Welcome to the world of panicology where your fears, real or imagined, take total control

Manic Panic! Scared that doomsday will soon be upon you? Worry that the mild gastric indigestion may really be sign of an impending heart attack? Welcome to the world of panicology where your fears, real or imagined, take total control

Scared that doomsday will soon be upon you? Worry that the mild gastric indigestion may really be sign of an impending heart attack? Welcome to the world of panicology where your fears, real or imagined, take total control…


JUST before the cricket match ends, how many of you go into a panic mode? How often do you get the jitters about being sacked? Are you worried often about not getting enough sex? Or why you’re not getting pregnant? Ever wondered why do people go in a panic every time the stock market fluctuates!

Scared that doomsday will soon be upon you? Worry that the mild gastric indigestion may really be sign of an impending heart attack? Welcome to the world of panicology where your fears, real or imagined, take total control


We’ve almost made a hobby of panicking. Ask yourself, how often do you wrestle with panic? Don’t worry; you’re not the only one. Barely a day or week passes without us panicking about something. A Times Life snap poll conducted in metros of India about what’s worth worrying about and what’s not threw up a few surprises.

It seems we’re panicking about a variety of things and the menu just got longer. We assessed panic in various areas of life: relationships (including marriage, sex, childlessness), health (obesity and serious illness), hobbies (drinking to dangerous art), society (pensions, debt and migrants), work (stress, jobs, promotion), law and order (including murder and terrorism). We asked men (age 23 to 47), women (23 to 47) and children (9 to 16) about what puts them in a state of panic.

People’s fear stories have got wilder. We think of panic as ‘something normal’. But how worried should we be about
trivial things? Says psychiatrist Dr Avdesh Sharma, “Men fear not being the best. After job and financial anxiety, more men are worried about looking old and not being good in bed. They fear someone younger will replace them at work. There’s great panic about losing control and getting angry at home or in public. Some men even worry over not being able to get enough sleep.”

That isn’t all, men fear losing a cricket match,

What men fear?

  • 80% men fear accidents
  • 80.5% panic about their job and finances
  • 79% worry about their sexual performance
  • 65.5% stressed about paying bills on time
  • 70% men fear being laughed at
  • 50% fear loneliness


Getting stuck in traffic jam, getting into a legal problem, taxation, illness of a loved one. Says cricketer Irfan Pathan, “A cricketer will get panicky before every game. But he can’t afford to do that. He needs to be focused and cool. The trick is panic management. Solve your problem.”

True. Ask Chandu Behl, 71, Delhi-based businessman, what does he panic about: “I stress about leaving my house unlocked, my business, taxation, road rage, health, fire, safety of loved ones. Most of my panic is imaginary.” While rating panic, more men admit, loneliness is a growing fear. Then there’s an increasing pressure to be a social animal. Says Karan Chandok, 25, working in a Gurgaon BPO, “I get very panicky when I have to walk to a party all alone. I wonder if I’ll get the right partner to dance with. What if girls laugh at me? I feel uneasy when I think about it.” A 25-year-old Mumbai boy fears bad luck every time he leaves his house in the morning.

Vinay Lal, director, University of California (UCLA) says, “As India becomes more modern, we’re bound to panic differently. We’re experiencing different kinds of fears. Some are irrational and illogical. Others are more profound. Migration of people to urban clusters has increased the things we panic about. Fear for safety because of law and order has driven people to seek justice themselves.”

Why are we getting fixated with fear? A new book Panicology tries to resolve the angst we feel about situations and things. The authors Simon Briscoe and Hugh Aldersey-Williams, tell Times Life, “It’s fashionable to worry about a variety of things, we have a bigger list of exotic worries. The problem is that we are poor at distinguishing between the amusing and entertaining —think of all those scary movies — and the real threats to our lives. We chat more and use the Internet that could be a reassuring process but often works in the opposite direction. It is a shame that we are not better at assessing risk in our lives,” says Simon.

What women fear?

