sugar level for a period of time while the body reacts to the intake. Patients with diabetes work to keep their blood sugar level in a tight range by checking their sugars throughout the day with finger sticks to check the glucose levels. This test will give an idea of a sugar range that your body has been in for the past 120 days as it measures how much sugar is in the Red Blood Cells which circulate for 120 days. This gives the doctor and the patient a better idea as to how well their blood sugar is doing for a long period of time5.Thyroid Function we dont discuss the thyroid much, that small gland that sits in our neck and is the powerhouse for our energy. If the thyroid is working well our energy level is where we need it. When it is not functioning at the right level, often low level, or hypo thyroid, we feel sluggish, fatigued and sometimes depressed. When it is working too much or hyperthyroid our heart may race, we may feel anxious and we may struggle to keep on weight.

These are just a few of the common tests that a physician may order as part of your checkup. It is important that you understand why a test is being done, when you will get the results back and who will explain them to you. Also you want to know how the results compare with your previous tests as slight changes may show a trend that needs more evaluation , intervention or possibly medication. It is good to have your own copy of your test results, with the electronic health record these are often available to you on your phone, in some cases as soon as the test is completed. For some individuals this is good as they know the goal for their diabetes or cholesterol, for others it is not great as many jump to conclusions after seeing a single blood test and then running off to Google the results. Abnormal results should be discussed with your physician or nursing staff, this should include a discussion of what the results mean, what you need to do, and what is the follow up on this abnormal result.

What is on the horizon for blood tests- some very exciting news

There are a few new blood tests worth discussing, three were reported recently.

ABBOTT Concussion blood test

2 weeks ago, Abbott reported the results of a study that showed their blood test for concussions could detect a concussion even when it was not noted on CT Scan. The blood test looks for proteins that are only found in the brain unless there is damage to the brain which allows it to be found in circulating blood stream. The test can be done in real time and takes about 15 minutes to get results, even on the sidelines of a football game or in the ER following some trauma. This test is very important as it may give a definitive answer to the question of a concussion. This information is very important as the current concussion testing is not completely accurate. An accurate diagnosis is key as removing the individual from activities that may result in another concussion is very necessary to minimize long term effects. This study showed that the test was much more accurate than any cognitive and physical exam screening and was also more exact than a CT scan. The test is not commercially available in the US yet but is expected to be soon.

This is important as a study out last week shows that repetitive mild impact to head is causing damage to the blood vessels in the brain. The study reports that repetitive impacts to the head not necessarily the big concussive blows are likely to changes to the micro vessels that deliver blood to our brain. If this blood test can identify those individuals as well we may see a much safer and accurate way to prevent the long term effects of concussions

CANCER SEEK

Cancer SEEK is a blood test that we have discussed in the past. It is a blood test that is being developed to identify 8 cancers from a single tube of blood. Essentially a liquid biopsy. The test will look for known DNA fragments from cancers that would be circulating in the blood stream. What is more interesting is the cancers this test may be able to identify. The current list includes Breast, lung, colon, ovarian, liver, stomach and pancreatic. As you look at this list, imagine that the test is perfected to a point where it can identify the cancer before traditional ways of testing, identify it earlier and more accurately.

The list includes some cancers that when identified are beyond the option for successful treatment. Lung cancer, ovarian cancer and pancreatic cancer comes to mind. Think about being able to eliminate the need for mammograms or colonoscopies to diagnose those two common cancers. The current stand is that this test will complement the current screening tools

Is this futuristic or is it something we will see soon? It may be here sooner than we think. It is currently in a large study and earlier studies have shown it to be quite good. The study that came out last year showed it to be quite accurate for ovarian, liver, pancreas, stomach and esophageal cancer, each of these very important as there are currently no screening test for each of these. The proposed price for this test is $500, which is a very appealing price for both patients and insurers. The ability to identify these cancers early will be lifesaving and game changing. Look for more information on this as well as the ability to potentially participate in a clinical trial, as they work to perfect this test.

LIFESPAN Blood Test

The other test is a bit more controversial, a group of researchers in Europe, are looking to design a blood test that could predict your lifespan as you age. The study is taking data from close to 45,000 individuals aged 18-109. During the follow up period 5,500 of the individuals had passed away. The researchers then looked at biomarkers in the blood and took that data to see if they could create a scoring system that would predict when a person might die. The researchers identified 14 different biomarkers in the blood, when some were found at low levels the chance of death was high, while other biomarkers when found at higher levels were associated with a lower chance of death. The data is being reviewed to see if levels could predict within a timeframe what the future life expectancy would be.

This obviously will be met with resistance from ethical view from a psychological view and from a healthcare utilization view. The concern about rationing health care would be raised quickly, along with utilization. If someone had this test and the results showed a predictive score that the patient would die within 5-10 years what would we do differently? Would we not do some surgery, would we not use expensive medications, would we give limited resources to an individual who had a better score. Would individuals make other life changing decisions based on the knowledge that they have a high chance of dying within the next 5 years. Many may argue that this is good information and that if we can predict our life span why wouldnt we want to know. It would allow us to make choices on work life balance, allow us to make financial decisions, and family and friend decisions.

Probably the biggest issue as this research is more publically available, would be can we change our lifestyle to change these biomarkers and improve or extend our lives. Would we start to track things we never thought were important, like our levels of leucine or valine. Would we find medications that could lower inflammation should be used as regularly as statin drugs are now.

There will be more to come on this study and how its results will be used in routine care in the future.

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Dr. Kevin Most: Blood Tests - WGN Radio - Chicago

Pregnancy test is an indicative marker test for determination of pregnancy, which measures the human chorionic gonadotropin (hCG) in urine samples. The hCG hormone is present in the human body only during pregnancy, which makes it possible for the test to provide accurate results. Various types of pregnancy tests are available in the market, the common one being the home pregnancy test (HPT), which offers benefits of pregnancy testing at home, without the need to visit a physician or gynecologist. Recent technological advancements in home pregnancy test have led to the emergence of digital pregnancy test kits. These test kits offer quick results in a digital format (pregnant / not pregnant) which eliminates the need for interpretation of results by the women, thereby improving accuracy of the test.

Rise in awareness among general population regarding pregnancy test kits and increase in pregnancy rates among women in emerging countries have boosted the adoption of pregnancy test kits globally. Conventional pregnancy test kits, including strip test kits and cup test kits, offer symbolic results of the test (lines or color code format), which need to be interpreted by the user. This increases chances of human error while interpretation of results. Digital pregnancy test kits have eliminated this possibility by offering a digital response (in yes or no format). These distinct benefits of digital pregnancy test kits over the conventional ones have propelled the adoption of digital pregnancy test kits in the global market, thereby driving the consumption and subsequent growth of the product in the global market during the forecast period. Moreover, incorporation of new technologies in the digital pregnancy test kits, such as indication of the pregnancy month of the woman, has been another major factor eliminating the undesired need to undergo ultrasound scans, thus reducing the health care cost of the patient and driving the adoption of these kits in the global market. However, higher price of digital pregnancy test kits than that of conventional ones, along with their unavailability in the emerging countries, is anticipated to restrain the growth of the global digital pregnancy test kits market in 2018.

The global digital pregnancy test kits market can be segmented into product type, distribution channel, and region. Based on product type, the global market can be divided into kits with week indicator and kits without week indicator. Based on distribution channel, the global digital pregnancy test kits market can be classified into institutional sales and retail sales. The institutional sales segment can further be categorized into maternity centers, gynecology clinics, and others. The retail sales segment can be bifurcated into hospital pharmacies, online pharmacies, and retail pharmacies & drug stores.

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In terms of region, the global digital pregnancy test kits market can be segmented into North America, Europe, Asia Pacific, Latin America, and Middle East & Africa. North America dominated the digital pregnancy test kits market in 2017, and was closely followed by Europe, in terms of revenue. Rise in adoption of new and advanced test kits owing to higher awareness among people regarding pregnancy test kits and adequate reimbursement policies for digital pregnancy test kits in the U.S., Canada, and European countries are some of the major factors contributing toward the prominent share of these regions in the global market. Asia Pacific is projected to register a comparatively higher CAGR from 2018 to 2026, owing to higher pregnancy rate in emerging countries, such as China, India, and other Southeast Asian countries and rising adoption of digital pregnancy test kits in these countries.

Key players operating in the global digital pregnancy test kits market include SPD Swiss Precision Diagnostics GmbH, Church & Dwight Co., Inc., Gregory Pharmaceutical Holdings, Inc., and Sugentech, Inc.

The report offers a comprehensive evaluation of the market. It does so via in-depth qualitative insights, historical data, and verifiable projections about market size. The projections featured in the report have been derived using proven research methodologies and assumptions. By doing so, the research report serves as a repository of analysis and information for every facet of the market, including but not limited to: Regional markets, technology, types, and applications.

The study is a source of reliable data on: Market segments and sub-segments Market trends and dynamics Supply and demand Market size Current trends/opportunities/challenges Competitive landscape Technological breakthroughs Value chain and stakeholder analysis

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The regional analysis covers: North America (U.S. and Canada) Latin America (Mexico, Brazil, Peru, Chile, and others) Western Europe (Germany, U.K., France, Spain, Italy, Nordic countries, Belgium, Netherlands, and Luxembourg) Eastern Europe (Poland and Russia) Asia Pacific (China, India, Japan, ASEAN, Australia, and New Zealand) Middle East and Africa (GCC, Southern Africa, and North Africa)

The report has been compiled through extensive primary research (through interviews, surveys, and observations of seasoned analysts) and secondary research (which entails reputable paid sources, trade journals, and industry body databases). The report also features a complete qualitative and quantitative assessment by analyzing data gathered from industry analysts and market participants across key points in the industrys value chain.

A separate analysis of prevailing trends in the parent market, macro- and micro-economic indicators, and regulations and mandates is included under the purview of the study. By doing so, the report projects the attractiveness of each major segment over the forecast period.

Highlights of the report: A complete backdrop analysis, which includes an assessment of the parent market Important changes in market dynamics Market segmentation up to the second or third level Historical, current, and projected size of the market from the standpoint of both value and volume Reporting and evaluation of recent industry developments Market shares and strategies of key players Emerging niche segments and regional markets An objective assessment of the trajectory of the market Recommendations to companies for strengthening their foothold in the market

Note:Although care has been taken to maintain the highest levels of accuracy in TMRs reports, recent market/vendor-specific changes may take time to reflect in the analysis.

