Cortisol Health Dictionary

Metyrapone is a drug that inhibits the production of CORTISOL in the adrenal cortex, which results in an increase in ACTH production and (completing the feedback control cycle) thus greater synthesis of the chemical precursors of cortisol. Metyrapone is used to treat patients with CUSHING’S SYNDROME (a condition caused by excess amounts of corticosteroid hormones in the body) where surgery is not possible.... metyrapone

Any factor or event that threatens a person’s health or adversely affects his or her normal functioning. Injury, disease or worry are common examples; others include internal con?icts, emotive life events – such as the death of a close relative or friend, the birth of a baby, separation or divorce – pressures at work or a hostile environment such as war or famine. Some individuals seem to be more prone than others to develop medical problems related to stress.

Stress prompts the body to raise its output of HORMONES such as ADRENALINE and CORTISOL, causing changes in blood pressure, heart rate and metabolism. These are physiological responses intended to improve a person’s physical and mental performance – the ‘?ght or ?ight’ reaction to fear. Stress may, however, disrupt the ability to cope. Constant or recurrent exposure to stress may produce symptoms such as anxiety, depression, headaches, indigestion, diarrhoea, palpitations and general malaise (see POST-TRAUMATIC STRESS DISORDER (PTSD)). Treatment can be di?cult and prolonged; counselling can help as can ANXIOLYTICS or ANTIDEPRESSANT DRUGS – but a change in job or lifestyle may be necessary in some circumstances.... stress

The cause of Addison’s disease (also called chronic adrenal insu?ciency and hypocortisolism) is a de?ciency of the adrenocortical hormones CORTISOL, ALDOSTERONE and androgens (see ANDROGEN) due to destruction of the adrenal cortex (see ADRENAL GLANDS). It occurs in about 1 in 25,000 of the population. In the past, destruction of the adrenal cortex was due to TUBERCULOSIS (TB), but nowadays fewer than 20 per cent of patients have TB while 70 per cent suffer from autoimmune damage. Rare causes of Addison’s disease include metastases (see METASTASIS) from CARCINOMA, usually of the bronchus; granulomata (see GRANULOMA); and HAEMOCHROMATOSIS. It can also occur as a result of surgery for cancer of the PITUITARY GLAND destroying the cells which produce ACTH (ADRENOCORTICOTROPHIC HORMONE)

– the hormone which provokes the adrenal cortex into action.

Symptoms The clinical symptoms appear slowly and depend upon the severity of the underlying disease process. The patient usually complains of appetite and weight loss, nausea, weakness and fatigue. The skin becomes pigmented due to the increased production of ACTH. Faintness, especially on standing, is due to postural HYPOTENSION secondary to aldosterone de?ciency. Women lose their axillary hair and both sexes are liable to develop mental symptoms such as DEPRESSION. Acute episodes – Addisonian crises – may occur, brought on by infection, injury or other stressful events; they are caused by a fall in aldosterone levels, leading to abnormal loss of sodium and water via the kidneys, dehydration, low blood pressure and confusion. Patients may develop increased tanning of the skin from extra pigmentation, with black or blue discoloration of the skin, lips, mouth, rectum and vagina occurring. ANOREXIA, nausea and vomiting are common and the sufferer may feel cold.

Diagnosis This depends on demonstrating impaired serum levels of cortisol and inability of these levels to rise after an injection of ACTH.

Treatment consists in replacement of the de?cient hormones. HYDROCORTISONE tablets are commonly used; some patients also require the salt-retaining hormone, ?udrocortisone. Treatment enables them to lead a completely normal life and to enjoy a normal life expectancy. Before surgery, or if the patient is pregnant and unable to take tablets, injectable hydrocortisone may be needed. Rarely, treated patients may have a crisis, perhaps because they have not been taking their medication or have been vomiting it. Emergency resuscitation is needed with ?uids, salt and sugar. Because of this, all patients should carry a card detailing their condition and necessary management. Treatment of any complicating infections such as tuberculosis is essential. Sometimes DIABETES MELLITUS coexists with Addison’s disease and must be treated.

Secondary adrenal insu?ciency may occur in panhypopituitarism (see PITUITARY GLAND), in patients treated with CORTICOSTEROIDS or after such patients have stopped treatment.... addison’s disease

Absence of MENSTRUATION at the time of life at which it should normally occur. If menstruation has never occurred, the amenorrhoea is termed primary; secondary amenorrhoea is de?ned as menstruation ceasing after a normal cycle has been experienced for a number of years.

A few patients with primary amenorrhoea have an abnormality of their CHROMOSOMES or malformation of the genital tract such as absecence of the UTERUS (see TURNER’S SYNDROME). A gynaecological examination will rarely disclose an IMPERFORATE HYMEN in a young girl who may also complain of regular cycles of pain like period pains.

There are many causes of secondary amenorrhoea and management requires dealing with the primary cause. The commonest cause is pregnancy. Disorders of the HYPOTHALAMUS and related psychological factors such as anorexia nervosa (see EATING DISORDERS) also cause amenorrhoea, as can poor nutrition and loss of weight by extreme dieting. It is common in ballet dancers and athletes who exercise a great deal, but can also be triggered by serious illnesses such as tuberculosis or malaria. Excess secretion of prolactin, either due to a micro-adenoma (see ADENOMA) of the PITUITARY GLAND or to various prescription drugs will produce amenorrhoea, and sometimes GALACTORRHOEA as well. Malfunction of other parts of the pituitary gland will cause failure to produce GONADOTROPHINS, thus causing ovarian failure with consequent amenorrhea. In CUSHING’S SYNDROME, amenorrhoea is caused by excessive production of cortisol. Similarly, androgen-production abnormalities are found in the common POLYCYSTIC OVARY SYNDROME. These conditions also have abnormalities of the insulin/glucose control mechanisms. Taking the contraceptive pill is not now considered to provoke secondary amenorrhoea but OBESITY and HYPOTHYROIDISM are potential causes.