  • 85% panic about office politics
  • 79% fear about relationships — marriage, sex, betrayal
  • 68% panic about not being liked enough
  • 50% panic about household jobs, maidservant going on leave


Trivial panics are about weight, looks and health issues. Almost 78% women panic if they put on weight

We asked a 26-year-old Mumbai girl to rate her scares out of 10, here what she said: Fear of losing a loved one — 10, jealousy — 7, faith issues — 6, loneliness — 8, family problems — 7, evil eye — 4, reputation — 5, clothes malfunction — 9.

Take Surabhi Mathur, schoolteacher, every other morning she panics about leaving the kitchen gas on. Says US-based Indian actor Sheetal Sheth, “Everyday you fret over things. But sometimes we women panic over non-issues. I think, we need to control our impulsive worrying over things like looks, weight etc. Real panic should be over serious concerns.”

Can we judge more astutely the real risks that face us? Says Priya Sarukkai Chabria, author, “We need right information to evaluate our fears. In conservative societies, there’s fear of losing social standing. There’s a pressure to be the best. Just talk to someone and half your anxiety is irrational.”

According to Panicology.com, people in different countries might fear different things (the Danes apparently worry most about nuclear power, the British about terrorist attacks, the Italians about radiation from their beloved mobile phones), yet anxiety is everywhere a condition of modern life. Says Hugh Aldersey-Williams, author of Panicology, “Giving people more freedom means that they have more to decide about — what sort of food to eat, what energy to consume, what school, doctor, hospital to use, etc — and this induces worry and panic.”


What children fear?

  • 80% panic about losing friends
  • 90% worry about doing badly in exams
  • 50% fear being laughed at or bullied
  • 75% girls want to make a good impression


“Children are particularly worried about their bodily changes, and if they’re looking like their icons. If a girl is over-weight, she goes through panic,” adds Sharma.

The big question is: how should we keep the calm? Says Geetanjali Prasad, relationship and family expert, “When we were in joint family, we could talk about our concerns, now there’s no outlet. Hence, we’re anxious about everything because we do not have access to right information. There’s insecurity, danger of losing job, husband. I was always superstitious when people told my husband we make a great couple. I panicked about nazar. It was crazy but true. Today, stress and competition give you anxiety. It’s all about being good in bed, at work, at home. But we need to cut back the stresses and keep our calm.”


When bird flu scare hit Delhi, Tandoori chicken was left untouched and uncooked! And when we’d just recovered from this scare, we heard Earth was going to be hit by a satellite. Now, as we near Earth Day, environmentalists are scaring us about a climatic change. Even TIME magazine warns, ‘Be worried, be very worried.’ The science of panicology is taking a new shape. It seems people are worrying themselves silly about everything and anything. From rising prices of petrol, gold to vegetables. Now it’s ladies who’re worrying about going bald.
We’re also freaking out over dry taps and no electricity. Imagine being in an urban office with no water, air-conditioning and non-functional loo! Enough to send you in a panic. Onion shortage is known to give grandmom stress! Just the other day, a woman was panicking how a lunar eclipse in August would throw her life into topsy-turvy. Meanwhile, Italian men not helping much around the house is apparently one of the principal reasons why their women are producing so few babies. While Indians are worrying about overpopulation right now. Going to a cinema hall for a movie brings its own panic attacks, what if there’s a b**b! Right now, everybody’s favourite panic story — being fat. The list is long one with every individual having his/her own panic story!!


What are Urachal Abnormalities? Causes, Symptoms, Diagnosis, Complications, Treatment in India

Before birth, there is a connection between the bellybutton and the bladder. This connection, called the urachus, normally disappears before birth. But what happens if part of the urachus remains after birth? Read on to learn more about what problems can arise.

What happens under normal conditions?

