Adrenal Cortex Hormones Cortisol and Aldosterone........

[Guest guest]

The Importance of the Adrenal Cortex Hormones Cortisol and \Aldosterone

By Dr.Ted Friedman, M.D. Ph.D.

The adrenals, small glands located above each kidney, produce a number of important

hormones. The adrenals' inner medulla produces epinephrine and norepinephrine (adrenaline). The adrenals also contain an outer cortex, which produces hormones such as cortisol, aldosterone, testosterone, DHEA, DHEAS, androstenedione and estrogens. Cortisol and aldosterone are two of the most important hormones the body makes. Excesses or deficiencies of these hormones result in important clinical problems. Cortisol, a glucocorticoid, is the stress hormone and is involved in weight control, infection fighting, quality of skin and bones, and heart function. Its levels are the highest in the morning, and are increased by stress and severe illness. Too much cortisol from any cause leads to Cushing's syndrome; the symptoms and signs of which include redistribution of fat to the face, upper back and abdomen, weight gain, stretch marks, bruising, extra hair growth, irregular periods in women, loss of muscle, trouble sleeping and emotional problems, such as depression. Too little cortisol is part of the syndrome called 's disease, often marked by low energy, joint and abdominal pain, weight loss, diarrhea, fever, and electrolyte disturbances. If the adrenals are making too little cortisol, the pituitary compensates and makes more of the hormone, ACTH. If the pituitary is not working, both ACTH and cortisol levels may be low.

Aldosterone is the salt-retaining hormone and is a mineralocorticoid. Excesses of aldosterone leads to high blood pressure and low potassium. Deficiencies of aldosterone are much less appreciated than deficiencies of cortisol, and lead to low blood pressure and high pulse, especially on standing, the desire to eat salt (salt-craving), dizziness or lightheadedness on standing, and palpitations. Severe cases may lead to high potassium and low sodium in blood tests. When the adrenal is not making aldosterone, renin, a kidney hormone, increases. Excesses of cortisol and aldosterone may occur independently, that is a patient may have only excess aldosterone, only excess cortisol, or excesses of both. Similarly, deficiencies of cortisol and aldosterone deficiencies may be independent.

Many patients with symptoms of fatigue and often salt-craving, "cognitive fuzziness", dizziness or lightheadedness on standing, or palpitations have low blood levels of aldosterone. The connection between low aldosterone levels and fatigue is as follows: with low aldosterone, the kidney loses salt, leading to low blood volume. This coupled with the idea that the leg veins don't constrict properly, leads to lower blood volume to the brain and fatigue and other symptoms. These patients often have a drop in their blood pressure and an increase in their pulse when standing. They may also have decreased blood flow to the brain when measured by SPECT scan. Aldosterone deficiency may be made worse if patients restrict their salt intake.

Soon-to-be-published research (Friedman, T., et al., in preparation) shows a few patterns of abnormalities in the renin-aldosterone axis. A little more than half the patients with fatigue had low blood levels of both renin and aldosterone. This is called hyporeninemic hypoaldosteronism and is probably due to dysfunction of what is called the autonomic nervous system, which' sends messages from the brain to the kidneys. Other aspects of the autonomic nervous system have been found to be deficient in chronic fatigue syndrome. About one-third of the patients studied were found to have low aldosterone and high renin. This indicates a deficiency in the aldosterone production in the adrenals themselves, with a compensatory rise in the renin coming from the kidney. The aldosterone defect can either be an isolated problem, or part of 's disease (often early 's disease), in which both cortisol and aldosterone production are diminished. The remaining patients (about one-sixth) had both high renin and high aldosterone. This is likely to be a compensatory rise in both of these hormones as a reaction to a low blood volume, most likely due to an inability of the kidney to retain salt.

