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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 98 to 122 of 147. Go back in thread:
Posted by ed_uk2010 on March 25, 2018, at 9:52:36
In reply to Re: How can I block Cortisol?, posted by farshad on March 24, 2018, at 21:23:38
Hi,
>Its not the dopamine antagonism of the antipsychotic im out for its bcus it inhibits CRH.
Olanzapine (Zyprexa) acts at many receptors, so it's not possible to be so specific about why it can relieve agitation.
You said you found it calming before - after a single dose, I believe? That was probably due to action at multiple receptors, and not necessarily related to CRH.
>Is it just becuase it would be dangerous? Im willing to quit prami tho no problem... Im currently on 4 meds , I can quit the 3 I get online (prami, armmodafinil and selegline)
Taking strange combinations like pramipexole with olanzapine is really unknown territory. You don't want to make yourself more ill.
Pramipexole should not be stopped suddenly. Reduce gradually.
>and I get wellbutrin from my doc . So wellbutrin + zyprexa it will be then... But i doubt I will get zyprexa...
This is something you can speak to your doctor about. A lot of people find that olanzapine (Zyprexa) calms severe agitation after a small dose. Since a doctor has given it to you before, you can mention this.
For schizophrenia, olanzapine is taken every day. For relief of agitation in depressive illness, it is usually short-term.
A major issue with olanzapine is that some users gain a lot of weight.
>So I have to do a MRI scan for the CRF1?
No sorry, this wouldn't show on a MRI. Routine medical tests and scans do not show the function of this receptor.
As you know, there has been research into the possible role of CRF-1 receptors in mental health conditions . Much of the research has been on rats, but there have been some clinical trials in humans. As far as I can see, some trials showed possible evidence of efficacy, whereas others did not. As an example, a trial of pexacerfont, a selective CRF-1 receptor antagonist, found that it was not effective for generalised anxiety.
So, although a few CRF-1 antagonists have been developed by pharmaceutical companies such as GSK and BMS, it isn't entirely clear what they might be most useful for in humans.
Posted by farshad on March 25, 2018, at 17:06:47
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 25, 2018, at 9:52:36
> Hi,
>
> >Its not the dopamine antagonism of the antipsychotic im out for its bcus it inhibits CRH.
>
> Olanzapine (Zyprexa) acts at many receptors, so it's not possible to be so specific about why it can relieve agitation.
>
> You said you found it calming before - after a single dose, I believe? That was probably due to action at multiple receptors, and not necessarily related to CRH.
>
> >Is it just becuase it would be dangerous? Im willing to quit prami tho no problem... Im currently on 4 meds , I can quit the 3 I get online (prami, armmodafinil and selegline)
>
> Taking strange combinations like pramipexole with olanzapine is really unknown territory. You don't want to make yourself more ill.
>
> Pramipexole should not be stopped suddenly. Reduce gradually.
>
> >and I get wellbutrin from my doc . So wellbutrin + zyprexa it will be then... But i doubt I will get zyprexa...
>
> This is something you can speak to your doctor about. A lot of people find that olanzapine (Zyprexa) calms severe agitation after a small dose. Since a doctor has given it to you before, you can mention this.
>
> For schizophrenia, olanzapine is taken every day. For relief of agitation in depressive illness, it is usually short-term.
>
> A major issue with olanzapine is that some users gain a lot of weight.
>
> >So I have to do a MRI scan for the CRF1?
>
> No sorry, this wouldn't show on a MRI. Routine medical tests and scans do not show the function of this receptor.
>
> As you know, there has been research into the possible role of CRF-1 receptors in mental health conditions . Much of the research has been on rats, but there have been some clinical trials in humans. As far as I can see, some trials showed possible evidence of efficacy, whereas others did not. As an example, a trial of pexacerfont, a selective CRF-1 receptor antagonist, found that it was not effective for generalised anxiety.
>
> So, although a few CRF-1 antagonists have been developed by pharmaceutical companies such as GSK and BMS, it isn't entirely clear what they might be most useful for in humans.
>
>If I went on zyprexa since its an antagonist on the dopamine receptors and many others, would my body evnetually upregulate them? Since I heard if you use an agonist on a receptor too much your body starts decreasing the activity and if you block something too much your body starts increasing . is that true?
Posted by ed_uk2010 on March 25, 2018, at 17:25:52
In reply to Re: How can I block Cortisol?, posted by farshad on March 25, 2018, at 17:06:47
>If I went on zyprexa since its an antagonist on the dopamine receptors and many others, would my body evnetually upregulate them? Since I heard if you use an agonist on a receptor too much your body starts decreasing the activity and if you block something too much your body starts increasing . is that true?