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Digital Pregnancy Test Kits Market: Strategic Analysis to Understand the Competitive Outlook of the Industry, 2026 - ScoopJunction

Cushing disease is caused by tumour in the pituitary gland which leads to excessive secretion of a hormone called adrenocorticotrophic (ACTH), which in turn leads to increasing levels of cortisol in the body. Cortisol is a steroid hormone released by the adrenal glands and helps the body to deal with injury or infection. Increasing levels of cortisol increases the blood sugar and can even cause diabetes mellitus. However the disease is also caused due to excess production of hypothalamus corticotropin releasing hormone (CRH) which stimulates the synthesis of cortisol by the adrenal glands. The condition is named after Harvey Cushing, the doctor who first identified the disease in 1912. Cushing disease results in Cushing syndrome. Cushing syndrome is a group of signs and symptoms developed due to prolonged exposure to cortisol. Signs and symptoms of Cushing syndrome includes hypertension, abdominal obesity, muscle weakness, headache, fragile skin, acne, thin arms and legs, red stretch marks on stomach, fluid retention or swelling, excess body and facial hair, weight gain, acne, buffalo hump, tiredness, fatigue, brittle bones, low back pain, moon shaped face etc. Symptoms vary from individual to individual depending upon the disease duration, age and gender of the patient. Disease diagnosis is done by measuring levels of cortisol in patients urine, saliva or blood. For confirming the diagnosis, a blood test for ACTH is performed. The first-line treatment of the disease is through surgical resection of ACTH-secreting pituitary adenoma, however disease management is also done through medications, Cushing disease treatment market comprises of the drugs designed for lowering the level of cortisol in the body. Thus patients suffering from Cushing disease are prescribed medications such as ketoconazole, mitotane, aminoglutethimide metyrapone, mifepristone, etomidate and pasireotide.

Cushings disease treatment market revenue is growing with a stable growth rate, this is attributed to increasing number of pipeline drugs. Also increasing interest of pharmaceutical companies to develop Cushing disease drugs is a major factor contributing to the revenue growth of Cushing disease treatment market over the forecast period. Current and emerging players focuses on physician education and awareness regarding availability of different drugs for curing Cushing disease, thus increasing the referral speeds, time to diagnosis and volume of diagnosed Cushing disease individuals. Growing healthcare expenditure and increasing awareness regarding Cushing syndrome aids in the revenue growth of Cushings disease treatment market. Increasing number of new product launches also drives the market for Cushings disease Treatment devices. However availability of alternative therapies for curing Cushing syndrome is expected to hamper the growth of the Cushings disease treatment market over the forecast period.

The Cushings disease Treatment market is segment based on the product type, technology type and end user

Cushings disease Treatment market is segmented into following types:

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By Drug Type Ketoconazole Mitotane Aminoglutethimide Metyrapone Mifepristone Etomidate Pasireotide

By End User Hospital Pharmacies Retail Pharmacies Drug Stores Clinics e-Commerce/Online Pharmacies

Cushings disease treatment market revenue is expected to grow at a good growth rate, over the forecast period. The market is anticipated to perform well in the near future due to increasing awareness regarding the condition. Also the market is anticipated to grow with a fastest CAGR over the forecast period, attributed to increasing investment in R&D and increasing number of new product launches which is estimated to drive the revenue growth of Cushings disease treatment market over the forecast period.

Depending on geographic region, the Cushings disease treatment market is segmented into five key regions: North America, Latin America, Europe, Asia Pacific (APAC) and Middle East & Africa (MEA).

North America is occupying the largest regional market share in the global Cushings disease treatment market owing to the presence of more number of market players, high awareness levels regarding Cushing syndrome. Healthcare expenditure and relatively larger number of R&D exercises pertaining to drug manufacturing and marketing activities in the region. Also Europe is expected to perform well in the near future due to increasing prevalence of the condition in the region.

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Asia Pacific is expected to grow at the fastest CAGR because of increase in the number of people showing the symptoms of Cushing syndrome, thus boosting the market growth of Cushings disease treatment market throughout the forecast period.

Some players of Cushings disease Treatment market includes CORCEPT THERAPEUTICS, HRA Pharma, Strongbridge Biopharma plc, Novartis AG, etc. However there are numerous companies producing branded generics for Cushing disease. The companies in Cushings disease treatment market are increasingly engaged in strategic partnerships, collaborations and promotional activities to capture a greater pie of market share.

The research report presents a comprehensive assessment of the market and contains thoughtful insights, facts, historical data, and statistically supported and industry-validated market data. It also contains projections using a suitable set of assumptions and methodologies. The research report provides analysis and information according to categories such as market segments, geographies, types, technology and applications.

The report covers exhaustive analysis on: Market Segments Market Dynamics Market Size Supply & Demand Current Trends/Issues/Challenges Competition & Companies involved Technology Value Chain

Regional analysis includes North America (U.S., Canada) Latin America (Argentina, Mexico, Brazil, Rest of Latin America) Europe (Germany, Italy, France, U.K., Spain, Russia, Rest of Europe) Asia Pacific (China, India, Japan, Rest of APAC) Middle East and Africa (Rest of MEA, S. Africa)

The report is a compilation of first-hand information, qualitative and quantitative assessment by industry analysts, inputs from industry experts and industry participants across the value chain. The report provides in-depth analysis of parent market trends, macro-economic indicators and governing factors along with market attractiveness as per segments. The report also maps the qualitative impact of various market factors on market segments and geographies.

Report Highlights: Detailed overview of parent market Changing market dynamics in the industry In-depth market segmentation Historical, current and projected market size in terms of volume and value Recent industry trends and developments Competitive landscape Strategies of key players and products offered Potential and niche segments, geographical regions exhibiting promising growth A neutral perspective on market performance Must-have information for market players to sustain and enhance their market footprint.

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Cushings Disease Treatment Market Size & Share Expanding Across The Globe By 2025 - Rapid News Network

On a recent episode of his Friday evening talk show, Bill Maher proposed that society combat obesity by body-shaming overweight individuals. He argued that fat shaming doesnt need to end, it needs to make a comeback to deter people from overeating.

Obesity is a national epidemic that is placing a significant burden on our health care system. Nearly 40% of Americans are considered obese, costing upwards of US$150 billion dollars per year in health costs, according to the Centers for Disease Control and Prevention.

To individuals who are not obese, it can be easy to assume that overeating is strictly a failure of willpower and discipline. However, evidence shows that body-shaming and weight discrimination are misguided approaches, and often make the problem worse. Moreover, there are multiple biological forces underlying appetite and metabolism that may be beyond a persons full control.

I am a molecular biologist with interests in the root causes of human behavior. As the author of the book, Pleased to Meet Me: Genes, Germs, and the Curious Forces That Make Us Who We Are, I have done extensive research into the biological forces that conspire to shape human personality and behavior, including the factors influencing our diet and tendency to overeat.

Maher tried to support his argument with the claim that being fat isnt a birth defect. This is not necessarily true. Some people are born with genetic variations in hormonal systems that regulate hunger and satiety. Leptin, for instance, is a hormone that tells the brain when the stomach is full. People born with leptin deficiency cannot sense when they are full and frequently overeat. Other genes linked to energy metabolism, food cravings and the brains reward response have been found to be driving factors in overeating and weight gain.

There is also growing evidence that several health conditions, including obesity, may arise from how the environment in the uterus affects the development of the fetus. A 2014 study at the University of Denver showed that prenatal maternal stress influences childhood obesity. Why should children be shamed for their mothers stress during pregnancy?

There is compelling data that the microbes in our intestines, part of our microbiome, may influence our food cravings and the tendency to overeat. Microbiologist Jeffrey Gordon at Washington University has conducted pioneering studies charting differences in the bacterial species inhabiting the guts of lean versus obese people.

Gordon and his team also transplanted intestinal bacteria from lean or obese people into the guts of mice. For the study, the intestinal bacteria were harvested from identical twins in which one was obese and the other lean. The result: While gut bacteria from the lean twin kept mice lean, gut bacteria from the obese twin led to obesity in the mouse. These findings provide evidence that the types of microbes in our gut influence our metabolism and contribute to our weight.

It is also well-established that certain medications, like steroids, alter metabolism and fat deposition, leading to weight gain. Brain injury and tumors can also induce overeating and obesity. While these causes of obesity are less common, I think it is unfair to make assumptions that obese individuals are in full control of their behavior.

Body-shaming is not only ineffective but frequently backfires. In a 2013 study, researchers at Florida State University revealed that people subjected to weight discrimination were three times more likely to remain obese. A year later, researchers at University College London added more supporting evidence; rather than helping people lose weight, weight discrimination promotes weight gain.

Most recently, a 2019 study showed that weight discrimination significantly contributed to an overall health decline in all participants. In addition to weight gain, multiple studies have shown that body-shaming also harms psychological health, frequently leading to depression.

There are more effective, not to mention more compassionate, ways to help those struggling with obesity. As British physician Stephen ORahilly has written, The growing evidence that humans can be genetically hardwired to become severely obese should eventually lead to a more widespread realization that morbid obesity is a disease requiring further scientific research, rather than a failure of willpower requiring sanctimonious moral opprobrium.

Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana University.

then let us make a small request. AlterNet is increasing its original reporting, edited by The Nations Joshua Holland, with a focus on 2020 election coverage. Weve also launched a weekly podcast, Weve Got Issues, focusing on the issues, not Donald Trumps tweets. Unlike other news outlets, weve decided to make our AlterNet 2020 coverage free to all. But we need your ongoing support to continue what we do.

AlterNet is independent. You wont find mainstream media bias here. From unflinching coverage of white nationalism, to spotlighting the overlooked struggles of the working poor, AlterNet continues to speak truth to power. As newspapers close, America needs voices like AlterNets to be sure no one is forgotten.

We need your support to keep producing quality journalism. As Silicon Valley absorbs more and more advertising dollars, ads dont pay what they used to. Every reader contribution, whatever the amount, makes a tremendous difference. Help ensure AlterNet remains independent long into the future. Support progressive journalism with a one-time contribution to AlterNet, or click here to become a subscriber. Thank you. Click here to donate by check.

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Heres why Bill Maher is wrong about fat-shaming - AlterNet

Dr. Patricia Coughlin, sole owner of Good Karma Dispensary, has applied for a dispensary facility license in Brentwood, Missouri. Like the other 2,300 applications, she awaits licensing results from the state. Coughlin is one of over 1,000 applicants applying to open a medical marijuana dispensary in Missouri.

The 83-year-old has lived in St. Louis her entire life. She was a registered nurse for 44 years and a social worker for 39 years. She has her doctorate in social work. Dr. Coughlin is a captain in the United States Army Nurse Corps; a former professor at Washington University, University of Missouri-St. Louis, and Maryville University; and even formerly hosted a local radio show.

I believe that my unique background, combined with my extensive knowledge in the area of medical marijuana will be to serve my dispensary clients well, Dr. Coughlin told Greenway Magazine. As a senior, I intend to focus quite a bit on the more mature population that does not feel comfortable with many of the stereotypical associations of marijuana. I believe it is important to promote the message that medical marijuana is an acceptable alternative to traditional pharmacology, and I hope my messages will help to de-stigmatize medical marijuana.

She said her reason for applying for a facility license comes down to her first-hand accounts of the needs of the aging community and a need for alternative treatment options.

My main reason for applying for a dispensary license is that I see first hand every day the significant need in the aging community for a healthier alternative to dangerous prescription medications to treat: sleep problems and insomnia, loss of appetite, chronic pain from age-related conditions, depression, and the agitation and other symptoms related to Alzheimers, Dr. Coughlin said. The aging population, in my opinion, is the most needlessly over-medicated and is in dire need of alternatives.