The bladder, located in the lower abdomen, is formed from structures located in the lower half of the developing fetus that are directly connected to the umbilical cord. After the first few weeks of gestation, this thick pathway to and from the placenta contains blood vessels, a merged channel to the future intestine and a tubular structure called the allantois. The internal part of the allantois is connected to the top of the developing bladder, and in ordinary circumstances, collapses and becomes a cord-like structure called the urachus. The formation and regression of this connection from the top of the bladder to the bellybutton are completed by the middle of the second trimester of pregnancy (approximately 20 weeks).

Although the urachus is easily seen by a surgeon whenever an operation inside the abdomen or around the bladder is performed, it is a remnant of development that serves no further purpose but can be a source of specific health problems. Such problems are rare and usually seen in childhood, but occasionally can be seen for the first time in adults.

What are the symptoms of urachal abnormalities?

Because this remnant of early development is found between the bellybutton and the top of the bladder, diseases of the urachus can appear anywhere in that space. In newborns and infants, persistent drainage or “wetness” of the bellybutton can be a sign of a urachal problem. However, the most common detectable problem at the bellybutton is a granuloma, a reddened area that is present because the base of the umbilical cord stump did not heal properly.

Urachal abnormalities can also be seen without persistent umbilical drainage — 35 percent of urachal problems are manifestations of an enclosed urachal cyst or infected urachal cyst (abscess). This type of problem is seen more often in older children and adults. Instead of visible bellybutton drainage, the symptoms of such a cyst consist of lower abdominal pain, fever, a lump that can be felt, pain with urination, urinary tract infection or hematuria.

How are urachal abnormalities treated?

A umbilical granuloma is usually treated by chemical cauterization in the office of the primary care provider. The condition is a superficial abdominal wall problem that heals after treatment and has no long-term implications; it is not caused by a urachal problem.

In contrast to the simple granuloma, persistent umbilical wetness needs to be further evaluated. Approximately 65 percent of all urachal problems appear as a sinus or drainage opening at the bellybutton. Most of those are not connected all the way to the bladder, but a small percentage represent an open pathway from the bladder to bellybutton, called a patent urachus. The drainage can be analyzed for urea and creatinine levels, which would be high if the fluid was primarily made of urine from a bladder connection instead of inflammatory tissue fluid. There can be associated redness from the drainage itself. Skin infection – indicated by tenderness, fever or spreading redness of the surrounding skin – can occur and requires prompt antibiotic treatment and possible hospitalization. This is called omphalitis and can be caused by bacteria that have become involved with a urachal sinus or the other embryologic structure in the bellybutton that was once connected to the intestinal system and might also be persistent. Once inflammation is controlled, the nature and extent of an opening at the bellybutton can be determined by a sinogram. This involves placing a small tube into the sinus opening and allowing contrast material to flow in while taking X-rays to determine the direction and extent of the channel. If the channel follows the expected pathway toward the top of the bladder, the diagnosis is urachal sinus. Treatment should be directed toward complete surgical removal of the urachus and all of its connections, including a small amount of the top of the bladder. Leaving any portion of the structure allows for the possible development of a future malignancy. Less than 1 percent of all bladder malignancies occur in the urachus, but once the urachus has become a potential problem, it should be removed.

When there is no draining sinus to investigate, an ultrasound of the lower abdomen will show the typical findings of a fluid-filled, enclosed lump in the location of the urachus. In an adult, where the rare possibility of malignancy could be present, an abdominal and pelvic CT scan might be helpful. Again, complete removal of the urachus is important. Simple needle or other drainage of the cyst will result in recurrence in at least one-third of patients, since the linings and structures are still present. About 80 percent of infected cysts are populated by staphylococcus aureus, and one-third contain multiple types of bacteria. Almost all the time, such an infected cyst stays confined to its predetermined anatomical location; rarely, an infected cyst can drain into the peritoneal cavity and present with additional signs of peritonitis and febrile illness.

