Wednesday, July 29, 2015

Experts Recommend Tumor Removal as First-line Treatment for Cushing's Syndrome



Endocrine Society publishes Clinical Practice Guideline on treatment of chronic excess cortisol
Washington, DC–The Endocrine Society today issued a Clinical Practice Guideline (CPG) on strategies for treating Cushing's syndrome, a condition caused by overexposure to the hormone cortisol.

The CPG, entitled "Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline," was published online and will appear in the August 2015 print issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of the Endocrine Society.

Cushing's syndrome occurs when a person has excess cortisol in the blood for an extended period, according to the Hormone Health Network. When it is present in normal amounts, cortisol is involved in the body's response to stress, maintains blood pressure and cardiovascular function, keeps the immune system in check, and converts fat, carbohydrates and proteins into energy. Chronis overexposure to the hormone can contribute to the development of cardiovascular disease, infections and blood clots in veins.

People who take cortisol-like medications such as prednisone to treat inflammatory conditions, including asthma and rheumatoid arthritis, can develop Cushing's syndrome. The high cortisol levels return to normal when they stop taking the medication. This is called exogenous Cushing's syndrome.

In other cases, tumors found on the adrenal or pituitary glands or elsewhere in the body cause the overproduction of cortisol and lead to the development of Cushing's syndrome. The Clinical Practice Guidelines focus on this form of the condition, known as endogenous Cushing's syndrome.

"People who have active Cushing's syndrome face a greater risk of death – anywhere from nearly twice as high to nearly five times higher – than the general population," said Lynnette K. Nieman, MD, of the National Institutes of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, MD, and chair of the task force that authored the guideline. "To reduce the risk of fatal cardiovascular disease, infections or blood clots, it is critical to identify the cause of the Cushing's syndrome and restore cortisol levels to the normal range."

In the CPG, the Endocrine Society recommends that the first-line treatment for endogenous Cushing's syndrome be the removal of the tumor unless surgery is not possible or unlikely to address the excess cortisol. Surgical removal of the tumor is optimal because it leaves intact the hypothalamic-pituitary-adrenal axis, which is integral to the body's central stress response.

Other recommendations from the CPG include:
  • Tumors should be removed by experienced surgeons in the following situations:
    • A tumor has formed on one or both of the two adrenal glands.
    • A tumor that secretes adrenocorticotropic hormone (ACTH) – the hormone that signals the adrenal glands to produce cortisol – has formed somewhere in the body other than the adrenal or pituitary gland.
    • A tumor has formed on the pituitary gland itself.
  • Patients who continue to have high levels of cortisol in the blood after surgery should undergo additional treatment.
  • People who had an ACTH-producing tumor should be screened regularly for the rest of their lives for high cortisol levels to spot recurrences.
  • If patients' cortisol levels are too low following surgery, they should receive glucocorticoid replacement medications and be educated about adrenal insufficiency, a condition where the adrenal glands produce too little cortisol. This condition often resolves in 1-2 years.
  • Morning cortisol and/or ACTH stimulation tests, or insulin-induced hypoglycemia, can be used to test for the recovery of the hypothalamic-pituitary-adrenal axis in people who have low cortisol levels after surgery. Once the tests results return to normal, glucocorticoid replacement can be stopped.
  • People who have undergone pituitary surgery should be re-evaluated for other pituitary hormone deficiencies during the post-operative period.
  • Patients who have a pituitary tumor and have undergone surgery to remove both adrenal glands should be regularly evaluated for tumor progression using pituitary MRIs and tests for ACTH levels.
  • Radiation therapy may be used to treat a pituitary tumor, especially if it is growing.  While awaiting the effect of radiation, which may take months to years, treatment with medication is advised.
  • To assess the effect of radiation therapy, the patient's cortisol levels should be measured at 6- to 12-month intervals.
  • Medications may be used to control cortisol levels as a second-line treatment after surgery for a pituitary gland tumor, as a primary treatment for ACTH-secreting tumors that have spread to other parts of the body or suspected ACTH-secreting tumors that cannot be detected on scans.  Medications also can be used as adjunctive treatment to reduce cortisol levels in people with adrenal cortical carcinoma, a rare condition where a cancerous growth develops in the adrenal gland.
  • People with Cushing's syndrome should be treated for conditions associated with the disease, such as cardiovascular disease risk factors, osteoporosis and psychiatric symptoms.
  • Patients should be tested for recurrence throughout their lives except in cases where the person had a benign adrenal tumor removed.
  • Patients should undergo urgent treatment within 24 to 72 hours of detecting excess cortisol if life-threatening complications such as serious infection, pulmonary thromboembolism, cardiovascular complications and acute psychosis are present.
     