When the cause is weight loss, restoring body weight may alone restore menstruation. Otherwise, measuring gonadotrophic hormone levels will help show whether amenorrhoea is due to primary ovarian failure or secondary to pituitary disease. Women with raised concentrations of serum gonadotrophic hormones have primary ovarian failure. When amenorrhoea is due to limited pituitary failure, treatment with CLOMIPHENE may solve the problem.... amenorrhoea

One of the two main groups of CORTICOSTEROIDS. CORTISOL, CORTISONE and corticosterone are part of this group and are essential for the body to utilise CARBOHYDRATE, FAT and PROTEIN – in particular, when the body is reacting to stress. Glucocorticoids occur naturally but can be synthesised, and they have strong anti-in?ammatory properties, being used to treat conditions in which in?ammation is a part.... glucocorticoids

A periodic change occurring in (female) human beings and the higher apes, consisting chie?y in a ?ow of blood from the cavity of the womb (UTERUS) and associated with various slight constitutional disturbances. It begins between the ages of 12 and 15, as a rule – although its onset may be delayed until as late as 20, or it may begin as early as ten or 11. Along with its ?rst appearance, the body develops the secondary sex characteristics: for example, enlargement of the BREASTS, and characteristic hair distribution. The duration of each menstrual period varies in di?erent persons from 2– 8 days. It recurs in the great majority of cases with regularity, most commonly at intervals of 28 or 30 days, less often with intervals of 21 or 27 days, and ceasing only during pregnancy and lactation, until the age of 45 or 50 arrives, when it stops altogether – as a rule ceasing early if it has begun early, and vice versa. The ?nal stoppage is known as the MENOPAUSE or the CLIMACTERIC.

Menstruation depends upon a functioning ovary (see OVARIES) and this upon a healthy PITUITARY GLAND. The regular rhythm may depend upon a centre in the HYPOTHALAMUS, which is in close connection with the pituitary. After menstruation, the denuded uterine ENDOMETRIUM is regenerated under the in?uence of the follicular hormone, oestradiol. The epithelium of the endometrium proliferates, and about a fortnight after the beginning of menstruation great development of the endometrial glands takes place under the in?uence of progesterone, the hormone secreted by the CORPUS LUTEUM. These changes are made for the reception of the fertilised OVUM. In the absence of fertilisation the uterine endometrium breaks down in the subsequent menstrual discharge.

Disorders of menstruation In most healthy women, menstruation proceeds regularly for 30 years or more, with the exceptions connected with childbirth. In many women, however, menstruation may be absent, excessive or painful. The term amenorrhoea is applied to the condition of absent menstruation; the terms menorrhagia and metrorrhagia describe excessive menstrual loss – the former if the excess occurs at the regular periods, and the latter if it is irregular. Dysmenorrhoea is the name given to painful menstruation. AMENORRHOEA If menstruation has never occurred, the amenorrhoea is termed primary; if it ceases after having once become established it is known as secondary amenorrhoea. The only value of these terms is that some patients with either chromosomal abnormalities (see CHROMOSOMES) or malformations of the genital tract fall into the primary category. Otherwise, the age of onset of symptoms is more important.

The causes of amenorrhoea are numerous and treatment requires dealing with the primary cause. The commonest cause is pregnancy; psychological stress or eating disorders can cause amenorrhoea, as can poor nutrition or loss of weight by dieting, and any serious underlying disease such as TUBERCULOSIS or MALARIA. The excess secretion of PROLACTIN, whether this is the result of a micro-adenoma of the pituitary gland or whether it is drug induced, will cause amenorrhoea and possibly GALACTORRHOEA as well. Malfunction of the pituitary gland will result in a failure to produce the gonadotrophic hormones (see GONADOTROPHINS) with consequent amenorrhoea. Excessive production of cortisol, as in CUSHING’S SYNDROME, or of androgens (see ANDROGEN) – as in the adreno-genital syndrome or the polycystic ovary syndrome – will result in amenorrhoea. Amenorrhoea occasionally follows use of the oral contraceptive pill and may be associated with both hypothyroidism (see under THYROID GLAND, DISEASES OF) and OBESITY.