Hi F,
There can be truth in that for some drugs. This can lead to unexpected effects. As an example, people who take benzodiazepines or opioids regularly can experience a reduction in effectiveness.
With antipsychotics, there is a theory that taking potent dopamine D2 receptor antagonists long term can lead to receptor upregulation. This may be a cause of tardive dyskinesia.
With olanzapine (Zyprexa) at low doses, and in younger people, tardive dyskinesia is not a high risk. The main risks are due to weight gain and associated metabolic issues.
Although I can't make any definitive suggestions for yourself because I don't know much about your medical and psychiatric problems, I can say that some people with agitated depression find small doses of olanzapine very calming, although it can be sedating initially. I'm unsure what you most want from a medication...
Posted by ed_uk2010 on March 30, 2018, at 14:46:01
In reply to Re: How can I block Cortisol?, posted by farshad on March 25, 2018, at 17:06:47
Hi Farshad,
How are you doing? Did you see your doctor to ask about tests, or maybe olanzapine?
Posted by farshad on March 31, 2018, at 0:25:48
In reply to Re: How are you doing? » farshad, posted by ed_uk2010 on March 30, 2018, at 14:46:01
> Hi Farshad,
>
> How are you doing? Did you see your doctor to ask about tests, or maybe olanzapine?Not yet my appointment is on 5 april. I have come to different conclusions now.. I think I have a tumor in the paraventricular nucleus that constantly releases CRH . So Im gonna ask for an MRI scan. Zyprexa Inhibits CRH. So if I do have a tumor I will get gamma knife surgery but if I cant for some reason have that particular surgery, since I dont want them to open my skull I will ask for medication that can help against the tumor and with that I will also ask my doctor for Zyprexa since thats the only drug that ever worked for my anxiety. Thats where I am at now. Now just waiting and trying to learn stuff about my situation.
Posted by SLS on March 31, 2018, at 6:08:49
In reply to Re: How are you doing?, posted by farshad on March 31, 2018, at 0:25:48
> I have come to different conclusions now.. I think I have a tumor in the paraventricular nucleus that constantly releases CRH.
That's an interesting conclusion. How did you come to it?
- Scott
Posted by farshad on March 31, 2018, at 6:55:10
In reply to Re: How are you doing? » farshad, posted by SLS on March 31, 2018, at 6:08:49
> > I have come to different conclusions now.. I think I have a tumor in the paraventricular nucleus that constantly releases CRH.
>
> That's an interesting conclusion. How did you come to it?
>
>
> - ScottCause thats the only way I can possibly have excess CRH release is if a tumor is there. Becuase the body is made in such a way that it wouldnt happen unless theres a tumor.
Also I have some symtomps of tumor. You can ask me what my symtomps are and I can tell you but at the end of the day its not gonna prove anything.After the MRI scan I can come back and tell you guys if I have a tumor or not if anyone cares, Just reply to this topic and I wil get a email notification .
Posted by SLS on March 31, 2018, at 8:17:37
In reply to Re: How are you doing?, posted by farshad on March 31, 2018, at 6:55:10
> > > I have come to different conclusions now.. I think I have a tumor in the paraventricular nucleus that constantly releases CRH.
> >
> > That's an interesting conclusion. How did you come to it?
> >
> >
> > - Scott
>
> Cause thats the only way I can possibly have excess CRH release is if a tumor is there. Becuase the body is made in such a way that it wouldnt happen unless theres a tumor.
> Also I have some symtomps of tumor. You can ask me what my symtomps are and I can tell you but at the end of the day its not gonna prove anything.After the MRI scan I can come back and tell you guys if I have a tumor or not if anyone cares, Just reply to this topic and I wil get a email notificationHave you tested positive for the dexamethasone suppression test (DST)?
I think a lot of people care and would like to see you find a way to feel better.
- Scott
Posted by farshad on March 31, 2018, at 8:51:29
In reply to Re: How are you doing? » farshad, posted by SLS on March 31, 2018, at 8:17:37
> > > > I have come to different conclusions now.. I think I have a tumor in the paraventricular nucleus that constantly releases CRH.
> > >
> > > That's an interesting conclusion. How did you come to it?
> > >
> > >
> > > - Scott
> >
> > Cause thats the only way I can possibly have excess CRH release is if a tumor is there. Becuase the body is made in such a way that it wouldnt happen unless theres a tumor.
> > Also I have some symtomps of tumor. You can ask me what my symtomps are and I can tell you but at the end of the day its not gonna prove anything.After the MRI scan I can come back and tell you guys if I have a tumor or not if anyone cares, Just reply to this topic and I wil get a email notification
>
> Have you tested positive for the dexamethasone suppression test (DST)?
