![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 65. Go back in thread:
Posted by 4WD on May 19, 2005, at 15:33:06
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 18, 2005, at 20:36:38
> Yes, weird, isn't it?
>
> Now with Cushing's, it is understood that the elevated levels will return as a tumor on the pituitary gland or in the adrenal gland is "forcing" the cortisol production. And with Cushing's (whatever variant), the daily cycle or rythym of secretion is greatly disturbed (so that excess secretion occurs late at night also). But with Pseudo Cushings (which includes everything else that result in high cortisol), that daily cycle is maintained.
>
> In fact, that is the main test to differentiate between Cushings and Pseudo Cushings. It's the Late Night Salivary Cortisol Test. You spit into a test tube between 11 PM and Midnite and they analyze it to see if your levels are high or not (like around 100 or higher - usually much higher). I have had about seven of those done and my ranges have been anywhere from 13 to 40.
>
> And yes, with multiple Dex Suppression tests done, I have always suppressed - and then reverted to elevated cortisol following said test!
>
> But then that's not unusual in many "psychotic depression cases" (see the various studies done with the RU486 therapy and addressing "psychotic depression").
>
> In those cases, the patient had highly elevated (but non Cushings) cortisol levels and were either cured following RU486 therapy OR previously unsuccessful anti-depression therapies rapidly were successful... (btw, the definition of psychotic depression seems pretty clearly to fit what I refer to as my "severe anxiety problem").
>
> So it seems obvious that in these cases, the HPA Axis has malfunctioned or somehow become dysfunctional and needs to be "re-set", no???
>
> And note that these are all therapies involving very short-term application of the RU486. Usually in the range of 4 to 7 days. RU486 - which was originally developed (France, I believe) as an anti-cortisol med for Cushing's patients (ones who couldn't have surgical intervention for some reason, etc.) - can have some nasty side effects if taken over a period of time, but I don't recall any of these studies or trials where subjects developed adverse side effects of any nature simply because the therapy protocol is conducted over such a short time period.
>
> Also, in one "informal" experiment that I did (i.e., w/out endo knowing about it), I found that aggressive supplementation with OTC anti-cortisol supps clearly brought the cortisol levels down. I'm not sure of the exact figures, but prior to starting those supps, my cortisol levels were in the range of 250 - 300 (with the reference range being 20 - 100). The next two tests were then around 150 *after about three weeks of supps) and the one after that around 110 (after about another months of supps). I then stopped the OTC supps - for about 3 weeks - and my next test (the last one done) was something like 243.
>
> So taking anti cortisol supps (aggressive doses) seems to be a good thing, except one notes that my levels went right back up when the supps were stopped. So it doesn't appear that this strategy of OTC anti-cortisol supps is "re-setting" the HPA Axis.... That's kind of one of the reasons why I thought that a short-term (say two weeks) of aggressive supplementation with licorice might be in order to see if it would duplicate the effects of the RU486 protocol (but then it seems to me that in the studies that I've seen, the RU486 drove the cortisol levels WAY down and that was what "re-set" the HPA Axis... it seems that the licorice injestion would have the opposite effect of raising cortisol levels quite a bit (and back last September my levels were almost 600 and that didn't "re-set anything so simply raising my own cortisol levels doesn't seem to be a logical answer)...
>
> Or is it that the aggressive OTC anti-cortisol supp protocol needs to be continued - possibly for several months - before the HPA Axis would normalize?
>
> Or is it that the severe anxiety (or psychotic depression?) is causing the elevated cortisol as a simple "side effect" and the cortisol problem will naturally correct once the anxiety (or whatever) problem clears?
>
> Elroy
>
> P.S. Thanks for the link. Will forward to my endo. Not sure it will do any good, tho... He's primarily a Cushings specialist, so once he determined that this isn't Cushings and is "Pseudo Cushings", his level of interest clearly waned. I finally did talk him into letting me send him some stuff on the RU486 therapy so with any luck at all.....
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> > > Yes, as part of ongoing testing have had a few dexamethasone suppression tests. Have always suppressed. Anywhere from moderately to significantly. Last dex suppression test was a result of a 1.2 ug/DL.
> >
> > Eh? What?
> >
> > How on earth is it that synthetic glucocorticoid suppresses your cortisol, whereas your native cortisol itself does not? Post dexamethasone, was your cortisol still above range?
> >
> > Lar
> >
> > P.S. I found an interesting study that shows that mifepristone can act as either a full agonist or a full antagonist, due to differences in GR-receptor density (and coupling proteins). Explains how some people get that "paradoxical response" thing going.
> >
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14636830
> >
> > Lar
This is fascinating to me. I also have highly elevated cortisol levels (along with a small pituitary tumor). My dexamethasone suppression test was "borderline." Metanephrines were normal although normetanephrine was high normal.My next test is the corticotropin releasing hormone deal where you get injected with a drug and then blood is drawn periodically afterward. I believe this is supposed to rule out Cushings?
The reason this is so important to me is that my formerly treatable depression has become treatment resistant in the last few years. I have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night.
My endoc. doesn't think the tumor is causing the problems but obviously something is going on. I don't know what other tests to ask for - I need to know what tests might conclusively reveal an endocrine problem causing depression/anxiety. I thought of just asking him to test for anything that could possibly be causing this but they tend to take you more seriously if you are well informed when you go in.
Any advice would be much appreciated.
Marsha
Posted by 4WD on May 19, 2005, at 15:48:19
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Larry Hoover, posted by Elroy on May 18, 2005, at 20:36:38
I forgot to ask. When you were taking the cortisol lowering supplements, did you notice a difference in the way you felt? Less anxiety? less depression? Did you take RelaCore or Cortislim?
Marsha
Posted by Elroy on May 19, 2005, at 21:45:06
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by 4WD on May 19, 2005, at 15:33:06
OK, will try to provide sufficient detail but keep it simple enough to insure that the main points are covered.
By the way, do you have any of your actual numbers AND the reference range that your lab uses (for example, cortisol is at 276 with a reference range of 20 - 100 for normal range)???
The dex suppression test being borderline is enough evidence to raise suspicions (obviously in combination with the known high cortisol). But the dex suppression test itself does not have a high degree of absolute reliability.
The CRH test is an older test that was done to (hopefully) determine Cushings or not - and to give some degree of an indication whether or not it is pituitary related or adrenal related.
QUOTE: The differentiation between mild Cushing’s syndrome and pseudo-Cushing’s syndrome can prove extremely difficult and poses a considerable challenge to the physician. A pseudo-Cushing’s state may be defined as some or all of the clinical features that resemble true Cushing’s syndrome together with some evidence of hypercortisolism, but resolution of the underlying primary condition results in the disappearance of the Cushing’s-like state. Such findings may appear particularly in patients with depression and alcohol-induced pseudo-Cushing’s syndrome... In both Cushing’s syndrome and pseudo-Cushing’s states there is prevailing hypercortisolemia, and hence there may be almost complete overlap between groups on basal 24-h UFC collections (58). When the results seen during investigation of individuals with Cushing’s syndrome and pseudo-Cushing’s states are compared directly, a value of UFC above 100 nmol/liter on the second day of a 48-h 2 mg/day LDDST gave a specificity of 100% and a sensitivity of 56% for the diagnosis of Cushing’s syndrome, while a 48-h plasma cortisol of 38 nmol/liter or more gave a specificity of 100% and a sensitivity of 90%. In contrast, although patients with depression usually demonstrate a blunted response to the administration of CRH, there is a large overlap with the responses seen in patients with Cushing’s disease, and thus testing with this peptide does not provide good discrimination END QUOTE
A much better test is the combined Dex/CRH Test. During that test you take the dexamethasone every six hours for two days (with it scheduled so that your last dose is at midnite on day 2). Then early on the next morning you go in and have the CRH test performed. Has something like a 95% reliability rating and is better at providing indicators of pituitary versus adrenal. My doctor also had me do a 24-hour UFC (Urinary Free Cortisol) test on day 2 of the dexamethasone phase.