A way she plans for her dispensary to serve aging patients better is by offering a VIP Service where her or another nurse will meet in-home with families and patients to discuss treatment.

I will work in conjunction with the patients physician and healthcare team to determine the best course of medical marijuana treatment, Dr. Coughlin said. I will follow up weekly with family members to assess progress, changes, and any concerns as well as to personally deliver the product to the family/patient and assist with teaching and training on side effects, symptoms, etc.

Dr. Coughlins dispensary also plans to make specific offerings for fellow veterans, including discounts and outreach. She will be providing lectures and visiting support groups touting the benefits of medical marijuana to treat post-traumatic stress disorder and other conditions unique to veterans.

Her outreach will further extend into the healthcare industry, where she plans to capitalize on her almost 50 years of nursing experience. She will also be providing workshops and seminars for counselors, social workers, therapists, psychologists, and psychiatrists to increase regional education for medical marijuana treatment for mental illness.

Her experience and multi-faceted outreach strategy is one that Dr. Coughlin hopes will make her application stand out.

Outside of her care experience, Dr. Coughlin founded the Magdala Foundation, the first halfway house for female offenders in the United States, for which former St. Louis Mayor A.J. Cervantes awarded her the key to the City.

Additionally, she co-founded The PMS Center, one of the first facilities of its kind in the country to treat women suffering from PMS and other hormone-related conditions. She emerged early on as an expert in PMS and bio-identical hormones, appearing on several national television shows. She volunteers as a counselor at Birthright Crisis Pregnancy Counseling and she is on the Board of Missouri Right to Life.

Her dispensary proposal, of which she is the sole owner and funder, has been welcomed by the City of Brentwood and local residents.

Dr. Coughlin is an active longtime member of the St. Louis Arch Diocese and a longtime serial entrepreneur. She is the mother of five professional adults and grandmother to 15, all living in the St. Louis area.

Continued here:
Longtime St. Louis nurse says Good Karma is about 'healthier alternatives' - Greenway

HCG (Human chorionic gonadotropin) is one of the fastest andeasiest ways to lose weight up to 3lbs per day for the first week. Nowadays,this protocol of weight loss has become popular among those who search for thequickest weight loss products out there in the market. HCG is a kind of hormonethat can be found in the placenta of pregnant women. In her pregnant period,the production of this hormone increases at its highest level. It sends themessage of a woman not to menstruate.

In comparison to other weight loss products in the market, HCG works faster. Thats why; its demand is on the rise at present. It is available as a form of sprays, drops, and injections. By eliminating cravings and controlling hunger for foods, HCG drops help you to lose weight according to your need.

It is also called an ultra-low-calorie diet which allows itsuser to consume only 500 calories per day as long as he or she is on this dietplan. As HCG helps to boost metabolism in your body, it works as a weight-losssupplement all without making you hungry.

If somebody takes the HGC diet plan and can keep stickduring this plan, he or she can lose 5 to 40 pounds or more. In the first week,you may end up losing nearly 3 to 4 pounds if it is your first time. And youhave to continue this diet plan (3 or 6 weeks) until it finishes following thediet plan. If you think that you have already burnt enough fat and fail tofollow the extreme diet plan, you will end up gaining more weight.

HCG, a very low-calorie diet comes up with three main stages you need to follow strictly. These include loading phase, weight loss phase, and maintenance phase. All three stages are equally important to observe. If you fail to maintain any of them, you will end up gaining some extra weight.

This is the phase where you are permitted to takehigh-calorie and high-fat foods just for two days after starting the HCG dietplan to lose weight.

This is the most crucial phase you have to followappropriately without making any mistake. Along with taking HCG, it will allowyou to choose only 500 calories each day for 3 to 6 weeks. You can have twomeals per day- lunch and dinner. You may think that this extreme diet plan willleave you to make hungry. HCG diet plan will not allow you to crave or make youhungry for foods.

In this phase, you can increase food intake and stopconsuming HCG. It does not mean that you can eat as much as you wish. For thenext three weeks, you have to avoid sugar and starch to maintain the phase.Otherwise, you will gain weight fast indeed.

Phase 3 should be the most crucial part of the HCG diet plan. Some people regain their weight during phase 3 because they start consuming sugar and starch randomly. To maintain the weight you have achieved during the diet plan, you have to eat foods that are recommended for phase 3. You should also be aware of including new food items into your diet. Instead, you can gain 2 pounds of weight more if you do not follow the instruction during this phase.

If you aim to lose weight within the shortest possible time,there is no alternative to HCG. Yes, it is a solid diet plan because itsinstructions are rigorous but concise. If you can follow all itsrecommendations while taking this extreme diet plan, you are sure to burn yourextra fat up to 40 pounds or even more.

Its beginning is faster than the later phases. At thebeginning of any diet plan for weight loss, all you lose is water from yourbody. You can eat fats as well as healthy foods you like once you have finishedthe diet plan. But you have to make sure that you are not overeating.

Losing extra weight is beneficial for your body. It iseasier to perform actions of your day to day life if you are not too bulky.Everyone under the sun wants to have a good appearance. But doing things toofast also leave you with some side effects.

So, it would be wise to consult with your physician beforetaking any diet plan. Your doctor knows it very well whether your body is up tothe mark to continue with the extreme-low diet plan, HCG. If it does not suityou, you will have some health conditions including headaches, depression, orfatigue.

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How much weight can you lose on the HCG diet? - VIVA GLAM MAGAZINE - vivaglammagazine.com

Steroids can be defined as a kind of natural or synthetic chemical compounds that can be produced naturally in the body as well as artificially in the laboratories.

Steroids help the cells, tissues, and organs to function properly and they are also used to treat various medical conditions. The two primary sorts of steroids are corticosteroids and anabolic-androgenic steroids which is also called anabolic steroids.

To decide which steroids are legal is a tricky one. The term legal steroids is a catch-all for muscle-gaining supplements that are not considered illegal. Legal steroids are also called Multi Ingredient Pre-Exercise Supplements (MIPS) and Over-The-Counter (OTC) health supplements.

These health supplements are intended to help with weight-lifting, developing muscles, and improve performance and stamina of athletes. Anabolic-androgenic steroids are engineered (artificial) renditions of the male sex hormone testosterone.

Medical practitioners prescribe these hormone enhancing steroids to individuals who have muscle atrophy or problems in producing enough testosterone. However, numerous reports and cases have come to light where athletes and bodybuilders have been found to use these steroids unlawfully to boost performance or grow muscles.

There are two sorts of steroids present inside the body. The adrenal organ situated over the kidney in our body produces corticosteroids. These hormones comprise of aldosterone, which plays a vital role in controlling the concentration of sodium in the body, and cortisol, which acts as the bodys stress reaction framework to reduce inflammation.

Corticosteroids are prescribed by medical practitioners to treat illnesses like asthma, bowel ailment, rheumatoid joint inflammation, and a number of ailments.

Anabolic or anabolic-androgenic steroids are produced artificially that copies characteristics of the male hormone testosterone in its capacity to build muscle tissue and in the development of the features of male secondary sex. Different types of medical conditions such as hypogonadism, osteoporosis, malnutrition, anemia, HIV (Human Immunodeficiency Virus), and breast cancer.

Corticosteroids are used as medicines that help combat inflammation in our body. These steroids are made in laboratories and perform just like the cortisol hormone that is produced inside our body. Cortisol or corticosteroids like the drug prednisone prevent our immune system from producing inflammation-causing substances.

Corticosteroids medically help treat conditions that cause swelling and irritation. They also help ease side effects of asthma, multiple sclerosis, rheumatoid inflammation of joints, skin conditions like dermatitis, short-term treatment of allergic reactions like poison ivy rash, lupus vulgaris or lupus erythematosus, chronic obstructive pulmonary disorder (COPD).

Regular intake of high doses of corticosteroids for quite a while can cause severe symptoms like osteoporosis, impedes the development in children, and also cause adrenal deficiency which is a deadly condition where the bodys stress reaction capacity stops it can no longer respond to illnesses or surgical procedures.

Other long-term effects of taking corticosteroids include eye problems like cataract, loss of muscle strength, and also a higher possibility of suffering from diabetes.

The anabolic or androgenic steroids are artificially composed to mimic the characteristics of testosterone hormone that is produced in the testicles and ovaries.

The androgenic compound of the testosterone hormone is associated with building up the male sex attributes, while the anabolic part is engaged with expanding the volume of body tissue by accelerating protein generation. The pituitary organ, situated at the base of the cerebrum, manages testosterone generation and hormone discharge.

Medical practitioners might advise the use of anabolic and androgenic steroids as prescription drugs for individuals whose body is not capable of producing enough hormone which is why they might need hormone supplements.

The anabolic steroids are recommended by medicinal services providers as legal prescription drugs, yet this type of medications is frequently mishandled and illegally consumed escalate performance of athletes and also develop physical appearance like muscle building.

At the point when utilized in a well-sustained body, anabolic steroids will cause weight gain to encourage an expansion in muscular tissues.

While anabolic steroids may have positive impacts when taken under the supervision of a physician, they have numerous severe and at times irreversible reactions. These reactions are caused because of the unusually abnormal accumulation of testosterone in the body and may result in hypertension, raised cholesterol levels, liver ailments, cardiovascular illness, skin inflammation, hair loss, and certain behavioral syndrome. The anabolic steroids are available in many different types.

Some copy the activities of testosterone, while others cause the body to create abundance testosterone by meddling with the typical hormone-producing system in the body.

No matter what the purpose of these steroids are, the excessive amount of testosterone-induced in the body always ends up in affecting the normal functioning of cells and organs in the body.

Anabolic steroids are usually prescribed to be taken orally or injected in the muscles, especially for individuals whose body does not produce enough testosterone. Medical practitioners also recommend them to individuals who have lost muscle strength due to chronic health conditions like cancer and AIDS. AIDS, and other wellbeing conditions.

High doses of anabolic steroids taken for a long time can harm our liver, kidneys, and heart. It can also cause heart failure and swelling of the heart because of extreme fluid retention. These medications can likewise raise the level of LDL cholesterol, which can cause strokes or heart attacks in individuals of any age.

Conclusion

It is safe to say that steroids irrespective of their legalities are never the best answer for growing muscles or keeping the body fit. They can cause many harmful reactions that may compromise the state of our wellbeing in the long haul.

Steroids are drugs that cause strong reactions in the body, and they can cause cataracts or illnesses of bones like osteopenia. Therefore, it is always ideal to concentrate on manageable, sound approaches to build muscles and remain fit.

This will not only prevent any additional physical and mental damage due to the dependence on synthetic chemicals to enhance physical stamina but also allow the cells and organs of our body to function normally.

Read more:
What Are Steroids and Are They Legal? - The Vistek

NEW YORK A recent pilot study of Pfizer's PARP inhibitor talazoparib (Talzenna) suggests that it might work as a neoadjuvant treatment for women with triple negative breast cancer and BRCA germline mutations.

Pfizer is conducting its own Phase II trial, results of which are still likely more than a year away, but the pilot, conducted by researchers from MD Anderson Cancer Center, showed promising results.