Therefore, most urachal problems can be characterized by the physical examination and a sinogram or ultrasound. Sometimes a combination of these is needed, and occasionally it is useful to obtain a voiding cystourethrogram. This is done when the draining urachus is associated with outlet obstruction of the bladder, which would also need to be treated. This possibility is usually determined by the age, gender and physical examination of the patient. There are also situations where a direct look inside the bladder (cystoscopy) can add a bit more information to the diagnostic picture, but most urologists recommend that the basic course of action be determined by the previously described approach.

What can be expected after treatment for urachal abnormalities?

After complete surgical removal of a troublesome urachus with no immediate postoperative problems, there should be no further issues and no need for follow-up or evaluation on a regular basis.

Frequently asked questions:

Besides the problems that have already been outlined, are there other diseases that appear at the bellybutton?  

As you might expect, there have been rare reports of other inflammatory problems involving the structures that are contained in the umbilical cord. These include infections of the remnant blood vessels. In addition, the vitelline duct, which is supposed to regress in its course between the bellybutton and the small intestine, sometimes has its own remnant problems. The sinogram that is useful for identifying urachal problems will also serve to identify a likely vitelline duct problem.

Occasionally, an intra-abdominal process such as appendicitis or ovarian cyst can mimic some of the symptoms of a urachal problem.

Are urachal abnormalities hereditary?

No. There is no evidence that they are inherited.

After my baby’s umbilical cord stump came off, his bellybutton was extremely red. Is this normal or does he need immediate evaluation?

Some redness is expected after the stump falls away. Dabbing a small amount of alcohol on the site with a Q-tip twice a day will usually allow complete healing in two to three days. If the redness fails to improve or worsens, contact your primary care provider.


Spermatoceles Causes, Symptoms, Diagnosis, Complications, Treatment in India

The male reproductive tract is responsible for the production, maturation of sperm, and delivery of sperm. This tract is a complex and highly integrated entity. Sperm are produced in the testicles and then are transported through the genital ductal system to the penis and out of the urethra during ejaculation. Each component of the reproductive tract is highly specialized.

Abnormalities within the male reproductive tract may appear as scrotal masses. Masses may be of little significance or may represent life-threatening illnesses. It is necessary to follow a set course of action to determine the nature of the masses and the most appropriate treatment option. For example, testicular cancer is a source of great concern and uniformly requires prompt intervention. Other masses, such as varicoceles, can cause pain or impair reproductive function. Spermatoceles are benign and generally painless masses that grow at the top of the testicle. Thus, it is important for a patient to seek prompt medical attention when he identifies a scrotal mass or abnormality while performing testicular self examination. The following information will assist you when talking to a urologist about spermatoceles.

What is a spermatoceles?

Spermatocele, also known as a spermatic cyst, are typically painless, noncancerous (benign) cysts that grow from the epididymis near the top of the testicle. Spermatoceles are typically smooth and they are usually filled with a milky or clear colored fluid containing sperm. Over time, spermatoceles may remain stable in size or they may grow. If in fact the size becomes bothersome, or results in pain, then there are several treatment options to rectify the problem. Spermatoceles are generally no more than a nuisance rather than a serious medical condition.

What can cause spermatoceles?

The precise cause of spermatoceles is not known. While spermatoceles may form as a result of trauma or inflammation, these conditions are certainly not required for spermatocele formation. Others suggest that blockage of the efferent ducts and epididymis result in spermatocele formation. Additionally, in utero exposure to diethylstilbestrol (DES), a synthetic form of estrogen, has also been suggested as a possible cause.

How common are spermatoceles?

The precise incidence of spermatoceles is unknown, but an estimated 30 percent of all men have this condition. Incidence increases with age, with peak rates for the diagnosis of spermatoceles occurring in men in their forties and fifties. No racial or ethnic predispositions to spermatocele formation are known.

What are the symptoms of spermatoceles?

Men with spermatoceles usually have no symptoms. However, when associated symptoms are present, they may include scrotal heaviness and/or pain.

How are spermatoceles diagnosed?