>
> I think a lot of people care and would like to see you find a way to feel better.
>
>
> - Scottno. what is the dexamethasone test?
Posted by SLS on March 31, 2018, at 13:00:54
In reply to Re: How are you doing?, posted by farshad on March 31, 2018, at 8:51:29
> > > > > I have come to different conclusions now.. I think I have a tumor in the paraventricular nucleus that constantly releases CRH.
> > > > That's an interesting conclusion. How did you come to it?
> > > Cause thats the only way I can possibly have excess CRH release is if a tumor is there. Becuase the body is made in such a way that it wouldnt happen unless theres a tumor.
> > > Also I have some symtomps of tumor. You can ask me what my symtomps are and I can tell you but at the end of the day its not gonna prove anything.After the MRI scan I can come back and tell you guys if I have a tumor or not if anyone cares, Just reply to this topic and I wil get a email notification> > Have you tested positive for the dexamethasone suppression test (DST)?
> >
> > I think a lot of people care and would like to see you find a way to feel better.> no. what is the dexamethasone test?
Dexamethasone is a synthetic corticosteroid that normally shuts off cortisol production via negative-feedback loops involving ACTH and CRH. Adiministering dexamethasone is a way to determine if your cortisol negative feedback loops are operating properly.
I was just curious. I don't know how the results of such a test would assess CRH secreting tumors.
- Scott
Posted by ed_uk2010 on March 31, 2018, at 13:06:51
In reply to Re: How are you doing?, posted by farshad on March 31, 2018, at 0:25:48
Hi Farshad,
Yes, people do care. If they didn't, they wouldn't be asking about you or logging on to have a conversation. It's also good that you have an appointment soon.
>I think I have a tumor in the paraventricular nucleus that constantly releases CRH.
To be absolutely honest, it is extremely unlikely that you have a brain tumour. I'm not sure why you would think that you do. You haven't mentioned any test so far that suggests you have a tumour releasing CRH. The genetic tests you did from an online source certainly don't suggest this.
I think it's important to make it clear that finding Zyprexa calming does not in any way prove that you have elevated CRH. A very high proportion of people find Zyprexa calming irrespective of CRH. Plus, a lot of people find Zyprexa calming even when other meds haven't helped.
From what you say, you seem to have had mental health symptoms for a long time, not just recently. Am I right? Brain tumours do not cause long term mental health symptoms in isolation.... This is because, if a brain tumour was the cause of your mental health symptoms, you would have been physically very ill a long time ago.
>So Im gonna ask for an MRI scan.
I think you would find that reassuring, but it's not the first step....
First of all, if you have neurological symptoms such as visual loss, you doctor would do a neurological examination. As a rule, people with rapid onset neurological symptoms over a few weeks would usually have an MRI. If you have had mental health symptoms for several years and no neurological dysfunction, this would not usually be a reason to do an MRI.
>I do have a tumor I will get gamma knife surgery but if I cant for some reason have that particular surgery, since I dont want them to open my skull.
Gamma Knife isn't actually surgery. It does not involve opening the skull. Gamma Knife is a special type of radiotherapy (radiation treatment) for brain cancers. From what you had said, there isn't any reason why you should think you have cancer though.
I think you should discuss all your concerns with your doctor, and get an examination done to put your mind at rest. The doctor may also do some blood tests like you wanted before.
Posted by ed_uk2010 on March 31, 2018, at 13:27:25
In reply to Re: How are you doing?, posted by SLS on March 31, 2018, at 13:00:54
Hi Scott,
Just some information :)
So far, Farshad hasn't had any tests performed by his doctor to assess HPA axis function or cortisol levels. S/he had some form of rather unconventional genetic test which I think was obtained online.
>I don't know how the results of such a test would assess CRH secreting tumors.
A CRH-secreting tumour would cause dexamethasone non-suppression, and early morning cortisol would be very elevated. Usually, there would be substantial metabolic derangement too eg. hyperglycaemia, hypokalaemia etc. CRH-releasing tumours are an extremely rare cause of Cushing's Syndrome though - ectopic ACTH is much more common, usually from the pituitary.
Posted by farshad on April 1, 2018, at 2:15:22
In reply to Re: How are you doing? » farshad, posted by ed_uk2010 on March 31, 2018, at 13:06:51
> Hi Farshad,
>
> Yes, people do care. If they didn't, they wouldn't be asking about you or logging on to have a conversation. It's also good that you have an appointment soon.
