Over 10 Years of Support For Cushing's Patients!
Getting a diagnosis and dealing with tests can be a very trying time. Here are some words you'll want to know.
Abnormal: Not normal. Deviating from the usual structure, position, condition, or behavior. In referring to a growth, abnormal may mean that it is cancerous or premalignant (likely to become cancer ).
See the entire definition of Abnormal
Acanthosis nigricans: Asymptomatic, brown to black skin, with a velvety texture. Pedunculated skin tags often are present. The most common sites are the axillae, neck, and groin. If the patient is obese, the eruption may clear with weight loss or correction of the underlying endocrine disorder. Local treatment is not effective.
More on Acanthosis nigricans.
Acromegaly: Excessive growth caused by overproduction of growth hormone by the pituitary gland. This is a condition that usually affects middle aged people. It is characterized by gradual, marked enlargement of the bones of the face, jaw and extremities. The excessive growth occurs first in the hands and feet, as soft tissue begins to swell.
Apart from these symptoms, the metabolic abnormalities associated with GH (Growth Hormone) that warrant effective GH lowering therapy. Acromegaly affects mostly middle-aged adults. Untreated, the disease can lead to severe illness and death. Acromegaly is the Greek word for "extremities" and "enlargement."
Acromegaly/ Gigantism is a very rare (annual incidence: 3/1.000.000) and serious chronic condition related to a permanent hypersecretion of growth hormone (GH) by the pituitary gland, generally of tumoral origin. The syndrome results from a chronic exposure to GH (Growth Hormone) leading to the classic clinical features.
This causes an excessive production of Insulin-like Growth Factor 1 (IGF-1), a hormone secreted from the liver and other tissues. Excessive production of IGF-1 and GH translates into uncontrolled growth of various organs, and debilitating symptoms. Control of the GH and IGF-1 levels by Sandostatin® LAR results in normalizing such excessive growth and symptoms. Medical treatment has an important role to play in the management of patients with acromegaly. It is a life long treatment, with few, mild side effects.
Read an article on acromegaly.
Symptoms of acromegaly.
Read an article on Gigantism
ACTH: Adrenocorticotropic Hormone. ACTH is a normal by-product of the anterior pituitary gland. It acts by controlling the secretion of the adrenal hormone, cortisol. Produced by the pituitary gland. A pituitary tumor often causes too little ACTH to be produced. Symptoms of ACTH deficiency include weakness, fatigue and gastrointestinal disturbances.
To cure the overproduction of cortisol caused by ectopic ACTH syndrome, it is necessary to eliminate all of the cancerous tissue that is secreting ACTH. The choice of cancer treatment--surgery, radiotherapy, chemotherapy, immunotherapy, or a combination of these treatments--depends on the type of cancer and how far it has spread. Since ACTH-secreting tumors (for example, small cell lung cancer) may be very small or widespread at the time of diagnosis, cortisol-inhibiting drugs, like mitotane, are an important part of treatment. In some cases, if pituitary surgery is not successful, surgical removal of the adrenal glands (bilateral adrenalectomy) may take the place of drug therapy. Read more about treatments for Ectopic ACTH Syndrome.
Addison's Disease (Adrenal insufficiency): Caused by low levels of cortisonelike hormones produced by the adrenal glands. The cause is usually unknown, but may be a complications of tuberculosis, cancer, pituitary disease of cortisone drugs.
Adrenal: Pertaining to one or both of these endocrine glands located on top of the kidneys. These glands secrete many hormones, including epinephrine (adrenaline), norepinephrine, and the corticosteroid, and play an important part in the body's endocrine system.
The adrenal is made up of an outer wall (the cortex) and an inner portion (the medulla).
Adrenalectomy: Surgical removal of the adrenal glands is a final measure for halting excess cortisol production This is used only when all other measures fail in individuals with pituitary tumors.
Sometimes, an abnormality of the adrenal glands, most often an adrenal tumor, causes Cushing's syndrome. The average age of onset is about 40 years. Most of these cases involve non-cancerous tumors of adrenal tissue, called adrenal adenomas, which release excess cortisol into the blood. adrenal glands. In Primary Pigmented Micronodular Adrenal Disease and the familial Carney's complex, surgical removal of the adrenal glands is required.
Adrenal insufficiency: See Addison's Disease. Adrenal insufficiency is a life threatening chronic illness. An active and vigorous lifestyle with normal life expectancy is possible as long as the prescribed medications are taken regularly and adjusted when indicated. As with most chronic diseases, adrenal insufficiency demands that the patients take responsibility and develop self-management skills and techniques.
Read an article on Adrenal insufficiency
Adrenocortical carcinomas, or adrenal cancers: These are the least common cause of Cushing's syndrome. Cancer cells secrete excess levels of several adrenal cortical hormones, including cortisol and adrenal androgens. Adrenocortical carcinomas usually cause very high hormone levels and rapid development of symptoms.
Adrenocortical hyperplasia: Increase in the number of cells of the adrenal cortex. It secretes cortisol, androgens and aldosterone. Increased production of any or all of these hormones may result in a variety of disorders, such as Cushing's syndrome and hypertension.
Agglutination: Clumping or gathering together of cells (usually red blood cells) into a mass. Normally each cell exists separately.
Read an article on Aldosterone testing
Analytical Chemical Analysis: Separates, determines and analyzes the quantity of any specific chemical or substance.
Anesthesia: A combination of drugs administered by a variety of techniques and routes by trained professionals that provide sedation, amnesia, analgesia, and immobility adequate for accomplishment of the surgical objectives with minimal discomfort, and without injury, to the patient.
Some operations require that the patient remain immobile, anesthetic, and amnesic for many hours at a time. From a variety of anesthetic options for any given procedure, the surgeon and anesthesiologist selects those that in patients demographically (diagnosis, age, neurologic condition) similar to the one being operated on, most reliably produce safe, effective, uncomplicated anesthesia in as non-invasively as possible.
Anovulation: Lack of ovulation. There may be anovulatory periods -- in which there is menstruation, but no egg has been released.
Anterior: Toward the front or in front of.
Apheresis: The process of apheresis involves removal of whole blood from a patient or donor. Within an instrument that is essentially designed as a centrifuge, the components of whole blood are separated. One of the separated portions is then withdrawn and the remaining components are retransfused into the patient or donor.