Patients should be reassured that amenorrhoea can often be successfully treated and does not necessarily affect their ability to have normal sexual relations and to conceive. When weight loss is the cause of amenorrhoea, restoration of body weight alone can result in spontaneous menstruation (see also EATING DISORDERS – Anorexia nervosa). Patients with raised concentration of serum gonadotrophin hormones have primary ovarian failure, and this is not amenable to treatment. Cyclical oestrogen/progestogen therapy will usually establish withdrawal bleeding. If the amenorrhoea is due to mild pituitary failure, menstruation may return after treatment with clomiphene, a nonsteroidal agent which competes for oestrogen receptors in the hypothalamus. The patients who are most likely to respond to clomiphene are those who have some evidence of endogenous oestrogen and gonadotrophin production. IRREGULAR MENSTRUATION This is a change from the normal monthly cycle of menstruation, the duration of bleeding or the amount of blood lost (see menorrhagia, below). Such changes may be the result of an upset in the balance of oestrogen and progesterone hormones which between them control the cycle. Cycles may be irregular after the MENARCHE and before the menopause. Unsuspected pregnancy may manifest itself as an ‘irregularity’, as can an early miscarriage (see ABORTION). Disorders of the uterus, ovaries or organs in the pelvic cavity can also cause irregular menstruation. Women with the condition should seek medical advice. MENORRHAGIA Abnormal bleeding from the uterus during menstruation. A woman loses on average about 60 ml of blood during her period; in menorrhagia this can rise to 100 ml. Some women have this problem occasionally, some quite frequently and others never. One cause is an imbalance of progesterone and oestrogen hormones which between them control menstruation: the result is an abnormal increase in the lining (endometrium) of the uterus, which increases the amount of ‘bleeding’ tissue. Other causes include ?broids, polyps, pelvic infection or an intrauterine contraceptive device (IUD – see under CONTRACEPTION). Sometimes no physical reason for menorrhagia can be identi?ed.

Treatment of the disorder will depend on how severe the loss of blood is (some women will become anaemic – see ANAEMIA – and require iron-replacement therapy); the woman’s age; the cause of heavy bleeding; and whether or not she wants children. An increase in menstrual bleeding may occur in the months before the menopause, in which case time may produce a cure. Medical or surgical treatments are available. Non-steroidal anti-in?ammatory drugs may help, as may tranexamic acid, which prevents the breakdown of blood clots in the circulation (FIBRINOLYSIS): this drug can be helpful if an IUD is causing bleeding. Hormones such as dydrogesterone (by mouth) may cure the condition, as may an IUD that releases small quantities of a PROGESTOGEN into the lining of the womb.

Traditionally, surgical intervention was either dilatation and curettage of the womb lining (D & C) or removal of the whole uterus (HYSTERECTOMY). Most surgery is now done using minimally invasive techniques. These do not require the abdomen to be cut open, as an ENDOSCOPE is passed via the vagina into the uterus. Using DIATHERMY or a laser, the surgeon then removes the whole lining of the womb. DYSMENORRHOEA This varies from discomfort to serious pain, and sometimes includes vomiting and general malaise. Anaemia is sometimes a cause of painful menstruation as well as of stoppage of this function.

In?ammation of the uterus, ovaries or FALLOPIAN TUBES is a common cause of dysmenorrhoea which comes on for the ?rst time late in life, especially when the trouble follows the birth of a child. In this case the pain exists more or less at all times, but is aggravated at the periods. Treatment with analgesics and remedying the underlying cause is called for.

Many cases of dysmenorrhoea appear with the beginning of menstrual life, and accompany every period. It has been estimated that 5–10 per cent of girls in their late teens or early 20s are severely incapacitated by dysmenorrhoea for several hours each month. Various causes have been suggested for the pain, one being an excessive production of PROSTAGLANDINS. There may be a psychological factor in some sufferers and, whether this is the result of inadequate sex instruction, fear, family, school or work problems, it is important to o?er advice and support, which in itself may resolve the dysmenorrhoea. Symptomatic relief is of value.... menstruation

An agent which stimulates the adrenal glands thereby increasing secretion of cortisol and adrenal hormones. A herb with a mild cortico-steroid effect. Liquorice. Ginseng. Sarsaparilla. ... adrenal-activator

Physiological functions that vary in a rhythmic way.

Most biorhythms are based on a daily, or circadian (24hour), cycle.

Our bodies are governed by an internal clock, which is itself regulated by hormones.

Periods of sleepiness and wakefulness may be affected by the level of melatonin secreted by the pineal gland in the brain.

Melatonin release is stimulated by darkness and suppressed by light.

Cortisol, secreted by the adrenal glands, also reflects the sleeping and waking states, being low in the evening and high in the morning.... biorhythms

See also MYALGIC ENCEPHALOMYELITIS (ME). A condition characterised by severe, disabling mental and physical fatigue brought on by mental or physical activity and associated with a range of symptoms including muscle pain, headaches, poor sleep, disturbed moods and impaired concentration. The prevalence of the condition is between 0.2 and 2.6 per cent of the population (depending on how investigators de?ne CFS/ME). Despite the stereotype of ‘yuppie ?u’, epidemiological research has shown that the condition occurs in all socioeconomic and ethnic groups. It is commoner in women and can also occur in children.

In the 19th century CFS was called neurasthenia. In the UK, myalgic encephalomyelitis (ME) is often used, a term originally introduced to describe a speci?c outbreak such as the one at the Royal Free Hospital, London in 1955. The term is inaccurate as there is no evidence of in?ammation of the brain and spinal cord (the meaning of encephalomyelitis). Doctors prefer the term CFS, but many patients see this as derogatory, perceiving it to imply that they are merely ‘tired all the time’ rather than having a disabling illness.

The cause (or causes) are unknown, so the condition is classi?ed alongside other ‘medically unexplained syndromes’ such as IRRITABLE BOWEL SYNDROME (IBS) and multiple chemical sensitivity – all of which overlap with CFS. In many patients the illness seems to start immediately after a documented infection, such as that caused by EPSTEIN BARR VIRUS, or after viral MENINGITIS, Q FEVER and TOXOPLASMOSIS. These infections seem to be a trigger rather than a cause: mild immune activation is found in patients, but it is not known if this is cause or e?ect. The body’s endocrine system is disturbed, particularly the hypothalamopituitary-adrenal axis, and levels of cortisol are often a little lower than normal – the opposite of what is found in severe depression. Psychiatric disorder, usually depression and/or anxiety, is associated with CFS, with rates too high to be explained solely as a reaction to the disability experienced.