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Post menopause is the period occurred after menopause followed by various syndromes like vaginal dryness, hot flashes, etc. During this period level of estrogen and progestin falls significantly leading to even serious complications like osteoporosis. The worldwide market for Postmenopausal Hormone Therapy is gaining moment substantially. This rising demand for Postmenopausal Hormone Therapy is due to increasing level of awareness about menopausal symptoms and its treatment. Another factor is growing population of post-menopausal women. Postmenopausal Hormone Therapy includes replenishment of body level of estrogen and progestin hormones in women through external intake of hormones. Thus, it help in treating the menopausal symptoms. It decreases the symptoms like vaginal dryness, hot flashes, disturbed sleep, night sweats and etc. The Postmenopausal Hormone Therapy helps in prevention of osteoporosis and hot flashes caused due to depletion of estrogen and progestin level in body. The Postmenopausal Hormone Therapy comprises of natural as well as synthetic estrogens. In order to enhance the menopausal treatment, it is also given in combination with progesterone.

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The treatment for post menopausal syndrome is generally treated with sequential or continuous schedules through various doses of estrogen, progestin or combination of both. Despite of existing controversy and confusion about the safety profile of the postmenopausal hormone therapy, the market for the postmenopausal hormone therapy has recorded positive inclining growth due to growing demand. The development of postmenopausal hormone therapy with respect to driving demand leads to introduction of highly safe treatment options to patients which include development of novel drug delivery system like vaginal estrogen drugs and transdermal estrogen patches. Low dose postmenopausal hormone therapy are used in order to address the backdrop caused due to safety issues. The non-hormonal treatment has comparatively least efficacy to produce optimum results, hence the postmenopausal hormone therapy market is observed to grow significantly.

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However, the major retarding factors to the market include the affordability to the therapy. The cost for postmenopausal hormone therapy approximately revolves around US$ 10,000 per annum, and thus incurring a major burden on the patients pocket. Thus the population from developing and under developed countries faces a challenge of affordability for the postmenopausal hormone therapy. The post treatment risk of cervical cancer and coronary disease are another restraining factors for the market. Approved recognition of the products related to postmenopausal hormone therapy in compounding pharmacies particularly from developed countries is another deterring factor. However the opportunity for the market is the introduction of the product targeting the cardiovascular disease prevention.

The Postmenopausal Hormone Therapy market can be segmented by product, by therapy, by dosage form, by route of administration, by end-user and by geography. In the terms of product, the postmenopausal hormone therapy is classified into patches, tablets, creams, suppositories, and injections. The tablet formulation comprises the largest market share of the total postmenopausal hormone therapy market. However, due to growing concern of safety and long-term therapy the market for the patches are growing at much faster compound annual growth rate. Based on the therapy, the market is segmented into individual progestin, estrogen and combination therapies. The majority of market is occupied by estrogen therapy across the world.

Based on the route of administration, the postmenopausal hormone therapy market is classified into oral, topical and subcutaneous implants. Due to high safety, oral administration has been the preferred choice of option for the patient. However, introduction of novel drug delivery system has driven the market for topical and subcutaneous products as well. In the terms of end-user, the target population are the women suffering from menopause. However, the treatment is influenced by the physician/ gynecologist, the target end-users are hospitals and specialty clinics.

Geographically, North America occupies the largest market share followed by other developed region like Europe. The United States accounts for a major share of the global market. The high awareness level and high purchasing power in this region led the market of postmenopausal hormone therapy for expansion significantly. However, the same factor of affordability has restrained the markets in developing regions. Despite of this, Asia Pacific has shown striking increase in its growth rate for the postmenopausal hormone therapy market. Rising population, increase in disposable income, and increase in awareness level are some key factors driving the Asia Pacific Market. Due to this factors, the Asian market is observing high number of new entrants compared to those in developed regions.

The Major players reported in the market include Abbott Laboratories, AbbVie, Inc., Bayer Pharma AG, Hisamitsu Pharmaceutical Co., Inc., Novartis AG, Novo Nordisk A/S, Orion Pharma AB, Pfizer, Inc., Meda pharmaceuticals, Teva Pharmaceutical Industries Ltd. and TherapeuticsMD, Inc., etc

Link:
Postmenopausal Hormone Therapy Market to Surge at a Robust Pace by 2024 - Market Reporter

Report Title: 2019-2024 Global and Regional Endocrine Testing Industry Production, Sales and Consumption Status and Prospects Professional Market Research Report

Endocrine Testing Market research report gives detailed information of major players like manufacturers, suppliers, distributors, traders, customers, investors and etc. Endocrine Testing market Report presents a professional and deep analysis on the present state of Endocrine Testing Market that Includes major types, major applications, Data type include capacity, production, market share, price, revenue, cost, gross, gross margin, growth rate, consumption, import, export and etc. Industry chain, manufacturing process, cost structure, marketing channel are also analyzed in this report.

Overview Of Endocrine Testing Market:

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Report further studies the Endocrine Testing market development status and future trend across the world. Also, it splits Endocrine Testing market by type and by applications to fully and deeply research and reveal market profile and prospects.

Segmentations Analysis:

Top Key Players:Abbott Laboratories, AdnaGen, Beckman Coulter/Danaher, Biomedical Diagnostics, BioMerieux, Bio-Rad, Dako, DiaSorin, Eiken, Fujirebio, Instrumentation Laboratory, Kyowa Medex, Matritech, Ortho-Clinical Diagnostics, Roche, Siemens, Sysmex, Thermo Fisher, Tosoh, Wako, Wallac/PE

By TestEstradiol (E2) Test, Follicle Stimulating Hormone (FSH) Test, Human Chorionic Gonadotropin (hCG) Test, Luteinizing Hormone (LH) Test, Dehydroepiandrosterone sulfate (DHEAS) Test, Progesterone Test, Testosterone Test, Thyroid Stimulating Hormone (TSH) Test, Others (Gastrin, Thymosin, Secretin, etc.)

By TechnologyTandem Mass spectrometry, Immunoassay (Enzyme immunoassays, Radioimmunoassays (RIA)) Technologies, Monoclonal and Polyclonal Antibody Technologies, Sensor (Electrochemical, Biosensors, etc.) Technologies, Clinical Chemistry Technologies, Others (Liquid Chromatography + Mass Spectrometry (LC-MS)

By End UserHospitals, Commercial Laboratories, Ambulatory Care Centers, Home Based Tests, Physician Offices.

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Endocrine Testing Market report covers the manufacturers data, including: shipment, price, revenue, gross profit, interview record, business distribution etc., these data help the consumer know about the competitors better. This report also covers all the regions and countries of the world, which shows a regional development status, including market size, volume and value, as well as price data.

Geographically, this report is segmented into severalkey regions, with sales, revenue, market share and growth Rate of Endocrine Testing in these regions, from 2014 to 2024, covering

The Endocrine Testing market report provides answers to the following key questions:

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Detailed TOC of 2019-2024Global and Regional Endocrine Testing Industry Production, Sales and Consumption Status and Prospects Professional Market Research Report

Chapter 1 Industry Overview

Chapter 2 Production Market Analysis

Chapter 3 Sales Market Analysis

Chapter 4 Consumption Market Analysis

Chapter 5 Production, Sales and Consumption Market Comparison Analysis

Chapter 6 Major Manufacturers Production and Sales Market Comparison Analysis

Chapter 7 Major Type Analysis

Chapter 8 Major Application Analysis

Chapter 9 Industry Chain Analysis

9.2 Manufacturing Analysis

9.3 Industry Chain Structure Analysis

Chapter 10 Global and Regional Market Forecast

10.2 Sales Market Forecast

10.3 Consumption Market Forecast

Chapter 11 Major Manufacturers Analysis

11.1 Company 3

11.2 Company 2

11.3 Company 3

Chapter 12 New Project Investment Feasibility Analysis

Continued.

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Endocrine Testing Market Report 2019 to 2024 With Top Countries Data : Growth, Provides Analysis on Supply, Market Size, Import and Export,...

An ultrasound exam is a procedure that uses high-frequency soundwaves to scan a womans abdomen and pelvic cavity, creating a picture(sonogram) of the baby and placenta. Although the terms ultrasoundand sonogram are technically different, they are used interchangeablyand reference the same exam.

There are basically seven different ultrasound exams, but the basic process is the same.

The different types of procedures include:

Transvaginal Scans Specially designed probe transducersare used inside the vagina to generate sonogram images. Most oftenused during the early stages of pregnancy.

Standard Ultrasound Traditional ultrasound examwhich uses a transducer over the abdomen to generate 2-D images ofthe developing fetus.

Advanced Ultrasound This exam is similar to thestandard ultrasound, but the exam targets a suspected problem anduses more sophisticated equipment.

Doppler Ultrasound This imaging procedure measuresslight changes in the frequency of the ultrasound waves as they bounceoff moving objects, such as blood cells.

3-D Ultrasound Uses specially designed probes andsoftware to generate 3-D images of the developing fetus.

4-D or Dynamic 3-D Ultrasound Uses specially designedscanners to look at the face and movements of the baby prior to delivery.

Fetal Echocardiography Uses ultrasound waves toassess the babys heart anatomy and function. This is used to helpassess suspected congenital heart defects.

The traditional ultrasound procedure involves placing gel on yourabdomen to work as a conductor for the sound waves. Your healthcareprovider uses a transducer to produce sound waves into the uterus.The sound waves bounce off bones and tissue returning back to thetransducer to generate black and white images of the fetus.

Ultrasounds may be performed at any point during pregnancy, and theresults are seen immediately on a monitor during the procedure. Transvaginalscans may be used early in pregnancy to diagnose potential ectopicor molar pregnancies.

There is not a recommended number of ultrasounds that should be performedduring routine prenatal care. Because ultrasound should only be usedwhen medically indicated, many healthy pregnancies will not require an ultrasound. The average number of ultrasounds varies with each healthcareprovider.

Additional ultrasounds might be ordered separately if yourhealthcare provider suspects a complication or problem related toyour pregnancy.

Ultrasounds are diagnostic procedures that detect or aid in the detectionof abnormalities and conditions related to pregnancy. Ultrasoundsare usually combined with other tests, such as tripletests, amniocentesis,or chorionic villus sampling,to validate a diagnosis.

An ultrasound exam may be performedthroughout pregnancy for the following medically-necessary reasons:

First Trimester:

Second Trimester:

Third Trimester:

The ultrasound is a noninvasive procedure which, when used properly,has not demonstrated fetal harm. The long-term effects of repeatedultrasound exposures on the fetus are not fully known. It is recommendedthat ultrasound only be used if medically indicated.

No, itdoes not mean there is a problem. The heartbeat may not be detectedfor reasons that include: tipped uterus, larger abdomen, or inaccuratedating with last menstrual period. Heartbeats are best detected withtransvaginal ultrasounds early in pregnancy.

Concern typically developsif there is no fetal heart activity in an embryo with a crown-rumplength greater than 5mm. If you receive an ultrasound exam after week6, your healthcare provider will begin to be concerned, if there isno gestational sac.

Your healthcare provider will use hormone levels in yourblood, the date of your last menstrual period and, in some cases,results from an ultrasound to generate an estimated gestational age.However, variations in each womans cycle and each pregnancy may hinderthe accuracy of the gestational age calculation.