QUOTE: In an effort to further improve diagnostic accuracy, it has recently been suggested that improved discrimination between Cushing’s syndrome and pseudo-Cushing’s states may be achieved by using a combined test with the administration of CRH after the 48-h, 2 mg/day LDDST, with a response to CRH being seen in individuals with Cushing’s syndrome but not in those with pseudo-Cushing’s states and a mild degree of hypercortisolism (58). In this retrospective study there was complete discrimination between patients with Cushing’s syndrome and pseudo-Cushing’s states, and it has thus been recommended for this purpose (274). Although the basal UFCs showed almost total overlap between Cushing’s syndrome and pseudo-Cushing’s groups (see above), emphasizing the similar biochemical pictures seen in these groups, with postinjection of CRH 100 µg iv, a plasma cortisol value at 15 min of greater than 38 nmol/liter (1.4 µg/dl) was seen in all patients with Cushing’s syndrome, but in none with a pseudo-Cushing’s state, giving it a sensitivity and specificity of 100%. END QUOTE
The BEST test however for determining if it is actual Cushings or "Pseudo Cushings" however is actually a very simple saliva test. It is called the Late Night Salivary Cortisol Test and consists of spitting a certain amount of saliva into provided test tube between 11 PM and Midnite. Cortisol is not secreted at the same rate throughout the day. It begins declining at night (that's what makes you sleepy) and is at a lowest point around 11 PM to Midnite (and somewhat later) and then begins rising again in the morning (that's what wakes you up). That cycle is called the circadian rhythm. People with "regular" Cushings no longer have that circadian rhythm as the offending tumor is "forcing" the excess production of the cortisol at all times. If your levels are definitely within the normal range (not "borderline" or especially not elevated) then there is an excellent chance that you are NOT a regular Cushings.
Here's a link with some better explanation (would print it out and take it to your doctor... btw, Dr. Friedman is considered THE guru of Cushings specialists).
http://www.goodhormonehealth.com/symptoms/pseudocush.pdf
I would NOT take any anti cortisol supps (OTC or otherwise) at any time during the time period of any of this type of testing. If you have real Cushings, the positive effect of OTC anti cortisol products would be very minimal (as they cannot overcome the power of the offending tumor)... BUT, if you are borderline, well, one would not want to do anything that would cause a positive result to end up "borderline".
Cushings is a very serious disorder and one needs to find out absolutely for sure whether or not one in fact has it or not (many doctors unfortunately will try to diagnose it simply by "visual symptoms"... so if you have highly elevated cortisol and a borderline dex suppression test, but don't have the major "usual" visual symptoms, then they declare that you're not Cushings and let it go at that... where in fact Cushings has numerous symptoms and many people do not have the "usual" visual symptoms but in fact ARE Cushings!).
That said, both depression (especially the type more often refered to as "psychotic depression") and anxiety very definitely cause elevated cortisol levels... and elevated cortisol causes increased anxiety and / or depression. Vicious cycle. Also, is very obvious in people who have become treatment resistant.
BTW, there is some clinical information out there that Prozac (and other SSRI meds) actually INCREASES cortisol levels (thereby worsening the situation*). I know that most people go nuts at the idea of benzos, but my psychiatrist put me on Ativan last October (my current problem actually only started last June!), and when that wasn't sufficient she replaced it with Xanax XR (the extended release version), at a low level (1mg twice a day) probably around early December. In addition, she put me on first Ambien and then Restoril as a sleep aid. Usually I would use the Ambien put if I had an especially tough evening, then I would opt to take the Restoril (Actually, now I often can even go without either one and just use Melatonin and Valerain). My main sleep problem currently is that I get up (without fail) between 3:30 and 4:30 AM and frequently have a problem getting back to sleep then... guess what, that's when the cortisol levels are starting to climb up again). In my case, I definitely have the correct circadian rhythm, but when my levels start climbing, they obviously quickly start shooting up above normal which results in that inability to get back to sleep. Anyway, my point is that you might want to talk to your doc - either a psych doc on endo -about getting you on something specifically for the anxiety. I truly believe that the Xanax XR "saved my life" in that the anxiety levels had climbed that tremendously!
See: http://www.remedyfind.com/HC-Anxiety.asp
http://www.remedyfind.com/all_remedies.asp?id=85BTW, have you had any similar - or otherwise related - physical symptoms?
* QUOTE: Studies at the University of Colorado and Greenslopes Private Hospital in Brisbane, Australia, showed that Prozac (fluoxetine) increases both cortisol and ACTH levels... Research at the Vanderbilt University School of Medicine in Nashville, Tennessee, also documented the cortisol-boosting effects of Prozac. .. Laudenslager ML, Clarke AS. Antidepressant treatment during social challenge prior to 1 year of age affects immune and endocrine responses in adult macaques. Psychiatry Res. 2000 Jul 24;95(1):25-34... Torpy DJ et al. Diurnal effects of fluoxetine and naloxone on the human hypothalamic-pituitary-adrenal axis. Clin Exp Pharmacol Physiol. 1997 June; 24 (6):421-3
http://members.aol.com/atracyphd/
http://health-essentials.info/science/health-issues/ssri01.htmlI have even read some information that indicates 5HTP (and tryptophan?) might cause increases in cortisol... and hope that someone like Larry Hoover might have some further information on that.... (that would be very unfortunate as tryptophan/5HTP are highly touted natural anti-anxiety supps).
http://www.earthtym.net/ref-serotonin.htm
http://www.rdc.ab.ca/scottpsych/website/student/herbal.htm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15202683I know that elevated cortisol has a strong effect on the utilization of tryptophan and believe that 5htp - if it in fact does NOT increase cortisol - might be a better choice than tryptophan....
QUOTE: Why should I consider 5-HTP supplementation?
All serotonin used by brain cells must be made within the neurons, since serotonin cannot cross the blood-brain barrier. Therefore, the synthesis of serotonin is heavily dependent upon the availability of L-tryptophan within the CNS. The production and transport of L-Tryptophan from the bloodstream into the CNS can be compromised by several factors including ostress, elevated cortisol levels, vitamin B6 deficiency, and even high dosages (above 2,000 mg) of L-Tryptophan, which all stimulate the conversion of L-Tryptophan to kynurenine, lowering serum tryptophan levels.1-3o END QUOTEhttp://www.millnut.com/L5HTP.shtml
http://www.smart-drugs.net/ias-tryptophan-article.htmWell, getting way off topic here.
I'm going to go out on a limb here - while insisting that proper follow-up testing be conducted - and offer my opinion. I believe that you will test out as non Cushings - or more technically correct as "Pseudo Cushings".
I suggest that as you make the following statement: "... have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night." That shouldn't be the case with "real" Cushings (though maybe it's an early onset - which is why one should have the testing!).
That SUGGESTS to me that your cortisol levels are following the normal rhythm pattern of declining at night and then rising significantly in the morning (and staying high through the day before once again declining at night).
Sounds very, very familiar to me!
Please keep updated as to testing done and results of same.... in addition to testing for Cushings, it might be of interest to have tests done for a Pheo tumor. While quite rare (a tumor inside an adrenal gland), Pheo tumors are notorious for producing anxiety. Generally those are accompanied (tho not always) by very high blood pressure. You mentioned "Metanephrines were normal although normetanephrine was high normal"... that sounds like it may have come from a test for checking the possibility of a Pheo tumor. Do you know if that was the case? I "believe" that in the case of a Pheo tumor that your Metanephrine would be highly elevated....
ElroyX
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> This is fascinating to me. I also have highly elevated cortisol levels (along with a small pituitary tumor). My dexamethasone suppression test was "borderline." Metanephrines were normal although normetanephrine was high normal.
>
> My next test is the corticotropin releasing hormone deal where you get injected with a drug and then blood is drawn periodically afterward. I believe this is supposed to rule out Cushings?
>
> The reason this is so important to me is that my formerly treatable depression has become treatment resistant in the last few years. I have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night.
>
> My endoc. doesn't think the tumor is causing the problems but obviously something is going on. I don't know what other tests to ask for - I need to know what tests might conclusively reveal an endocrine problem causing depression/anxiety. I thought of just asking him to test for anything that could possibly be causing this but they tend to take you more seriously if you are well informed when you go in.
>
> Any advice would be much appreciated.
>
> Marsha
>
>
Posted by 4WD on May 19, 2005, at 22:53:43
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » 4WD, posted by Elroy on May 19, 2005, at 21:45:06
First of all, thank you so much for your post. I've been reading Merck Manual and on the web but it's a lot to sift through and take in.