Because we do not know the cause, the underlying problem cannot be dealt with e?ectively and treatments are directed at the factors leading to symptoms persisting. For example, a slow increase in physical activity can help many, as can COGNITIVE BEHAVIOUR THERAPY. Too much rest can be harmful, as muscles are rapidly weakened, but aggressive attempts at coercing patients into exercising can be counter-productive as their symptoms may worsen. Outcome is in?uenced by the presence of any pre-existing psychiatric disorder and the sufferer’s beliefs about its causes and treatment. Research continues.... chronic fatigue syndrome (cfs)

Described in 1932 by Harvey Cushing, the American neurosurgeon, Cushing’s syndrome is due to an excess production of CORTISOL. It can thus result from a tumour of the ADRENAL GLANDS secreting cortisol, or from a PITUITARY GLAND tumour secreting ACTH and stimulating both adrenal cortexes to hypertrophy and secrete excess cortisol. It is sometimes the result of ectopic production of ACTH from non-endocrine tumours in the LUNGS and PANCREAS.

The patient gains weight and the obesity tends to have a characteristic distribution over the face, neck, and shoulder and pelvic girdles. Purple striae develop over the abdomen and there is often increased hairiness or hirsutism. The blood pressure is commonly raised and the bone softens as a result of osteoporosis. The best test to establish the diagnosis is to measure the amount of cortisol in a 24-hourly specimen of urine. Once the diagnosis has been established, it is then necessary to undertake further tests to determine the cause.... cushing’s syndrome

A drug used to test the functioning of the adrenal glands. Tetracosactide is a chemical analogue of the natural hormone corticotrophin (ACTH). stimulates the cortices of the adrenal glands to secrete hormones such as cortisol. To diagnose a disorder of the adrenal glands, a tetracosactide injection is given and the blood cortisol level measured. Failure of the level to rise indicates an abnormality.... tetracosactide

(corticoid) n. any steroid hormone synthesized by the adrenal cortex. There are two main groups of corticosteroids. The glucocorticoids (e.g. *cortisol, *cortisone, and corticosterone) are essential for the utilization of carbohydrate, fat, and protein by the body and for a normal response to stress. Naturally occurring and synthetic glucocorticoids have very powerful anti-inflammatory effects and are used to treat conditions that involve inflammation. The mineralocorticoids (e.g. *aldosterone) are necessary for the regulation of salt and water balance.... corticosteroid

(CRH) a peptide hypothalamic hormone (of 41 amino acids) stimulating the release of *ACTH (adrenocorticotrophic hormone) from the anterior pituitary. Its own release is suppressed by a *negative feedback loop involving cortisol, and its action is increased by antidiuretic hormone (see vasopressin) and *angiotensin II. It can be administered intravenously as part of the CRH test, during which blood is analysed at 15-minute intervals for one hour for the ACTH response, which is excessive in cases of primary adrenal failure and suppressed in cases of anterior *hypopituitarism.... corticotrophin-releasing hormone

The generic term for the group of hormones produced by the ADRENAL GLANDS, with a profound e?ect on mineral and glucose metabolism.

Many modi?cations have been devised of the basic steroid molecule in an attempt to keep useful therapeutic effects and minimise unwanted side-effects. The main corticosteroid hormones currently available are CORTISONE, HYDROCORTISONE, PREDNISONE, PREDNISOLONE, methyl prednisolone, triamcinolone, dexamethasone, betamethasone, paramethasone and de?azacort.

They are used clinically in three quite distinct circumstances. First they constitute replacement therapy where a patient is unable to produce their own steroids – for example, in adrenocortical insu?ciency or hypopituitarism. In this situation the dose is physiological – namely, the equivalent of the normal adrenal output under similar circumstances – and is not associated with any side-effects. Secondly, steroids are used to depress activity of the adrenal cortex in conditions where this is abnormally high or where the adrenal cortex is producing abnormal hormones, as occurs in some hirsute women.

The third application for corticosteroids is in suppressing the manifestations of disease in a wide variety of in?ammatory and allergic conditions, and in reducing antibody production in a number of AUTOIMMUNE DISORDERS. The in?ammatory reaction is normally part of the body’s defence mechanism and is to be encouraged rather than inhibited. However, in the case of those diseases in which the body’s reaction is disproportionate to the o?ending agent, such that it causes unpleasant symptoms or frank illness, the steroid hormones can inhibit this undesirable response. Although the underlying condition is not cured as a result, it may resolve spontaneously. When corticosteroids are used for their anti-in?ammatory properties, the dose is pharmacological; that is, higher – often much higher – than the normal physiological requirement. Indeed, the necessary dose may exceed the normal maximum output of the healthy adrenal gland, which is about 250–300 mg cortisol per day. When doses of this order are used there are inevitable risks and side-effects: a drug-induced CUSHING’S SYNDROME will result.