>
> >I think I have a tumor in the paraventricular nucleus that constantly releases CRH.
>
> To be absolutely honest, it is extremely unlikely that you have a brain tumour. I'm not sure why you would think that you do. You haven't mentioned any test so far that suggests you have a tumour releasing CRH. The genetic tests you did from an online source certainly don't suggest this.
>
> I think it's important to make it clear that finding Zyprexa calming does not in any way prove that you have elevated CRH. A very high proportion of people find Zyprexa calming irrespective of CRH. Plus, a lot of people find Zyprexa calming even when other meds haven't helped.
>
> From what you say, you seem to have had mental health symptoms for a long time, not just recently. Am I right? Brain tumours do not cause long term mental health symptoms in isolation.... This is because, if a brain tumour was the cause of your mental health symptoms, you would have been physically very ill a long time ago.
>
> >So Im gonna ask for an MRI scan.
>
> I think you would find that reassuring, but it's not the first step....
>
> First of all, if you have neurological symptoms such as visual loss, you doctor would do a neurological examination. As a rule, people with rapid onset neurological symptoms over a few weeks would usually have an MRI. If you have had mental health symptoms for several years and no neurological dysfunction, this would not usually be a reason to do an MRI.
>
> >I do have a tumor I will get gamma knife surgery but if I cant for some reason have that particular surgery, since I dont want them to open my skull.
>
> Gamma Knife isn't actually surgery. It does not involve opening the skull. Gamma Knife is a special type of radiotherapy (radiation treatment) for brain cancers. From what you had said, there isn't any reason why you should think you have cancer though.
>
> I think you should discuss all your concerns with your doctor, and get an examination done to put your mind at rest. The doctor may also do some blood tests like you wanted before.
>Well like I said im not gonna argue with you if I have a tumor or not I will just have to see and find out.
I believe its a benign tumor (non cancerous) so it doesent spread anywhere and its just in one part of my brain in the paraventricular nucleus .
I believe I have had this since I was 10-11 years old.... the older I got the more anxiety I got this would make sense since this mean the tumor got bigger more cells built up and pressing the CRH harder..
I know gamma knife is radiotherapy . I maybe worded it wrong when I said surgery I thought you could call it a surgery since it invovles operating on a person from doctor. and I havent even told you my symtomps but here are some: blurry vision , loss of balance, headache/pressure, sometimes tinnitus to name a few..
I will discuss this with my doc but since You asked I thought I would explain where im at right now.
Posted by farshad on April 1, 2018, at 2:17:38
In reply to Re: How are you doing?, posted by farshad on April 1, 2018, at 2:15:22
> > Hi Farshad,
> >
> > Yes, people do care. If they didn't, they wouldn't be asking about you or logging on to have a conversation. It's also good that you have an appointment soon.
> >
> > >I think I have a tumor in the paraventricular nucleus that constantly releases CRH.
> >
> > To be absolutely honest, it is extremely unlikely that you have a brain tumour. I'm not sure why you would think that you do. You haven't mentioned any test so far that suggests you have a tumour releasing CRH. The genetic tests you did from an online source certainly don't suggest this.
> >
> > I think it's important to make it clear that finding Zyprexa calming does not in any way prove that you have elevated CRH. A very high proportion of people find Zyprexa calming irrespective of CRH. Plus, a lot of people find Zyprexa calming even when other meds haven't helped.
> >
> > From what you say, you seem to have had mental health symptoms for a long time, not just recently. Am I right? Brain tumours do not cause long term mental health symptoms in isolation.... This is because, if a brain tumour was the cause of your mental health symptoms, you would have been physically very ill a long time ago.
> >
> > >So Im gonna ask for an MRI scan.
> >
> > I think you would find that reassuring, but it's not the first step....
> >
> > First of all, if you have neurological symptoms such as visual loss, you doctor would do a neurological examination. As a rule, people with rapid onset neurological symptoms over a few weeks would usually have an MRI. If you have had mental health symptoms for several years and no neurological dysfunction, this would not usually be a reason to do an MRI.
> >
> > >I do have a tumor I will get gamma knife surgery but if I cant for some reason have that particular surgery, since I dont want them to open my skull.
> >
> > Gamma Knife isn't actually surgery. It does not involve opening the skull. Gamma Knife is a special type of radiotherapy (radiation treatment) for brain cancers. From what you had said, there isn't any reason why you should think you have cancer though.
> >
> > I think you should discuss all your concerns with your doctor, and get an examination done to put your mind at rest. The doctor may also do some blood tests like you wanted before.
> >
>
> Well like I said im not gonna argue with you if I have a tumor or not I will just have to see and find out.
