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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pheochromocytomas in pregnancy are rare but potentially lethal. Even rarer is the combination of pheochromocytoma in pregnancy with subsequent development of ectopic Cushing's syndrome. We report a 36-year-old woman, previously diagnosed with essential hypertension, who developed severe hypertension in pregnancy complicated by insulin-dependent gestational diabetes. A cesarean section was performed at 32 weeks following a hypertensive crisis after routine administration of betamethasone. Postnatal persistence of signs and symptoms of catecholamine excess led to the diagnosis of a left adrenal pheochromocytoma. Between diagnosis and planned tumor removal, the patient developed signs and symptoms of Cushing's syndrome (facial edema and hirsutism, myopathy and fatigue). Biochemical testing confirmed hypercortisolism with extremely elevated levels of plasma adrenocorticotropin, urinary cortisol and multiple steroids of a plasma panel that were all normal at previous testing. The previously noradrenergic tumor also started producing epinephrine. Histopathological examination confirmed the pheochromocytoma, which was also immunohistochemically positive for adrenocorticotropin. Full post-surgical recovery was sustained with normal blood pressure and biochemical findings after one year. This report not only underlines the chameleon behavior of pheochromocytoma but also illustrates its potential for a metamorphosing presentation. Corticosteroid administration in pregnancy requires a cautious approach in patients with hypertension.
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PMID:Hypertensive crisis in pregnancy due to a metamorphosing pheochromocytoma with postdelivery Cushing's syndrome. 2893 94

Primary stress-related diseases such as chronic fatigue syndrome, fibromyalgia or chronic widespread pain have been associated with altered activity of the hypothalamic-pituitary-adrenal axis due to measured relative hyper- or hypo-cortisolism in basal or experimentally stimulated states. A hereditary risk to development of these diseases has been proposed. Corticosteroid-binding globulin (CBG), a plasma transport vehicle for cortisol, may play a more active role in the hypothalamic-pituitary-adrenal axis. Chronically altered hypothalamic-pituitary-adrenal axis has been associated with common medical problems. Hypocortisolism has been observed in kindred studies of rare mutations of the SERPIN A6 (CBG) gene and more common SERPIN A6 polymorphisms associated with reduced CBG levels or CBG:cortisol-binding affinity. Over the last decade, studies of five different CBG gene mutations in humans, human genetic associations and transgenic mouse models have suggested that CBG may have hitherto unexpected roles in modulation of the stress response. Naturally occurring CBG variants may alter susceptibility to disorders associated with chronic stress and relative hypocortisolism. On the other hand, hypercortisolism has been linked with Cushing's disease and metabolic syndrome and CBG gene polymorphisms have been linked to obesity in animal models. In this article, we look at the evidence suggesting a role for CBG in stress-related disorders, focusing particularly on CBG gene polymorphisms and chronic pain/fatigue syndromes.
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PMID:A role for corticosteroid-binding globulin variants in stress-related disorders. 3078 Aug 48

Hormones play a fundamental role in homeostasis. We develop a state-space model relating the body's internal energy to cortisol hormone secretions. Cortisol is secreted in pulses and follows a 24 h circadian rhythm. Secretory event timings carry important information regarding internal feedback signaling taking place, as do the upper and lower serum cortisol levels. We relate an internal energy state variable to cortisol pulse timings and to the upper and lower serum cortisol envelopes. We derive Bayesian filter equations for state estimation and use the Expectation-Maximization algorithm for model parameter recovery. Results on multi-day simulated data show circadian energy variations in healthy subjects and non-circadian fluctuations throughout 24 h periods in patient models suffering from hypercortisolism. The results shed new light on why patients diagnosed with excess cortisol disorders frequently experience symptoms of daytime fatigue and sleep disturbances at night. The state-space model is also an important first step towards the design of closed-loop controllers for treating hormone-related disorders in a manner that closely emulates the body's own pulsatile feedback mechanisms.
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PMID:A Cortisol-Based Energy Decoder for Investigation of Fatigue in Hypercortisolism. 3194 33


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