Corticosteroid treatment of short duration, as in angioneurotic OEDEMA of the larynx or other allergic crises, may at the same time be life-saving and without signi?cant risk (see URTICARIA). Prolonged therapy of such connective-tissue disorders, such as POLYARTERITIS NODOSA with its attendant hazards, is generally accepted because there are no other agents of therapeutic value. Similarly the absence of alternative medical treatment for such conditions as autoimmune haemolytic ANAEMIA establishes steroid therapy as the treatment of choice which few would dispute. The use of steroids in such chronic conditions as RHEUMATOID ARTHRITIS, ASTHMA and DERMATITIS needs careful assessment and monitoring.

Although there is a risk of ill-effects, these should be set against the misery and danger of unrelieved chronic asthma or the incapacity, frustration and psychological trauma of rheumatoid arthritis. Patients should carry cards giving details of their dosage and possible complications.

The incidence and severity of side-effects are related to the dose and duration of treatment. Prolonged daily treatment with 15 mg of prednisolone, or more, will cause hypercortisonism; less than 10 mg prednisolone a day may be tolerated by most patients inde?nitely. Inhaled steroids rarely produce any ill-e?ect apart from a propensity to oral thrush (CANDIDA infection) unless given in excessive doses.

General side-effects may include weight gain, fat distribution of the cushingoid type, ACNE and HIRSUTISM, AMENORRHOEA, striae and increased bruising tendency. The more serious complications which can occur during long-term treatment include HYPERTENSION, oedema, DIABETES MELLITUS, psychosis, infection, DYSPEPSIA and peptic ulceration, gastrointestinal haemorrhage, adrenal suppression, osteoporosis (see BONE, DISORDERS OF), myopathy (see MUSCLES, DISORDERS OF), sodium retention and potassium depletion.... corticosteroids

A disease causing failure of adrenal gland function, in particular deficiency of adrenal cortical hormones, mainly cortisol and aldosterone. Commonest causes are tuberculosis and auto- immune disease.

Symptoms: (acute) abdominal pain, muscle weakness, vomiting, low blood pressure due to dehydration, tiredness, mental confusion, loss of weight and appetite. Vomiting, dizzy spells. Increased dark pigmentation around genitals, nipples, palms and inside mouth. Persistent low blood pressure with occasional low blood sugar. Crisis is treated by increased salt intake. Research project revealed a craving for liquorice sweets in twenty five per cent of patients.

Herbs with an affinity for the adrenal glands: Parsley, Sarsaparilla, Wild Yam, Borage, Liquorice, Ginseng, Chaparral. Where steroid therapy is unavoidable, supplementation with Liquorice and Ginseng is believed to sustain function of the glands. Ginseng is supportive when glands are exhausted by prolonged stress. BHP (1983) recommends: Liquorice, Dandelion leaf.

Alternatives. Teas. Gotu Kola, Parsley, Liquorice root, Borage, Ginseng, Balm.

Tea formula. Combine equal parts: Balm and Gotu Kola. Preparation of teas and tea mixture: 1 heaped teaspoon to each cup boiling water: infuse 5-10 minutes; 1 cup 2 to 3 times daily.

Tablets/capsules. Ginseng, Seaweed and Sarsaparilla, Wild Yam, Liquorice. Dosage as on bottle. Formula. Combine: Gotu Kola 3; Sarsaparilla 2; Ginseng 1; Liquorice quarter. Doses. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 30-60 drops. Tinctures: 1-2 teaspoons 2 to 3 times daily.

Formula. Alternative. Tinctures 1:5. Echinacea 20ml; Yellow Dock 10ml; Barberry 10ml; Sarsaparilla 10ml; Liquorice (liquid extract) 5ml. Dose: 1-2 teaspoons thrice daily.

Supplementation. Cod liver oil. Extra salt. B-Vitamins. Folic acid. ... addison’s disease

n. a pharmaceutical preparation of the steroid hormone *cortisol. Hydrocortisone is used in the treatment of adrenal failure (*Addison’s disease), shock, and inflammatory, allergic, and rheumatic conditions (including rheumatoid arthritis, colitis, and eczema). Possible side-effects include peptic ulcers, bone and muscle damage, suppression of growth in children, and the signs of *Cushing’s syndrome.... hydrocortisone

a test of the ability of the pituitary to secrete growth hormone, in which levodopa is administered by mouth and plasma levels of growth hormone are subsequently measured (they should peak within the following hour). It is a safer alternative to the *insulin stress test but does not give information on cortisol production, which is usually more clinically important to know.... levodopa test

