Adrenocortical Hormone Abnormalities in Men with CP/CPPS

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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

Post by webslave »

J Dimitrakov wrote:These pathways and cortisol in particular are involved in muscle tension, muscle contraction and relaxation. Some of the substances produced by the adrenal also determine your individual pain perception threshold and can sensitize nerve endings causing the perception of pain induced by stimuli which are normally non-painful (a phenomenon, known as allodynia). Sensitized and damaged nerve endings in the pelvis are also implicated in frequency and urgency. Hope this helps with understanding the whole picture.
This is interesting considering this new research, which shows that IC/PBS patients do not habituate normally to stimuli and may have "catastrophic" responses to stimuli:
Neurourol Urodyn. 2009 Feb 3. [Epub ahead of print]

Patients with painful bladder syndrome have altered response to thermal stimuli and catastrophic reaction to painful experiences.
Lowenstein L, Kenton K, Mueller ER, Brubaker L, Heneghan M, Senka J, Fitzgerald MP.
Division of Female Pelvic Medicine & Reconstructive Surgery, Departments of Obstetrics & Gynecology and Urology, Loyola University Stritch School of Medicine, Maywood, Illinois.


AIMS: To compare cutaneous sensory thresholds, habituation to somatic stimuli, and tendency towards catastrophic reaction to painful stimuli in patients with Painful Bladder Syndrome (PBS) to controls without PBS. METHOD: Thermal and vibratory sensory thresholds were established in 11 PBS patients and 10 controls at C5, T1, T12, and S3 dermatomes. Supra-threshold thermal stimuli were then applied at T12 and S3 for 60 sec while patients periodically rated the intensity of stimuli using a visual analog scale. A Pain Catastrophizing Scale (PCS) questionnaire was also completed by all participants before testing. RESULTS: PBS patients were less sensitive to warm stimuli in the T12 dermatome than asymptomatic controls (thresholds 36.6 +/- 1.10 degrees C vs. 35.3 +/- 1.0 degrees C, P < 0.02) but otherwise had similar thermal and vibratory thresholds. Habituation to supra-threshold stimuli at T12 and S3 dermatomes was more common in controls than PBS subjects (7 (70%) vs. 2 (18%), P < 0.03 and 9 (90%) vs. 3 (27%), P < 0.008, respectively). The PCS score correlated with the duration of PBS symptoms and with thresholds to warm stimuli at T12 dermatome (rho = 0.65, P < 0.03 and rho = 0.5, P < 0.021, respectively). CONCLUSION: Our data suggests that habituation to stimuli may be impaired and that a catastrophic reaction to perceived stimuli may be involved in the sensory experience of PBS patients and facilitate chronic pain. Neurourol. Urodyn. (c) 2009 Wiley-Liss, Inc.

PMID: 19191279 [PubMed - as supplied by publisher]
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

Post by J Dimitrakov »

Indeed quite interesting

Best,
JD
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

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Some of the substances produced by the adrenal also determine your individual pain perception threshold and can sensitize nerve endings causing the perception of pain induced by stimuli which are normally non-painful (a phenomenon, known as allodynia).
Interesting, Dr. Dimitrakov. Is it known specifically which adrenal substances are most likely to affect pain perception?
Started: Spring 2003; high urinary frequency and pain associated with bladder filling; urinary hesitancy; pubic/prostate/perineal discomfort; Helped by: trigger point therapy, Afrin nasal spray, Cymbalta, hydrocodone (small doses), distraction. Makes worse: sex.

Not medical advice. Consult your doctor.
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

Post by J Dimitrakov »

Hi, Kevin,

Thanks for the interesting question. Cortisol is the predominant pacemaker of pain threshold setting. There are numerous intracellular pathways that are implicated in pain perception that are under glucocorticoid regulation, so any substance in the glucocorticoid pathway (the end product of which is cortisol) is, by itself, a regulator of pain perception. The facts are just starting to come together in a pattern in this field but here is a very intriguing abstract that just came out on glucocorticoids and dopamine (a major player in pain, anxiety and emotions):
Nature Neuroscience 12, 247 - 249 (2009)
Published online: 22 February 2009 | doi:10.1038/nn.2282

Stress and addiction: glucocorticoid receptor in dopaminoceptive neurons facilitates cocaine seeking

Frédéric Ambroggi1,2,7,8, Marc Turiault3,4,8, Aude Milet3,4, Véronique Deroche-Gamonet1,2, Sébastien Parnaudeau3,4,5, Eric Balado1,2, Jacques Barik3,4,5, Rixt van der Veen1,2, Grégoire Maroteaux3,4, Thomas Lemberger6, Günther Schütz6, Monique Lazar3,4, Michela Marinelli1,2,7, Pier Vincenzo Piazza1,2,8 & François Tronche3,4,5,8