The Hormone Health Network offers resources on Cushing's syndrome at http://www.hormone.org/questions-and-answers/2012/cushing-syndrome.  

Other members of the Endocrine Society task force that developed this CPG include: Beverly M.K. Biller of Massachusetts General Hospital in Boston, MA; James W. Findling of the Medical College of Wisconsin in Milwaukee, WI; M. Hassan Murad of the Mayo Clinic in Rochester, MN; John Newell-Price of the University of Sheffield in Sheffield, U.K.; Martin O. Savage of the William Harvey Research Institute at Barts and the London School of Medicine and Dentistry in London, U.K.; and Antoine Tabarin of CHU de Bordeaux and INSERM at the University of Bordeaux, Bordeaux France.

The Society established the CPG Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis and treatment of endocrine-related conditions. Each CPG is created by a task force of topic-related experts in the field. Task forces rely on scientific reviews of the literature in the development of CPG recommendations. The Endocrine Society does not solicit or accept corporate support for its CPGs. All CPGs are supported entirely by Society funds.

The CPG was co-sponsored by the European Society of Endocrinology.
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Founded in 1916, the Endocrine Society is the world's oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology.  Today, the Endocrine Society's membership consists of over 18,000 scientists, physicians, educators, nurses and students in 122 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Washington, DC. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at https://twitter.com/#!/EndoMedia.

Monday, July 27, 2015

Bioethicist speaks out against Medicare end-of-life announcement


The U.S. Centers for Medicare and Medicaid Services announced that it will begin paying doctors to counsel patients about end-of-life care, effective January 1, 2016


St. Petersburg, Fla. (July 27, 2015) – Nearly every day, Fernando Gutierrez, a certified healthcare mediator and registered professional guardian, helps patients face death with compassion, expertise and experience. He delicately guides patients and their families through the difficult choices they must make about treatments such as cardiopulmonary resuscitation (CPR), artificial breathing machines and intravenous nutrition.

Gutierrez and his team of experts at Ethics 4 Healthcare spend many hours with each patient, thoroughly discussing their end-of-life wishes, navigating through the complicated and confusing choices they are faced with, to make informed decisions:

"A patient may initially object to ever using a ventilator," explains Gutierrez. "But they might not have considered the use of a ventilator for something simple, such as pneumonia with a good prognosis. I discuss with them such circumstances and develop a relationship to understand their needs."

The U.S. Centers for Medicare and Medicaid Services recently announced that it will begin paying doctors to counsel patients about end-of-life care, effective January 1, 2016. Medicare provides health insurance for 55 million people who are at least 65 years old, and about 80 percent of Americans who die each year are insured by the program.

"This is very troubling," Gutierrez says. "Counseling patients on end-of-life care requires a great deal of time and sensitivity. Physicians are already squeezed for time as never before, rushing through appointments to see more patients, and performing more procedures to make-up for flat or declining reimbursements."

To address Gutierrez's concerns, Ethics 4 Healthcare will seek to establish a referral procedure, allowing physicians to refer a consultation with an independent bioethics committee to make informed and unbiased decisions for their end-of-life care.

About Fernando Gutierrez
Mr. Fernando Gutierrez, is a Florida Registered Professional Guardian since 2009.
Mr. Gutierrez has specialized training in clinical healthcare ethics and consultations, where he has obtained certification and certificates of accomplishment. He has graduated from numerous intensive healthcare educational courses and programs at several  prominent institutions including, the National Catholic Bioethics Center in Philadelphia, University of Washington School of Medicine, University of Virginia Medical School and Washington D.C. Hospital Center.
Mr. Gutierrez recently completed Bioethics studies at Union Graduate College, receiving another certificate in Clinical Bioethics.

About Ethics 4 Healthcare
We make sure you're making the best choices for your practice and your patients with the help of our health care ethics consultant in Clearwater, Florida. We have the knowledge and skills necessary to help you make the best decisions when it comes to working with your chronically ill, terminal and non-compliant patients and their families.
Staffing of our Bioethics Committee includes: a Certified Bioethicist, Registered Professional Guardians, Registered Nurses, Registered Dietitian and a Registered Respiratory Therapist. We have experience explaining clinical ethics, in simple and easy to learn terms. For more information, visit: http://www.ethics4healthcare.com/about-us