If your healthcareprovider uses an ultrasound to get an estimated delivery date to basethe timing of your prenatal care, the original estimated gestationalage will not be changed.

If there are any questions regarding gestational age, placenta location,or possible complications then more ultrasounds may be scheduled.Because ultrasound should only be used when medically indicated, manyhealthy pregnancies will not require an ultrasound. The average numberof ultrasounds varies with each healthcare provider.

Your healthcare provider willuse hormone levels in your blood, the date of your last menstrualperiod and, in some cases, results from an ultrasound to generatean expected date of conception. However, many differences in eachwomans cycle may hinder the accuracy of the conception date calculation.

The viability of sperm varies as well, which means intercoursethree to five days prior to ovulation may result in conception. Ultrasounddating of conception is not reliable for determining paternity becausethe ultrasound can be off by at least 5-7 days in early pregnancy.

Youmay have an ultrasound between 18 to 20 weeks to evaluate dates, amultiples pregnancy, placenta location or complications. It may alsobe possible to determine the gender of your baby during this ultrasound.Several factors, such as the stage of pregnancy and position of the fetus,will influence the accuracy of the gender prediction.

To be 100% sureyou will have an anxious wait until the birth!

Ultrasoundsare only necessary if there is a medical concern. As noted above,ultrasounds enable your healthcare provider to evaluate the babyswell being as well as diagnose potential problems. For women withan uncomplicated pregnancy, an ultrasound is not a necessary partof prenatal care.

Last updated: November 3, 2017 at 14:29 pm

Compiled using information from the following sources:

1. Williams Obstetrics Twenty-Second Ed. Cunningham,F. Gary, et al, Ch. 16.

2. American Institute of Ultrasound in Medicine

https://www.aium.org

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Ultrasound: Sonogram - American Pregnancy Association

Overview

Hyperparathyroidism is an excess of parathyroid hormone in the bloodstream due to overactivity of one or more of the body's four parathyroid glands. These glands are about the size of a grain of rice and are located in your neck.

The parathyroid glands produce parathyroid hormone, which helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning.

Two types of hyperparathyroidism exist. In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of the hormone, resulting in high levels of calcium in the blood (hypercalcemia), which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism.

Secondary hyperparathyroidism occurs as a result of another disease that initially causes low levels of calcium in the body and over time, increased parathyroid hormone levels occur.

Hyperparathyroidism is often diagnosed before signs or symptoms of the disorder are apparent. When symptoms do occur, they're the result of damage or dysfunction in other organs or tissues due to high calcium levels circulating in the blood and urine or too little calcium in bones.

Symptoms may be so mild and nonspecific that they don't seem at all related to parathyroid function, or they may be severe. The range of signs and symptoms include:

See your doctor if you have any signs or symptoms of hyperparathyroidism. These symptoms could be caused by any number of disorders, including some with serious complications. It's important to get a prompt, accurate diagnosis and appropriate treatment.

Hyperparathyroidism is caused by factors that increase the production of parathyroid hormone.

The parathyroid glands maintain proper levels of both calcium and phosphorus in your body by turning the secretion of parathyroid hormone (PTH) off or on, much like a thermostat controls a heating system to maintain a constant air temperature. Vitamin D also is involved in regulating the amount of calcium in your blood.

Normally, this balancing act works well. When calcium levels in your blood fall too low, your parathyroid glands secrete enough PTH to restore the balance. PTH raises calcium levels by releasing calcium from your bones and increasing the amount of calcium absorbed from your small intestine.

When blood-calcium levels are too high, the parathyroid glands produce less PTH. But sometimes one or more of these glands produce too much hormone, leading to abnormally high levels of calcium (hypercalcemia) and low levels of phosphorus in your blood.

The mineral calcium is best known for its role in keeping your teeth and bones healthy. But calcium has other functions. It aids in the transmission of signals in nerve cells, and it's involved in muscle contraction. Phosphorus, another mineral, works in conjunction with calcium in these areas.

The disorder can generally be divided into two types based on the cause. Hyperparathyroidism may occur because of a problem with the parathyroid glands themselves (primary hyperparathyroidism) or because of another disease that affects the glands' function (secondary hyperparathyroidism).

Primary hyperparathyroidism occurs because of some problem with one or more of the four parathyroid glands:

Primary hyperparathyroidism usually occurs randomly, but some people inherit a gene that causes the disorder.

Secondary hyperparathyroidism is the result of another condition that lowers calcium levels. Therefore, your parathyroid glands overwork to compensate for the loss of calcium. Factors that may contribute to secondary hyperparathyroidism include:

Severe vitamin D deficiency. Vitamin D helps maintain appropriate levels of calcium in the blood, and it helps your digestive system absorb calcium from your food.

Your body produces vitamin D when your skin is exposed to sunlight, and you consume some vitamin D in food. If you don't get enough vitamin D, then calcium levels may drop.

You may be at an increased risk of primary hyperparathyroidism if you:

Complications of hyperparathyroidism are primarily related to the long-term effect of too little calcium in your bones and too much calcium circulating in your bloodstream. Common complications include:

Here is the original post:
Hyperparathyroidism - Symptoms and causes - Mayo Clinic

Melatonin, hormone secreted by the pineal gland, a tiny endocrine gland situated at the centre of the brain. Melatonin was first isolated in 1958 by American physician Aaron B. Lerner and his colleagues at Yale University School of Medicine. They gave the substance its name on the basis of its ability to lighten skin colour in frogs by reversing the skin-darkening effects of melanocyte-stimulating hormone. Melatonin, a derivative of the amino acid tryptophan, is produced in humans, other mammals, birds, reptiles, and amphibians.

In humans, melatonin plays an important role in the regulation of sleep cycles (i.e., circadian rhythm). Its production is influenced by the detection of light and dark by the retina of the eye. For example, the production of melatonin is inhibited when the retina detects light and is stimulated in the absence of light. Special photoreceptor cells in the retina send signals about light status to the suprachiasmatic nucleus (SCN) in the hypothalamus of the brain. These signals are then transmitted to the pineal gland. Melatonin generation by the pineal gland, which peaks during the nighttime hours, induces physiological changes that promote sleep, such as decreased body temperature and respiration rate. During the day, melatonin levels are low because large amounts of light are detected by the retina. Light inhibition of melatonin production is central to stimulating wakefulness in the morning and to maintaining alertness throughout the day.

Melatonin receptors are found in the SCN and the pituitary gland of the brain, as well as in the ovaries, blood vessels, and intestinal tract. There is a high concentration of receptors in the SCN because this is where melatonin mediates the majority of its affects on circadian rhythm. The binding of melatonin to its receptors on the pituitary gland and the ovaries appears to play a role in regulating the release of reproductive hormones in females. For example, the timing, length, and frequency of menstrual cycles in women are influenced by melatonin. In addition, in certain mammals (other than humans), such as horses and sheep, melatonin acts as a breeding and mating cue, since it is produced in greater amounts in response to the longer nights of winter and less so during summer. Animals who time their mating or breeding to coincide with favourable seasons (such as spring) may depend on melatonin production as a kind of biological clock that regulates their reproductive cycles on the basis of the length of the solar day.

Melatonin has antiaging properties. For example, it acts as an antioxidant, neutralizing harmful oxidative radicals, and it is capable of activating certain antioxidant enzymes. Melatonin production gradually declines with age, and its loss is associated with several age-related diseases. Melatonin also plays a role in modulating certain functions of the immune system.

Synthetic melatonin is available in pill form and can be used to treat insomnia and other sleep disorders, to adjust sleep schedules following jet lag or other major disruptions, and to help blind people establish night and day cycles. Melatonin supplements may also help lower blood pressure and aid in withdrawal from benzodiazepines, though further research is needed.

Read more:
melatonin | Description, Hormone, & Effects | Britannica.com

This web site offers health, wellness, fitness and nutritional information and is provided for informational purposes only. This information is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment, Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or using any treatment for a health problem. If you have or suspect that you have a medical problem, contact your health care provider promptly. Do not disregard professional medical advice or delay in seeking professional advice because of something you have read on this web site. The use of any information provided on this web site is solely at your own risk. Nothing stated or posted on this web site or available through any services offered by Dr. Jolene Brighten, ND and Brighten Wellness, LLC, are intended to be, and must not be taken to be, the practice of medicine. Information provided on this web site DOES NOT create a doctor-patient relationship between you and any doctor affiliated with our web site. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.

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Original post:
Supplements Archives - Dr. Jolene Brighten

Thyroid hormone is easy to take. Because it stays in your system for a long time, it can be taken just once a day, and this results in very stable levels of thyroid hormone in the blood stream. When thyroid hormone is used to treat hypothyroidism, the goal of treatment is to keep thyroid function within the same range as people without thyroid problems. Keeping the TSH level in the normal range does this. The best time to take thyroid hormone is probably first thing in the morning on an empty stomach. This is because food in the stomach can affect the absorption of thyroid hormone. However, the most important thing is to be consistent, and take your thyroid hormone at the same time, and in the same way, every day. If you are taking several other medications, you should discuss the timing of your thyroid hormone dose with your physician. Sometimes taking your thyroid hormone at night can make it simpler to prevent your thyroid hormone from interacting with food or other medications.

Do not stop your thyroid hormone without discussing this with your physician. Most thyroid problems are permanent, and therefore most patients require thyroid hormone for life. If you miss a dose of thyroid hormone, it is usually best to take the missed dose as soon as you remember. It is also safe to take two pills the next day; one in the morning and one in the evening. It is very important that your thyroid hormone and TSH levels are checked periodically, even if you are feeling fine, so that your dose of thyroid hormone can be adjusted if needed.

Continue reading here:
Thyroid Hormone Treatment | American Thyroid Association

The thyroid is a small butterfly-shaped gland inside the neck, located in front of the trachea (windpipe) and below the larynx (voicebox). It produces two thyroid hormonestriiodothyronine (T3) and thyroxine (T4)that travel through the blood to all tissues of the body.

Thyroid hormones regulate how the body breaks down food and either uses that energy immediately or stores it for the future. In other words, our thyroid hormones regulate our body's metabolism.

Another gland, called the pituitary gland, controls how well the thyroid works. The pituitary gland is located at the base of the brain and produces thyroid-stimulating hormone (TSH). The bloodstream carries TSH to the thyroid gland, where it tells the thyroid to produce more thyroid hormones, as needed.

Thyroid hormones influence virtually every organ system in the body. They tell organs how fast or slow they should work. Thyroid hormones also regulate the consumption of oxygen and the production of heat.

Endocrinologistsphysicians and scientists who study and care for patients with endocrine gland and hormone problemsstudy and treat several major disorders of the thyroid gland. The following is a list of some common thyroid disorders.

Too much thyroid hormone from an overactive thyroid gland is called hyperthyroidism, because it speeds up the body's metabolism. This hormone imbalance occurs in about 1 percent of all women, who get hyperthyroidism more often than men. One of the most common forms of hyperthyroidism is known as Graves' disease. This autoimmune disorder (when your bodys defense system attacks your own cells) tends to run in families. Because the thyroid gland is producing too much hormone in hyperthyroidism, the body develops an increased metabolic state, with many body systems developing abnormal function.