The glucocorticoid receptor is a ubiquitous transcription factor mediating adaptation to environmental challenges and stress. Selective Nr3c1 (the glucocorticoid receptor gene) ablation in mouse dopaminoceptive neurons expressing dopamine receptor 1a, but not in dopamine-releasing neurons, markedly decreased the motivation of mice to self-administer cocaine, dopamine cell firing and the control exerted by dopaminoceptive neurons on dopamine cell firing activity. In contrast, anxiety was unaffected, indicating that glucocorticoid receptors modify a number of behavioral disorders through different neuronal populations.
This communication provides general information, and is not a substitute for face-to-face medical care. A doctor-patient relationship should not be assumed by the reader.
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

Post by kevin »

Thanks for the reply, Dr. Dimitrakov. I will do some reading those chemicals when I have a chance.
Started: Spring 2003; high urinary frequency and pain associated with bladder filling; urinary hesitancy; pubic/prostate/perineal discomfort; Helped by: trigger point therapy, Afrin nasal spray, Cymbalta, hydrocodone (small doses), distraction. Makes worse: sex.

Not medical advice. Consult your doctor.
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

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Rufus wrote:http://www.washingtonpost.com/wp-dyn/co ... 02351.html
Tweaking Hormones Might Ease Chronic Stress

TUESDAY, Jan. 27 (HealthDay News) -- U.S. and Canadian scientists say they've devised a potential new method of promoting recovery from chronic stress disorders by utilizing the natural dynamics of the body's "fight or flight" response.

The approach focuses on the hypothalamic, pituitary, adrenal (HPA) axis, one of the body's major control systems. The HPA axis uses hormone feedback regulatory loops to help maintain body homeostasis (balance of systems).

A team led by Amos Ben-Zvi, of the University of Alberta, Edmonton, say that when the HPA axis is pushed far from its natural homeostatic rest point, it may be unable to fully recover. When that happens, HPA axis dysfunction may become permanent, according to background information in the study.

HPA axis dysfunction has been linked to disorders such as chronic fatigue syndrome, depression, post-traumatic stress disorder, and Alzheimer's disease.

The researchers created a short-term intervention designed to help restore normal HPA axis. This method involves temporarily reducing the availability of cortisol, a hormone involved in immune function. Reduced cortisol levels prompt the HPA axis to overcompensate and re-set itself into normal regulation.

This new model, which needs to be tested in clinical tests, was described in an article published Jan. 23 in the journal PLoS Computational Biology.
After being hit by 3 different types of CFS (viral, hormone tampering drug induced and overtraining, and antibiotic drug induced again) I pretty much can say that this is a major iatrogenic mistake to try and tweak hormones or push cortisol down via binding it or decreasing its production at several levels. Have read the article completely and was astonished by the complete lack of medical information from the people who develop it --- computational biology---- what goes on inside a human body is far away from computations at this period of time (I wanna see such a clinical case for sure, depressing cortisol without overcompensations by other parts of the stress system). CFS is not a single disease but a complex of diseases which seem to have similar symptoms but those authors prob don't know it for sure.

For example its not similar to have low response of adrenals to ACTH, to having low basal CRF levels, or low basal hippocampal efferent or afferent frequency, to having an overinhibitory signal from cortisol to CRF/hippocampus, or overinhibitory signals from hippocampus or CRF/AVP to cortisol or have mild adrenal atrophy or PVN nuclear, suprahypothalamic or amygdala damage, or neurotransmitter receptor binding activity issues or or or... There's like more than 10-15 known reasons of HPA axis integrity dysregulation and probably more than twice as many exist which we don't know that manifest as similar symptoms and they all pack up in one big basket called chronic fatigue syndrome. Well this is a joke of course to try and mess with hormones, I have done it and found myself in VERY BIG PROBLEMS.

To take hydrocortisone for example, 5-10 mg per day a minimal physiologic dose is ok for some in whom it will signal the CRF to not shut down, and this is a very limited group of CFS patients whose HPA axis works in the paradoxical way of amplifying its activity after introduction of a low dose of cortisol. It is really paradoxical but this is what has been found to happen, the exact opposite of negative feedback.

Some others benefit when trying sleep deprivation. The people that suffer from this sort of chronic fatigue could benefit from sleeping later than normal and waking up later than normal, (due to morning cortisol levels that don't respond properly to ACTH stimulation) or even avoiding sleep every once in a while (not more than once per week). They will definitely see a difference in their levels of alertness and concentration (amazing but true).

Last but not least other benefit from exercise (graded).