MICHELIN chefs collaborate for EUPHORIA's 10th anniversary






A FOOD LOVER'S DREAM:
DINNER WITH THREE MICHELIN STARRED CHEFS AT EUPHORIA
 
[Greenville, SC, July 27, 2015] – In celebration of euphoria's 10th Food, Wine and Music Festival September 17-20, 2015, euphoria has added a once-in-a-lifetime dining experience with three MICHELIN starred chefs, Saturday September 19th.  The "Coast to Coast" dinner will feature three star MICHELIN Chef Curtis Duffy of Grace in Chicago, Illinois, two star Chef Sean Gray of Momofuku Ko in New York, New York, and two star Chef David Kinch of Manresa in Los Gatos, California. Master Sommelier Fred Dexheimer will select the wines for each course. Taking place at the picturesque Hotel Domestique with Executive Chef Greg McPhee, this dinner is the crown jewel of an all-star festival. 

MICHELIN North America has operated in South Carolina for more than four decades and located its United States headquarters to Greenville, SC in 1988. The company has supported euphoria since its inception in 2006 when they invited celebrated three-star MICHELIN Chef Thomas Keller to participate.
Chef Curtis Duffy of Grace in Chicago leads this all-star chef line-up.  A Columbus OH native, Duffy moved to Chicago after culinary school to learn from the late chef Charlie Trotter at his eponymous restaurant.  After Charlie Trotter, Duffy moved on to Trio, was co-owner of Alinea with Chef Grant Achatz and earned two Michelin stars at Avenue before opening Grace in late 2012.  As the Executive Chef and owner of Grace, Duffy has garnered many accolades including Three Michelin Stars in the Chicago 2015 Guide, AAA's Five Diamond Rating, Forbes Travel Guide's 5 Star Rating, Robb Report's Best Restaurant in the World 2013, Chicago Magazine's Best New Restaurant, and Eater National's Chef of the Year.

Hailing from New York, Sean Gray is the Executive Chef of Momofuku Ko. Originally from Eastern Pennsylvania, Gray moved to New York City in 2005 after working in a variety of kitchens between New York and Philadelphia. Gray joined David Chang's Momofuku team in 2007, spending time at Noodle Bar, Ssäm Bar, and then moving to Ko in 2009 as Sous Chef. He became Ko's Chef de Cuisine in 2011 and Executive Chef in 2014. Ko has two MICHELIN stars, which it has retained for the past seven years. 

Rounding out this impressive line-up is renowned Chef David Kinch from Manresa in Los Gatos CA who has retained a two MICHELIN star rating for nine consecutive years and been at the forefront of the new contemporary California cuisine movement.  Since opening in 2002, Manresa and Kinch have been a James Beard "Outstanding Chef" finalist, Restaurant Magazine's "Top 50 Restaurants in the World," Bon Appetit's "20 Most Important Restaurants in America'" and GQ's Chef of the Year in 2011.  Additionally, Kinch's first cookbook Manresa: An Edible Reflection is a The New York Times Bestseller.
Fred Dexheimer is 1 of 210 Master Sommeliers in the world, and the only one hailing from the Carolinas. In 2007, as the National Wine and Beverage Director for BLT Restaurant Group, Dexheimer passed the Court of Master Sommeliers "Master Sommelier" exam. He is the founder of Juiceman Consulting, a restaurant, wine, spirits, and cocktail consulting agency, through which he consults for Wines of Chile and Wines of Southwest France. In 2015, he began RX Wine Lab in North Carolina, a wine bar & premier wine education service. Dexheimer competed in the "Best Sommelier in World Competition" as the representative from the United States and.is the emcee for Star Chef's SOMM SLAM.

In addition to the dinner, these famous chefs will get their hands dirty when they serve as sous chefs for the finalists of euphoria's first annual Kids in the Kitchen: Healthy Lunchtime Throwdown. Open to all Greenville County School students between the ages of 8 and 12, euphoria's cooking competition is modeled after First Lady Michelle Obama's Healthy Lunchtime Challenge and Kids' State Dinner, an annual event that promotes healthy eating and healthy lifestyles for children across the United States. Judges of the contest include Tanya Steel, founder of the Healthy Lunchtime Challenge and Kids' State Dinner in conjunction with First Lady Michelle Obama, the U.S. Department of Education and the U.S. Department of Agriculture. (Steel is also Award Director of the Julia Child Award, former editor-in-chief of epicurious.com and was an editor at Bon Appetit and Food & Wine magazines.)
Tickets for the "Coast to Coast" dinner are $350 each and are available at: http://www.euphoriagreenville.com/events-and-tickets/80/coast-to-coast-michelin-star-dinner-at-hotel-domestique-

This year, euphoria celebrates its 10th year as one of the country's premier food, wine and music festivals, September 17–20, 2015 (www.EuphoriaGreenville.com; @AchieveEuphoria). What began in 2006 as a one-day festival highlighting Greenville, SC's culture, depth of talent and outstanding revitalized downtown, now draws more than 6,000 people from 30 states and multiple countries for a four-day weekend featuring nationally acclaimed chefs, celebrity singers and songwriters, craft brewers, Master Sommeliers, and unique luxury experiences. Proceeds from euphoria Food, Wine & Music Festival benefit charitable organizations that focus on providing sustenance to those in need, educating through music, and supporting children in need across the Upstate of South Carolina.