OK, will try to provide sufficient detail but keep it simple enough to insure that the main points are covered.
>
> By the way, do you have any of your actual numbers AND the reference range that your lab uses (for example, cortisol is at 276 with a reference range of 20 - 100 for normal range)???My 24hr. cortisol level was 134 on the first test and 178 on the second test a couple of weeks later. Ref range 20-90.
>
> The dex suppression test being borderline is enough evidence to raise suspicions (obviously in combination with the known high cortisol). But the dex suppression test itself does not have a high degree of absolute reliability.
>
> The CRH test is an older test that was done to (hopefully) determine Cushings or not - and to give some degree of an indication whether or not it is pituitary related or adrenal related.They had to order the drugs special and I had to get prior approval from my insurance to pay for the test.
I think the endo said it would tell whether the elevated cortisol was from the pituitary tumor or not. His thought was that the elevated cortisol might be *from* the anxiety.
>
>
> A much better test is the combined Dex/CRH Test. During that test you take the dexamethasone every six hours for two days (with it scheduled so that your last dose is at midnite on day 2). Then early on the next morning you go in and have the CRH test performed. Has something like a 95% reliability rating and is better at providing indicators of pituitary versus adrenal. My doctor also had me do a 24-hour UFC (Urinary Free Cortisol) test on day 2 of the dexamethasone phase.I wonder why my endo didn't do this. Perhaps because he is already assuming the tumor is not active. He said that even if it were, it would not be causing the level of depression and anxiety I described.
> The BEST test however for determining if it is actual Cushings or "Pseudo Cushings" however is actually a very simple saliva test. It is called the Late Night Salivary Cortisol Test and consists of spitting a certain amount of saliva into provided test tube between 11 PM and Midnite. Cortisol is not secreted at the same rate throughout the day. It begins declining at night (that's what makes you sleepy) and is at a lowest point around 11 PM to Midnite (and somewhat later) and then begins rising again in the morning (that's what wakes you up). That cycle is called the circadian rhythm. People with "regular" Cushings no longer have that circadian rhythm as the offending tumor is "forcing" the excess production of the cortisol at all times. If your levels are definitely within the normal range (not "borderline" or especially not elevated) then there is an excellent chance that you are NOT a regular Cushings.I don't fit the profile for Cushings except that I feel I have an abnormal amount of belly fat for a person who is 5ft.4 and weighs 116. That could of course be simply from the constant high cortisol level.
> I would NOT take any anti cortisol supps (OTC or otherwise) at any time during the time period of any of this type of testing. If you have real Cushings, the positive effect of OTC anti cortisol products would be very minimal (as they cannot overcome the power of the offending tumor)... BUT, if you are borderline, well, one would not want to do anything that would cause a positive result to end up "borderline".
I've been waiting months to try Relacore. The whole process of getting these tests done seems to drag on forever.
>
> Cushings is a very serious disorder and one needs to find out absolutely for sure whether or not one in fact has it or not (many doctors unfortunately will try to diagnose it simply by "visual symptoms"... so if you have highly elevated cortisol and a borderline dex suppression test, but don't have the major "usual" visual symptoms, then they declare that you're not Cushings and let it go at that... where in fact Cushings has numerous symptoms and many people do not have the "usual" visual symptoms but in fact ARE Cushings!).
>
> That said, both depression (especially the type more often refered to as "psychotic depression") and anxiety very definitely cause elevated cortisol levels... and elevated cortisol causes increased anxiety and / or depression. Vicious cycle. Also, is very obvious in people who have become treatment resistant.Okay, this is good. My endo said that elevated cortisol does not make you feel differently. He said feeling terrified could increase cortisol but that the converse was not true. Can I tell him Elroy begs to differ?
>
> BTW, there is some clinical information out there that Prozac (and other SSRI meds) actually INCREASES cortisol levels (thereby worsening the situation*). I know that most people go nuts at the idea of benzos, but my psychiatrist put me on Ativan last October (my current problem actually only started last June!), and when that wasn't sufficient she replaced it with Xanax XR (the extended release version), at a low level (1mg twice a day) probably around early December. In addition, she put me on first Ambien and then Restoril as a sleep aid. Usually I would use the Ambien put if I had an especially tough evening, then I would opt to take the Restoril (Actually, now I often can even go without either one and just use Melatonin and Valerain). My main sleep problem currently is that I get up (without fail) between 3:30 and 4:30 AM and frequently have a problem getting back to sleep then... guess what, that's when the cortisol levels are starting to climb up again). In my case, I definitely have the correct circadian rhythm, but when my levels start climbing, they obviously quickly start shooting up above normal which results in that inability to get back to sleep.Exactly. I wake up too early and can't go back to sleep because I have been "injected" with a big whopping dose of cortisol or adrenaline or something.
>Anyway, my point is that you might want to talk to your doc - either a psych doc on endo -about getting you on something specifically for the anxiety. I truly believe that the Xanax XR "saved my life" in that the anxiety levels had climbed that tremendously!I have been prescribed Klonopin by my pdoc. I have been reluctant to take it on a regular basis because I was once dependent on Ativan for a long time and because I go to NA for previous pain med abuse and they say Klonopin etc.is a no-no in the program. I've been trying to deal with that and still stay sane (talk about cognitive dissonance) that and have accepted they do not have a clue what I am dealing with. So I have begun to take my Klonopin as directed.
>
> BTW, have you had any similar - or otherwise related - physical symptoms?When the terror peaks, I shake, my heart pounds, my teeth chatter, I start crying and can't stop. This is not panic attacks. I wake up (two hours too early) with a feeling of too much adrenaline surging around in my stomach and chest. I get up and it gets worse over the next half hour. It goes from nervousness to fear - think of a phobic person facing the object of his phobia. Then it continues to build until it's terror- think of having a psychotic person holding a loaded gun to your head. The terror brings on even more anxiety (rumination anxiety). This lasts for a couple or three hours until I completely break down, start to cry and am overcome with horrible despair. AFter crying for an hour or so, I feel marginally better, get up off the floor, try to go on and then it starts to build again. This can last all day. It's pretty bad.
Oh, wait, you asked about physical symptoms. I got off track. I do continue to lose bone mass even though I am on HRT and spend a fair amount of time on the treadmill (going hard and fast on the treadmill for 45 minutes will lessen the terror down to fear or the fear down to nervousness). So far no delayed healing or easy bruising.
>
> * QUOTE: Studies at the University of Colorado and Greenslopes Private Hospital in Brisbane, Australia, showed that Prozac (fluoxetine) increases both cortisol and ACTH levels... Research at the Vanderbilt University School of Medicine in Nashville, Tennessee, also documented the cortisol-boosting effects of Prozac. ..I am currently on 10mg Celexa. I can only take small doses of SSRI's - side effects are too intense. I was on Nortriptyline 25mg in addition for about a month. I was better briefly but after 3 weeks, the terror got way worse. Now I'm off the NOrt. Prozac gave me terrible insomnia but the reverse kind. I couldnt fall asleep but once I did, I could sleep 12 hours.
> I know that elevated cortisol has a strong effect on the utilization of tryptophan and believe that 5htp - if it in fact does NOT increase cortisol - might be a better choice than tryptophan....
I have 5HTP but haven't used it yet.
>
> QUOTE: Why should I consider 5-HTP supplementation?
> All serotonin used by brain cells must be made within the neurons, since serotonin cannot cross the blood-brain barrier. Therefore, the synthesis of serotonin is heavily dependent upon the availability of L-tryptophan within the CNS. The production and transport of L-Tryptophan from the bloodstream into the CNS can be compromised by several factors including ostress, elevated cortisol levels, vitamin B6 deficiency, and even high dosages (above 2,000 mg) of L-Tryptophan, which all stimulate the conversion of L-Tryptophan to kynurenine, lowering serum tryptophan levels.1-3o END QUOTE
>
> http://www.millnut.com/L5HTP.shtml
> http://www.smart-drugs.net/ias-tryptophan-article.htm
>
> Well, getting way off topic here.5HTP might help anxiety? Why, when SSRI's generally increase my anxiety level? I'm only on Celexa now because I'm out of options and it's the lesser of the evils.
>
> I'm going to go out on a limb here - while insisting that proper follow-up testing be conducted - and offer my opinion. I believe that you will test out as non Cushings - or more technically correct as "Pseudo Cushings".