>
> I believe its a benign tumor (non cancerous) so it doesent spread anywhere and its just in one part of my brain in the paraventricular nucleus .
>
> I believe I have had this since I was 10-11 years old.... the older I got the more anxiety I got this would make sense since this mean the tumor got bigger more cells built up and pressing the CRH harder..
>
> I know gamma knife is radiotherapy . I maybe worded it wrong when I said surgery I thought you could call it a surgery since it invovles operating on a person from doctor. and I havent even told you my symtomps but here are some: blurry vision , loss of balance, headache/pressure, sometimes tinnitus to name a few..
>
>
>
> I will discuss this with my doc but since You asked I thought I would explain where im at right now.
>wow my grammar is horrible... im just so tired.
Posted by ed_uk2010 on April 1, 2018, at 7:31:32
In reply to Re: How are you doing?, posted by farshad on April 1, 2018, at 2:15:22
Good luck at the doctor. Let us know how you get on.
If you had a CRH-secreting tumour since you were a child, you would have Cushing Syndrome at an advanced stage (assuming you are now an adult?). This would cause severe physical symptoms of a very widespread nature.
I'm not arguing :)
Posted by farshad on April 1, 2018, at 8:53:07
In reply to Re: How are you doing? » farshad, posted by ed_uk2010 on April 1, 2018, at 7:31:32
> Good luck at the doctor. Let us know how you get on.
>
> If you had a CRH-secreting tumour since you were a child, you would have Cushing Syndrome at an advanced stage (assuming you are now an adult?). This would cause severe physical symptoms of a very widespread nature.
>
> I'm not arguing :)But im saying I have a tumor in the paraventricular nucleus which releases CRH and CRH is a Peptide hormone . People with cushings have a tumor in the pituatary which releases constant cortisol and cortisol is a non peptide hormone and the effects would be very different wouldnt it? . isnt there a difference?
Im 20 now. Not arguing either just wanna understand stuff.
Posted by SLS on April 1, 2018, at 9:18:17
In reply to Re: How are you doing?, posted by farshad on April 1, 2018, at 2:15:22
> Well like I said im not gonna argue with you if I have a tumor or not I will just have to see and find out.
>
> I believe its a benign tumor (non cancerous) so it doesent spread anywhere and its just in one part of my brain in the paraventricular nucleus .
>
> I believe I have had this since I was 10-11 years old.... the older I got the more anxiety I got this would make sense since this mean the tumor got bigger more cells built up and pressing the CRH harder..
>
> I know gamma knife is radiotherapy . I maybe worded it wrong when I said surgery I thought you could call it a surgery since it invovles operating on a person from doctor. and I havent even told you my symtomps but here are some: blurry vision , loss of balance, headache/pressure, sometimes tinnitus to name a few..
>
>
>
> I will discuss this with my doc but since You asked I thought I would explain where im at right now.I hope you are able to come to a resolution of the syndrome you are experiencing. I guess it wouldn't hurt to have a MRI if that is what you need to do. Ed_UK gives good advice. I don't think he is challenging your intellect. He genuinely cares.
There might be some sort of dysautonomia thing going on. One of my doctors said that dysautonomia can be a component of depressive disorders, but symptoms are variable, and can include the symptoms you describe. Usually, it involves an imbalance of sympathetic/parasympathetic systems in favor of sympathetic. You would be in constant "fight-or-flight" mode. If your MRI is negative, you can then test your HPA axis function using low-dose dexamethasone suppression test or a dexamethasone/CRH test. If HPA is normal, then dysautonomia can explain high cortisol levels, if they exist. Major Depressive Disorder and bipolar depression often present with high cortisol levels. Do you have high cortisol levels? Do you have a depressive, anxiety, or OCD disorder as diagnosed by a doctor?
I must have missed your list of symptoms and diagnostic history.
- Scott
Posted by farshad on April 1, 2018, at 11:05:49
In reply to Re: How are you doing? » farshad, posted by SLS on April 1, 2018, at 9:18:17
> > Well like I said im not gonna argue with you if I have a tumor or not I will just have to see and find out.
> >
> > I believe its a benign tumor (non cancerous) so it doesent spread anywhere and its just in one part of my brain in the paraventricular nucleus .
> >
> > I believe I have had this since I was 10-11 years old.... the older I got the more anxiety I got this would make sense since this mean the tumor got bigger more cells built up and pressing the CRH harder..
> >
> > I know gamma knife is radiotherapy . I maybe worded it wrong when I said surgery I thought you could call it a surgery since it invovles operating on a person from doctor. and I havent even told you my symtomps but here are some: blurry vision , loss of balance, headache/pressure, sometimes tinnitus to name a few..