Ascites: An abnormal pooling of fluid in the abdominal cavity; the fluid contains large amounts of protein and other cells. Ascites is usually noticed when more than 1 pint (500 ml) of fluid has collected. The condition may lead to general abdominal swelling, dilution of the blood, or less urinary output. The most common cause is liver disease (cirrhosis). However, ascites can be caused by cancer, kidney disease, congestive heart failure, or other diseases. the fluid can be removed with a needle (paracentesis). This relieves pain and improves breathing and organ function.
Assay: Determination of the amount of a particular constituent of a mixture or the biological or pharmacological potency of a drug.
Atomic Absorption Spectroscopy: Measures trace elements, such as calcium, magnesium or copper, in body fluids.
Autoimmune Premature Ovarian Failure: Premature ovarian failure due to a autoimmune disorder, including other autoimmune disorders such as lupus, rheumatoid arthritis, etc., or an autoimmune reaction to your ovaries, endometrial lining, FSH, etc.
Benign: Tumor or growth that is neither cancerous nor located where it might impair normal function. It is not progressive or recurrent. Benign also means harmless. A benign tumor does not invade surrounding tissue or spread to other parts of the body. A benign tumor may grow but it stays put (in the same place).
BLA, Bilateral Adrenalectomy: Surgical removal of both the adrenal glands.
Blood tests: Blood tests can determine relative levels of cortisol and ACTH. Because these hormones are secreted episodically, your doctor will likely request that measurements be done on two or three separate days. The relative levels of cortisol and ACTH can help differentiate between the different causes of Cushing's syndrome.
Blood Pressure: Constant force placed on the walls of the arteries.
Brain Stem: Portion of the brain that connects the hemispheres with the spinal cord. Consists of medulla oblongata, pons, and midbrain.
Read more about the Buffalo Hump.
Read an article on Dostinex.
CAH (Congenital Adrenal Hyperplasia): Congenital adrenal hyperplasia refers to a group of inherited disorders relating to the adrenal glands, characterized by a deficiency in the hormones cortisol and aldosterone and an overproduction of androgen.
Read more about Congenital Adrenal Hyperplasia (CAH)
Catheter: Hollow tube used to introduce fluids into the body of drain fluids from the body.
Catheterization: Passage of a tubular, flexible, surgical instrument called a catheter into a cavity of the body.
Central Serous Retinopathy (CSR): A condition which causes temporary or permanent impairment of vision. The symptoms are loss of sensitivity in dim light, usually in an oval shaped gray or brown area, blurring or distortion of the visual image. It is a result of the detachment of most of the layers of the retina (the back of the eye) from its supporting tissue as a result of the buildup of fluid. The buildup of fluid appears to be due to one or more small breaks in the retinal pigment epithelium.
Cholesterol: A waxy, fat-like substance contained in every cell in the body and in many foods. Some cholesterol in the blood is necessary - but a high level can lead to heart disease. Drugs like Lipitor are often used to help control high cholesterol.
Chronic: Term used to describe long-lasting diseases or conditions. Usually, a chronic disease will last in some form for the remainder of the patient's life.
Congenital Adrenal Hyperplasia (CAH): Congenital adrenal hyperplasia refers to a group of inherited disorders relating to the adrenal glands, characterized by a deficiency in the hormones cortisol and aldosterone and an overproduction of androgen.
Read more about Congenital Adrenal Hyperplasia (CAH)
Corticosteroids: Hormones produced by the cortex of the adrenal glands; also, a class of such hormones used as medications. They are used in inflammatory conditions for their anti-inflammatory effects. They have a rapid onset of action, and profoundly affect many parts of the immune system as well as most other body systems. Corticosteroids are a cornerstone of treating most types of vasculitis, and are often used in combination with other immunosuppressive medications. See also Cortisol and Prednisone.
Cortisol: A hormone which produced by the
gland (cortex) to control blood sugar. The production of cortisol is
triggered by the pituitary hormone ACTH. Cortisol is a glucocorticoid which stimulates an increase in blood glucose. Cortisol
will also stimulate the release of amino acids from muscle tissue and fatty acids from adipose tissue. The amino acids are then
converted in the liver to glucose (for use by the brain). The fatty acids can be used by skeletal muscles for energy (rather
glucose) thereby freeing up glucose for selective utilization by the brain. Cortisol levels are often measured to evaluate the
function of the pituitary or adrenal glands. Some of the cortisol is metabolized by the liver to produce 17
hydroxycorticosteroids, which is then excreted in the urine.
The primary stress hormone. Cortisol is the major natural GLUCOCORTICOID (GC) in humans.
Synthetic cortisol, also known as hydrocortisone, is used as a drug mainly to fight allergies and inflammation.
The amount of cortisol present in the serum undergoes diurnal variation, with the highest levels present in the early morning, and lower levels in the evening, several hours after the onset of sleep. Information about the light/dark cycle is transmitted from the retina to the paired suprachiasmatic nuclei in the hypothalamus. Changed patterns of the serum cortisol levels have been observed in connection with abnormal ACTH levels, clinical depression, psychological stress, and such physiological stressors as hypoglycemia, illness, fever, trauma, surgery, fear, pain, physical exertion or extremes of temperature. There is also significant individual variation, although a given person tends to have consistent rhythms.
Cortisol also inhibits the secretion of corticotropin releasing hormone (CRH), resulting in feedback inhibition of ACTH secretion. Some researchers believe that this normal feedback system may break down when animals are exposed to chronic stress.
In normal release, cortisol has widespread actions which help restore homeostasis after stress. It acts as a physiological antagonist to insulin by promoting gluconeogenesis, breakdown of lipids, and proteins, and mobilization of extrahepatic amino acids and ketone bodies. This leads to increased blood glucose concentrations, resulting in increased glycogen formation in the liver (Freeman, 2002). It also increases blood pressure. In addition, immune and inflammatory cells have their responses to stress attenuated by cortisol, and the hormone thus lowers the activity of the immune system. Bone formation is also lowered by cortisol.
These normal endogenous functions are the basis for the physiological consequences of chronic stress - prolonged cortisol secretion causes muscle wastage, hyperglycemia, and suppresses immune / inflammatory responses. The same consequences arise from long-term use of glucocorticoid drugs.
Also, long-term exposure to cortisol results in damage to cells in the hippocampus. This damage results in impaired learning. However, short-term exposure of cortisol helps to create memories; this is the proposed mechanism for storage of flash bulb memories.