Spermatoceles are typically discovered through a man’s self-examination of his testicles or at the time of an evaluation by a physician. Light can be shined through a spermatocele (transillumination), indicating that the mass is not a solid tumor but more likely a benign cyst. Ultrasound examination remains a very reliable means of evaluation and is a relatively quick, noninvasive and inexpensive test. Other diagnostic imaging tests are not generally used although magnetic resonance imaging (MRI) can also be used as an adjunct in cases where scrotal ultrasound is inconclusive.

How are spermatoceles treated?

Since spermatoceles generally do not cause discomfort and often go unnoticed by patients, they rarely require treatment. Nevertheless, some affected individuals do experience significant associated symptoms, such as bothersome size or pain. When intervention is indicated, the available treatment options include:

Medical therapy: Oral analgesics or anti-inflammatory agents may be used to relieve pain associated with symptomatic spermatoceles. No other type of medical therapy is specifically indicated for the treatment of spermatoceles.

Surgical therapy: Spermatocelectomy involves surgical removal of the spermatocele from the adjoining epididymal tissue. The overall goal of surgical therapy is removal of the spermatocele with preservation of the continuity of the male reproductive tract.

Other therapies: Aspiration and sclerotherapy are two less commonly utilized approaches to treat spermatoceles. Aspiration involves puncture of the spermatocele with a needle and withdrawal of its contents into a syringe. Sclerotherapy is performed with subsequent injection of an irritating agent directly into the spermatocele sac to cause it to heal or scar closed, removing the spermatocele space and decreasing the odds of fluid reaccumulation. Although several reports describe the effectiveness and tolerability of these treatment options, they are generally not recommended. Spermatocele recurrence is a common complication with both approaches, and chemical epididymitis and pain are common complications with sclerotherapy. Furthermore, aspiration and sclerotherapy have limited applicability in men of reproductive age, due to the significant risk of epididymal damage potentially leading to obstruction and resultant subfertility.

What can be expected after surgical treatment?

Spermatocelectomy is typically performed as an outpatient procedure, under a variety of possible anesthetic agents. Patients are generally discharged home with a pressure dressing consisting of an athletic supporter filled with fluffy gauze. Ice packs are applied for two to three days to minimize swelling. Oral pain medications are generally used for one to two days postoperatively. Patients may shower 24 to 48 hours after surgery, and a follow-up visit is scheduled for one to two weeks after the procedure.

Potential complications of spermatocelectomy include fever, infection, bleeding (scrotal hematoma) and persistent pain. Furthermore, inadvertent epididymal obstruction may result, which can lead to subfertility or infertility. Therefore, intervention should be avoided in men who still desire children. These complications may potentially be minimized by use of meticulous surgical technique (including use of an operating microscope or optical magnification).

Frequently asked questions:

Do spermatoceles lead to testicular cancer?

Spermatoceles are benign epididymal lesions. They are separate and distinct from the testicle. Patients with spermatoceles do not have an identified increased risk of testicular cancer.

Are any medications available to cure my spermatocele or prevent the formation of additional ones?

Medications are available to treat associated discomfort or pain, but no medication will lead to resolution or prevention of spermatoceles.

How often should I perform scrotal self-exams?

These exams should be performed at least once per month. Your physician can instruct you in the specific technique. If you detect any suspicious changes, such as increasing size or unusual firmness of scrotal structures, contact your physician.


Renal Fusion (Horseshoe Kidney) Causes, Symptoms, Diagnosis, Complications, Treatment in India

Renal Fusion (Horseshoe Kidney)

Most people are born with two kidneys, which are located in the back of the abdominal cavity on either side of the body covered by the ribs. But factors can occasionally interfere with the development of the kidneys as is the case for people with renal fusion abnormalities. The following information will help you talk to your urologist when your condition, or that of your child, belongs to this family of diseases.

What happens under normal conditions?

The kidney is the organ whose principal function is to filter toxins from the blood and maintain an appropriate chemical environment so that the body’s other organ systems can function properly. Other functions that the kidneys serve include maintaining appropriate blood pressure and ensuring that enough red blood cells are produced by the bone marrow. As a child develops in its mother’s uterus, the kidneys are formed lower in the abdomen and gradually ascend to their final position as they develop.