Too little thyroid hormone from an underactive thyroid gland is called hypothyroidism. In hypothyroidism, the body's metabolism is slowed. Several causes for this condition exist, most of which affect the thyroid gland directly, impairing its ability to make enough hormone. More rarely, there may be a pituitary gland tumor, which blocks the pituitary from producing TSH. Whether the problem is caused by the thyroid or by the pituitary gland, the result is that the thyroid is producing too few hormones, causing many physical and mental processes to become sluggish. The body consumes less oxygen and produces less body heat.

A thyroid nodule is a small lump in the thyroid gland. Thyroid nodules are common. These nodules can be either a growth of thyroid tissue or a fluid-filled cyst, which forms a lump in the thyroid gland. Almost half of the population will have tiny thyroid nodules at some point in their lives but, typically, these are not noticeable until they become large and affect normal thyroid size. About 5% of people develop large nodules, more than a half inch across (about 1 centimeter).

Although most nodules are not cancerous, people who have them should seek medical attention to rule out cancer. Also, some thyroid nodules may produce too much thyroid hormone and cause hyperthyroidism, or become too large, interfering with breathing or swallowing or causing neck discomfort.

Other thyroid problems include cancer, thyroiditis (swelling of the thyroid gland), or a goiter, which is an enlargement of the thyroid gland.

July 2018

Editors

Bryan Haugen, MD

Leonard Wartofsky, MD, MACP

Ramon Martinez, MD

Continued here:
Thyroid Disorders | Hormone Health Network

The use of bioidentical hormones got a lot of press after Suzanne Somers (Threes Company cast member and promoter of the ThighMaster) began touting them as an alternative to synthetic hormone replacement. I wholeheartedly agree that bioidentical hormones are preferable to synthetic hormone replacement therapy (HRT). Recall the large experiment on the female population known as the Womens Health Initiative Postmenopausal Hormone Therapy Trials. If you arent familiar with the results of that study, here is a summary provided by the National Institutes of Health:

Compared with the placebo, estrogen plus progestin resulted in:

Increased risk of heart attackIncreased risk of strokeIncreased risk of blood clotsIncreased risk of breast cancerReduced risk of colorectal cancerFewer fracturesNo protection against mild cognitive impairment and increased risk of dementia (study included only women 65 and older)

Compared with the placebo, estrogen alone resulted in:

No difference in risk for heart attackIncreased risk of strokeIncreased risk of blood clotsUncertain effect for breast cancerNo difference in risk for colorectal cancerReduced risk of fracture(Findings about memory and cognitive function are not yet available.)

Just because synthetic hormones come with proven risk, it seems that people have decided bioidentical hormones are totally fine to take. Bioidentical hormones are crafted to be the exact molecular structure of the hormone(s) your body produces. Synthetic hormones, on the other hand are not. Synthetic hormones are typically a bit different from the exact structure that your body makes because that way it can be patented by the manufacturer.

The purpose of this article is not necessarily to compare and contrast synthetic from bioidentical HRT; but to alert you as to how the body responds when bioidentical (and synthetic) hormones are taken. Well, really to alert you on the downside consequences of taking ANY hormones. The physiology is simple and logical. It can be more in depth, but Ill focus on the basics. By the way, Im referring to the pathways of the most commonly replaced hormones, steroid (e.g.: estrogen, testosterone, progesterone, cortisol, DHEA, etc.) and thyroid hormones.

Most hormones work in the body via a negative feedback loop. This means that as the level of a hormone rises, a signal is mediated that ceases that hormones production and release; in order to prevent the production of the hormone from getting out of control. Lets begin with an example using thyroid hormone.

The three main glands involved in thyroid hormone production are the hypothalamus, pituitary and thyroid. The hypothalamus releases thyroid releasing hormone (TRH), which stimulates the pituitary gland to release thyroid stimulating hormone (TSH), which in turn stimulates the thyroid gland to manufacture and release thyroid hormones (thyroxine or T4 and triiodothyronine or T3). Once the thyroid hormone begins to do its job throughout the body, production begins to decline, so as not to produce too many hormones. So, as the level of thyroid hormone increases, the levels of TRH and TSH decrease. Its called a negative feedback loop because the rise in hormone levels results in a decreased production; as opposed to a positive feedback loop where a rise in hormone levels would produce an even greater rise in the level of that same hormone. The only example of a hormone that works on a positive feedback loop that I can think of is oxytocin.

Because these hormones work this way, you may be able to guess what happens when you are exposed to (i.e.: ingest) exogenous hormones. Exogenous (as opposed to endogenous) refers to those taken in from outside the body, and can be any type of hormone. So, if you take a hormone, you can be sure that those negative feedback loops will still function as usual. The resultyour body stops (or significantly slows) its own production of these hormones. Whats wrong with that? Eventually, youll be dependent on these hormones as your glands have gone to sleep, because someone else is doing their job. Its simply not necessary for the glands to have to do anything.

So if you stop taking them, it may be extremely difficult to get your bodys own production back up to par. Now, considering people often take hormones because theyre not producing enough on their own in the first place, you can imagine how difficult it would be to begin the production process after taking exogenous hormones and suppressing your hormone production even further. Therefore, people usually become completely dependent on hormones, bioidentical or not. In general, as long as youre okay with taking a hormone for the rest of your life, there is no need to worry. However, most (if not all) of my patients shun that idea.

The next issue is that of hormone receptor insensitivity. Generally speaking, each hormone docks into a receptor on its target cell. Its as if the receptor is the lock and the hormone is the key. Once the cell door opens, the hormone goes on to carry out its function (usually turning on or off genes). The problem with bombarding the cells with large doses of a hormone is that eventually its as if the cell decides to change the lock on the door. The result is that it is harder and harder for the hormone to open the cell door, and therefore more and more of the hormone is needed each successive time you want to make an effect on the cell/genes. Its almost as if you need enough hormone to knock the cell door down, because it doesnt want to open. This is especially prevalent with the use of hormone creams (usu. progesterone). However, if you make no lifestyle changes it typically happens with any hormone. Thats why people on thyroid hormone often have to continue increasing the dose to get the same effect; the same goes for those who take insulin. Have you ever known of diabetic or person with hypothyroidism (except for autoimmune thyroid disease/Hashimotos) that had to decrease their dose, without making lifestyle changes? So, taking a hormone for the rest of your life may not even do the trick, especially insulin. You may be familiar with how well diabetics fare without changing their lifestyle, and continually increasing their doses of insulin. By the way, hormone receptor sites often run out of the vitamin and minerals that are necessary to allow them to function properly, due to the constant bombardment of hormones they are subject to in these cases.

This is not to say that no one should be on HRT, bioidentical or synthetic. There is a time and place for everything. And when these hormones are necessary, they can be miraculous. The big question is: When are they necessary? Thats a debatable issue and can certainly vary between individuals. So I am not absolutely against HRT, though I definitely prefer bioidentical over synthetic when possible.

The point Im trying to get across is that I wouldnt recommend anyone start with HRT, unless they are in a very unmanageable state. In these instances, one option may be to start with HRT to prime the pump and then eventually wean off them. Unfortunately, with all the books written about HRT and the attention it gets these days, many people (and doctors) go straight for hormones (with or without lab tests). Dont get me wrong, chances are youll feel like a million bucks if you take hormones that you are deficient in, or insensitive to. But dont forget to ask the million dollar question just because you feel like a million bucks: How long does that last? Well, there is no single answer to that question because everybodys condition and lifestyle is a bit different. But, from what Ive seen, it lasts about six months at best, before they have to adjust the dose upward. You may eventually find yourself always having to increase the dose to get the same effect. And finally, your cells just may not respond adequately, despite the dose. Thats not say there is no hope though.

Im currently working with a patient who had low testosterone and used testosterone replacement therapy for over a year. Sure enough, he had to continually increase the dose, until it eventually stopped giving him the results he needed (i.e.: absence of musculoskeletal pain, strength, libido, and an erection). In this case (and others), I determine if the hypothalamus, pituitary, gonads (when it comes to testosterone), and/or cell receptors need support. Fortunately, in the above mentioned case, the patient got immediate results that according to him, showed via the number of plates he kept adding on the machines at the gym.

In some cases, it may not be easy to get everything back up and running like new. But with the proper nutritional support and lifestyle improvements, it certainly is an attainable goal. The willingness of the patient to change their lifestyle and the length of time the person has been on hormones are two very important factors that will help to determine the outcome. Fortunately, I havent seen a lost cause yet; but I sure have seen people feeling miserable after the hormones stop giving the desired effect. Remember, theres no such thing as a free lunch!

Not to go into politicsbut Im a big advocate of being able to buy supplements over-the-counter. Although I truly believe that hormones should only be dispensed through licensed health care practitioners who know how to use them.

PS: There are more problems associated with HRT (bioidentical or not) than what I mentioned above. For example, many men who take testosterone can eventually wind up converting it into estrogen (just about the opposite effect they are looking for)thats enough on that for now.

PSS: Im not saying that bioidentical hormones are never necessary. They certainly can be in some instancesjust consider the potential side-effects and work with a licensed, competent, qualified health care professional who knows how to use them appropriately. They can be very useful to prime the pump when other lifestyle changes are implemented.

Dr. Robert DAquila NYC Chiropractor Applied Kinesiology

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Bioidentical Hormone Doctors

The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol.[1][2] They are found above the kidneys. Each gland has an outer cortex which produces steroid hormones and an inner medulla. The adrenal cortex itself is divided into three zones: the zona glomerulosa, the zona fasciculata and the zona reticularis.[3]

The adrenal cortex produces three main types of steroid hormones: mineralocorticoids, glucocorticoids, and androgens. Mineralocorticoids (such as aldosterone) produced in the zona glomerulosa help in the regulation of blood pressure and electrolyte balance. The glucocorticoids cortisol and corticosterone are synthesized in the zona fasciculata; their functions include the regulation of metabolism and immune system suppression. The innermost layer of the cortex, the zona reticularis, produces androgens that are converted to fully functional sex hormones in the gonads and other target organs.[4] The production of steroid hormones is called steroidogenesis, and involves a number of reactions and processes that take place in cortical cells.[5] The medulla produces the catecholamines adrenaline and noradrenaline, which function to produce a rapid response throughout the body in stress situations.[4]

A number of endocrine diseases involve dysfunctions of the adrenal gland. Overproduction of cortisol leads to Cushing's syndrome, whereas insufficient production is associated with Addison's disease. Congenital adrenal hyperplasia is a genetic disease produced by dysregulation of endocrine control mechanisms.[4][6] A variety of tumors can arise from adrenal tissue and are commonly found in medical imaging when searching for other diseases.[7]

The adrenal glands are located on both sides of the body in the retroperitoneum, above and slightly medial to the kidneys. In humans, the right adrenal gland is pyramidal in shape, whereas the left is semilunar or crescent shaped and somewhat larger.[8] The adrenal glands measure approximately 3cm in width, 5.0cm in length, and up to 1.0cm in thickness.[9] Their combined weight in an adult human ranges from 7 to 10grams.[10] The glands are yellowish in colour.[8]

