Flattened stress induced cortisol response
08-01-2007 04:38 PM
Flattened stress induced cortisol response
My main problem is familial hyprcholesterolimia- bad genetic code causes the liver to synthesize too much cholesterol thus leading to arterial plaquie build up and greatly increased risk of heart attack and stroke. One component of the process is inflammation of the arterial wall. The study below indicates that the normal cortisol response is blunted in cases such as mine.
Blackwell Synergy - J Intern Med, OnlineEarly Articles (Article Abstract)
The authors describe one of the principle symptoms of adrenal fatigue, yet the AMA fails to recognize adrenal insuffisiency at less than Addisons levels. I can see good in concervatism too.
Five years ago I suffered a bilateral thalamic infarction (stroke in the thalmus gland) with loss of speech and swallowing ability. (Which has returned since.) But lifestyle changes of monumental proportions were forced upon me unexpectedtly. Smoking, drinking and partying, my principle coping mechanisms, were out the window. I think this qualifies as stress too. lol
Interestingly, within a month, a reccurance of childhood asthma developed. Not serious at first but becoming progresively worse over the next 5 years and requiring short and long acting Beta2 agonists from onset and inhaled corticosteroids for the past 2-3 years.
The dozen doctors I have talked to about this have been at a loss to explain the sudden onset and the worsening progression. As have I until now.
It appears clear to me now that the the asthmatic inflammatory component has been present all my life and held in check by my endogenous glucocorticoid production and that the stress of the abovementioned events depleted my ability to counteract the bronchial inflammation and so- the onset of asthmatic symptoms. I further contend that inhaled corticosteroid therapy has further comprimised my ability to respond to stress- specifically bronchial inflammation. The studies that indicate an absense of effect on the HPA by these drugs are exclusively financed by the drug companies. Some independant studies find that the HPA is depressed by Mometatose, a common asthma steroid drug.
METABOLISM OF MOMETASONE FUROATE AND BIOLOGICAL ACTIVITY OF THE METABOLITES -- Sahasranaman et al. 34 (2): 225 -- Drug Metabolism and Disposition
One study found that cortisol production was reduced 46% when on the usual maintance dose of Mometasone. It appears that the drug that is saving me is also weakining me in the long run.
So what to do ? Stopping the steroid will put a real cramp in my lifestyle, ie. short of breath at the least exertion.
I think a clue is to be found in my response to a shot of prednisolone and a weeks dosepak which was prescribed for back trauma but has eliminated the asthma symptoms. The question is how long will the releif last after the effects of the drug are gone? Half life is 6-8 hrs. Have stopped the Mometasone on day 5 of the weeks therapy . The effects of it will be gone in a couple days. So then, fighting the inflammation will be up entirely to my HPA axis in a few days. Should be interesting to see how it goes. My hope is that after a weeks relief from cortisol demand the adrenals will be better able to handle the load. Biochemicallly this makes some sense since inflammation gives rise to prostaglandins which stimulate the thalmus to release ACTH and so on.
If this plays out as I hope it will and any measure of adrenal recovery is seen then there is evidence for theraputic value in a periodic, but not maintance, dosing with more potent glucosteroids and possibly with fewer side effects.
There is one more piece to the puzzle. Last december-january I had strong remission of asthma symptoms lasting a week or so. Never explained- never repeated. Could his have a period when the aqdrenals "kicked-in" for some as yet unknown reason ?
There is possible another factor at work here. Statin drugs, which lower cholesterol have been found in some studies to lower testosterone. Presumably by lowering pregnenolone and therefor all of its metabolites, possibly including cortisol.
Let me add that measures of breathing , PEV and FEV1, have increased 20% since initiating TRT as the following study predicts.
The Effect of Testosterone Replacement on Endogenous Inflammatory Cytokines and Lipid Profiles in Hypogonadal Men -- Malkin et al. 89 (7): 3313 -- Journal of Clinical Endocrinology & Metabolism
Last edited by Dr. John; 08-01-2007 at 06:00 PM.
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