The previous subject is obviously an endless one, but as this is the glossary of an herbal nature, let me assure you, virtually no plants have a direct steroid hormone-mimicking effect. There are a few notable exceptions with limited application, like Cimicifuga and Licorice. Plant steroids are usually called phytosterols, and, when they have any hormonal effect at all, it is usually to interfere with human hormone functions. Beta sitosterol, found in lots of food, interferes with the ability to absorb cholesterol from the diet. Corn oil and legumes are two well-endowed sources that can help lower cholesterol absorption. This is of only limited value, however, since cholesterol is readily manufactured in the body, and elevated cholesterol in the blood is often the result of internal hormone and neurologic stimulus, not the diet. Cannabis can act to interfere with androgenic hormones, and Taraxacum phytosterols can both block the synthesis of some new cholesterol by the liver and increase the excretion of cholesterol as bile acids; but other than that, plants offer little direct hormonal implication. The first method discovered for synthesizing pharmaceutical hormones used a saponin, diosgenin, and a five-step chemical degradation, to get to progesterone, and another, using stigmasterol and bacterial culturing, to get to cortisol. These were chemical procedures that have nothing to do with human synthesis of such hormones, and the plants used for the starting materials-Mexican Wild Yam, Agave, and Soy were nothing more than commercially feasible sources of compounds widely distributed in the plant kingdom. A clever biochemist could obtain testosterone from potato sterols, but no one would be likely to make the leap of faith that eating potatoes makes you manly (or less womanly), and there is no reason to presume that Wild Yam (Dioscorea) has any progesterone effects in humans. First, the method of synthesis from diosgenin to progesterone has nothing to do with human synthesis of the corpus luteum hormone; second, oral progesterone has virtually no effect since it is rapidly digested; and third, orally active synthetic progesterones such as norethindrone are test-tube born, and never saw a Wild Yam. The only “precursor” the ovaries, testes and adrenal cortices EVER need (and the ONLY one that they can use if synthesizing from scratch) is something almost NONE of us ever run out of...Low Density Cholesterol. Unless you are grimly fasting, anorectic, alcoholic, seriously ill or training for a triathlon, you only need blood to make steroid hormones from. If hormones are off, it isn’t from any lack of building materials...and any product claiming to supply “precursors” better contain lard or butter (they don’t)...or they are profoundly mistaken, or worse. The recent gaggle of “Wild Yam” creams actually do contain some Wild Yam. (Dioscorea villosa, NOT even the old plant source of diosgenin, D. mexicana...if you are going to make these mistakes, at least get the PLANT right) This is a useful and once widely used antispasmodic herb...I have had great success using it for my three separate bouts with kidney stones...until I learned to drink more water and alkalizing teas and NEVER stay in a hot tub for three hours. What these various Wild Yam creams DO contain, is Natural Progesterone. Although this is inactive orally (oral progesterone is really a synthetic relative of testosterone), it IS active when injected...or, to a lesser degree, when applied topically. This is pharmaceutical progesterone, synthesized from stigmasterol, an inexpensive (soy-bean oil) starting substance, and, although it is identical to ovarian progesterone, it is a completely manufactured pharmaceutical. Taking advantage of an FDA loophole (to them this is only a cosmetic use...they have the misguided belief that it is not bioactive topically), coupled with some rather convincing (if irregular) studies showing the anti-osteoporotic value of topical progesterone for SOME women, a dozen or so manufacturers are marketing synthetic Natural Progesterone for topical use, yet inferring that Wild Yam is what’s doing good. I am not taking issue with the use of topical progesterone. It takes advantage of the natural slow release into the bloodstream of ANY steroid hormones that have been absorbed into subcutaneous adipose tissue. It enters the blood from general circulation the same way normal extra-ovarian estradiol is released, and this is philosophically (and physiologically) preferable to oral steroids, cagily constructed to blast on through the liver before it can break them down. This causes the liver to react FIRST to the hormones, instead of, if the source is general circulation, LAST. My objection is both moral and herbal: the user may believe hormonal effects are “natural”, the Wild Yam somehow supplying “precursors” her body can use if needed, rejected if not. This implies self-empowerment, the honoring of a woman’s metabolic choice...something often lacking in medicine. This is a cheat. The creams supply a steady source of pharmaceutical hormone (no precursor here) , but they are being SOLD as if the benefits alone come from the Wild Yam extract, seemingly formulated with the intent of having Wild Yam the most abundant substance so it can be listed first in the list of constituents. I have even seen the pharmaceutical Natural Progesterone labeled as “Wild Yam Progesterone” or “Wild Yam Estrogen precursor” or, with utter fraud, “Wild Yam Hormone”. To my knowledge, the use of Mexican Yam for its saponins ceased to be important by the early 1960’s, with other processes for synthesizing steroids proving to be cheaper and more reliable. I have been unable to find ANY manufacturer of progesterone that has used the old Marker Degradation Method and/or diosgenin (from whatever Dioscorea) within the last twenty years. Just think of it as a low-tech, non invasive and non-prescription source of progesterone, applied topically and having a slow release of moderate amounts of the hormone. Read some of the reputable monographs on its use, make your choice based solely on the presence of the synthetic hormone, and use it or don’t. It has helped some women indefinitely, for others it helped various symptoms for a month or two and then stopped working, for still other women I have spoken with it caused unpleasant symptoms until they ceased its use. Since marketing a product means selling as much as possible and (understandably) presenting only the product’s positive aspects, it would be better to try and find the parameters of “use” or “don’t use” from articles, monographs, and best of all, other women who have used it. Then ask them again in a month or two and see if their personal evaluation has changed. If you have some bad uterine cramps, however, feel free to try some Wild Yam itself...it often helps. Unless there is organic disease, hormones are off is because the whole body is making the wrong choices in the hormones it does or doesn’t make. It’s a constitutional or metabolic or dietary or life-stress problem, not something akin to a lack of essential amino acids or essential fatty acids that will clear up if only you supply some mythic plant-derived “precursor”. End of tirade.... steroids, plant

High blood pressure. The World Health Organisation defines high blood pressure (arterial hypertension) as that with a persistent sphygomanometer reading of 160/90, and over. Average blood pressure is 120/80 for men but lower in women. The diastolic pressure (lower figure) represents pressure to which the arterial walls are subject and is the more important figure.

Main causes of a raised pressure include increase in blood thickness, kidney disorder or loss of elasticity in the arteries by hardening or calcification.