Follow on Twitter @AchieveEuphoria, on Instagram @EuphoriaGreenville,
and Euphoria Greenville on Facebook.
#euphoria2015 #KidsInTheKitchen
www.euphoriagreenville.com

When Depression Kills--STORY on Why 'Judgment' Keeps Therapy from Mainstream


 You See a Shrink?
The Judgment that Comes From Admitting You Need Help

It is often the assumption that if you go to therapy that you have serious problems you cannot manage on your own and there is something fundamentally wrong with you.  In reality, if someone is attending therapy, they tend to be on the healthier side of self-love and self-awareness.  Because seeing a therapist is stigmatized many people who want to seek help, either often don't, or they keep their therapy private so they do not invoke judgment.
1.  Everyone Can Benefit from Therapy:  We are not here to do life on our own and nor are we equipped to be 100% objective in our own lives. Therapy is the perfect way to get that objective view, get to know yourself more deeply, analyze your habits of behavior and to find solutions and resolutions to life's everyday issues.
2. Healthy People Seek Therapy:  Healthy people are on the search from continual improvement, self-awareness and better solutions to life's problems.  Healthy people are 'ok' being wrong in life and in taking direction.  They have enough self-awareness to know when they need help and when they do not.  In this way, therapy becomes a modicum for continual expansion and improvement in the quality of one's emotional life.
3, Crazy-Makers DON'T Attend Therapy:  The unhealthiest people, the people who need treatment the most, are the ones who never consider therapy. In their mind's they are never wrong, it is always someone else's problem, and they should not have to change.  Rather, the world is 'who' needs to change.  The people who end up in therapy are those trying to deal with the relationships they have with these crazy-makers—the spouses, the children, the partners, the parents.  These people, cannot benefit from therapy because they have little to no insight into themselves.
4. Own Your Personal Journey: If you have chosen to attend therapy be proud of it.  Most people who are seeing the benefits of therapy, tend to brag about how much the therapy is changing their lives. We all want to be happy and when you communicate about your therapy as a major benefit to your life you will be surprised how many people either ask for your therapists information or confess back to you they have also sought therapy.  When you own and take pride in your growth, much to your surprise many others will take your lead.
5. Reaching Higher Levels:  Therapy is that space developed and created to facilitate your growth into the higher levels of life and understanding what you wish to achieve in life. Most of our most successful people regularly attend some type of therapy, weather that be coaching, mentoring, therapy, motivational seminars, reading self-help books, etc. It is really all the same stuff being delivered through a different channel, a different medium.  Why be ashamed of something that is improving the quality of your life.
If someone is judging you for your choice to seek therapy of some sort, it says more about that person and their ignorance and insecurity than it says about your desire to improve your life, and become a happier more satisfied person.  Take hold of what you are willing to do to make this life more understandable to you and live it with confidence. Emotions are contagious, so those around you will take on the attitude that you hold about your choice to go to therapy.  If you communicate that you love it and it is transforming your life make sure to carry your Shrink's business card because you will be surprised at how many people all want the same thing…a happier and more satisfying life.

Sherrie Campbell, PhD is a veteran, licensed Psychologist with two decades of clinical training and experience providing counseling and psychotherapy services to residents of Yorba Linda, Irvine, Anaheim, Fullerton and Brea, California.  In her private practice, she currently specializes in psychotherapy with adults and teenagers, including marriage and family therapy, grief counselling, childhood trauma, sexual issues, personality disorders, illness and more. She has helped individuals manage their highest high and survive their lowest low—from winning the lottery to the death of a child.  Her interactive sessions are as unique and impactful as her new book, Loving Yourself : The Mastery of Being Your Own Person.
She earned her Ph.D. in Clinical Psychology in 2003 and has regularly contributes to numerous publications, including Intent.com, Beliefnet.com, DrLaura.com and Hitched.com.  She is also an inspirational speaker, avid writer and proud mother.  She can be reached at Sherriecampbellphd.com.
Loving Yourself: The Mastery of Being Your Own Person is available on Amazon.com and other fine booksellers.