Treatment of patients with such symptoms requires an individualized combination of increased salt consumption, a synthetic form of aldosterone called Florinef (fludrocortisone), or Midodrine (proamantine), a drug used to raise blood pressure. Salt is the most benign of the treatments. Salt tablets can be purchased in a drug store or a patient can add an extra teaspoon of salt to their food per day. Florinef comes in 0.1 mg pills and the usual recommended starting dose is 1/2 pill in the morning for a week or two. If no side effects occur, the dose can be increased to 1 pill in the morning if needed. The main side effects are headache and swelling in legs (edema). Midodrine comes in 5 mg pills and Dr. Friedman usually starts with one 5 mg pill in the morning and another at noon. This may be increased up to 2 pills three times a day. Sometimes both Florinef and Midodrine, as well as extra salt are needed. The side effects of Midodrine include high blood pressure, itching, goosebumps, numbness and the feeling of writing on your skin or scalp. Many of these side effects go away with use and both drugs are unlikely to cause long term damage. Most patients taking Florinef and Midodrine, as well as extra salt report an improvement in their symptoms of palpitations and dizziness/lightheadedness on standing, and many report an improvement in fatigue and cognitive dysfunction. Licorice, available as a tea from Alvita, may help with mild cases.

Editor's Note: Dr. Friedman is Associate Professor of Medicine-UCLA, Endocrinology Division, R. Drew University in Los Angeles, CA. Dr. Friedman has ongoing clinical research studies on the renin-aldosterone axis in chronic fatigue syndrome (CFS) and testosterone replacement in hypopituitary women. He also has a private clinic in Los Angeles where he sees patients with pituitary, adrenal and thyroid disorders. More information about enrolling in these studies or seeing Dr. Friedman in clinic can be obtained by visiting Dr. Friedman's web site (www.goodhormonehealth.com), emailing mail@..., or calling 310-335-0327.

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[Guest guest]

Hey Patty ~

I am glad you are getting something from my researching.

I have been reading all his stuff all morning. I have a low aldosterone, renin, and cortisol. I look like I have cushings, even the hump back, I was 105-115 for years during the summers, then all of a sudden 22 mos ago, the heart and all went, then slowly I gained wt all the way up to 180 ! ! What is interesting, is before all this, I drank so much water, at least a gallon plus a day. Then I was put on salt and water restriction when the heart went. Also put on spironolactone ! I took myself off of it back in november. Anyway, I have the hump back now, went from a 25 inch waist to a 42 inch waist, and a round face, I look very cushings, but I dont think I have it.

My salt and water hormone doesnt work, they are both low, that is why the diuretic didnt work, and why I have so much edema, coupled with low renal function.

So, next is the test I am having is the cortrosyn stim test. I need to schedule it when I find out when Dad will be free to take me. Personally, I dont feel I have Conns, Cushings, nor s. But there is some great abnormality, prob caused by fungal growth and malabsorption........

something that I can improve once explanted. I am real curious about the condition of these implants. Even if they arent moldy, I am know I have systemic fungal issues....I am pretty sure they are tho.

Today, I had a spot under my left breast on my stomach area, that looks like a burn that had a blister that burst........really weird ! I had this happen about 4 years ago too, but on my right breast by the areola, 2 blistery burns one the size of a quarter and one the size of a dime. It took awhile to go away.

I wish they would do a whole bunch of tests on my blood and get it all over with. This doing one a month or every 3 months is for the birds, meanwhile, I am not being treated for anything.......which is probably best til I know why all the disarray of my hormones........

Loveya ~ DedeSee what's free at AOL.com.

[Guest guest]

Hi Dede,

Wow, the low aldesterone sounds like me!! Thanks for this...love

your research! I am still looking for a good doctor to test

this...I may even consider this guy.

Patty

>

>

> The Importance of the Adrenal Cortex Hormones Cortisol and \

> Aldosterone

>

> By Dr.Ted Friedman, M.D. Ph.D.

>

>

>

> The adrenals, small glands located above each kidney, produce

> a number of important

>

> hormones. The adrenals' inner medulla produces epinephrine

> and norepinephrine (adrenaline). The adrenals also contain

> an outer cortex, which produces hormones such as cortisol,

> aldosterone, testosterone, DHEA, DHEAS, androstenedione and

> estrogens.

