It's been quiet here. Everyone must be enjoying the summer. We certainly are. My wife and I have a few big events coming up in the next few weeks - a wedding for one of my brothers, and a wedding for my best friend. My wife's parents and sister are coming over this weekend to help us paint our baby's future room. Our little one is due in October! The weeks until then can't go quickly enough.
To get on topic, I've recently been following a research study going on at the University of Chicago, which may be of interest to many of you. Its purpose is to study circadian rhythm misalignment in people with adrenal insufficiency. I don't claim to be an expert on this by any means, but as I understand it, replacement steroids do not come close to replicating the body's normal production of cortisol, which often causes fatigue and sleep problems for people with adrenal insufficiency. A healthy individual's adrenal glands typically begin producing cortisol a few hours before they wake up in the morning, which allows for a burst of energy upon waking. In a person with adrenal insufficiency, there may be great difficulty in waking up, despite receiving what should be adequate sleep. I know that sleep is typically unrefreshing for me, whether I get four hours or nine. I have to force myself to get out of bed, go downstairs, and take my hydrocortisone and fludrocortisone. It might take 45 minutes or so for me to actually feel awake. Do others with AI experience this, as well?
I've been in contact with Dr. Eve Van Cauter at the University of Chicago, and she informed me that they are still recruiting individuals with AI for this study. If you are interested, the clinical trial number is NCT03000231. It is encouraging that they are performing research that may lead to better treatment methods for AI in the future.
Below is a write-up that Dr. Van Cauter sent me regarding this study.
I hope everyone is having a lovely summer. Be well!
"Cortisol, a glucocorticoid hormone produced by the adrenal glands, is one of the few hormones that are essential for life. Patients with adrenal insufficiency (AI) do not produce cortisol and need to be on lifelong replacement therapy with synthetic glucocorticoids. Despite the fact that AI patients receive hormonal replacement, they still have a reduced life expectancy. In healthy people, the bodily production of glucocorticoids follows a large daily rhythm, with a peak around habitual wake-up time and minimal levels in the evening and early part of the night. It has been long recognized that this 24-h rhythm partly reflects the activity of a master clock in a specific area of the brain. In recent years, secondary clocks were found in most peripheral tissues, including the adrenal glands, the heart, the pancreas and the liver. When all these clocks do not tick in synchrony (referred to as “misaligned”), adverse effects on cardiovascular function, metabolism, and the immune system occur. It is now recognized that, under normal conditions, the 24-h rhythm of cortisol serves as a major synchronizing signal for the central and peripheral clocks. Patients with AI are at high risk of circadian misalignment and its adverse consequences because current regimens of glucocorticoid replacement do not mimic very well the normal rhythm of cortisol release. The present study will document for the first time the daily rhythms of sleep-wake behavior and food intake in AI patients as compared to healthy well-matched controls, and examine whether the 24-h rhythms of blood pressure and heart rate are absent or disrupted. The study will also examine whether the 24-h rhythms of other hormones are “out of sync”. Lastly, the study will determine which regimens of glucocorticoid replacement minimize the disruption of bodily rhythms.
The study is conducted at the University of Chicago Medical Center and involves 2 inpatient stays, one for 24 hours and one for 48 hours. Travel expenses are covered. The study is for research only, it does not provide diagnosis or treatment."