As an oral or injectable drug, cortisol is also known as hydrocortisone. It is used as an immunosuppressive drug, given by injection in the treatment of severe allergic reactions such as anaphylaxis and angioedema, in place of prednisolone in patients who need steroid treatment but cannot take oral medication, and peri-operatively in patients on long-term steroid treatment to prevent an Addisonian crisis.
It is given by topical application for its anti-inflammatory effect in allergic rashes, eczema and certain other inflammatory conditions. It may also be injected into inflamed joints resulting from diseases such as gout.
Compared to prednisolone, hydrocortisone is about 1/4th the strength. Dexamethasone is about 40 times stronger than hydrocortisone. For side effects, see corticosteroid and prednisolone.
A certain amount of cortisol is necessary for life. Without cortisol even a small amount of stress will kill you. Addison's disease is a disease which causes low cortisol levels, and which is treated by cortisol replacement therapy.
- helps maintain blood pressure and cardiovascular function;
- helps slow the immune system's inflammatory response;
- helps balance the effects of insulin in breaking down sugar for energy; and
- helps regulate the metabolism of proteins, carbohydrates, and fats.
Chromophobe: Chromophobe adenoma; pituitary adenoma; undifferentiated cell adenoma; an adenoma of the hypophysis composed of cells for which there is no overt evidence or hormone production, but which produce hypopituitarism and visual disturbances by compression of adjacent structures; approximately one third of these tumors have cells with abundant mitochondria (oncocytes) that are somewhat larger than the monocytic null cells.
Condition: The term "condition" has a number of biomedical meanings including the following:
CRH Stimulation Test: See under Tests
CSR: See Central Serous Retinopathy
CT Scan (CAT Scan): Procedure in which an extremely narrow X-ray beam passes through a cross-section of the body or brain. It is picked up by an electronic instrument called a SCINTILLATOR rather than being exposed on X-ray film. Scintillator reads the density that tissue X-rays pass through. A computer prints out the densities as an illustration of the cross-section.
Cushing's Disease/ Cushing's Syndrome: Cushing's is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. Your adrenal glands, which are right above your kidneys, release cortisol when they receive a chemical message from your pituitary gland. The message comes in the form of adrenocorticotrophic hormone (ACTH), which travels through the bloodstream.
Cushing's Disease Is the result of a pituitary tumor which causesthe emergence of secondary male characteristics (like hair growth, acne, etc.), and ovarian failure. Other symptoms usually include high blood pressure and water retention.
An estimated 10 to 15 of every million people are affected each year. Cushing's is an increased concentration of glucocorticoid hormone (ACTH) in the bloodstream that is being produced by an adrenal gland tumor (adenoma). Ectopic Cushing syndrome refers to the production of ACTH in a location other than the pituitary gland or adrenalgland. Examples of ectopic sites include thymoma, medullary carcinoma of the thyroid, pheochromocytoma, islet cell tumors of the pancreas, and oat cell carcinoma of the lung.
Symptoms include weight gain, central obesity, moon face, weakness, fatigue, backache, headache, increased thirst, increased urination, impotence, mental status changes, and muscle atrophy.
Dexamethasone-CRH Test: See under Tests.
DEXA scan: Dual-Energy X-ray Absorbtiometry. It is the most accurate form of bone density checking.
DHEA (dehydroepiandrosterone) : DHEA is a male hormone (androgen) which is converted into estrogen and testosterone. It is mainly produced by the adrenal gland. Considered a "building-block hormone," one from which the other sex hormones are made. It may help prevent osteoporosis, heart disease and Alzheimer's.
Diabetes Insipidus: Diabetes insipidus is a condition that results from insufficient production of the antidiuretic hormone by the hypothalamus, the portion of the brain that stimulates the pituitary gland. Normally, the antidiuretic hormone controls the kidneys' output of urine. Diabetes insipidus causes excessive thirst and excessive production of very diluted urine.
More information on Diabetes insipidus
Diagnosis: Identification of a disease or disorder by a physician or other qualified medical personnel.
Dysmenorrhoea: Painful menstrual periods.
Ectopic ACTH production: Adrenocorticotropic hormone (ACTH) at some site other than the pituitary gland. Some benign or malignant (cancerous) tumors that arise outside the pituitary can produce ACTH. This condition is known as Ectopic ACTH Syndrome. Lung tumors cause over 50 percent of these cases. Men are affected 3 times more frequently than women. The most common forms of ACTH-producing tumors are oat cell, or small cell lung cancer, which accounts for about 25 percent of all lung cancer cases, and carcinoid tumors. Other less common types of tumors that can produce ACTH are thymomas, pancreatic islet cell tumors, and medullary carcinomas of the thyroid.
Read about treatments for Ectopic ACTH Syndrome
Empty Sella Syndrome: Empty sella syndrome is common in women who are overweight or have high blood pressure. Characterized by an enlarged bony structure (sella turcica) that houses the pituitary gland at the base of the brain, the disorders sometimes results in high fluid pressure inside the skull. The pituitary gland is usually normal size or small.
More on Empty Sella
Endocrinologist, Endocrinology: A doctor specifically trained in diagnosis and treatment of the system of organs that secretes hormones into the blood. The endocrine organs are the anterior and posterior pituitary glands, thyroid and parathyroid glands, pancreas, adrenal glands, ovaries (in women) and testicles (in men).
Endometrium: The lining of the uterus shed with each menstrual period.
Estrogen (Oestrogen): Female hormones produced by ovary and responsible for regulating certain reproductive functions. Estrogen is responsible for stabilizing moods and plays a role in lubrication. Estrogen is involved in breast development and may help some types of breast cancer to grow.
Familial Cushing's Syndrome: Most cases of Cushing's syndrome are not inherited. Rarely, however, some individuals have special causes of Cushing's syndrome due to an inherited tendency to develop tumors of one or more endocrine glands.
In Primary Pigmented Micronodular Adrenal Disease, children or young adults develop small cortisol-producing tumors of the adrenal glands.
FSH (Follicle Stimulating Hormone): A hormone secreted from the anterior pituitary gland. In the woman, FSH stimulates production of ovarian follicles ("eggs") and estradiol (another reproductive hormone) during the first half of the menstrual cycle. In men FSH stimulates the testes to produce sperm.