>
> I suggest that as you make the following statement: "... have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night." That shouldn't be the case with "real" Cushings (though maybe it's an early onset - which is why one should have the testing!).
>
> That SUGGESTS to me that your cortisol levels are following the normal rhythm pattern of declining at night and then rising significantly in the morning (and staying high through the day before once again declining at night).
>
> Sounds very, very familiar to me!Do you feel good at night? I mean does the depression and anxiety lift at some point and then suddenly, miraculously, you feel almost like a normal person?
>
> Please keep updated as to testing done and results of same.... in addition to testing for Cushings, it might be of interest to have tests done for a Pheo tumor. While quite rare (a tumor inside an adrenal gland), Pheo tumors are notorious for producing anxiety. Generally those are accompanied (tho not always) by very high blood pressure. You mentioned "Metanephrines were normal although normetanephrine was high normal"... that sounds like it may have come from a test for checking the possibility of a Pheo tumor. Do you know if that was the case?Metanephrines were tested as part of my 24hr. urinary cortisol test. They also tested for VMA, catecholamines and creatinine. Not sure what these are or why they were tested.
I "believe" that in the case of a Pheo tumor that your Metanephrine would be highly elevated....Only slightly elevated, still in the normal range.
Again, I can't thank you enough. You must have spent a long time answering my post and I sincerely appreciate it.Marsha
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> > This is fascinating to me. I also have highly elevated cortisol levels (along with a small pituitary tumor). My dexamethasone suppression test was "borderline." Metanephrines were normal although normetanephrine was high normal.
> >
> > My next test is the corticotropin releasing hormone deal where you get injected with a drug and then blood is drawn periodically afterward. I believe this is supposed to rule out Cushings?
> >
> > The reason this is so important to me is that my formerly treatable depression has become treatment resistant in the last few years. I have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night.
> >
> > My endoc. doesn't think the tumor is causing the problems but obviously something is going on. I don't know what other tests to ask for - I need to know what tests might conclusively reveal an endocrine problem causing depression/anxiety. I thought of just asking him to test for anything that could possibly be causing this but they tend to take you more seriously if you are well informed when you go in.
> >
> > Any advice would be much appreciated.
> >
> > Marsha
> >
> >
>
>
Posted by Elroy on May 22, 2005, at 19:19:45
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by 4WD on May 19, 2005, at 22:53:43
Arrrrgggghhhh.....
RE: "My endo said that elevated cortisol does not make you feel differently... he is already assuming the tumor is not active. He said that even if it were, it would not be causing the level of depression and anxiety I described. "
I cannot, absolutely cannot believe that an Endo actually said that!
Have him go to the following web site:
http://boards.cushings-interactive.com/invboard/index.php?act=idx
Tell him to register and then spend a few hours looking through the various stories of agony that are posted there. Have him read of the numerous stories posted there of how HIGH cortisol made these people feel horrible. Not just making them "fat", not just driving their blood pressure off the chart, not just causing numerous physical symptoms that have actual physical pain, but also very specifically anxiety and depression.
Have him specifically read through thepostings at this section (or, heck, print them out and shove them in his face):
http://boards.cushings-interactive.com/invboard/index.php?showforum=28
http://boards.cushings-interactive.com/invboard/index.php?showtopic=12264
http://boards.cushings-interactive.com/invboard/index.php?showtopic=12172
http://boards.cushings-interactive.com/invboard/index.php?showtopic=11996 (especially this one... )
http://boards.cushings-interactive.com/invboard/index.php?showtopic=10431&hl=anxiety
http://boards.cushings-interactive.com/invboard/index.php?showtopic=10541&hl=anxiety
http://boards.cushings-interactive.com/invboard/index.php?showtopic=3375&hl=anxiety
http://boards.cushings-interactive.com/invboard/index.php?showtopic=6206&hl=anxietyOkay, okay... most of these are either full-blown Cushing's patients or people who are going through the Cushing's testing process. But many are not... they "just" have highly elevated cortisol levels.... and still have high anxiety and / or deep depression problems...
Here's another section to (firmly) suggest he read:
http://boards.cushings-interactive.com/invboard/index.php?showforum=80
http://boards.cushings-interactive.com/invboard/index.php?showtopic=10439Have him read about the success stories and how - once surgical intervention corrects the offending tumor problem (and the cortisol immediately drops down), that ALL the symptoms - including anxiety and depression, etc., etc. - immediately go away. Now if the cortisol, the elevated cortisol, wasn't causing those problems, then why do those problems immediately go away when the ortisol is drastically lowered.
How about a quote from a legitimate medical source:
QUOTE: From Cushing's Syndrome - Allan D. Marks, MD - Cushing's syndrome: the clinical signs, symptoms, and laboratory abnormalities caused by excessive exposure to cortisol (or its synthetic analogs)...
Manifestations of Steroid Excess (lists a bunch of stuff here)... Mental changes (glucocorticoid excess): Range from irritability to depression to psychosis... END QUOTE
http://www.cushings-help.com/syndrome1.htm
Note what it says: "Mental changes (glucocorticoid excess): Range from irritability to depression to psychosis.."
It means excess cortisol from WHATEVER cause - that could include from oversecretion caused by a tumor, excessive artificial cortisol (hydrocortisone, etc.) as used for asthma patients or arthritis patients, etc... to "Pseudo Cushings". The latter simply means that there is indeed excess cortisol being secreted, but that it is NOT coming from an offending tumor or a cancer in the body. It coud be due to extreme alcoholism, or from a highly active HIV condition, etc., etc... to include excessive cortisol being secreted due to a dysfunctional HPA axis (in a situation where chronic stress and low-level anxiety has kept the HPA axis overproducing for months or even years and the HPA axis basically "breaks down"... the adrenals keep now think that excess cortisol is "the norm" and when they switch on, they oversecrete cortisol... now I'm assuming that your "endo" is an ENDOCRINOLOGIST. You might point out to him that this is an endocrine problem - whether it's "REAL" Cushings or Pseudo Cushings or whatever... and ask him what he's going to do about it*).
more???.
Dr. Blevins's Book Cushing's Syndrome, Chapter 3, Psychiatric Manifestions of Cushing's Syndrome, Dr. Loosen discusses the differential diagnosis.
QUOTE: "Cushing's major laboratory findings (hypercortisolemia, loss of normal diurnal cortisol rhythm, increased renal ecretion of cortisol and cortisol metabolites and abnormal resistance to dexamethasone suppression) can overlap with clinical depression." In his article, he further states "50% of patients with acute Cushing's suffer from major depression, 18% suffer from anxiety disorder, 7% have bi-polar disorder, and 4% suffer from substance abuse. None had schizophrenia."
"Sonino et al reported that depression in acute Cushing's syndrome was associated wtih older age, female sex, higher pretreatment urinary cortisol levels, relatively more severe clinical condition and absence of pituitary adenoma."
The thing that was interesting is that 79% have anxiety and panic symptoms, but this does not represent a formal anxiety diagnosis." END QUOTEAw, heck, how about some more....
http://wideberthasmessageboard.com/showthread.php?t=28&highlight=denyse
How about Denyse's story?
http://pages.zdnet.com/nana2003/id9.html
http://wideberthasmessageboard.com/showthread.php?t=325&highlight=denyse
QUOTE: I was dizzy for years and at night when I went to bed, i could often hear a high pitched note that would slurr down very slowly and believe me, I thought all of my life was shutting down. I would stand up rapidly because I really felt I was dying because of that slurring note. I heard only a few times that other Cushinoids had this symptoms but not often. One of my first symptoms was anxiety and had no reasons to have this problem. I saw a psychiatrist for years, giving me all kinds of pills for my depression due to Cushing and only later did I find out that the high cortisol in your body makes you suffer from anxiety also.... The high cortisol makes you feel like you have to run for your life because you are in danger and there is nothing going on that is life threatening and this also explains why we cant sleep when we have this... END QUOTESound familiar?