The adrenal glands are surrounded by a fatty capsule and lie within the renal fascia, which also surrounds the kidneys. A weak septum (wall) of connective tissue separates the glands from the kidneys.[11] The adrenal glands are directly below the diaphragm, and are attached to the crura of the diaphragm by the renal fascia.[11]

Each adrenal gland has two distinct parts, each with a unique function, the outer adrenal cortex and the inner medulla, both of which produce hormones.[12]

The adrenal cortex is the outermost layer of the adrenal gland. Within the cortex are three layers, called "zones". When viewed under a microscope each layer has a distinct appearance, and each has a different function.[13] The adrenal cortex is devoted to production of hormones, namely aldosterone, cortisol, and androgens.[14]

The outermost zone of the adrenal cortex is the zona glomerulosa. It lies immediately under the fibrous capsule of the gland. Cells in this layer form oval groups, separated by thin strands of connective tissue from the fibrous capsule of the gland and carry wide capillaries.[15]

This layer is the main site for production of aldosterone, a mineralocorticoid, by the action of the enzyme aldosterone synthase.[16][17] Aldosterone plays an important role in the long-term regulation of blood pressure.[18]

The zona fasciculata is situated between the zona glomerulosa and zona reticularis. Cells in this layer are responsible for producing glucocorticoids such as cortisol.[19] It is the largest of the three layers, accounting for nearly 80% of the volume of the cortex.[3] In the zona fasciculata, cells are arranged in columns radially oriented towards the medulla. Cells contain numerous lipid droplets, abundant mitochondria and a complex smooth endoplasmic reticulum.[15]

The innermost cortical layer, the zona reticularis, lies directly adjacent to the medulla. It produces androgens, mainly dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), and androstenedione (the precursor to testosterone) in humans.[19] Its small cells form irregular cords and clusters, separated by capillaries and connective tissue. The cells contain relatively small quantities of cytoplasm and lipid droplets, and sometimes display brown lipofuscin pigment.[15]

The adrenal medulla is at the centre of each adrenal gland, and is surrounded by the adrenal cortex. The chromaffin cells of the medulla are the body's main source of the catecholamines adrenaline and noradrenaline, released by the medulla. Approximately 20% noradrenaline (norepinephrine) and 80% adrenaline (epinephrine) are secreted here.[19]

The adrenal medulla is driven by the sympathetic nervous system via preganglionic fibers originating in the thoracic spinal cord, from vertebrae T5T11.[20] Because it is innervated by preganglionic nerve fibers, the adrenal medulla can be considered as a specialized sympathetic ganglion.[20] Unlike other sympathetic ganglia, however, the adrenal medulla lacks distinct synapses and releases its secretions directly into the blood.

The adrenal glands have one of the greatest blood supply rates per gram of tissue of any organ: up to 60 small arteries may enter each gland.[21] Three arteries usually supply each adrenal gland:[8]

These blood vessels supply a network of small arteries within the capsule of the adrenal glands. Thin strands of the capsule enter the glands, carrying blood to them.[8]

Venous blood is drained from the glands by the suprarenal veins, usually one for each gland:[8]

The central adrenomedullary vein, in the adrenal medulla, is an unusual type of blood vessel. Its structure is different from the other veins in that the smooth muscle in its tunica media (the middle layer of the vessel) is arranged in conspicuous, longitudinally oriented bundles.[3]

The adrenal glands may not develop at all, or may be fused in the midline behind the aorta.[12] These are associated with other congenital abnormalities, such as failure of the kidneys to develop, or fused kidneys.[12] The gland may develop with a partial or complete absence of the cortex, or may develop in an unusual location.[12]

The adrenal gland secretes a number of different hormones which are metabolised by enzymes either within the gland or in other parts of the body. These hormones are involved in a number of essential biological functions.[23]

Corticosteroids are a group of steroid hormones produced from the cortex of the adrenal gland, from which they are named.[24] Corticosteroids are named according to their actions:

The adrenal gland produces aldosterone, a mineralocorticoid, which is important in the regulation of salt ("mineral") balance and blood volume. In the kidneys, aldosterone acts on the distal convoluted tubules and the collecting ducts by increasing the reabsorption of sodium and the excretion of both potassium and hydrogen ions.[18] Aldosterone is responsible for the reabsorption of about 2% of filtered glomerular filtration rates.[27] Sodium retention is also a response of the distal colon and sweat glands to aldosterone receptor stimulation. Angiotensin II and extracellular potassium are the two main regulators of aldosterone production.[19] The amount of sodium present in the body affects the extracellular volume, which in turn influences blood pressure. Therefore, the effects of aldosterone in sodium retention are important for the regulation of blood pressure.[28]

Cortisol is the main glucocorticoid in humans. In species that do not create cortisol, this role is played by corticosterone instead. Glucocorticoids have many effects on metabolism. As their name suggests, they increase the circulating level of glucose. This is the result of an increase in the mobilization of amino acids from protein and the stimulation of synthesis of glucose from these amino acids in the liver. In addition, they increase the levels of free fatty acids, which cells can use as an alternative to glucose to obtain energy. Glucocorticoids also have effects unrelated to the regulation of blood sugar levels, including the suppression of the immune system and a potent anti-inflammatory effect. Cortisol reduces the capacity of osteoblasts to produce new bone tissue and decreases the absorption of calcium in the gastrointestinal tract.[28]

The adrenal gland secretes a basal level of cortisol but can also produce bursts of the hormone in response to adrenocorticotropic hormone (ACTH) from the anterior pituitary. Cortisol is not evenly released during the day its concentrations in the blood are highest in the early morning and lowest in the evening as a result of the circadian rhythm of ACTH secretion.[28] Cortisone is an inactive product of the action of the enzyme 11-HSD on cortisol. The reaction catalyzed by 11-HSD is reversible, which means that it can turn administered cortisone into cortisol, the biologically active hormone.[28]

All corticosteroid hormones share cholesterol as a common precursor. Therefore, the first step in steroidogenesis is cholesterol uptake or synthesis. Cells that produce steroid hormones can acquire cholesterol through two paths. The main source is through dietary cholesterol transported via the blood as cholesterol esters within low density lipoproteins (LDL). LDL enters the cells through receptor-mediated endocytosis. The other source of cholesterol is synthesis in the cell's endoplasmic reticulum. Synthesis can compensate when LDL levels are abnormally low.[4] In the lysosome, cholesterol esters are converted to free cholesterol, which is then used for steroidogenesis or stored in the cell.[29]

The initial part of conversion of cholesterol into steroid hormones involves a number of enzymes of the cytochrome P450 family that are located in the inner membrane of mitochondria. Transport of cholesterol from the outer to the inner membrane is facilitated by steroidogenic acute regulatory protein and is the rate-limiting step of steroid synthesis.[29]

The layers of the adrenal gland differ by function, with each layer having distinct enzymes that produce different hormones from a common precursor.[4] The first enzymatic step in the production of all steroid hormones is cleavage of the cholesterol side chain, a reaction that forms pregnenolone as a product and is catalyzed by the enzyme P450scc, also known as cholesterol desmolase. After the production of pregnenolone, specific enzymes of each cortical layer further modify it. Enzymes involved in this process include both mitochondrial and microsomal P450s and hydroxysteroid dehydrogenases. Usually a number of intermediate steps in which pregnenolone is modified several times are required to form the functional hormones.[5] Enzymes that catalyze reactions in these metabolic pathways are involved in a number of endocrine diseases. For example, the most common form of congenital adrenal hyperplasia develops as a result of deficiency of 21-hydroxylase, an enzyme involved in an intermediate step of cortisol production.[30]

Glucocorticoids are under the regulatory influence of the hypothalamus-pituitary-adrenal (HPA) axis. Glucocorticoid synthesis is stimulated by adrenocorticotropic hormone (ACTH), a hormone released into the bloodstream by the anterior pituitary. In turn, production of ACTH is stimulated by the presence of corticotropin-releasing hormone (CRH), which is released by neurons of the hypothalamus. ACTH acts on the adrenal cells first by increasing the levels of StAR within the cells, and then of all steroidogenic P450 enzymes. The HPA axis is an example of a negative feedback system, in which cortisol itself acts as a direct inhibitor of both CRH and ACTH synthesis. The HPA axis also interacts with the immune system through increased secretion of ACTH at the presence of certain molecules of the inflammatory response.[4]

Mineralocorticoid secretion is regulated mainly by the reninangiotensinaldosterone system (RAAS), the concentration of potassium, and to a lesser extent the concentration of ACTH.[4] Sensors of blood pressure in the juxtaglomerular apparatus of the kidneys release the enzyme renin into the blood, which starts a cascade of reactions that lead to formation of angiotensin II. Angiotensin receptors in cells of the zona glomerulosa recognize the substance, and upon binding they stimulate the release of aldosterone.[31]

Primarily referred to in the United States as epinephrine and norepinephrine, adrenaline and noradrenaline are catecholamines, water-soluble compounds that have a structure made of a catechol group and an amine group. The adrenal glands are responsible for most of the adrenaline that circulates in the body, but only for a small amount of circulating noradrenaline.[23] These hormones are released by the adrenal medulla, which contains a dense network of blood vessels. Adrenaline and noradrenaline act at adrenoreceptors throughout the body, with effects that include an increase in blood pressure and heart rate.[23] actions of adrenaline and noradrenaline are responsible for the fight or flight response, characterised by a quickening of breathing and heart rate, an increase in blood pressure, and constriction of blood vessels in many parts of the body.[32]

Catecholamines are produced in chromaffin cells in the medulla of the adrenal gland, from tyrosine, a non-essential amino acid derived from food or produced from phenylalanine in the liver. The enzyme tyrosine hydroxylase converts tyrosine to L-DOPA in the first step of catecholamine synthesis. L-DOPA is then converted to dopamine before it can be turned into noradrenaline. In the cytosol, noradrenaline is converted to epinephrine by the enzyme phenylethanolamine N-methyltransferase (PNMT) and stored in granules. Glucocorticoids produced in the adrenal cortex stimulate the synthesis of catecholamines by increasing the levels of tyrosine hydroxylase and PNMT.[4][13]

Catecholamine release is stimulated by the activation of the sympathetic nervous system. Splanchnic nerves of the sympathetic nervous system innervate the medulla of the adrenal gland. When activated, it evokes the release of catecholamines from the storage granules by stimulating the opening of calcium channels in the cell membrane.[33]

Cells in zona reticularis of the adrenal glands produce male sex hormones, or androgens, the most important of which is DHEA. In general, these hormones do not have an overall effect in the male body, and are converted to more potent androgens such as testosterone and DHT or to estrogens (female sex hormones) in the gonads, acting in this way as a metabolic intermediate.[34]