What is horseshoe kidney?

Horseshoe kidney occurs in about one in 500 children. It occurs during fetal development as the kidneys move into their normal position. With horseshoe kidney, however, as the kidneys of the fetus rise from the pelvic area, they fuse together at the lower end or base. By fusing, they form a “U” shape, which gives it the name “horseshoe.” It is believed that this condition exists more frequently in males.

What are the symptoms of a horseshoe kidney?

Horseshoe kidneys are much more frequently symptomatic than other varieties of fused and ectopic kidneys. Up to 70 percent of children and adults with this abnormality will have symptoms, which can include abdominal pain, nausea, kidney stones and urinary tract infections. Although still rare, cancerous tumors are somewhat more likely to occur in horseshoe kidneys than in normal kidneys. Blood in the urine, a mass in the abdomen and flank pain can be symptoms of a kidney tumor.

How is horseshoe kidney treated? 

In a child without symptoms, treatment may not be necessary. If your child has complications, they may require supportive treatment, which means their symptoms will be treated, but there is no cure for the condition. As with ectopic kidneys, obstruction and vesicoureteral reflux are very common in these patients and may require surgical correction.

What can be expected after treatment for horseshoe kidney?

It is important to note that if the patient’s only complaint from the horseshoe kidney is pain, surgery frequently will not relieve the pain.


Normal and Abnormal Sexual Differentiation Causes, Symptoms, Diagnosis, Complications, Treatment in India

Normal and Abnormal Sexual Differentiation

The words, “It’s a boy” and “It’s a girl” can be heard every hour of every day all around the world. But how distressing it must be when the birth attendants are unable to make such a clear pronouncement? Ambiguous genitalia occurs in about one in every 2,000 births, is usually unanticipated and can be a difficult experience for all concerned. What causes ambiguous genitalia? What can be done to correct it? The following information has been developed to answer such questions.

What happens under normal conditions?

The development of the human embryo into a male or female is a complex process that is both dynamic and sequential. Interference with this highly ordered process at any step could result in abnormal sexual differentiation.

At the moment of conception, the mother imparts an X (female) chromosome and the father an X or Y (male) chromosome, creating either an XX (female) or XY (male) embryo. Despite this immediate definition of genetic sex, male and female embryos are identical with respect to internal and external genitalia until the seventh or eighth week of pregnancy. In these early weeks, embryos have two gonads – undefined organs that, during the pregnancy, will develop into testicles or ovaries based on whether the embryo carries the Y chromosome. This chromosome carries the gene responsible for testicle formation, and it is the secretion of testosterone that determines how internal and external genitalia will develop.

Young embryos at this stage also have both male and female internal genital structures. Depending on secretion of testosterone, one set of internal structures will regress, becoming either distinctly male (prostate and vas deferens) or distinctly female (uterus, fallopian tubes and vagina). It is important to note that it is the absence of the male hormones – rather than the presence of female ones – which causes the external and internal genitalia to become female. By the end of the first trimester, embryos can be recognized as having male or female external genitalia. The formation of the internal and external genitalia is called sexual differentiation.


What are some of the processes involved with sexual differentiation?

Gonadal sexual determination: In 1921, it was shown that humans have X- and Y-chromosomes. But it was not demonstrated until the 1950s that the Y chromosome specified development of the testicle.

Over the past 50 years, there has been an intense search to identify the testicle-determining gene, which, in essence, flips the developmental switch for a gonad to develop into a testicle. In 1990, Sinclair and his group discovered a small genetic sequence on the Y chromosome that they believed represented the testicle-determining factor. This gene, called SRY (for sex determining region-Y gene), has now been scientifically demonstrated to be the testicle-determining factor. There also appear to be other genes that are important in the process of sexual differentiation. They appear to act as a series of sequential switches to turn on cellular processes, resulting in development of a testicle or ovary.