How about "Psychiatric Issues of Cushing's Patients" from the Cushing's Support and Research Foundation? QUOTE: High cortisol levels also can be experienced by the body as anxiety, and insomnia is extremely common in patients on steroids and with high cortisol states. Elevated, agitated mood, like in mania, can also be seen in a minority of patients, and some actually hallucinate and have psychotic symptoms.... END QUOTE
http://csrf.net/CopingAnswers.htm
Okay, so let's grant that your tests all come back (and insist that he use the correct, more updated ones - or go find a more qualified Endo*) and you're clearly NOT a Cushie... well, at least not a regular Cushie. If you have cosnsistenly elevated cortisol, you ARE a Pseudo Cushie... and my response is "So what?"....
All of this information still applies.
Cortisol can and does cause depression and anxiety and even psychosis! Your "personal" elevated cortisol simply isn't coming from a pituitary tumor or an adernal tumor or a small-cell caner excreting ACTH. But is clearly IS coming from somewhere and for some reason. Just writing it off as "coming from your anxiety" is BS. Stress and chronic low-level anxiety may have initially caused the problem, but the elevated cortisol in and of itself is now causing even worse anxiety... or "psychotic depression" as it is sometimes termed).
http://goodhormonehealth.com/symptoms/pseudocush.pdf (Great article... "trouble sleeping, depression or mood swings, anxiety, fatigue and altered mentation ... but lack elevated cortisol production. The psychiatric conditions causing pseudo-Cushing's states ... ")
http://www.endotext.org/adrenal/adrenal18/adrenal18.htm
http://av.rds.yahoo.com/_ylt=A0Je5W.oGZFCtm4BpTGDBqMX;_ylu=X3oDMTBwMjNqdWVsBHBndANhdHdfd2ViX3Jlc3VsdARzZWMDc3I-/SIG=12dsqj29l/EXP=1116891944/**http%3a//www.niaaa.nih.gov/publications/arh23-4/272-283.pdfSo my next question is this. If cortisol does NOT cause anxiety or depression or "psychotic depression" (which seems to be the anxiety form of depression) or psychosis, etc., then why are neuropsychiatrists currently reviewing the use of anti-cortisol drugs like RU486 (for very SHORT-TERM therapy dosings) for anti-depressent / anti-anxiety trials??? And with excellent successes in trials to date (with very minimal to no side effects due to the nature of the SHORT-TERM nature of theprotocol).
Now if your endo's position was correct, that anxiety can cause high cortisol, but cortisol can NOT cause anxiety, then how can all of these trial studies be coming back with such effective results?
This definesd "Psychotic Depression" (soundslike anxiety to me):
http://www.healthyplace.com/communities/depression/psychotic.asp
http://www.psychosomaticmedicine.org/cgi/content/full/61/5/698
http://www.utmj.org/issues/77.1/pdf/Psych77-1.pdf
http://www.psychiatrictimes.com/p040592.html
http://www.namiscc.org/News/2002/Fall/MifepristoneClinicalTrial.htm
http://news-service.stanford.edu/news/2000/november8/ru486-1108.html
http://www2.eclinicalpsychiatrynews.com/scripts/om.dll/serve(* Actually I'd already be looking at shopping for a new Endo as this guy - IMHO - seems to be dangerous. I'd also get a qualified psychiatrist on board and be looking at something to specifically treat the anxiety - Xanax XR or whatever).
ElroyP.S. I still stand by this i if he wants to know for sure if it's Cushing's or not: The BEST test however for determining if it is actual Cushings or "Pseudo Cushings" however is actually a very simple saliva test. It is called the Late Night Salivary Cortisol Test and consists of spitting a certain amount of saliva into provided test tube between 11 PM and Midnite. Cortisol is not secreted at the same rate throughout the day. It begins declining at night (that's what makes you sleepy) and is at a lowest point around 11 PM to Midnite (and somewhat later) and then begins rising again in the morning (that's what wakes you up). That cycle is called the circadian rhythm. People with "regular" Cushings no longer have that circadian rhythm as the offending tumor is "forcing" the excess production of the cortisol at all times. If your levels are definitely within the normal range (not "borderline" or especially not elevated) then there is an excellent chance that you are NOT a regular Cushings.... and then follow up with the combined Dex/CRH Test. During that test you take the dexamethasone every six hours for two days (with it scheduled so that your last dose is at midnite on day 2). Then early on the next morning you go in and have the CRH test performed. Has something like a 95% reliability rating and is better at providing indicators of pituitary versus adrenal. My doctor also had me do a 24-hour UFC (Urinary Free Cortisol) test on day 2 of the dexamethasone phase.
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> First of all, thank you so much for your post. I've been reading Merck Manual and on the web but it's a lot to sift through and take in.
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> OK, will try to provide sufficient detail but keep it simple enough to insure that the main points are covered.
> >
> > By the way, do you have any of your actual numbers AND the reference range that your lab uses (for example, cortisol is at 276 with a reference range of 20 - 100 for normal range)???
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> My 24hr. cortisol level was 134 on the first test and 178 on the second test a couple of weeks later. Ref range 20-90.
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> >
> > The dex suppression test being borderline is enough evidence to raise suspicions (obviously in combination with the known high cortisol). But the dex suppression test itself does not have a high degree of absolute reliability.
> >
> > The CRH test is an older test that was done to (hopefully) determine Cushings or not - and to give some degree of an indication whether or not it is pituitary related or adrenal related.
>
> They had to order the drugs special and I had to get prior approval from my insurance to pay for the test.
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> I think the endo said it would tell whether the elevated cortisol was from the pituitary tumor or not. His thought was that the elevated cortisol might be *from* the anxiety.
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> >
> >
> > A much better test is the combined Dex/CRH Test. During that test you take the dexamethasone every six hours for two days (with it scheduled so that your last dose is at midnite on day 2). Then early on the next morning you go in and have the CRH test performed. Has something like a 95% reliability rating and is better at providing indicators of pituitary versus adrenal. My doctor also had me do a 24-hour UFC (Urinary Free Cortisol) test on day 2 of the dexamethasone phase.
>
> I wonder why my endo didn't do this. Perhaps because he is already assuming the tumor is not active. He said that even if it were, it would not be causing the level of depression and anxiety I described.
>
>
> > The BEST test however for determining if it is actual Cushings or "Pseudo Cushings" however is actually a very simple saliva test. It is called the Late Night Salivary Cortisol Test and consists of spitting a certain amount of saliva into provided test tube between 11 PM and Midnite. Cortisol is not secreted at the same rate throughout the day. It begins declining at night (that's what makes you sleepy) and is at a lowest point around 11 PM to Midnite (and somewhat later) and then begins rising again in the morning (that's what wakes you up). That cycle is called the circadian rhythm. People with "regular" Cushings no longer have that circadian rhythm as the offending tumor is "forcing" the excess production of the cortisol at all times. If your levels are definitely within the normal range (not "borderline" or especially not elevated) then there is an excellent chance that you are NOT a regular Cushings.
>
> I don't fit the profile for Cushings except that I feel I have an abnormal amount of belly fat for a person who is 5ft.4 and weighs 116. That could of course be simply from the constant high cortisol level.
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> > I would NOT take any anti cortisol supps (OTC or otherwise) at any time during the time period of any of this type of testing. If you have real Cushings, the positive effect of OTC anti cortisol products would be very minimal (as they cannot overcome the power of the offending tumor)... BUT, if you are borderline, well, one would not want to do anything that would cause a positive result to end up "borderline".
>
> I've been waiting months to try Relacore. The whole process of getting these tests done seems to drag on forever.
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> >
> > Cushings is a very serious disorder and one needs to find out absolutely for sure whether or not one in fact has it or not (many doctors unfortunately will try to diagnose it simply by "visual symptoms"... so if you have highly elevated cortisol and a borderline dex suppression test, but don't have the major "usual" visual symptoms, then they declare that you're not Cushings and let it go at that... where in fact Cushings has numerous symptoms and many people do not have the "usual" visual symptoms but in fact ARE Cushings!).
> >
> > That said, both depression (especially the type more often refered to as "psychotic depression") and anxiety very definitely cause elevated cortisol levels... and elevated cortisol causes increased anxiety and / or depression. Vicious cycle. Also, is very obvious in people who have become treatment resistant.
>
> Okay, this is good. My endo said that elevated cortisol does not make you feel differently. He said feeling terrified could increase cortisol but that the converse was not true. Can I tell him Elroy begs to differ?