FESS: Image-guided Functional Endoscopic Sinus Surgery (FESS). ENT surgeons are taking a new route to treat common problems like sinusitis, nasal obstruction, nasal allergy and polyps.
FESS is performed with the aid of nasal endoscopes that leave no post-operative scarring on the face. FESS techniques are also extending the boundaries of the ENT speciality to crossover to other disciplines. Surgeries include endoscopic dacryocystorhinostomy (performed usually by ophthalmologists for blockage of the flow of tears), cerebrospinal fluid leak and removal of pituitary tumours (neurosurgery domain).
Gamma Knife: This is a more focused radiation treatment than conventional radiation, which reduces the risk of hypopituitarism. It provides a large dose of radiation to a tumor so that when the tumor cells divide, they die. As this method depends on the rate of cell division, symptoms may persist long after the radiation treatment.
Gigantism/Acromegaly is a very rare disease (annual incidence: 3/1.000.000). The syndrome results from a chronic exposure to GH (Growth Hormone) leading to the classic clinical features that the diagnosis seems to be easy.
Read an article on Giantism
Gland: Any organ or tissue that releases a substance to be used elsewhere in the body; endocrine glands release hormones directly into the bloodstream.
GnRH: A neuroendocrine peptide which stimulates the secretion of the pituitary LH, which in turn stimulates the production of estrogen by the ovary or testosterone by the testes. The most widely prescribed drugs which modulate the GnRH receptor are peptide agonists, such as, Lupron(R) and Zoladex(R), with estimated combined sales in excess of $2.5 billion worldwide (2003). These compounds are administered as injectable depots which act by first stimulating then eventually inhibiting the secretion of pituitary LH and consequently, estrogen or testosterone production. GnRH peptide agonists have proven clinically useful in the treatment hormone dependent diseases such as endometriosis, uterine fibroids, prostate cancer and breast cancer, as well as being used for assisted-reproductive therapy. Despite a multitude of potential applications, deleterious consequences of GnRH agonist therapy, especially permanent bone loss in women's health diseases, have limited the useful duration of treatment.
Gonadatropin Releasing Hormone Stimulating Test: Indication: To evaluate patients who present with low LH and sex steroids. The test may also be used to diagnose patients with delayed puberty.
Growth Hormone: Growth of cells, fat metabolism, improved mood, increased energy levels. See also Hgh (Human growth hormone)
Hematologist, Hematology: A doctor who specializes in diseases of the blood and blood-forming organs.
hGH: Human Growth Hormone (hGH) is produced in the pituitary gland of humans, and the hormone is secreted throughout a person's lifetime. It promotes growth in children and plays an important role in adult metabolism.
More about HgH
Hirsutism: If this is mild, cosmetic methods may be all that are required. These included plucking, bleaching, waxing, depilatory creams which dissolve the hair, or shaving. Many people are worried that shaving will make the hair grow more rapidly, but there is no evidence for this. The disadvantage of these methods is that they are temporary, although they are relatively inexpensive. Electrolysis has a more permanent effect, but takes time (the hair follicles are destroyed one by one), and is therefore more expensive. If the hair growth is more extensive, then medical treatment may be considered. Although different types of treatment are available, the most common used drugs are the antiandrogens (spironolactone or cyproterone acetate). These are not curative, but reduce the rate of hair growth and the coarseness of the hair. They may take three to six months to work, and the effect gradually wears off once the drug is stopped. However many people find that it is very reassuring that the hair growth can be controlled.
Hormonal Disorders: The endocrine system consists of a group of glands and organs that secrete hormones into the bloodstream. (see illustration) The major glands are the pituitary gland (controlled by the hypothalamus), the thyroid gland, the parathyroid glands, the islets of the pancreas (which produce insulin), the adrenal glands, the testes in males, and the ovaries in females. Hormones secreted by these glands control physical growth, sexual function, metabolism, and other functions. Many of the endocrine disorders that affect adults also affect children but may produce different symptoms.
Hormone: A specific protein substance, secreted by an endocrine gland into the bloodstream, to regulate the functions of tissues and organs elsewhere in the body where it acts to modify their structure of function.
HRT (Hormone Replacement Therapy): Usually used during menopause, it contains estrogen and progestogen. Hormone therapy with tamoxifen can act on cells all over the body and may increase your chance of getting cancer of the uterus. If you are taking tamoxifen, you should go to your doctor for a pelvic exam every year, and you should report any vaginal bleeding other than your menstrual period to your doctor as soon as possible.
Continuous combined HRT: A therapy for women past menopause who want a period-free HRT
- Sequential HRT: A one pill, once a day HRT containing estrogen and progestogen. This type of therapy induces regular periods.
- Unopposed HRT: HRT containing estrogen only. Often called ERT.
HRT: COMMON SIDE EFFECTS: Fluid retention, bloating, weight gain, Breast tenderness Vaginal discharge, Headaches/Migraines, Nausea, Acne, Depression not attributable to other factors, Dizziness, shortness of breath
HRT: SERIOUS SIDE EFFECTS: Thrombophlebitis, High blood pressure, Thyroid problems, Fibroid tumors, Cancer, Gallstones, Hyperplasia, Hypoglycemia
Human growth hormone (hGH ): Human Growth Hormone (hGH) is produced in the pituitary gland of humans, and the hormone is secreted throughout a person's lifetime. It promotes growth in children and plays an important role in adult metabolism.
More about hGH
Hypercortisolemia: Hypercortisolemia is simply the overproduction of cortisol.
Basically, what happens with people who have hypercortisolemia is that they have the inability to shut off the stress response so they are constantly responding to stress differently than other people.
In addition to diseases like Cushing's, high stress responses can come from many different sources such as traumatic events, busy lifestyles, or physically, emotionally, or spiritually threatening situations. Stress responses are real, and are typically out of the control of the person experiencing them.
More about the HPA (hypothalamic-pituitary-adrenal) axis
Hyperprolactinemia: Is a condition marked by excessive prolactin production -- which can suppress the production of LH and FSH and thus cause amenorrhea. It is often treated by taking bromocriptine (Parlodel®)
More about Hyperaldosteronism
Hypoglycemia: Hypoglycemia, or low blood sugar, occurs when blood levels of glucose drop too low to fuel the body's activity.