Well defined physical problems account for 10 per cent of high blood pressure cases. By the age of 60, a third of the peoples of the West are hypertensive. Other causes: genetic pre-disposition, endocrine disorders such as hyperactive thyroid and adrenal glands, lead and other chemical poisoning, brain tumour, heart disorder, anxiety, stress and emotional instability.

Other causes may be food allergies. By taking one’s pulse after eating a certain food one can see if the food raises the pulse. If so, that food should be avoided. Most cases of high blood pressure are related to lifestyle – how people think, act and care for themselves. When a person is under constant stress blood pressure goes up. It temporarily increases on drinking the stimulants: alcohol, strong tea, coffee, cola and caffeine drinks generally.

Symptoms. Morning headache (back of the head), possible palpitation, visual disturbances, dizziness, angina-like pains, inability to concentrate, nose-bleeds, ringing in the ears, fatigue, breathlessness (left ventricular failure).

Dr Wm Castelli, Director of the Framlingham Heart Study in Massachusetts, U.S.A., records: “The greatest risk is for coronary heart disease (CHD). Hypertensives have more than double the risk of people with normal blood pressure and seven times the risk of strokes.”

In countries where salt intake is restricted, a rise in blood pressure with age is not seen.

Simple hypotensive herbs may achieve effective control without the side-effects of sleep disturbance, adverse metabolic effects, lethargy and impaired peripheral circulation.

Essential hypertension is where high blood pressure is not associated with any disease elsewhere; it accounts for 90 per cent cases. Most of the remainder have kidney disease except for a few other abnormalities.

Alternatives. Balm, Black Haw, Black Cohosh (blood pressure of the menopause), Cactus, Cramp bark, Chamomile (German). Garlic, Buckwheat, Lily of the Valley, Balm, Mistletoe, Motherwort. Passion flower, Nettles, Lime flowers, Wood Betony, Yarrow, Rosemary, Hawthorn flowers, Olive leaves, Dandelion. Where there is nerve excitability: Valerian.

Tea No 1. Equal parts: Hawthorn leaves and flowers, Mistletoe, Lime flowers. Mix. 2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup 2-3 times daily. Alternative:–

Tea No 2. Equal parts: Nettles, Lime flowers, Yarrow, Passion flower. Mix. 2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup 2-3 times daily.

Nettles. Nettle tea is capable of removing cholesterol deposits (“fur”) from artery walls, increasing their elasticity. Like so many herbs they are rich in chlorophyll. The tea may be made as strong as desired. Mistletoe. 2-3 teaspoons cut herb (fresh or dried) to cup cold water. Allow to infuse overnight (at least 8 hours). 1 cup morning and evening.

Garlic. Juice from one Garlic corm expressed through a juicer taken morning and evening. Garlic dilates blood vessels. Alternative: 2-3 Garlic capsules at night.

Blood pressure of pregnancy: See – PREGNANCY.

Tablets/capsules: Cramp bark, Mistletoe, Motherwort, Rutin, Garlic.

Powders. Formula. Buckwheat (rutin) 1; Motherwort 1; Mistletoe half; Valerian quarter. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Liquid extracts, tinctures. Formula. Equal parts: Cactus, Mistletoe, Valerian. Dose: liquid extracts, one 5ml teaspoon; tinctures, two 5ml teaspoons; thrice daily.

Practitioner Formula. Tinctures: equal parts: Lily of the Valley, Mistletoe, Valerian. Dose: 30-60 drops thrice daily.

Where high blood pressure is due to faulty kidney function diuretics such as Dandelion or Bearberry will be added according to individual requirements. Dandelion root is one of the most widely-used potassium-conserving agents for increasing flow of urine, as well as being a mild beta-blocker to reduce myocardial infarction. Broom (Sarothamnus scoparius) (diuretic) is not used in cases of high blood pressure. It is good practice to assess kidney function in all new cases of hypertension for renal artery stenosis.

Evidence from two major studies confirms that diuretics rather than beta-blockers should be the treatment of choice for most elderly hypertensives. The addition of a diuretic (Yarrow, etc) to prescriptions for the elderly is commended.

Prevention. Chances of developing high blood pressure are said to be reduced by a daily dose of Cod

Liver oil. Results from studies at the University of Munich, Germany, show that when an ounce of Cod Liver oil was added to the typical Western diet, better pressure readings and lower cholesterol levels followed. When the flavour renders it objectionable to the palate, taste may be masked by stirring briskly into fruit juice.

General. Stop smoking. Watch weight. Moderate exercise. Avoidance of stress by relaxation, yoga, music, etc. These relieve constriction of peripheral blood vessels. Curb temper

Diet. Avoid processed and fast foods high in fat and salt, and empty calories. Cheese and meat sparingly. Eat plenty of natural foods. Positively reject coffee, strong tea and alcohol. “There is a significant drop in plasma Cortisol with a fall in blood pressure after stopping alcohol.” (Dr J.F. Potter, University of Birmingham, England) It is well-documented that a vegetarian diet is associated with a lower blood pressure.

Salt. The association of salt with blood pressure is larger than generally appreciated and increases with age and initial blood pressure. Even a small reduction in salt (3g) may reduce a systolic and diastolic pressure by 5mmHg and 2.5mmHg respectively. All processed foods containing salt should be avoided. Supplementation. Inositol, zinc, Vitamin C, Vitamin B6. (Dr C. Pfeiffer) Vitamin E to improve circulation. Check with practitioner pressure level before starting 200iu increasing to 400iu daily. Magnesium: 300mg daily. Choline.