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> >
> > BTW, there is some clinical information out there that Prozac (and other SSRI meds) actually INCREASES cortisol levels (thereby worsening the situation*). I know that most people go nuts at the idea of benzos, but my psychiatrist put me on Ativan last October (my current problem actually only started last June!), and when that wasn't sufficient she replaced it with Xanax XR (the extended release version), at a low level (1mg twice a day) probably around early December. In addition, she put me on first Ambien and then Restoril as a sleep aid. Usually I would use the Ambien put if I had an especially tough evening, then I would opt to take the Restoril (Actually, now I often can even go without either one and just use Melatonin and Valerain). My main sleep problem currently is that I get up (without fail) between 3:30 and 4:30 AM and frequently have a problem getting back to sleep then... guess what, that's when the cortisol levels are starting to climb up again). In my case, I definitely have the correct circadian rhythm, but when my levels start climbing, they obviously quickly start shooting up above normal which results in that inability to get back to sleep.
>
> Exactly. I wake up too early and can't go back to sleep because I have been "injected" with a big whopping dose of cortisol or adrenaline or something.
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> >Anyway, my point is that you might want to talk to your doc - either a psych doc on endo -about getting you on something specifically for the anxiety. I truly believe that the Xanax XR "saved my life" in that the anxiety levels had climbed that tremendously!
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> I have been prescribed Klonopin by my pdoc. I have been reluctant to take it on a regular basis because I was once dependent on Ativan for a long time and because I go to NA for previous pain med abuse and they say Klonopin etc.is a no-no in the program. I've been trying to deal with that and still stay sane (talk about cognitive dissonance) that and have accepted they do not have a clue what I am dealing with. So I have begun to take my Klonopin as directed.
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> >
> > BTW, have you had any similar - or otherwise related - physical symptoms?
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> When the terror peaks, I shake, my heart pounds, my teeth chatter, I start crying and can't stop. This is not panic attacks. I wake up (two hours too early) with a feeling of too much adrenaline surging around in my stomach and chest. I get up and it gets worse over the next half hour. It goes from nervousness to fear - think of a phobic person facing the object of his phobia. Then it continues to build until it's terror- think of having a psychotic person holding a loaded gun to your head. The terror brings on even more anxiety (rumination anxiety). This lasts for a couple or three hours until I completely break down, start to cry and am overcome with horrible despair. AFter crying for an hour or so, I feel marginally better, get up off the floor, try to go on and then it starts to build again. This can last all day. It's pretty bad.
>
> Oh, wait, you asked about physical symptoms. I got off track. I do continue to lose bone mass even though I am on HRT and spend a fair amount of time on the treadmill (going hard and fast on the treadmill for 45 minutes will lessen the terror down to fear or the fear down to nervousness). So far no delayed healing or easy bruising.
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> >
> > * QUOTE: Studies at the University of Colorado and Greenslopes Private Hospital in Brisbane, Australia, showed that Prozac (fluoxetine) increases both cortisol and ACTH levels... Research at the Vanderbilt University School of Medicine in Nashville, Tennessee, also documented the cortisol-boosting effects of Prozac. ..
>
> I am currently on 10mg Celexa. I can only take small doses of SSRI's - side effects are too intense. I was on Nortriptyline 25mg in addition for about a month. I was better briefly but after 3 weeks, the terror got way worse. Now I'm off the NOrt. Prozac gave me terrible insomnia but the reverse kind. I couldnt fall asleep but once I did, I could sleep 12 hours.
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> > I know that elevated cortisol has a strong effect on the utilization of tryptophan and believe that 5htp - if it in fact does NOT increase cortisol - might be a better choice than tryptophan....
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> I have 5HTP but haven't used it yet.
>
> >
> > QUOTE: Why should I consider 5-HTP supplementation?
> > All serotonin used by brain cells must be made within the neurons, since serotonin cannot cross the blood-brain barrier. Therefore, the synthesis of serotonin is heavily dependent upon the availability of L-tryptophan within the CNS. The production and transport of L-Tryptophan from the bloodstream into the CNS can be compromised by several factors including ostress, elevated cortisol levels, vitamin B6 deficiency, and even high dosages (above 2,000 mg) of L-Tryptophan, which all stimulate the conversion of L-Tryptophan to kynurenine, lowering serum tryptophan levels.1-3o END QUOTE
> >
> > http://www.millnut.com/L5HTP.shtml
> > http://www.smart-drugs.net/ias-tryptophan-article.htm
> >
> > Well, getting way off topic here.
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> 5HTP might help anxiety? Why, when SSRI's generally increase my anxiety level? I'm only on Celexa now because I'm out of options and it's the lesser of the evils.
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> >
> > I'm going to go out on a limb here - while insisting that proper follow-up testing be conducted - and offer my opinion. I believe that you will test out as non Cushings - or more technically correct as "Pseudo Cushings".
> >
> > I suggest that as you make the following statement: "... have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night." That shouldn't be the case with "real" Cushings (though maybe it's an early onset - which is why one should have the testing!).
> >
> > That SUGGESTS to me that your cortisol levels are following the normal rhythm pattern of declining at night and then rising significantly in the morning (and staying high through the day before once again declining at night).
> >
> > Sounds very, very familiar to me!
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> Do you feel good at night? I mean does the depression and anxiety lift at some point and then suddenly, miraculously, you feel almost like a normal person?
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> >
> > Please keep updated as to testing done and results of same.... in addition to testing for Cushings, it might be of interest to have tests done for a Pheo tumor. While quite rare (a tumor inside an adrenal gland), Pheo tumors are notorious for producing anxiety. Generally those are accompanied (tho not always) by very high blood pressure. You mentioned "Metanephrines were normal although normetanephrine was high normal"... that sounds like it may have come from a test for checking the possibility of a Pheo tumor. Do you know if that was the case?
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> Metanephrines were tested as part of my 24hr. urinary cortisol test. They also tested for VMA, catecholamines and creatinine. Not sure what these are or why they were tested.
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> I "believe" that in the case of a Pheo tumor that your Metanephrine would be highly elevated....
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> Only slightly elevated, still in the normal range.
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> Again, I can't thank you enough. You must have spent a long time answering my post and I sincerely appreciate it.
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> Marsha
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> > > This is fascinating to me. I also have highly elevated cortisol levels (along with a small pituitary tumor). My dexamethasone suppression test was "borderline." Metanephrines were normal although normetanephrine was high normal.
> > >
> > > My next test is the corticotropin releasing hormone deal where you get injected with a drug and then blood is drawn periodically afterward. I believe this is supposed to rule out Cushings?
> > >
> > > The reason this is so important to me is that my formerly treatable depression has become treatment resistant in the last few years. I have also begun to have uncontrollable fear or terror in the mornings upon waking. It lasts most of the day and goes away spontaneously at night.
> > >
> > > My endoc. doesn't think the tumor is causing the problems but obviously something is going on. I don't know what other tests to ask for - I need to know what tests might conclusively reveal an endocrine problem causing depression/anxiety. I thought of just asking him to test for anything that could possibly be causing this but they tend to take you more seriously if you are well informed when you go in.
> > >
> > > Any advice would be much appreciated.
> > >
> > > Marsha
> > >
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Posted by 4WD on May 23, 2005, at 22:12:36
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » 4WD, posted by Elroy on May 22, 2005, at 19:19:45
> Arrrrgggghhhh.....
>
> RE: "My endo said that elevated cortisol does not make you feel differently... he is already assuming the tumor is not active. He said that even if it were, it would not be causing the level of depression and anxiety I described. "
>
> I cannot, absolutely cannot believe that an Endo actually said that!
>
> Have him go to the following web site:
>
> http://boards.cushings-interactive.com/invboard/index.php?act=idx
Dear Elroy,Thank you so much. I have registered at the Cushings site and will read the postings you cited as soon as I get my confirmation email. I will print some out and take with me to my next appt. If the guy is still adamant I will find another endocrinologist.
I am so relieved to know this terror and anxiety could be from the elevated cortisol. Part of what makes it so horrible is just not knowing why it's happening. I have been over every possible reason a million times. Now I have hope that there is an answer.
I can't believe you took the time to look all that up for me. Truly, I am so grateful.
Marsha
Posted by Elroy on May 24, 2005, at 10:45:41
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by 4WD on May 23, 2005, at 22:12:36
Marsha,
You are very welcome.
Fortunately (unfortunately) so much of what's going on parallels my case that it was easy (this time around) for me to locate this information... as I had found it already in the recent past as relates to my case!