More about Hypoglycemia
Hypopituitarism: Inadequate pituitary function. It is also called an underactive pituitary gland, is a condition that affects the anterior lobe of the pituitary gland -- usually resulting in a partial or complete loss of functioning of that lobe. The resulting symptoms depend on which hormones are no longer being produced by the gland. Because the pituitary gland affects the other endocrine organs, effects of hypopituitarism may be gradual or sudden and dramatic.
In children, hypopituitarism may be caused by a benign pituitary tumor (craniopharyngioma), an injury, or an infection, or it may have no identifiable cause (idiopathic hypopituitarism). Rarely, hypopituitarism (and diabetes insipidus) occurs as part of Hand-Schüller-Christian disease, which affects small areas of bone and lungs and the function of the pituitary gland.
If the pituitary gland malfunctions before puberty, growth is delayed, sexual characteristics do not develop, and the thyroid and adrenal glands function inadequately. After puberty, pituitary malfunction can cause decreased sex drive, impotence, and shrinking of the testes.
An image of the Hypothalamus Gland
Hypothalamic Obesity: Damage to the hypothalamus (VMH) and termed "hypothalamic obesity", is characterized by weight gain that is unresponsive to diet, exercise, and pharmacotherapy. VMH damage leads to increased weight gain. Severe obesity after VMH damage due to brain tumors or cranial irradiation were treated for 6 months to 1 year. Obese children and adults exhibit a syndrome of Primary Insulin Hypersecretion; for which a specific etiology, pathogenesis, diagnosis, and pharmacotherapy are now identified.
Hypothyroidism: An autoimmune disorder in which the thyroid gland under produces insufficient thyroid hormone. Can cause symptoms that overlap with menopausal symptoms -- such as fatigue, weight gain, skipped periods, etc.
Iatrogenic: Induced by a physician.
Idiopathic: No known cause.
Image-guided Functional Endoscopic Sinus Surgery: See FESS
Insulin resistance: The condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. Insulin resistance in fat cells results in hydrolysis of stored triglycerides, which elevates free fatty acids in the blood plasma. Insulin resistance in muscle reduces glucose uptake whereas insulin resistance in liver reduces glucose storage, with both effects serving to elevate blood glucose. High plasma levels of insulin and glucose due to insulin resistance often leads to the metabolic syndrome and type 2 diabetes.
Isolated luteinizing hormone deficiency: Only one pituitary hormone, the luteinizing hormone, is missing.
IGF-1: (also known as Serum IGF-1 or Somatomedin C) is a polypeptide hormone. It belongs to a family of peptides whose levels are regulated by growth hormone (GH) through receptors. IGF-1 is secreted mainly by the liver and has potent growth stimulating activity. Its mitogenic activity has caused interest in its possible role in cancer growth but its present clinical use is for the diagnosis of human growth disorders. Less than 5% of IGF-1 is free and the rest is bound to IGF-binding proteins (IGFBP). The major one in circulation is IGFBP-3.
Read more about Serum IGF-1 or Somatomedin C
JAMA: The Journal of the American Medical Association. JAMA began publication in 1883. It now bills itself as "the world's best-read medical journal". However one defines "best-read", JAMA clearly ranks as one of the two leading general medical journals published in the United States. (The other is the New England Journal of Medicine.)
JAMA is published by the American Medical Association (AMA) and reports American Medical Association policy, "as appropriate." However, according to JAMA, articles in it "do not reflect the official policy of the American Medical Association...." and JAMA has the objective of " maintaining editorial independence, objectivity, and responsibility."
The mission of JAMA is lofty: "To promote the science and art of medicine and the betterment of the public health."
JAMA carries original, generally well-documented, peer-reviewed medical articles on a diversity of clinical as well as laboratory topics. It has become a publication that is timely, credible and, as medical journals go, important.
Kidney: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.
Laparoscopic adrenalectomy: Laparoscopic adrenalectomy uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision in the flank (fleshy area between the ribs and hip). The laparoscope is connected to a tiny video camera - smaller than a dime - which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Two or three additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon manipulates these instruments to perform the adrenalectomy. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
Read more about laparoscopic adrenalectomy
Luteinizing Hormone (LH): Pituitary hormone that causes a follicle to rupture and an egg to be released (ovulation); the surge of LH that does this is called the LH surge. In men LH stimulates the testes to produce Testosterone.
The Magnetic Stereotaxis System (MSS): MSS was developed by a team of American neurosurgeons, is touted as a safer, less invasive and more effective way to biopsy brain tumors. Other applications may include diagnosing and treating cardiovascular conditions, such as coronary artery disease, cardiac arrhythmia and aneurysms.
Malignant: Prone to spread, cancerous.
MEN type 1: There are at least 3 tumors of the endocrine glands, one of the pituitary, one possibly of the thyroid, one possibly of the pancreas.
Myasthenia Gravis: A neuromuscular disorder characterized by weakness and fatigability of skeletal muscles. The defect is due to a decrease in the number of acetylcholine receptors at neuromuscular junctions, due to an antibody-mediated autoimmune attack. Common symptoms include weakness of the eye muscles, diplopia, and a drooping eyelid (ptosis).
This clinical condition results when a patient with an ACTH-producing pituitary adenoma undergoes bilateral adrenal gland removal (adrenalectomy). Approximately 15-25% of patients with Cushing's disease treated with adrenalectomy will develop Nelson's syndrome within 1 to 4 years. Because these ACTH-secreting tumors are typically aggressive and invasive in their growth, patients may develop large tumors resulting in visual loss, pituitary failure (hypopituitarism) and headache. These adenomas also secrete melanocyte-stimulating hormone, resulting in characteristic hyperpigmentation of the skin. ACTH blood levels are generally markedly elevated but hypercortisolemia is absent.
Transsphenoidal surgery is generally the primary therapy, however cure is often difficult. Radiotherapy, preferably with stereotactic radiation, is effective in controlling tumor growth in the majority of patients who have residual tumor after surgery.
Neurologist, Neurology: Doctor specially trained to diagnose and treat diseases of the nervous system.
Octreotide Scan:A type of radionuclide scan used to find carcinoid and other types of tumors. Radioactive octreotide, a drug similar to somatostatin, is injected into a vein and travels through the bloodstream. The radioactive octreotide attaches to tumor cells that have receptors for somatostatin. A radiation-measuring device detects the radioactive octreotide, and makes pictures showing where the tumor cells are in the body. This procedure is also called somatostatin receptor scintigraphy (SRS).