> >
> >
> >
> > I will discuss this with my doc but since You asked I thought I would explain where im at right now.
>
> I hope you are able to come to a resolution of the syndrome you are experiencing. I guess it wouldn't hurt to have a MRI if that is what you need to do. Ed_UK gives good advice. I don't think he is challenging your intellect. He genuinely cares.
>
> There might be some sort of dysautonomia thing going on. One of my doctors said that dysautonomia can be a component of depressive disorders, but symptoms are variable, and can include the symptoms you describe. Usually, it involves an imbalance of sympathetic/parasympathetic systems in favor of sympathetic. You would be in constant "fight-or-flight" mode. If your MRI is negative, you can then test your HPA axis function using low-dose dexamethasone suppression test or a dexamethasone/CRH test. If HPA is normal, then dysautonomia can explain high cortisol levels, if they exist. Major Depressive Disorder and bipolar depression often present with high cortisol levels. Do you have high cortisol levels? Do you have a depressive, anxiety, or OCD disorder as diagnosed by a doctor?
>
> I must have missed your list of symptoms and diagnostic history.
>
>
> - ScottI dont know.... I dont think I have Dysautonomia...maybe it could be the tumor is causing dysautomia since autonomic nervous system is regulated by the hypothalamus?? and the paraventricular nucleus is in the hypothalamus right?
Posted by ed_uk2010 on April 1, 2018, at 17:40:47
In reply to Re: How are you doing?, posted by farshad on April 1, 2018, at 8:53:07
Hi Farshad,
There are a few different types of Cushing Syndrome. All types cause a large elevation of cortisol. The reason for cortisol being elevated differs between the different types.
>People with cushings have a tumor in the pituatary which releases constant cortisol and cortisol is a non peptide hormone and the effects would be very different wouldnt it? . isnt there a difference?
One cause of Cushing's is a tumour in the pituitary. It releases ACTH, not cortisol. The large amounts of ACTH cause the adrenal glands to produce large amounts of cortisol. The highly elevated cortisol levels then cause the symptoms.
>I have a tumor in the paraventricular nucleus which releases CRH and CRH is a Peptide hormone
Tumours releasing CRH are a very rare cause of Cushing Syndrome. The high CRH causes the pituitary to produce large amounts of ACTH. The ACTH causes the adrenal glands to produce large amounts of cortisol. So, the overall effect of CRH-producing tumours is Cushing Syndrome (from very high cortisol).
Posted by farshad on April 2, 2018, at 1:22:47
In reply to Re: How are you doing? » farshad, posted by ed_uk2010 on April 1, 2018, at 17:40:47
> Hi Farshad,
>
> There are a few different types of Cushing Syndrome. All types cause a large elevation of cortisol. The reason for cortisol being elevated differs between the different types.
>
> >People with cushings have a tumor in the pituatary which releases constant cortisol and cortisol is a non peptide hormone and the effects would be very different wouldnt it? . isnt there a difference?
>
> One cause of Cushing's is a tumour in the pituitary. It releases ACTH, not cortisol. The large amounts of ACTH cause the adrenal glands to produce large amounts of cortisol. The highly elevated cortisol levels then cause the symptoms.
>
> >I have a tumor in the paraventricular nucleus which releases CRH and CRH is a Peptide hormone
>
> Tumours releasing CRH are a very rare cause of Cushing Syndrome. The high CRH causes the pituitary to produce large amounts of ACTH. The ACTH causes the adrenal glands to produce large amounts of cortisol. So, the overall effect of CRH-producing tumours is Cushing Syndrome (from very high cortisol).
>Can you tell me about the other 3?
I think a tumor in the nucleus would be different. Becuase it has to go like this CRH > ACTH .. So in between the two cortisol can inhibit ACTH if it gets too much. But if the tumor is in the pituatary it will just release ACTH directly doesent go trough other so theres no way your body can inhibit it.
CRH on its own work in different way than cortisol and ACTH I think. There are actually CRH receptors in the Amygdala and other parts of the brain. But there are no ACTH receptors in the brain as far as I know they are in the thyroid or adrenals one of them.
CRH is the only cortisol type in the brain.check out this picture http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/adrenal/feedback.gif
So a tumor in the CRH wouldnt mean high cortisol it would just mean constant CRH release which is a peptide not a hormone so it doesent have direct effect on the body like regular cortisol. It can cause high levels of cortisol yeah but not cushings high. I belive I do have high cortisol but not like people with cushings and I do have high ACTH also but since there is a loop that your body has its own way of combatiing it so my level arent of the chart.