Some other doctors* and people confuse adrenal fatigue with chronic fatigue syndrome (this is a big mistake). Adrenal fatigue is another case where due to low gonadotrophins, cortisol has to overcompensate for stresses and this drives the gland either to exhaustion or nearly almost to a breaking point (after this breaking point there could be major HPA axis suppression or death ??? few people know that for sure!!!). In cases of adrenal fatigue, you need like 25-30 mg of cortisol, thyroid hormones and testosterone to get better, some psych docs claim to do it via antidepressants(!) instead of cortisol and others by plain rest (for months and years) and so other herbs/vitamins (tried many ways). It's almost impossible to shut down the norepinephrine signal in a short time without high cortisol levels or suppressing the whole axis with sleeping aids for long lasting periods of time.

There is also a case of overactive autonomic systems but this is similar to adrenal fatigue in a sense that when your HPG axis is low and your HPA axis is a bit weak then your LC-NA-adrenomedullary system takes over and each average stressor can signify problems (this is also similar to adrenal fatigue in the end result or it could be worse).
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

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S0b0T wrote:In cases of adrenal fatigue, you need like 25-30 mg of cortisol, thyroid hormones and testosterone to get better, some psych docs claim to do it via antidepressants(!) instead of cortisol and others by plain rest (for months and years) and so other herbs/vitamins (tried many ways). It's almost impossible to shut down the norepinephrine signal in a short time without high cortisol levels or suppressing the whole axis with sleeping aids for long lasting periods of time.
In my case, years of rest did the trick. I appreciate the points you raise about the complexity of trying to influence the HPA axis. It's not simple.
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

Post by J Dimitrakov »

I think that we all agree with your statement that those are complex conditions and there is no one single approach that works for everyone. It will be an oversimplification to state that EVERYONE with CPPS has adrenocortical dysfunction, just as it would be incorrect to say they have CRH, pituitary or hypothalamic dysfunction. Therefore, I have repeatedly suggested that anyone considering such therapy be absolutely sure they know exactly what mechanism is abnormal in their case and know well the risks associated with their therapy. For example, I had two patients who developed CPPS symptoms following treatment with finasteride prescribed for their CPPS symptoms. While not currently routine, patients considering such therapy might as well be genotyped to prevent undesirable events following such treatment. Naturally, having an expert endocrinologist to initiate therapy and follow the patient is a must, especially when considering hormonal therapy

Best,
JD
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

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Webslave you overcame adrenal fatigue by plain rest? How long did you rest and what sort of rest was that ?? Could you sleep?? What did you do in the mean time while being "fatigued" apart from rest?? And how long did that last, where there any ups and downs??, how depressed where you cort levels and what about other hormonal/neurotransmitter parameters??

What is you testosterone values at present approximately?

sorry for the questions!!!!

Doc I agree that surely not everyone with CPPS manifests with major HPA axis abnormalities, but if you consider that a persons stress system comprises the HPA, HPT, HPG, RAAS, LC-NA-AdME, immune factors and other neural paths it think it will take a while (probably 20-30 or maybe 50 years) but at some point we will be able to quantify and qualify more precisely the extend of the damage or the effect the stress system has on CPPS and CP. At this point its probably like trying to scavenge galaxies with binoculars. I know in my case finasteride brought about CP and CPPS, and thats enough for me. Maybe others who had other triggers suspect other reasons behind it, still if you consider that the most appreciated strategies to deal with it are hormonal based and stress relief related, there has to be some relation to the stress system.

I don't know maybe I'm oversimplifying things, you surely have seen many a different types of CP/CPPS and you know more, I'm just talking in general.
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

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S0b0T wrote:Webslave you overcame adrenal fatigue by plain rest?
The body is a self-healing mechanism, and when I got CPPS+CFS I was told that I was revving the body's engine too fast (extreme stress from job and multiple house moves, extreme overwork). I ended up bedridden for months and then working from home for years. Found that even talking on the phone to people for work purposes made me sweat heavily (the "sympatho-adrenal response" — inappropriate sweating of this kind is a sign of overactivity of the sympathetic nervous system).

Never underestimate controlling stress and anxiety as a force for healing. That's why David Wise makes a big deal of paradoxical relaxation.

As for my cortisone, testosterone and other levels, I'm sure they were haywire, but back in those days nobody thought to test them. Instead, we kept testing my T-cells and immune system, which always showed a state the doctors described as "ready for battle", IOW slightly abnormal with lots of natural killer cells etc. One doctor commented that this was frequently seen in people who were hyper-anxious.

Later on I also found that gluten caused me major problems. Now I avoid stress and gluten. I have remained well for many years. I only once or twice, in the early days, used internal massage (using an implement). It did help.
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

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I have waited to post this because I'm not sure if there is a connection?

