Friday, November 12, 2004

Cortisol: The "Stress Hormone"

One day, when I am feeling a little stronger, I'll contact my GP and ask for a referral to a specialist - probably a neurologist or endocrinologist, or both. If by next year I don't feel improved enough to go out, I am mentally preparing myself for a stay in hospital to undergo the tests. At the moment, I just cannot organise or make the round trip journey, and all that is involved with visiting a specialist, including follow ups.

Some four and a half years ago, after reading a book on M.E. (by Dr Charles Shepherd), I asked a GP about Cortisol. He wasn't the right person to ask. He was a medical examiner on behalf of the government who came to my home assess my application to the department of works and pensions for disability living allowance. Doctors from government (or insurance company) medical boards have a reputation for seeking to dispprove claims. It was only afterwards I found out, one should always have a witness sit in on these horribly gruelling interviews.

Those were the early days of my illness. Now when I look back at what I had to endure, I shudder. After an hour and a half of answering his questions and watching him scribble my answers on 25 pages of a form, he asked me to sign the box where he'd summarised the exam. He read it out to me, insisted I sign it and refused to show me the other 24 pages. He said it wasn't necessary (I found out this is not true). I've never signed anything that I haven't at least glanced over but I was too ill to object and could barely see straight. When he left, I recall him saying he couldn't be sure what they'd make of his report.

My application was turned down. To cut a long story short, it went to Tribunal. Only then did I see what he'd written.
His shockingly weird spidery handwriting - one inch high - with an extreme slant to the right (and left) like one long series of heavy handed slashes, had to be seen to be believed. I'd never seen anything like it, except in books on handwriting analysis that gave such examples from people who had mental health or alcohol problems.

To my horror, I found out from an Advisor that my application was turned down probably because nobody could read the doctor's report, apart from a few lines he'd scrawled at the top of the front page that made judgements about my personality and character, described my home as "sparkling squeaky clean", said "everything was white" (not true - some colours were muted - even the carpets were dark, upholstery and bedcover were multi coloured tapestry quilt) - and that I was "dressed immaculately in snow white sweater and trousers" - he added that he "had to use a chair to lean notes on, instead of a table".

This was from a man who wore pale grey shiny fake leather slip-on shoes with dark brown polyester trousers. When I asked what he knew about M.E., he told me (in a derogatory tone) that he had seen "loads" of ME patients and that, quote "they all see in grey - if you turn them over you find they're all soft bellied." Charming eh?

A year later, after attending a Tribunal, I was awarded the disability living allowance, backdated to the date of my original claim. That one doctor caused me much distress and suffering and no doubt contributed towards my downward spiral because I couldn't get help for the first eighteen months of near total incapacity. Oh yes, and his answer to my question about Cortisol? He said "Ahhhh ... how interesting, you've picked up on that ... now, let me see .... I'll just make a note of this ... "well educated". I said if there is something wrong with ones Cortisol - is there a treatment to calm whatever is wrong - "oooh no" he said ... and mumbled something about adrenaline and heart attacks ... his answer was woolly but left me in no doubt that there was no treatment for Coristol problems (which is the reason I dropped the idea of asking for a test).

Fellow blogger Hazy, who has been very ill for the past year and is 80% housebound has undergone either doctors visits or tests every fortnight for the past 15 months. The tests rule out this and that. Still no firm diagnosis. Next appointment is with a gland doctor. Interestingly, Hazy is having Cortisol tests. She has explained in her blog that it can be done by 24 hour urine or blood tests. Urine tests can be done at home but blood tests require overnight stay in hospital. I look forward with interest to see what Hazy's Dr Gland says.

The following information that explains the stress hormone cortisol is courtesy of Melissa C. Stöppler, M.D. at
http://stress.about.com/cs/cortisol/a/aa012901.htm

Cortisol is a hormone which is secreted by the body in response to emotional and physical stress.  Since cortisol levels rise rapidly in response to physical or emotional stresses, this hormone has been called the "stress hormone". Cortisol can be detected at any time in the body, and high levels of this hormone do not necessarily lead to stress.

This critical hormone is released in response to stress.

The hormone cortisol, which is released in the body during stressed or agitated states, has gained widespread attention as the so-called "stress hormone." But this hormone is more than a simple marker of stress levels- it is necessary for the functioning of almost every part of the body. Excesses or deficiencies of this crucial hormone are also lead to various physical symptoms and disease states.

Background

Cortisol is a steroid hormone made in the adrenal glands, which are small glands adjacent to the kidneys. Among its important functions in the body include roles in the regulation of blood pressure and cardiovascular function as well as regulation of the body's use of proteins, carbohydrates, and fats.