Please keep us informed as to what happens with your situation (especially me!). I would like to know if you in fact end up having "real" Cushing's (I'm still betting on that it's going to be "Pseudo Cushings"), if you end up having to get a new Endo (I'm betting that you do), and if your new Endo (or psyciatrist as you should have one of those "on board your team" also) come up with a way to (a) control the cortisol levels and (b) cure the anxiety problem (or "psychotic depression" as it may end up more accurately being defined). On a personal level, your team might end up coming up with a very positive approach that I can then get my team to give a try!
Also might want to see if you can get a lab test to see if your histamine levels are highly elevated. Have recently read where it's not uncommon for depressed / anxious people with too high cortisol to also have too high histamine levels.
To educate yourself on the mega nutrient approach to balancing and correcting neurotransmitter problems, would suggest reading thebook "The Edge Effect" (by Dr. Eric Braverman) and "The Brain Chemistry Plan" by (Dr. Michael Lesser). I believe the two comliment each other very well (with neither, alone, being quite "THE" answer).
Elroy
P.S. Let me know if it ends up being Pseudo Cushings as soon as possible and I can post some info about anti-cortisol supps (and histamine lowering supps if that get tested also) to address the high cortisol levels.
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X> > Arrrrgggghhhh.....
> >
> > RE: "My endo said that elevated cortisol does not make you feel differently... he is already assuming the tumor is not active. He said that even if it were, it would not be causing the level of depression and anxiety I described. "
> >
> > I cannot, absolutely cannot believe that an Endo actually said that!
> >
> > Have him go to the following web site:
> >
> > http://boards.cushings-interactive.com/invboard/index.php?act=idx
>
>
> Dear Elroy,
>
> Thank you so much. I have registered at the Cushings site and will read the postings you cited as soon as I get my confirmation email. I will print some out and take with me to my next appt. If the guy is still adamant I will find another endocrinologist.
>
> I am so relieved to know this terror and anxiety could be from the elevated cortisol. Part of what makes it so horrible is just not knowing why it's happening. I have been over every possible reason a million times. Now I have hope that there is an answer.
>
> I can't believe you took the time to look all that up for me. Truly, I am so grateful.
>
> Marsha
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Posted by Elroy on May 24, 2005, at 14:26:05
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » Elroy, posted by 4WD on May 23, 2005, at 22:12:36
BTW, here's some more information on how (elevated) cortisol can impact on one's brai neurotransmitters - and affect how they feel, anxiety levels, depression levels, etc....
QUOTE: Cortisol receptors exist on almost every cell in the body and have an important role in brain function. Cortisol may cause fatigue by depleting serotonn (5-HT) in the raphe nuclei, the area of the brain that normally activates the release of NE to increase vigilance. Moderate and transient amounts of cortisol increase the release of dopamine from this pleasure pathway as part of the reward cascade. High and chronic levels of cortisol decrease the production and release of dopamine – thus feelings of pleasure can be harder to produce. In this aspect stress can be a factor in depressive symptoms if either the levels of cortisol are too high or too low. Cortisol is the precursor to the anxiety reducing (anxiolytic) and GABA potentiating neurosteroid, 4-deoxycorticosterone. Cortisol also upregulates tyrosine hydroxylase, the rate limiting enzyme in the synthesis of catecholamines. Cortisol can also increase the transcription of PMNT phenyl-N-methyltransferase, the enzyme responsible for converting norepinephrine to epinephrine. As previously mentioned the upregulation of neurotransmitter function is tempered because cortisol also increases MAO (monoamine oxidase). END QUOTE
http://www.neurorelief.info/newsletterarchive.php?issue=460
Some others (may be repeats of ones earlier sent):
http://www.healthyplace.com/communities/depression/psychotic.asp
http://www2.eclinicalpsychiatrynews.com/scripts/om.dll/serve
http://www.pslgroup.com/dg/2030E2.htmElroy
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> > Arrrrgggghhhh.....
> >
> > RE: "My endo said that elevated cortisol does not make you feel differently... he is already assuming the tumor is not active. He said that even if it were, it would not be causing the level of depression and anxiety I described. "
> >
> > I cannot, absolutely cannot believe that an Endo actually said that!
> >
> > Have him go to the following web site:
> >
> > http://boards.cushings-interactive.com/invboard/index.php?act=idx
>
>
> Dear Elroy,
>
> Thank you so much. I have registered at the Cushings site and will read the postings you cited as soon as I get my confirmation email. I will print some out and take with me to my next appt. If the guy is still adamant I will find another endocrinologist.
>
> I am so relieved to know this terror and anxiety could be from the elevated cortisol. Part of what makes it so horrible is just not knowing why it's happening. I have been over every possible reason a million times. Now I have hope that there is an answer.
>
> I can't believe you took the time to look all that up for me. Truly, I am so grateful.
>
> Marsha
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Posted by piejack on December 28, 2007, at 13:09:33
In reply to Re: Urine Test to Measure Neurotransmitter Levels??? » Elroy, posted by Larry Hoover on May 4, 2005, at 22:24:32
YES. There is an excellent way to measure neurotransmitter testing via uring and saliva by Neuroscience. They have been doing this for years. www.neuroscienceinc.com
Posted by piejack on December 28, 2007, at 13:10:47
In reply to Urine Test to Measure Neurotransmitter Levels???, posted by Elroy on May 4, 2005, at 18:58:16
YES. There is an excellent way to measure neurotransmitter testing via URINE and saliva by Neuroscience. They have been doing this for years. www.neuroscienceinc.com
> Ran across this quote on a web site:
>
> QUOTE: The most effective way to correct a neurotransmitter deficiency is to perform a simple urine test to measure the neurotransmitter levels. END QUOTE
>
> http://www.theelementsofhealth.com/pages.html?section=resources&page=nttherapy
>
> The article has some other interesting things to say:
>
> QUOTE: Neurotransmitters (NTs) are essential chemical messengers that regulate brain, muscle, nerve and organ function. The most common neurotransmitters are serotonin, dopamine, norepinephrine, and epinephrine. Low levels of these important chemicals is extremely common in the general public and is due to innumerable lifestyle, environmental, and dietary factors. This article is intended to help the reader determine whether they may be deficient in neurotransmitters and how evaluation and treatment of this disorder can help.
>
> (Actually I would personally believe this to be not quite that accurate... Dopamine, Acetylcholine, GABA and Serotonin are probably the most important brain neurotransmitters with dopamine, being the "precursor" for norepinephrine and epinephrine - elroy)
>
> People with neurotransmitter deficiency disorder can suffer from one or more of the following conditions: obesity, depression, anxiety, fibromyalgia, chronic fatigue, insomnia, attention deficit, learning disorders, panic attacks, migraines, pms, menopausal symptoms, digestive complaints and many more.
>
> Selective serotonin re-uptake inhibitors (SSRIs) such as Prozac, Zoloft, Effexor, Celexa, Wellbutrin, etc. are currently some of the most commonly prescribed drugs. They work by artificially increasing the amount of serotonin in the synapse of the nerve which allows a temporary improvement in the chemical messaging system.
>
> The problem with this approach is that these drugs DO NOT increase serotonin levels and in fact deplete reserves of the NT. This occurs because the SSRI class drugs cause an increase in an enzyme called MAO It is common for people to experience only temporary improvement due to this effect.
>
> The most effective way to correct a neurotransmitter deficiency is to perform a simple urine test to measure the neurotransmitter levels. The treatment for optimizing the neurotransmitter levels is to provide the basic amino acid precursors or building blocks so the body can replenish the inadequate neurotransmitter levels. END QUOTE
>
> I asked my psych doc and she was like clueless. She "seemed" to indicate that she wasn't aware that there was such a test that could be run to determine NT levels (other than running an expensive BEAM scan)?
>
> It seems to make sense to me that one would check something like this. Why would a psych doc prescribe an SSRI for serotinin deficiency if the patient high normal or even high levels of serotonin but was deficient in dopamine or some other NT??? Is it because this particular SSRI or that particular SSNRI happens to be the flavor of the month?
>
> Anyone familiar with this test and what it is "technically" called? I believe that it is a 24-hour urine test like that run for cortisol to show your daily total.