Thehuman genomeincludes approximately 20,000 protein coding genes and 70% of thesegenes are expressedin the normal, adult adrenal glands.[35][36]Only some 250 genes are more specifically expressed in the adrenal glands compared to other organs and tissues.The adrenal gland specific genes with highest level of expression include members of the cytochrome P450 superfamily of enzymes. Corresponding proteins are expressed in the different compartments of the adrenal gland, such as CYP11A1, HSD3B2 and FDX1 involved in steroid hormone synthesis and expressed in cortical cell layers, and PNMT and DBH involved in noradrenalin and adrenalin synthesis and expressed in the medulla.[37]

The adrenal glands are composed of two heterogenous types of tissue. In the center is the adrenal medulla, which produces adrenaline and noradrenaline and releases them into the bloodstream, as part of the sympathetic nervous system. Surrounding the medulla is the cortex, which produces a variety of steroid hormones. These tissues come from different embryological precursors and have distinct prenatal development paths. The cortex of the adrenal gland is derived from mesoderm, whereas the medulla is derived from the neural crest, which is of ectodermal origin.[12]

The adrenal glands in a newborn baby are much larger as a proportion of the body size than in an adult.[38] For example, at age three months the glands are four times the size of the kidneys. The size of the glands decreases relatively after birth, mainly because of shrinkage of the cortex. The cortex, which almost completely disappears by age 1, develops again from age 45. The glands weigh about 1 g at birth[12] and develop to an adult weight of about 4 grams each.[28] In a fetus the glands are first detectable after the sixth week of development.[12]

Adrenal cortex tissue is derived from the intermediate mesoderm. It first appears 33 days after fertilisation, shows steroid hormone production capabilities by the eighth week and undergoes rapid growth during the first trimester of pregnancy. The fetal adrenal cortex is different from its adult counterpart, as it is composed of two distinct zones: the inner "fetal" zone, which carries most of the hormone-producing activity, and the outer "definitive" zone, which is in a proliferative phase. The fetal zone produces large amounts of adrenal androgens (male sex hormones) that are used by the placenta for estrogen biosynthesis.[39] Cortical development of the adrenal gland is regulated mostly by ACTH, a hormone produced by the pituitary gland that stimulates cortisol synthesis.[40] During midgestation, the fetal zone occupies most of the cortical volume and produces 100200mg/day of DHEA-S, an androgen and precursor of both androgens and estrogens (female sex hormones).[41] Adrenal hormones, especially glucocorticoids such as cortisol, are essential for prenatal development of organs, particularly for the maturation of the lungs. The adrenal gland decreases in size after birth because of the rapid disappearance of the fetal zone, with a corresponding decrease in androgen secretion.[39]

During early childhood androgen synthesis and secretion remain low, but several years before puberty (from 68 years of age) changes occur in both anatomical and functional aspects of cortical androgen production that lead to increased secretion of the steroids DHEA and DHEA-S. These changes are part of a process called adrenarche, which has only been described in humans and some other primates. Adrenarche is independent of ACTH or gonadotropins and correlates with a progressive thickening of the zona reticularis layer of the cortex. Functionally, adrenarche provides a source of androgens for the development of axillary and pubic hair before the beginning of puberty.[42][43]

The adrenal medulla is derived from neural crest cells, which come from the ectoderm layer of the embryo. These cells migrate from their initial position and aggregate in the vicinity of the dorsal aorta, a primitive blood vessel, which activates the differentiation of these cells through the release of proteins known as BMPs. These cells then undergo a second migration from the dorsal aorta to form the adrenal medulla and other organs of the sympathetic nervous system.[44] Cells of the adrenal medulla are called chromaffin cells because they contain granules that stain with chromium salts, a characteristic not present in all sympathetic organs. Glucocorticoids produced in the adrenal cortex were once thought to be responsible for the differentiation of chromaffin cells. More recent research suggests that BMP-4 secreted in adrenal tissue is the main responsible for this, and that glucocorticoids only play a role in the subsequent development of the cells.[45]

The normal function of the adrenal gland may be impaired by conditions such as infections, tumors, genetic disorders and autoimmune diseases, or as a side effect of medical therapy. These disorders affect the gland either directly (as with infections or autoimmune diseases) or as a result of the dysregulation of hormone production (as in some types of Cushing's syndrome) leading to an excess or insufficiency of adrenal hormones and the related symptoms.

Cushing's syndrome is the manifestation of glucocorticoid excess. It can be the result of a prolonged treatment with glucocorticoids or be caused by an underlying disease which produces alterations in the HPA axis or the production of cortisol. Causes can be further classified into ACTH-dependent or ACTH-independent. The most common cause of endogenous Cushing's syndrome is a pituitary adenoma which causes an excessive production of ACTH. The disease produces a wide variety of signs and symptoms which include obesity, diabetes, increased blood pressure, excessive body hair (hirsutism), osteoporosis, depression, and most distinctively, stretch marks in the skin, caused by its progressive thinning.[4][6]

When the zona glomerulosa produces excess aldosterone, the result is primary aldosteronism. Causes for this condition are bilateral hyperplasia (excessive tissue growth) of the glands, or aldosterone-producing adenomas (a condition called Conn's syndrome). Primary aldosteronism produces hypertension and electrolyte imbalance, increasing potassium depletion and sodium retention.[6]

Adrenal insufficiency (the deficiency of glucocorticoids) occurs in about 5 in 10,000 in the general population.[6] Diseases classified as primary adrenal insufficiency (including Addison's disease and genetic causes) directly affect the adrenal cortex. If a problem that affects the hypothalamic-pituitary-adrenal axis arises outside the gland, it is a secondary adrenal insufficiency.

Addison's disease refers to primary hypoadrenalism, which is a deficiency in glucocorticoid and mineralocorticoid production by the adrenal gland. In the Western world, Addison's disease is most commonly an autoimmune condition, in which the body produces antibodies against cells of the adrenal cortex. Worldwide, the disease is more frequently caused by infection, especially from tuberculosis. A distinctive feature of Addison's disease is hyperpigmentation of the skin, which presents with other nonspecific symptoms such as fatigue.[4]

A complication seen in untreated Addison's disease and other types of primary adrenal insufficiency is the adrenal crisis, a medical emergency in which low glucocorticoid and mineralocorticoid levels result in hypovolemic shock and symptoms such as vomiting and fever. An adrenal crisis can progressively lead to stupor and coma.[4] The management of adrenal crises includes the application of hydrocortisone injections.[46]

In secondary adrenal insufficiency, a dysfunction of the hypothalamic-pituitary-adrenal axis leads to decreased stimulation of the adrenal cortex. Apart from suppression of the axis by glucocorticoid therapy, the most common cause of secondary adrenal insufficiency are tumors that affect the production of adrenocorticotropic hormone (ACTH) by the pituitary gland.[6] This type of adrenal insufficiency usually does not affect the production of mineralocorticoids, which are under regulation of the reninangiotensin system instead.[4]

Congenital adrenal hyperplasia is a congenital disease in which mutations of enzymes that produce steroid hormones result in a glucocorticoid deficiency and malfunction of the negative feedback loop of the HPA axis. In the HPA axis, cortisol (a glucocorticoid) inhibits the release of CRH and ACTH, hormones that in turn stimulate corticosteroid synthesis. As cortisol cannot be synthesized, these hormones are released in high quantities and stimulate production of other adrenal steroids instead. The most common form of congenital adrenal hyperplasia is due to 21-hydroxylase deficiency. 21-hydroxylase is necessary for production of both mineralocorticoids and glucocorticoids, but not androgens. Therefore, ACTH stimulation of the adrenal cortex induces the release of excessive amounts of adrenal androgens, which can lead to the development of ambiguous genitalia and secondary sex characteristics.[30]

Adrenal tumors are commonly found as incidentalomas, unexpected asymptomatic tumors found during medical imaging. They are seen in around 3.4% of CT scans,[7] and in most cases they are benign adenomas.[47] Adrenal carcinomas are very rare, with an incidence of 1 case per million per year.[4]

Pheochromocytomas are tumors of the adrenal medulla that arise from chromaffin cells. They can produce a variety of nonspecific symptoms, which include headaches, sweating, anxiety and palpitations. Common signs include hypertension and tachycardia. Surgery, especially adrenal laparoscopy, is the most common treatment for small pheochromocytomas.[48]

Bartolomeo Eustachi, an Italian anatomist, is credited with the first description of the adrenal glands in 1563-4.[49][50] However, these publications were part of the papal library and did not receive public attention, which was first received with Caspar Bartholin the Elder's illustrations in 1611.[50]

The adrenal glands are named for their location relative to the kidneys. The term "adrenal" comes from ad- (Latin, "near") and renes (Latin, "kidney").[51] Similarly, "suprarenal", as termed by Jean Riolan the Younger in 1629, is derived from the Latin supra (Latin: "above") and renes (Latin: kidney). The suprarenal nature of the glands was not truly accepted until the 19th century, as anatomists clarified the ductless nature of the glands and their likely secretory role prior to this, there was some debate as to whether the glands were indeed suprarenal or part of the kidney.[50]

One of the most recognized works on the adrenal glands came in 1855 with the publication of On the Constitutional and Local Effects of Disease of the Suprarenal Capsule, by the English physician Thomas Addison. In his monography, Addison described what the French physician George Trousseau would later name Addison's disease, an eponym still used today for a condition of adrenal insufficiency and its related clinical manifestations.[52] In 1894, English physiologists George Oliver and Edward Schafer studied the action of adrenal extracts and observed their pressor effects. In the following decades several physicians experimented with extracts from the adrenal cortex to treat Addison's disease.[49] Edward Calvin Kendall, Philip Hench and Tadeusz Reichstein were then awarded the 1950 Nobel Prize in Physiology or Medicine for their discoveries on the structure and effects of the adrenal hormones.[53]

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Adrenal gland - Wikipedia

A frequent need to get up and go to the bathroom to urinate at night is called nocturia. It differs from enuresis, or bedwetting, in which the person does not arouse from sleep, but the bladder empties anyway. Nocturia is a common cause of sleep loss, especially among older adults.

Most people without nocturia can sleep for 6 to 8 hours without having to urinate. Some researchers believe that one event per night is within normal limits; two or more events per night may be associated with daytime tiredness. Patients with severe nocturia may get up five or six times during the night to go to the bathroom.

Nocturia is often a symptom of other medical conditions including urological infection, a tumor of the bladder or prostate, a condition called bladder prolapse, or disorders affecting sphincter control. It is also common in people with heart failure, liver failure, poorly controlled diabetes mellitus, or diabetes insipidus. Diabetes, pregnancy and diuretic medications are also associated with nocturia.

Until recently, nocturia was thought to be caused by a full bladder, but it is also a symptom of sleep apnea.

Nocturia becomes more common as we age. As we get older, our bodies produce less of an anti-diuretic hormone that enables us to retain fluid. With decreased concentrations of this hormone, we produce more urine at night. Another reason for nocturia among the elderly is that the bladder tends to lose holding capacity as we age. Finally, older people are more likely to suffer from medical problems that may have an effect on the bladder.

In fact, nearly two-thirds (65%) of those responding to NSF's 2003 Sleep in America poll of adults between the ages of 55 and 84 reported this disturbance at least a few nights per week.

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Nocturia or Frequent Urination at Night - National Sleep ...