Cortisol secretion increases in response to any stress in the body, whether physical (such as illness, trauma, surgery, or temperature extremes) or psychological. When cortisol is secreted, it causes a breakdown of muscle protein, leading to release of amino acids (the "building blocks" of protein) into the bloodstream. These amino acids are then used by the liver to synthesize glucose for energy, in a process called gluconeogenesis. This process raises the blood sugar level so the brain will have more glucose for energy. At the same time the other tissues of the body decrease their use of glucose as fuel. Cortisol also leads to the release of so-called fatty acids, an energy source from fat cells, for use by the muscles. Taken together, these energy-directing processes prepare the individual to deal with stressors and ensure that the brain receives adequate energy sources.

The body possesses an elaborate feedback system for controlling cortisol secretion and regulating the amount of cortisol in the bloodstream. The pituitary gland, a small gland at the base of the brain, makes and secretes a hormone known as adrenocorticotrophin, or ACTH. Secretion of ACTH signals the adrenal glands to increase cortisol production and secretion. The pituitary, in turn, receives signals from the hypothalamus of the brain in the form of the hormone CRH, or corticotropin-releasing hormone, which signals the pituitary to release ACTH. Almost immediately after a stressful event, the levels of the regulatory hormones ACTH and CRH increase, causing an immediate rise in cortisol levels. When cortisol is present in adequate (or excess) amounts, a negative feedback system operates on the pituitary gland and hypothalamus which alerts these areas to reduce the output of ACTH and CRH, respectively, in order to reduce cortisol secretion when adequate levels are present.

Measurement of Cortisol Levels

The body's level of cortisol in the bloodstream displays what is known as a diurnal variation - that is, normal concentrations of cortisol vary throughout a 24-hour period. Cortisol levels in normal individuals are highest in the early morning at around 6-8 am and are lowest around midnight.

Normal levels of cortisol in the bloodstream range from 6-23 mcg/dl (micrograms per deciliter).

In addition to early morning, cortisol levels may be somewhat higher after meals. While the most common test is measurement of the cortisol level in the blood, some doctors measure cortisol through a saliva sample, as salivary cortisol levels have been shown to be an index of blood cortisol levels. Sometimes by-products of cortisol metabolism are also measured, such as 17-hydroxycorticosteroids, which are inactive products of cortisol breakdown in the liver. In some cases measurement of urinary cortisol levels is of value. For this test, urine is collected over a 24-hour period and analyzed.

Normal 24-hour urinary cortisol levels range from 10-100 micrograms/ 24 hours.

Part II: Abnormal Cortisol Levels

Abnormal Cortisol Levels

Certain drugs can lead to increased cortisol levels. Examples include the diuretic spironolactone and estrogen hormone therapy. Low cortisol levels can be due to drug therapy with androgens or the anti-seizure medication phenytoin. Highly-trained athletes can have higher-than-average cortisol levels, and women in the last trimester of pregnancy also generally have elevated cortisol levels. Recent research has even shown that drinking 2-3 cups of coffee per day can elevate cortisol levels. Likely due to the increased physical and psychological stresses associated with these conditions, persons suffering from depression, anxiety, panic disorder, malnutrition and alcohol abuse also often have elevated cortisol values. Rare tumors of the adrenal glands or pituitary gland can also lead to abnormally high levels of cortisol.

Cushing's Syndrome

Persons exposed to abnormally high levels of cortisol over time develop a syndrome known as Cushing's Syndrome.

This condition generally affects adults, and approximately 10-15 per million persons will develop this condition each year. Signs and symptoms of Cushing's Syndrome include elevated blood pressure, development of diabetes, pink-to-purple stretch marks on the abdominal skin, fatigue, depression, moodiness, and accentuated fatty tissue on the face and upper back. Women with Cushing's Syndrome often have irregular menstrual periods and develop new facial hair growth. Men may show a decrease in sex drive. Treatment options are varied and depend on the cause of the excess cortisol.

Addison's Disease

Primary problems with the adrenal glands or with the pituitary gland can lead to a condition known as Addison's Disease, in which the adrenal glands fail to produce adequate amounts of cortisol. This condition occurs in persons of all ages and affects approximately one in 100,000 people per year. Symptoms are fatigue, low blood pressure, weight loss, weakness, loss of appetite, moodiness, nausea, vomiting, and diarrhea. The production of other hormones by the adrenal is also often affected, with reduced levels of the hormone aldosterone, which is important for body salt and water balance, often accompanying the reduction in cortisol. This condition can be treated by the administration of synthetic steroid hormone preparations.

1 Comments:

Blogger Hazel said...

Thanks for the mention, Ingrid! Your information on cortisol is interesting reading. I try to stay away from most medical sources on diseases as it scares me too much. To be honest, since this process has been going on for so long I wouldn't be surprised if this gland doctor refers me on to yet another specialist!

November 12, 2004  

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