Oestrogen (Estrogen): Female hormones produced by ovary and responsible for regulating certain reproductive functions. Estrogen is responsible for stabilizing moods and plays a role in lubrication. Estrogen is involved in breast development and may help some types of breast cancer to grow.
Oncologist, Oncology: Doctor specially trained to treat cancer.
Osteoporosis: A disease which causes bones to lose mass and become porous and brittle. Frequently leads to fractured spine, wrists or hips in elderly women. It is a weakening of bones, leading to bone loss; often as a result of extended exposure to low estrogen levels. One of the primary risks of premature ovarian failure and early menopause.
Once-Weekly Fosamax (Alendronate) Approved In US For Treatment, Prevention Of Postmenopausal Osteoporosis
Ovaries: The pair of female reproductive organs that produce eggs and hormones.
Ovarian Failure: A state that exists when the ovaries run out of eggs and the ovary fails to respond to FSH. Ovulation does not occur. This can be due to an autoimmune disorder, ovarian damage, or malformation of the ovary, among other things.
Oxytocin: Induces milk movement, and uterine contractions.
Panhypopituitarism: Production of all pituitary hormones decreases or stops. This disorder can result when the entire pituitary gland is damaged. Sometimes only one pituitary hormone is missing. For example, if only luteinizing hormone is missing (isolated luteinizing hormone deficiency), the testes develop and produce sperm, because these functions are controlled by follicle-stimulating hormone, but the testes do not produce enough testosterone. Testosterone is the hormone that stimulates the development of male secondary sexual characteristics, such as deepening of the voice, growth of facial hair, and maturation of the penis. Consequently, boys who have isolated luteinizing hormone deficiency do not develop these characteristics. Abnormally long arms and legs may be another symptom of this deficiency.
Parlodel® (Bromocriptine) Prescription medication that reduces prolactin levels and/or shrinks pituitary tumors. Used to treat hyperprolactinemia and pituitary tumors.
Petechiae: Pinpoint-sized hemorrhages of small capillaries in the skin or mucous membranes. Petechiae result from tiny areas of superficial bleeding into the skin. They appear as round, pinpoint-sized dots that are not raised. The color varies from red to blue or purple as they age and gradually disappear. Petechiae commonly appear on the lower legs, but may be distributed all over the body.
Pheochromocytoma: A pheochromocytoma is a tumor that originates from the adrenal gland's chromaffin cells, causing overproduction of catecholamines, powerful hormones that induce high blood pressure and other symptoms.
Phlebotomist : A phlebotomist draws blood for tests, transfusions, donations and research. S/he draws blood samples by venipuncture, skin puncture or arterial collection. For apparent reasons, safety precautions must be taken to prevent the transmission of infectious diseases. Phlebotomists must adhere to strict policies and procedures while treating patients with care. These healthcare professionals may work in hospitals, commercial laboratories, private physician offices, public health departments, clinics or blood banks.
PICC Line: A PICC line (Peripherally Inserted Central Catheter) is a semi-permanent IV line), which is inserted into a large vein, usually in your arm although other places may be used. This will allow fluids and injections to be given, and blood samples to be taken. It will save you the discomfort of repeated sticks.
Pituitary Adenoma: Pituitary adenomas cause most cases of Cushing's syndrome. They are benign, or non-cancerous, tumors of the pituitary gland which secrete increased amounts of ACTH. Most patients have a single adenoma. This form of the syndrome, known as "Cushing's disease", affects women five times more frequently than men.
Pituitary dwarfism: The pituitary gland produces inadequate amounts of growth hormone, causing abnormally slow growth and short stature. Most short children, however, have normally functioning pituitary glands and are short because their growth spurt is late or their parents are relatively short.
Pituitary gland: Because the pituitary controls the function of most other endocrine oval gland at the base of the brain, in the fossa (depression) of the sphenoid bone,which produces a number of different hormones . It oversees hormone production by the sex glands (the ovaries, in women), adrenal glands, and thyroid gland. Pituitary disorders (such as tumors) can cause amenorrhea -- and, thus, be mistaken for early menopause.
The pituitary secrets several hormones which are as follows:
Pituitary hyperplasia: The is the increase in number of cells/proliferation of cells on the pituitary gland. It may result in the gross enlargement of the pituitary and is occasionally a cause of Cushing's Disease. Despite recent progress in imaging, it is still difficult to distinguish between pituitary adenoma and hyperplasia, even using Magnetic Resonance Imaging (MRI) with gadolinium injection.
More on pituitary tumors
Types of pituitary tumors
Once a pituitary tumor is found, more tests will be done to find out how far the tumor has spread and whether or not it makes hormones. A doctor needs to know the type of tumor to plan treatment. The following types of pituitary tumors are found:
- Acth-producing tumors These tumors make a hormone called adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to make glucocorticoids. When the body makes too much ACTH, it causes Cushing's disease
- Prolactin-producing tumors These tumors make prolactin, a hormone that stimulates a woman's breasts to make milk during and after pregnancy. Prolactin-secreting tumors can cause the breasts to make milk and menstrual periods to stop when a woman is not pregnant. In men, prolactin-producing tumors can cause impotence.
- Growth hormone-producing tumors
These tumors make growth hormone, which can cause acromegaly or gigantism when too much is made.
- Nonfunctioning pituitary tumors
Nonfunctioning tumors do not produce hormones.
- Recurrent pituitary tumors
Recurrent disease means that the tumor has come back (recurred) after it has been treated. It may come back in the pituitary gland or in another part of the body.
Polycystic Ovary Syndrome (PCOS): Having many cysts on the ovaries can produce similar symptoms to Cushing's or menopause. It can be an inherited hormonal imbalance that won't allow eggs to be expelled from the ovaries. It can lead to extremely irregular or heavy menstrual periods, lack of periods, infertility, endometrial and uterine cancer, male-pattern hair growth and fat deposition, weight gain, insulin resistance and increased risk for cardiovascular disease, among other things. No two women are affected exactly the same way. This syndrome is also called Stein-Leventhal Syndrome.
More information on Polycystic Ovary Syndrome.
Posterior: Following or located behind.
Pendred's Syndrome: Pendred's syndrome is a rare autosomal recessive condition characterized by incomplete oxidation of trapped iodide prior to organification. Named for Vaughan Pendred, 1869-1946, English physician.