Its just the constant CRH release that ruins my brain and gives me this anxiety which in turn breaks down my body.
Posted by ed_uk2010 on April 2, 2018, at 16:32:47
In reply to Re: How are you doing?, posted by farshad on April 2, 2018, at 1:22:47
Hi Farshad,
>Because it has to go like this CRH > ACTH .. So in between the two cortisol can inhibit ACTH if it gets too much.
I understand what you're saying, but... you're describing what happens in a healthy person, not someone with a tumour.
Tumours releasing CRH do cause Cushing's Syndrome because the amount of CRH released by tumours is very large compared with normal levels. Because of this, negative feedback loops aren't sufficient to prevent cortisol from becoming elevated. So, high cortisol results.
CRH-releasing tumours are extremely rare, but in reported cases, these tumours are normally not in the brain, but elsewhere in the body.
On the other hand, most tumours in the hypothalamus are due to cancer and do not release hormones. An exception is the hypothalamic hamartoma, which is a benign tumour present from birth. It does not normally release CRH, however, but other hormones instead. If you did have a tumour like this you would have physical symptoms (seizures, or very early puberty due to hormonal changes). A very rare case of a CRH-releasing hypothalamic hamartoma has been reported, which caused symptoms in the child at a very young age.
>check out this picture http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/adrenal/feedback.gif
Nice diagram. The diagram shows the release of CRH which occurs due to stress/fear/anxiety. This can happen to anyone, as part of the body's normal response to stress. In anxiety, negative feedback occurs, as shown in the diagram, so cortisol may be moderately and intermittently elevated, but not severely.
In the case of hormone-releasing tumours, negative feedback does not prevent a large rise in cortisol. The quantities of ACTH or CRH released by tumours are too large for the normal feedback system to work. This is why tumours can cause Cushing's Syndrome, but anxiety does not.
>CRH is the only cortisol type in the brain.
The brain also has receptors for cortisol, including the glucocorticoid receptors.
>So a tumor in the CRH wouldnt mean high cortisol it would just mean constant CRH release....
As far as I can tell, this situation has never been reported.
Disturbances of the HPA axis due to excessive release of CRH are believed to occur due to severe chronic stress, trauma and abuse. This situation may occur in a variety of forms of depressive illness and anxiety disorders. Because of the negative feedback loops shown in the diagram, Cushing's Syndrome does not occur due to mental health conditions. In depression, for example, the negative feedback loops may be blunted, but not entirely unresponsive. This can be shown in a 'low dose' overnight dexamethasone suppression test.
Hormone-releasing tumours are a different situation, causing prominent elevation of cortisol and physical Cushing's symptoms. It's a matter of quantity - the amount of hormones released by these rare tumours is so much higher and more continuous than the body could normally produce.
Hope you find this to be a good explanation :)
Posted by farshad on April 4, 2018, at 4:51:55
In reply to Re: How are you doing? » farshad, posted by ed_uk2010 on April 2, 2018, at 16:32:47
CRH-releasing tumours are extremely rare, but in reported cases, these tumours are normally not in the brain, but elsewhere in the body.
> >So a tumor in the CRH wouldnt mean high cortisol it would just mean constant CRH release....
>
> As far as I can tell, this situation has never been reported.
So you can have a tumor outside of your brain that releases CRH? that doesent make much sense to me.. how is that possible? Is it becuase the tumor is connected to the CNS and this somehow releases CRH?
Are you telling me there has been no reports of a tumor in the brain releasing CRH? Maybe I will be the first then.
Are there any signs you can look for on your body to see if a tumor is there if its not in the brain?
Posted by ed_uk2010 on April 4, 2018, at 16:14:38
In reply to Re: How are you doing?, posted by farshad on April 4, 2018, at 4:51:55
Hi,
>So you can have a tumor outside of your brain that releases CRH?
Yes, you can, but it's very rare. Can happen with conditions such as lung cancer, but it is extremely uncommon.
>that doesn't make much sense to me.. how is that possible?
Cancer cells are not the same as the surrounding tissue. Some cancers do release hormones.
>Is it because the tumor is connected to the CNS and this somehow releases CRH?
No, the tumours are not connected to the CNS.
>Are you telling me there has been no reports of a tumor in the brain releasing CRH?
There have been reports of hypothalamic hamartoma releasing CRH. This condition is present from birth and causes physical changes at an early age eg. seizures.
>Are there any signs you can look for on your body to see if a tumor is there if its not in the brain?
CRH-releasing tumours elsewhere in the body are cancers. It sounds like you've had anxiety and depression for about ten years? This shows that the symptoms are definitely not due to cancer.