>

>

>

> Cortisol and aldosterone are two of the most important

> hormones

> the body makes. Excesses or deficiencies of these hormones

> result in important clinical problems. Cortisol, a

> glucocorticoid, is the stress hormone and is involved

> in weight control, infection fighting, quality of skin

> and bones, and heart function. Its levels are the

> highest in the morning, and are increased by stress

> and severe illness. Too much cortisol from any cause

> leads to Cushing's syndrome; the symptoms and signs

> of which include redistribution of fat to the face,

> upper back and abdomen, weight gain, stretch marks,

> bruising, extra hair growth, irregular periods in

> women, loss of muscle, trouble sleeping and emotional

> problems, such as depression. Too little cortisol

> is part of the syndrome called 's disease,

> often marked by low energy, joint and abdominal pain,

> weight loss, diarrhea, fever, and electrolyte

> disturbances. If the adrenals are making too

> little cortisol, the pituitary compensates and

> makes more of the hormone, ACTH. If the pituitary

> is not working, both ACTH and cortisol levels

> may be low.

>

>

>

> Aldosterone is the salt-retaining hormone and is a

> mineralocorticoid. Excesses of aldosterone leads to high

> blood pressure and low potassium. Deficiencies of aldosterone

> are much less appreciated than deficiencies of cortisol,

> and lead to low blood pressure and high pulse, especially

> on standing, the desire to eat salt (salt-craving),

> dizziness or lightheadedness on standing, and palpitations.

> Severe cases may lead to high potassium and low sodium in

> blood tests. When the adrenal is not making aldosterone,

> renin, a kidney hormone, increases. Excesses of cortisol

> and aldosterone may occur independently, that is a patient

> may have only excess aldosterone, only excess cortisol,

> or excesses of both. Similarly, deficiencies of cortisol

> and aldosterone deficiencies may be independent.

>

>

>

> Many patients with symptoms of fatigue and often

> salt-craving, " cognitive fuzziness " , dizziness or

> lightheadedness on standing, or palpitations have low

> blood levels of aldosterone. The connection between low

> aldosterone levels and fatigue is as follows: with low

> aldosterone, the kidney loses salt, leading to low blood

> volume. This coupled with the idea that the leg veins

> don't constrict properly, leads to lower blood volume to

> the brain and fatigue and other symptoms. These patients

> often have a drop in their blood pressure and an

> increase in their pulse when standing. They may also have

> decreased blood flow to the brain when measured by

> SPECT scan. Aldosterone deficiency may be made worse

> if patients restrict their salt intake.

>

>

>

> Soon-to-be-published research (Friedman, T., et al.,

> in preparation) shows a few patterns of abnormalities

> in the renin-aldosterone axis. A little more than half

> the patients with fatigue had low blood levels of both

> renin and aldosterone. This is called hyporeninemic

> hypoaldosteronism and is probably due to dysfunction

> of what is called the autonomic nervous system, which

> ' sends messages from the brain to the kidneys.

> Other aspects of the autonomic nervous system have

> been found to be deficient in chronic fatigue

> syndrome. About one-third of the patients studied

> were found to have low aldosterone and high renin.

> This indicates a deficiency in the aldosterone

> production in the adrenals themselves, with a

> compensatory rise in the renin coming from the

> kidney. The aldosterone defect can either be an isolated

> problem, or part of 's disease (often early

> 's disease), in which both cortisol and

> aldosterone production are diminished. The remaining

> patients (about one-sixth) had both high renin and

> high aldosterone. This is likely to be a compensatory

> rise in both of these hormones as a reaction to a

> low blood volume, most likely due to an inability of

> the kidney to retain salt.

>

>

>

> Treatment of patients with such symptoms requires an

> individualized combination of increased salt consumption,

> a synthetic form of aldosterone called Florinef

> (fludrocortisone), or Midodrine (proamantine), a

> drug used to raise blood pressure. Salt is the most

> benign of the treatments. Salt tablets can be purchased

> in a drug store or a patient can add an extra teaspoon of

> salt to their food per day. Florinef comes in 0.1 mg

> pills and the usual recommended starting dose is

> 1/2 pill in the morning for a week or two. If no side

> effects occur, the dose can be increased to 1 pill in

> the morning if needed. The main side effects are

> headache and swelling in legs (edema). Midodrine

> comes in 5 mg pills and Dr. Friedman usually starts

> with one 5 mg pill in the morning and another at noon.