>
> I'd like to have one run and ascertain my levels. I have anxiety problems almost exclusively (along with a number of other cortisol and possibly candida related {HYSICAL problems) and have been fighting off taking a SSRI or SSNRI....
>
> A recent blood test that I took (to check for a pheo tumor) showed that - at that moment - I had minor low dopamine levels, low normal epinephrine and below normal norepinephrine. Unfortunately that was all the NTs that particular test showed, and a blood test only reveals what's circulating at that given moment, so isn't as accurate as a 24-hr urine test for showing totals....
>
> Thanks.
Posted by marty hinz, MD on August 20, 2010, at 22:52:56
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » 4WD, posted by Elroy on May 19, 2005, at 21:45:06
Contrary to the assertions in the blog urinary neurotransmitter testing is quackery. Baseline testing is of no value since baseline value fluctuate greatly from day to day and there is no correlation between baseline testing performed on one day and another. Furthermore, there is no correlation between baseline testing and tests performed while taking amino acid precursors. The monoamine neurotransmitters found in the urine are synthesized by the kidneys and have no correlation with central or peripheral levels. A lab test is only of value if it is interpreted properly. Simply determining if levels are high or low on testing is of no value. Only in side of the 3 phase model of organic cation transporter functional status interpretation is this valid. The only lab doing this is www.DBSlabs.com. Why are they the only one doing this? Because they ahve the patents on the process. DBS Labs has peer reviewed scientific articles on its web site that discuss what I am saying here. Please read them if you thing labs promoting urinary neurotransmitter testing are legitimate.
Marty Hinz, MD
Posted by chujoe on August 21, 2010, at 12:17:45
In reply to Re: Urine Test to Measure Neurotransmitter Levels?, posted by marty hinz, MD on August 20, 2010, at 22:52:56
So, Marty, what do you think of the use of precursors in general? I'm convinced that tyrosine helps with my ADHD / Anxiety, but I only have my own sense of things to go on.
Posted by Zzzz on August 21, 2010, at 14:12:51
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » marty hinz, MD, posted by chujoe on August 21, 2010, at 12:17:45
I have used L-tyrosine for many years. TSH was climbing in the high zone 6's and standard thyroid replacement caused severe tachycardia.The L-tyrosine amount was adjusted according to the TSH results. For reasons unknown the L-tyrosine dose amount will continue to lower my TSH as the dose increases. This can lead to hyperthyroid. So I am blood tested for the results and have been stable at a certain dose. The L-tyrosine did not cause any blood pressure or pulse increase.
This type of use for the amino acid was well planned out and took a couple years of blood testing for the pre and post results as body fluctuations or use of different labs can alter test results.
I have an underlying anomaly somewhere but neuro-endocrine disorders are a real challenge and only part is known for cetain. I do feel better with the TSH corrected.
Posted by marty hinz, MD on August 22, 2010, at 9:56:01
In reply to Re: Urine Test to Measure Neurotransmitter Levels? » marty hinz, MD, posted by chujoe on August 21, 2010, at 12:17:45
I have headed up a medical research project since 1997 on the use of amino acids in neurotransmitter dysfunction. The amino acids can be exceptionally helful when prescribed by properly trained doctors. Go to www.neuroassist.com for an over view.
Posted by chujoe on August 22, 2010, at 10:55:51
In reply to they do help in the right hands, posted by marty hinz, MD on August 22, 2010, at 9:56:01
Thanks, Marty, for the link. I've been reading the material on your site, but I have to admit that I'm a little suspicious of any scientific result that claims 100% effectiveness. From my own research I can see that you & your associates are working with the usual neurotransmitter supplements, but if I'm understanding you correctly, you are getting superior results because of careful case management and precise dosing, is that correct?
Posted by violette on August 22, 2010, at 11:34:46
In reply to they do help in the right hands, posted by marty hinz, MD on August 22, 2010, at 9:56:01
Pretty interesting. I wanted to see the doctors or clinics in my area associated with this treatment approach-but saw you had to give out your personal information to get that information. It makes me think someone would be calling me back to do a sales pitch....which completely turned me off from even considering it.
Why would the clinicians need to be kept a secret? I'd feel more comfortable in seeing who the actual doctors are before giving out my information....
Just some feedback for you..but thank you for the link.
Posted by marty hinz, MD on August 22, 2010, at 11:37:00
In reply to Re: they do help in the right hands » marty hinz, MD, posted by violette on August 22, 2010, at 11:34:46
call 877-626-2220 you will talk to real people that can give you information
Posted by violette on August 22, 2010, at 11:54:50
In reply to Re: they do help in the right hands, posted by marty hinz, MD on August 22, 2010, at 11:37:00
Why would I call-so I can talk to a telemarketer who makes $8 an hour base pay plus a sliding-scale commission based upon the number of patients they can draw in for the month?
I'm all about using amino acids and natural substances as treatment tools..but please, consumers are smarter than that these days.
Maybe they are alternative doctors who 'test' your neurotransmitters and send them to expensive labs. If the treatment was so great, I think there would be a list of doctors on the site who are confident with this approach-confident enough to have their name listed.
Maybe it would be useful to others who are desperate but who also have $ to spend friviously. I am not that desperate, but not as symptomatic anymore either.
Posted by marty hinz, MD on August 22, 2010, at 11:58:03
In reply to Re: they do help in the right hands » marty hinz, MD, posted by violette on August 22, 2010, at 11:54:50
Kook born every day and you obviously were the one on your birthday. This is a medical operation when you call one of our RNs answer the phone. I would suggest you go harrass someone else.
Posted by chujoe on August 22, 2010, at 12:03:27
In reply to Re: they do help in the right hands, posted by marty hinz, MD on August 22, 2010, at 11:58:03
Hey Doc, we don't call people names on this board. You might want to rephrase your response to Violette so that it doesn't read like an insult.
Posted by violette on August 22, 2010, at 12:04:45
In reply to Re: they do help in the right hands, posted by marty hinz, MD on August 22, 2010, at 11:58:03
Glad you appreciated the feedback! Hmm. Something I said must have touched a nerve to set you off like that. I was going to give you some advice about how to draw in patients from the market niche you are targeting...but hey, I'm just a kook, what do I know?
I would fire your marketing director, if you even have one.
Posted by violette on August 22, 2010, at 12:10:02
In reply to Helping Dr. Marty not get blocked, posted by chujoe on August 22, 2010, at 12:03:27
Thanks Chujoe! It's ok. I think his reaction says more about him than it does about me. I was actually thinking of giving him advice regarding how to draw in patients to help his business/practice. Totally honest! But hey he can always pay an MBA a six figure salary if he wants his business to succeed.
You know as well as I, Chujoe-kooks can be smart and creative too! :)
Posted by chujoe on August 22, 2010, at 12:17:14
In reply to Re: Helping Dr. Marty not get blocked » chujoe, posted by violette on August 22, 2010, at 12:10:02
Posted by violette on August 22, 2010, at 15:23:32
In reply to We're all kooks here, Doctor! (nm), posted by chujoe on August 22, 2010, at 12:17:14
Well that 100% efficiacy you mentioned made me think of all the marketing that targets people who suffer. It also reminded me of the weight loss market scams....
Apparantly, the products sold through the clinics are or were a revenue generator, which in itself is not suprising...but there are license suspensions and lawsuits involved...
Maybe it is a good treatment/service...but people can make their own conclusions and a quick google search led to my own conclusion (about kooks too!):
http://online.drl.wi.gov/decisions/1998/ls9812161med-00067535.pdf
http://www.manta.com/c/mmg79d5/martin-c-hinz-md
http://www.casewatch.org/fdawarning/prod/2005/neuroresearch.shtml
http://www.legalmetric.com/cases/patent/mnd/mnd_003cv00868.html#s10
http://caselaw.findlaw.com/us-8th-circuit/1336355.html
http://www.chknutrition.com/lab%20board%20statement.pdf
http://www.morelaw.com/verdicts/case.asp?n=07-2694/2699&s=MN&d=36991
Posted by Free on August 22, 2010, at 19:24:47
In reply to Re: Helping Dr. Marty not get blocked » chujoe, posted by violette on August 22, 2010, at 12:10:02
>
> You know as well as I, Chujoe-kooks can be smart and creative too! :)And nimble around the net.
Wow, Violette, that was fast investigative work!
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