The situation with most mental health problems is that no clear physical cause can ever be determined.
Posted by farshad on April 4, 2018, at 16:41:59
In reply to Re: How are you doing? » farshad, posted by ed_uk2010 on April 4, 2018, at 16:14:38
> Hi,
>
> >So you can have a tumor outside of your brain that releases CRH?
>
> Yes, you can, but it's very rare. Can happen with conditions such as lung cancer, but it is extremely uncommon.
>
> >that doesn't make much sense to me.. how is that possible?
>
> Cancer cells are not the same as the surrounding tissue. Some cancers do release hormones.
>
> >Is it because the tumor is connected to the CNS and this somehow releases CRH?
>
> No, the tumours are not connected to the CNS.
>
> >Are you telling me there has been no reports of a tumor in the brain releasing CRH?
>
> There have been reports of hypothalamic hamartoma releasing CRH. This condition is present from birth and causes physical changes at an early age eg. seizures.
>
> >Are there any signs you can look for on your body to see if a tumor is there if its not in the brain?
>
> CRH-releasing tumours elsewhere in the body are cancers. It sounds like you've had anxiety and depression for about ten years? This shows that the symptoms are definitely not due to cancer.
>
> The situation with most mental health problems is that no clear physical cause can ever be determined.
>
So a CRH releasing tumor in the brain is not cancer? but if its in other places it is cancer? I have had anxiety problems since age 10 im 20 now almost 21. My anxiety just got worse and worse.. Im thinking I have a benign tumor non cancerous in the brain that releases CRH or maybe something else that could be causing my 24/7 anxiety, I dont know what you would label that as.. Anyway my appointment is tommorow so hopefully my doctor will agree to check this out... But I dont have any seizurez... I have sometimes had random head twitches where my head will make a fast reflex movement but its quick and suddel and then im back to normal .
So I dont think I have hypothalamic hamartoma releasing CRH but something close to it. Is hypothalamic hamartoma releasing CRH rare?So a crh releasing tumor outside of the brain would different from inside? a tumor outside wouldnt cause anxiety problems?
Posted by ed_uk2010 on April 4, 2018, at 17:30:12
In reply to Re: How are you doing?, posted by farshad on April 4, 2018, at 16:41:59
Hi Farshad,
Good to hear you have an appointment tomorrow. I hope your doctor listens carefully. He might do an examination and some blood tests, perhaps.
Most forms of chronic severe anxiety (or depression) are not found to be due to any specific medical problem, but doctors often do blood tests to check your general health and rule out complicating factors. As an example, GPs often do blood tests such as a complete blood count, thyroid function and blood glucose to check on the health of people suffering from anxiety. In addition, it's a good idea to have a blood pressure reading and physical examination if you're worried about your health.
>So a CRH releasing tumor in the brain is not cancer?
The hypothalamic hamartomas are not cancerous. They are present from birth and cause medical problems such as frequent seizures in young children. Other brain tumours do not release hormones.
>but if its in other places it is cancer?
Yes, that's right.
>Im thinking I have a benign tumor non cancerous in the brain that releases CRH
Brain tumours aren't a cause of chronic anxiety disorders of over 10 years duration. A tumour would have caused multiple medical problems.
>something else that could be causing my 24/7 anxiety, I dont know what you would label that as...
It sounds like a severe anxiety disorder, or anxiety associated with depressive illness. There are various forms of anxiety such as generalised anxiety disorder. It is rare to find any specific medical cause. A psychiatrist may diagnose a specific anxiety disorder if you saw one. Anxiety can be very severe and distressing, but this does not mean that a medical condition is the cause.
>I dont think I have hypothalamic hamartoma releasing CRH but something close to it. Is hypothalamic hamartoma releasing CRH rare?
It's very rare, and I am not aware of any condition close to it. To be absolutely honest, the chance of a tumour being the cause of your symptoms is almost zero. When symptoms are caused by a brain tumour, they cause medical symptoms quite rapidly. You wouldn't have a benign tumour for ten years and have anxiety as your main symptom.
>I have sometimes had random head twitches where my head will make a fast reflex movement but its quick
Most people have occasional muscle twitches. It doesn't sound unusual.
>So a crh releasing tumor outside of the brain would different from inside? a tumor outside wouldnt cause anxiety problems?
CRH-releasing tumours outside the brain normally present with the symptoms of whatever type of cancer is the cause. Cushing's Syndrome follows. Other CRH-releasing tumours present as Cushing's Syndrome.
If you look at descriptions for conditions such as generalised anxiety disorder, you may recognise some of the symptoms in yourself.
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