> This may be increased up to 2 pills three times a day.

> Sometimes both Florinef and Midodrine, as well as

> extra salt are needed. The side effects of Midodrine

> include high blood pressure, itching, goosebumps,

> numbness and the feeling of writing on your skin or

> scalp. Many of these side effects go away with use

> and both drugs are unlikely to cause long term

> damage. Most patients taking Florinef and Midodrine,

> as well as extra salt report an improvement in their

> symptoms of palpitations and dizziness/lightheadedness

> on standing, and many report an improvement in

> fatigue and cognitive dysfunction. Licorice, available

> as a tea from Alvita, may help with mild cases.

>

>

>

> Editor's Note: Dr. Friedman is Associate Professor

> of Medicine-UCLA, Endocrinology Division, R.

> Drew University in Los Angeles, CA. Dr. Friedman has

> ongoing clinical research studies on the

> renin-aldosterone axis in chronic fatigue syndrome

> (CFS) and testosterone replacement in hypopituitary

> women. He also has a private clinic in Los Angeles where

> he sees patients with pituitary, adrenal and thyroid

> disorders. More information about enrolling in these

> studies or seeing Dr. Friedman in clinic can be obtained

> by visiting Dr. Friedman's web site

> (www.goodhormonehealth.com), emailing _mail@..._

> (mailto:mail@...) ,

> or calling 310-335-0327.

>

>

>

>

>

>

>

>

>

> ************************************** See what's free at

http://www.aol.com.

>

[Guest guest]

Dede,

It sounds like with your test results and your symptoms, you have

something with the adrenals going on, and you could have had high

cortisol, though not totally cushings, doesn't it? All those

symptoms seem associated with high cortisol.

High cortisol eventually leads to low cortisol and adrenal fatigue,

if I understand right.

Anyway, you surely have something going on with your hormones! I

hope you can get hooked up with a very good doctor who can interpret

all of the complex stuff going on with you.

These stupid implants! I bet you do have a fungal issue that is

raging inside you. That must be treated before you can adequately

treat the adrenals,at least that is what I understand. We'll get it

figured out Dede, you are a great sleuth, with medical knowledge!

Once those implants come out, you will be on your way.

Patty

>

> Hey Patty ~

> I am glad you are getting something from my researching.

> I have been reading all his stuff all morning. I have a low

aldosterone,

> renin, and cortisol. I look like I have cushings, even the hump

back, I was

> 105-115 for years during the summers, then all of a sudden 22 mos

ago, the

> heart and all went, then slowly I gained wt all the way up to

180 ! ! What is

> interesting, is before all this, I drank so much water, at least

a gallon plus

> a day. Then I was put on salt and water restriction when the

heart went.

> Also put on spironolactone ! I took myself off of it back in

november.

> Anyway, I have the hump back now, went from a 25 inch waist to a

42 inch waist,

> and a round face, I look very cushings, but I dont think I have

it.

> My salt and water hormone doesnt work, they are both low, that

is why the

> diuretic didnt work, and why I have so much edema, coupled with

low renal

> function.

> So, next is the test I am having is the cortrosyn stim test. I

need to

> schedule it when I find out when Dad will be free to take me.

Personally, I

> dont feel I have Conns, Cushings, nor s. But there is

some great

> abnormality, prob caused by fungal growth and

malabsorption........

> something that I can improve once explanted. I am real curious

about the

> condition of these implants. Even if they arent moldy, I am know

I have

> systemic fungal issues....I am pretty sure they are tho.

> Today, I had a spot under my left breast on my stomach area, that

looks like

> a burn that had a blister that burst........really weird ! I had

this

> happen about 4 years ago too, but on my right breast by the

areola, 2 blistery

> burns one the size of a quarter and one the size of a dime. It

took awhile to

> go away.

> I wish they would do a whole bunch of tests on my blood and get

it all over

> with. This doing one a month or every 3 months is for the birds,

meanwhile,

> I am not being treated for anything.......which is probably best

til I know

> why all the disarray of my hormones........

> Loveya ~ Dede

>

>

>

> ************************************** See what's free at

http://www.aol.com.

>