See: BLOOD PRESSURE. ... hypertension

tests used to assess the ability of the adrenal cortex to produce cortisol. Serum cortisol is measured before and then 30 minutes (or 5 hours) after an intramuscular injection of 250 ?g (or 1 mg) tetracosactide (Synacthen), an analogue of *ACTH. The adrenal glands are considered to be inadequate if there is a low baseline concentration of cortisol or the rise is less than a certain predefined amount.... synacthen tests

The common abbreviation for adrenocorticotrophic hormone (also called corticotrophin). is produced by the anterior pituitary gland and stimulates the adrenal cortex (outer layer of the adrenal glands) to release various corticosteroid hormones, most importantly hydrocortisone (cortisol) but also aldosterone and androgen hormones.

production is controlled by a feedback mechanism involving both the hypothalamus and the level of hydrocortisone in the blood. levels increase in response to stress, emotion, injury, infection, burns, surgery, and decreased blood pressure.

A tumour of the pituitary gland can cause excessive production which leads to overproduction of hydrocortisone by the adrenal cortex, resulting in Cushing’s syndrome. Insufficient production results in decreased production of hydrocortisone, causing low blood pressure. Synthetic is occasionally given by injection to treat arthritis or allergy.... acth

(suprarenal glands) two triangular *endocrine glands, each of which covers the superior surface of a kidney. Each gland has two parts, the medulla and cortex. The medulla forms the grey core of the gland; it consists mainly of *chromaffin tissue and is stimulated by the sympathetic nervous system to produce *adrenaline and *noradrenaline. The cortex is a yellowish tissue surrounding the medulla. It is derived embryologically from mesoderm and is stimulated by pituitary hormones (principally *ACTH) to produce three kinds of *corticosteroid hormones, which affect carbohydrate metabolism (e.g. *cortisol), electrolyte metabolism (e.g. *aldosterone), and the sex glands (oestrogens and androgens).... adrenal glands

a family of autosomal *recessive genetic disorders causing decreased activity of any of the enzymes involved in the synthesis of *cortisol from *cholesterol. The most commonly affected enzymes are 21-hydroxylase and 11-hydroxylase, and each enzyme deficiency can itself be due to a variety of genetic mutations. The clinical manifestations depend on which enzyme is affected and the resultant deficiencies and build-up products produced. The most serious consequence is adrenal crisis and/or severe salt wasting due to lack of cortisol and/or aldosterone, which may prove fatal if undiagnosed. The condition is often easier to spot at birth in females, who may have indeterminate genitalia due to high levels of *testosterone in utero. Adrenal hyperplasia occurs due to excessive stimulation of the glands by *ACTH (adrenocorticotrophic hormone) in response to the resultant cortisol deficiency of these conditions. Less complete deficiencies of the enzymes concerned may present for the first time in young women after puberty, with signs of androgen excess and menstrual irregularity mimicking *polycystic ovary syndrome.... congenital adrenal hyperplasia

(DSTs) tests based on the principle that appropriate doses of *dexamethasone can suppress the output of cortisol from the adrenal glands in the normal state and that this ability is reduced or lost in *Cushing’s syndrome. In the overnight DST 1 mg of dexamethasone is administered at midnight and the serum cortisol level is measured at 9.00 am the next morning. Failure to suppress cortisol output may indicate Cushing’s syndrome but also occurs in patients with obesity and depressive illness. In the low-dose DST (0.5 mg dexamethasone every 6 hours for 48 hours), cortisol suppression occurs in patients with obesity and depression but not in those with Cushing’s syndrome. In the high-dose DST (2 mg dexamethasone every 6 hours for 48 hours), cortisol is suppressed in patients with Cushing’s disease (in which excess amounts of ACTH are secreted by the pituitary gland) but not in those with Cushing’s syndrome due to other causes. Although the low- and high-dose tests are unreliable, all three tests should be performed to aid the diagnosis of Cushing’s syndrome.... dexamethasone suppression tests

an important but potentially dangerous test of anterior pituitary function involving the deliberate induction of a hypoglycaemic episode with injected insulin and the subsequent measurement of plasma cortisol and growth hormone at regular intervals over the next three hours. The stress of the hypoglycaemia should induce a rise in the levels of these hormones unless the anterior pituitary or the adrenal glands are diseased. The test can induce epileptic seizures or angina in those with a predisposition and should not be performed in susceptible individuals. It is often combined with the thyrotrophin-releasing hormone (TRH) test and the gonadotrophin-releasing hormone (GnRH) test in what is known as the triple test (or dynamic pituitary function test).... insulin stress test

n. an intensely itchy eruption of small papules. Besnier’s prurigo is a type of chronic atopic *eczema that is lichenified (see lichenification). Nodular prurigo is a condition of unknown cause, although it is usually found in atopic individuals (see atopy). Very severe itching characterizes these nodules, which mostly occur on the distal limbs. Prurigo of pregnancy occurs in 1 in 300 women in the middle trimester of pregnancy, affecting mainly the abdomen and the extensor surfaces of the limbs. It may recur in later pregnancies. It is linked to abnormal blood hormone levels, particularly elevated levels of gonadotrophins and lower levels of cortisol and oestrogen. Pruritic folliculitis of pregnancy is a similar pruritic eruption, predominantly on the trunk and thighs, consisting of follicular papules and pustules. It usually presents in the latter half of pregnancy and resolves early after delivery.... prurigo