Prednisone: Prednisone is a corticosteroid. In contrast to anabolic steroids (used by "bodybuilders"), corticosteroids are used in inflammatory conditions for their anti-inflammatory effects. They have a rapid onset of action, and profoundly affect many parts of the immune system as well as most other body systems. Corticosteroids are a cornerstone of treating most types of vasculitis, and are often used in combination with other immunosuppressive medications.
More information on Prednisone
Primary pigmented nodular adrenocortical disease (PPNAD): A rare disease of the adrenal glands. The adrenal glands are small glands located above each kidney. The adrenals make hormones. Hormones are chemical substances formed in one organ or part of the body that travel in the blood to other body parts where they influence how that body part works. Cortisol is one of the hormones made by the adrenals. Cortisol influences body metabolism (how the body converts small molecules to large and vice versa) and can decrease inflammation. People with PPNAD have adrenal glands that make too much cortisol or make it at inappropriate times (when the body does not need it).
More information on PPNAD
Information on Liddle Test for diagnosing PPNAD
Progesterone: Female crystalline ketatonic steroid hormone. It is obtained from the corpus luteum or made synthetically. It is regarded as a biological precursor of corticoid and androgenic hormones. It is usually used in treating functional uterine bleeding.
Prolactinoma: A pituitary tumor causes breast milk production and other symptoms similar to menopause in women. Men with prolactinomas typically have headaches or lose their peripheral vision. About two-thirds of men lose their interest in sex and become impotent. The tumor is benign (non-cancerous) over 99% of the time. It is the most common of all pituitary tumors (28%). The cause of the tumor is unknown.
Symptoms of prolactinoma
- Reduction in sex drive (libido)
- Pain during intercourse; vaginal dryness
- Visual field disturbances
- Unexplained weight gain
- Mood changes
- Male hypogonadism
- Milk discharge from nipples
- Changes in or loss of menstrual cycle
- Fractures from osteoporosis
- Delayed puberty
Pseudo Cushing's: Pseudo-Cushing's is a catch all term used for misregulation of cortisol by the brain. There is no cure but instead, treatment is given for the underlying disorder in order to reduce the excess cortisol.
Elevated cortisol induced by alcohol, steroid use, stress, and clinical depression fall into this category. Polycystic Ovarian Syndrome or Disease also falls into this category. PCOS and PCOD often do not have elevated cortisol, but the physical findings mimic Cushing's. There is a diagnostic criteria for PCOS and PCOD but with Pseudo-Cushing's, there is a great amount of trial and error in determining the underlying problem. Maintenance may be achieved through drugs.
Qualitative Test: Determines the presence or absence of a particular property or condition. Determines ingredients of a substance.
Quantitative Test: Accurate determination of the quantity of a chemical element, compound or functional group present in a specimen.
Radiation: Radiation can be a useful treatment when pituitary tumors cannot be completely removed by surgery. Radiation of pituitary tumors reduces cortisol levels in about half of adults and most children with Cushing's disease. Because this cortisol-lowering effect takes time (3 to 12 months), doctors often prescribe medications that lower adrenal cortisol production while waiting for the effects of radiation to occur. These medications include ketoconazole, metyrapone, and aminoglutethimide.
Rathke's cleft cyst (RCC): A remnant of Rathke's pouch in the pituitary often persists as a cleft that lies within the pituitary gland. It is usually present at birth.
More about Rathke's cleft
Sertoli-Leydig cell tumor: Sertoli-Leydig cell tumor is a cancer that starts in the female ovaries. The cancer cells produce and release a male sex hormone, which may cause the women to develop male physical characteristics (virilization), including facial hair and a deep voice.
Serum IGF-1: (also known as IGF-1 or Somatomedin C) is a polypeptide hormone. It belongs to a family of peptides whose levels are regulated by growth hormone (GH) through receptors. IGF-1 is secreted mainly by the liver and has potent growth stimulating activity. Its mitogenic activity has caused interest in its possible role in cancer growth but its present clinical use is for the diagnosis of human growth disorders. Less than 5% of IGF-1 is free and the rest is bound to IGF-binding proteins (IGFBP). The major one in circulation is IGFBP-3.
Read more about Serum IGF-1 or Somatomedin C
Sheehan's Syndrome: In Sheehan's syndrome, which affects women, lactation may not develop postpartum as a result of pituitary necrosis from hypovolemia and shock that occurred in the immediate peripartum period. The patient may complain of fatigue and may lose pubic and axillary hair. (From the Merck Manual)
Somatomedin C: (also known as IGF-1 or Serum IGF-1) is a polypeptide hormone. It belongs to a family of peptides whose levels are regulated by growth hormone (GH) through receptors. IGF-1 is secreted mainly by the liver and has potent growth stimulating activity. Its mitogenic activity has caused interest in its possible role in cancer growth but its present clinical use is for the diagnosis of human growth disorders. Less than 5% of IGF-1 is free and the rest is bound to IGF-binding proteins (IGFBP). The major one in circulation is IGFBP-3.
Read more about Serum IGF-1 or Somatomedin C
Somatostatin Receptor Scintigraphy (SRS): A type of radionuclide scan used to find carcinoid and other types of tumors. In SRS, radioactive octreotide, a drug similar to somatostatin, is injected into a vein and travels through the bloodstream. The radioactive octreotide attaches to tumor cells that have receptors for somatostatin. A radiation-measuring device detects the radioactive octreotide, and makes pictures showing where the tumor cells are in the body. This procedure is also called an octreotide scan.
Sphenoid sinus: Either of the two irregular cavities in the body of the sphenoid bone that communicate with the nasal cavities. This is the most direct to the pituitary gland.
Sonogram: See Ultrasound.
Striae: Stretch marks or stripes, usually purplish with Cushing's. The exact cause is unclear but it is suggested that they are a kind of scar within the dermis. It is thought that the collagen ruptures and the gaps produced are filled with scar. This process may be made worse by increased hormonal levels seen in Cushing's. Because the scar is permanent and due to factors other than simple stretching, application of creams to the surface of the skin during pregnancy will not prevent the striae from forming. Although many methods to remove striae have been described they have not produced consistent results. Unfortunately there is no good method which consistently removes stretch marks. Some doctors claim limited success with Retin-A and lasers but the long term benefits are unclear.