I have been off of Nasacort, a corticosteroid for more than a year now...and I have had the most significant recovery this past year out of the 3 plus years since my onset...Going back in my minds eye, my onset came a few years after continued use of this drug for non allergic rhinitis..Not sure if the discontinued use of that drug has played a roll in my over-all recovery along with everything else I have done along with time???

Perhaps Dr. D or Mark can enlighten me on this...forgive me for my laymen explanation...

Regards, Carl...
I am not a medical doctor. Please fill out your signature (click here) ☼ ☼ My Starter List for new members
I encourage anxiety prone UCPPS people to consider L-Theanine
Age, 44 onset age 37 Feb 2006 Freq. need to urinate. Sensation of having to urinate soon after going. Perineum discomfort/burning/tightness, pubic area discomfort @ times,poor urine stream, post urine dripping/spray. All symptoms have improved with my protocol. At the worst I give it a 1 to 2 on irritation and discomfort and frequency. Helps: Elavil 5mg for anxiety and mast cell protection, (will only take it as needed) self internal PT as needed, stretching, walking, stairmaster cardio workout and light weights, reducing stress, moment to moment relaxation, deep breathing relaxation and using a Theracane. Makes worse: sitting for long periods, stress, over focusing on it. Currently 95%-98% recovered. Stay positive, relaxed and control your anxiety.
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

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The only evidence we have about steroids is actually positive. However, they never helped me, and in fact I developed new symptoms when I took prednisolone as a trial many years ago.

Any drug as powerful as a steroid could hinder recovery, even if you were only using a spray like Nasacort (Triamcinolone), because you do swallow it and it does become absorbed systemically. Nasacort does have Hypothalamic-pituitary-adrenal (HPA) axis effects, and some people DO develop systemic corticosteroid effects such as hypercorticism and adrenal suppression.

And if you used it for YEARS ... well, that really was a risky thing to do.

So yes, I'd say coming off it could well have influenced your CPPS!
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

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Interesting!...I wonder if there are any long term/side effects from that spray... I did it for a few years at least...well, can't dwell on the past, so I will move on. The way I see it....anxiety control and learning how to relax and stay relaxed is key here for all of us period!! When you can do that, the healing begins... :-D The brain will re-train itself just the way neurofeedback has helped train my brain to stay focused and in a more alpha state... :-D Except when I get pissed off... :lol:
I am not a medical doctor. Please fill out your signature (click here) ☼ ☼ My Starter List for new members
I encourage anxiety prone UCPPS people to consider L-Theanine
Age, 44 onset age 37 Feb 2006 Freq. need to urinate. Sensation of having to urinate soon after going. Perineum discomfort/burning/tightness, pubic area discomfort @ times,poor urine stream, post urine dripping/spray. All symptoms have improved with my protocol. At the worst I give it a 1 to 2 on irritation and discomfort and frequency. Helps: Elavil 5mg for anxiety and mast cell protection, (will only take it as needed) self internal PT as needed, stretching, walking, stairmaster cardio workout and light weights, reducing stress, moment to moment relaxation, deep breathing relaxation and using a Theracane. Makes worse: sitting for long periods, stress, over focusing on it. Currently 95%-98% recovered. Stay positive, relaxed and control your anxiety.
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

Post by J Dimitrakov »

S0b0T wrote: At this point its probably like trying to scavenge galaxies with binoculars.
It might actually be closer than you think. Technology is getting better now and gene sequencing, for example, which used to take several months, can now be done in a few days

Best,
JD
This communication provides general information, and is not a substitute for face-to-face medical care. A doctor-patient relationship should not be assumed by the reader.
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Re: Adrenocortical Hormone Abnormalities in Men with CP/CPPS

Post by J Dimitrakov »

carld wrote:I have waited to post this because I'm not sure if there is a connection?

I have been off of Nasacort, a corticosteroid for more than a year now...and I have had the most significant recovery this past year out of the 3 plus years since my onset...Going back in my minds eye, my onset came a few years after continued use of this drug for non allergic rhinitis..Not sure if the discontinued use of that drug has played a roll in my over-all recovery along with everything else I have done along with time???

Perhaps Dr. D or Mark can enlighten me on this...forgive me for my laymen explanation...

Regards, Carl...
Carl, although I don't know the details of your case, there have been cases where the corticosteroid receptors can be desensitized and cortisone would stop working, even if administered continuously. Withdrawing cortisone could restore receptor function in some of those cases

Best,
JD
This communication provides general information, and is not a substitute for face-to-face medical care. A doctor-patient relationship should not be assumed by the reader.
Jordan Dimitrakov, M.D., Ph.D.
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