Usually post-op these striae will lighten or fade somewhat. It is important to note that not all Cushing's patients have striae, so they are not a reliable diagnostic symptom in and of themselves. On the Message Boards these are often referred to as "Racing Stripes".
Examples: 1. transsphenoidal craniotomy is indicated for removal of a pituitary tumor that is causing compression of the optic chiasm 2. embolization of a cerebral arteriovenous malformation is indicated to reduce the number of feeding vessels so that open resection (indicated to eliminate further potentially damaging or fatal hemorrhage) can be performed more safely.
Surgical objectives: What the surgeon intends to do.
Telangiectasias (spider veins) are small enlarged blood vessels near the surface of the skin; usually they measure only a few millimeters. They can develop anywhere on the body but commonly on the face around the nose, cheeks, and chin. They can also develop on the legs, specifically on the upper thigh, below the knee joint, and around the ankles.
Testosterone: An androgen, commonly considered a 'male' hormone, testosterone plays a major role in libido and overall energy in both men and women; promotes masculine characteristics such as hair growth. Boosts libido and energy; help build bone and maintain muscle. Because it is produced in small amounts by the ovaries and (to a lesser degree) the adrenal glands in women, it's becoming more common to include this as part of a woman's hormone replacement therapy, particularly for women who have had their ovaries removed.
Titrate: Determine strength of, or analyse, etc., by finding the smallest amount of the substance that will produce a given effect with another known quantity. titre, n. such smallest amount. titrimetry, n. measuring by such means. titration, n.
Thymus: A lymphoid organ located in the superior mediastinum and lower portion of the neck. This gland is necessary in early fetal development for the normal development of the immune system. It is at it's greatest relative weight shortly after birth, and reaches it's greatest absolute weight at puberty. From this point it begins to involute, and much of the glandular tissue is replaced by fat.
Thyroid Gland Disorders: Some problems that affect the thyroid gland may also cause the gland to enlarge--a condition called goiter. A goiter may exist if the thyroid gland is underactive (producing too little thyroid hormone) or overactive (producing too much). An enlarged thyroid gland that is present at birth is called congenital goiter. Some children have Pendred's syndrome, a hereditary condition that combines deaf-mutism and congenital goiter.
Thyrotroph: A cell that is located in the anterior lobe of the pituitary gland and that produces thyrotropin.
Thyrotropin: Thyroid-stimulating hormone (TSH), hormone released by the anterior pituitary gland that stimulates the thyroid gland to release thyroxine . The release of thyrotropin is triggered by the action of thyrotropin-releasing factor (TRF), a substance found in the hypothalamus of the brain. TRF, once released from the hypothalamus, travels in the bloodstream to the anterior pituitary, where it causes the release of thyrotropin. This latter substance, a glycoprotein, is carried to the thyroid gland by the blood, where it stimulates the uptake of iodine, the conversion of diiodotyrosine to thyroxine, and the secretion of thyroid hormones into the bloodstream. Thyroxine inhibits the further release of thyrotropin by interfering with the action of TRF; thus the levels of thyroid hormones are regulated. If not enough iodine is available in the diet, then not enough thyroxine will be made to shut off the release of thyrotropin. Prolonged stimulation of the thyroid by thyroid-stimulating hormone results in an abnormal enlargement of the gland, known as goiter, a condition which has been largely eradicated by the widespread usage of iodized salt.
Transsphenoidal Hyposection: Surgery to remove a pituitary tumor. Since the pituitary is located behind the sphenoid sinus, it is possible to remove the tumor by that pathway, rather than some of the more invasive methods of the past.
Read about the Transsphenoidal Surgery
What to expect after Transsphenoidal Surgery
Tumor: A growth or mass of abnormal tissue which resembles the normal tissue in structure, but which fulfills no useful function and which grows at the expense of the body. Tumors may be benign or malignant (spreading and infiltrate adjacent tissue).
Turner's Syndrome: A genetic disorder that can cause premature ovarian failure, in which a woman is born without the second X chromosome or without part of it. Causes deficient ovarian development -- and often primary amenorrhea.
UFC: UFC is an abbreviation used on the message boards for Urine Free Cortisol. There is more information about that test here: http://www.cushings-help.com/urine.htm
Ultrasonography (Ultrasound; Sonogram): View of deep structures of the body by recording reflections or echoes of pulses of ultrasound waves directed into tissues. Sound waves are transmissible in liquid and solid.
Venipuncture: Surgical puncture of a vein, usually with a hypodermic needle for the purpose of withdrawing blood or for intravenous injection of medication.
Von Hippel-Lindau disease: A rare, genetic multi-system disorder characterized by the abnormal growth of tumors in certain parts of the body (angiomatosis). The tumors of the central nervous system (CNS) are benign and are comprised of a nest of blood vessels and are called hemangioblastomas (or angiomas in the eye). Hemangioblastomas may develop in the brain, the retina of the eyes, and other areas of the nervous system.
Other types of tumors develop in the adrenal glands, the kidneys, or the pancreas. Symptoms of VHL vary among patients and depend on the size and location of the tumors.
Symptoms may include headaches, problems with balance and walking, dizziness, weakness of the limbs, vision problems, and high blood pressure. Cysts (fluid-filled sacs) and/or tumors (benign or cancerous) may develop around the hemangioblastomas and cause the symptoms listed above. Individuals with VHL are also at a higher risk than normal for certain types of cancer, especially kidney cancer.
Withdrawal: The state experienced when addicting medications, illegal drugs, or alcohol are withdrawn. Symptoms may be physiological or psychological or both. Visit the Cortisone Withdrawal Boards.
X-RAY: High-energy, visible electromagnetic waves capable of penetrating the body and creating shadows on photographic film. Shadows provide images of body tissue through which X-rays pass. Also called roentgen ray.
Zollinger-Ellison Syndrome: A disorder where increased levels of the hormone gastrin are produced, causing the stomach to produce excess hydrochloric acid. Often, the cause is a tumor (gastrinoma) of the duodenum or pancreas producing the hormone gastrin. Gastrin then causes an excessive production of acid which can lead to peptic ulcers (in almost 95% of patients)
Patients with Zollinger-Ellison syndrome may experience abdominal pain and diarrhea. The diagnosis is also suspected in patients without symptoms who have severe ulceration of the stomach and small bowel, especially if they fail to respond to treatment.