Chromosomal sex determination: During the first six weeks of an embryo’s development, the cells that develop into gonads, internal ducts and external genitalia have the potential to become male or female and are therefore called “bipotential.” In the presence of SRY, the bipotential gonad develops into a testicle, which becomes apparent at six to seven weeks of development. In the absence of SRY, an ovary results.

The fetal testicle begins producing hormones at the seventh or eighth week of pregnancy but direct development of the internal ducts and subsequently, external genitalia does not take place until weeks nine to 12.

In the presence of ovaries and in the absence of testicular hormones, the internal ducts and external genitalia follow a female path of development. While the ovary has been shown to produce hormones at the eighth week of pregnancy, the role of these hormones in sexual differentiation is unclear.

Phenotypic sexual differentiation: Before the eighth week of development, the internal reproductive ductal system is identical in the two sexes. As a result of testicular hormones, the rudimentary male ductal system develops and the female system disappears. At the tenth week of pregnancy, adjacent to the testicle, epididymis, vas deferens and seminal vesicle appear. In the female fetus in which testicular hormones are not produced, the rudimentary female internal ductal system develops and the male internal ductal system disappears. As a result, adjacent to the ovary, fallopian tubes, uterus and the upper vagina form.

The fetal tissues that develop into male or female external genitalia are also bipotential.  Under the influence of testicular hormone (androgen), male external genitalia begin developing during the tenth week of pregnancy. In the third trimester, testicular hormone secretion results in growth of the penis and testicular descent. In the female fetus, in which no testicular hormone is circulating, the rudimentary tissues develop into a clitoris and labium.


What are ambiguous genitalia?

The medical term “intersex” is used to describe a number of conditions that affect the formation of the genitalia early in pregnancy, resulting in an appearance that is typical of neither a boy nor a girl. 

What causes ambiguous genitalia?

The reproductive organs and genitals associated arise from the same fetal tissue. If the genetic process that causes this fetal tissue to become “male” or “female” is disrupted, ambiguous genitalia can develop. Even if genetic sexual determination occurs uneventfully, hormonal sexual differentiation can be disrupted. For example, a baby could still have ambiguous genitalia due to inadequate or overabundant levels of the male sex hormone testosterone. The precise underlying cause can usually be determined so that a recommendation can be made as to the appropriate gender in which to raise the baby.

How is ambiguous genitalia classified?

Ambiguous genitalia ranges in degree of severity but the most common variations include:

True hermaphroditism: Children who have both male and female genitalia and internal reproductive organs.

Gonadal dysgenesis: Children who have internal organs that are primarily female, external genitals that may vary between normal female and normal male and an underdeveloped gonad.

Psuedohermaphroditism: Children who have questionable external genitalia but have only one gender’s internal reproductive organs. For instance, a person may have a uterus, fallopian tubes and vagina but not a clearly defined clitoris and labia.

Congenital adrenal hyperplasia (CAH): Females with CAH are born with an enlarged clitoris and normal internal reproductive tract structures. Males have normal genitals at birth. CAH causes abnormal growth for both sexes; patients will be tall as children and short as adults. Females develop male characteristics and males experience premature sexual development.

How can the exact cause be identified?

The necessary investigations to determine the underlying cause of your baby’s problem include various blood tests and an ultrasound of the abdomen and pelvic area. Investigation will also include a genitogram, which is a special X-ray test. During this test, a radiologist inserts a small catheter into the urethral opening and injects a contrast dye that will determine if a vagina exists. In addition, it may sometimes be necessary to take a sample of tissue from the gonads for examination under the microscope to be certain of their nature. 

What are some recommended treatments?

Surgery will also be offered so that the genitalia can look normal, like those of any other boy or girl. Nowadays, operations to correct masculinized female genitalia, when carried out by an experienced surgeon, are remarkably successful resulting in an appearance, that is indistinguishable from that of a normal girl. Surgery, though, is not always necessary, particularly among girls with congenital adrenal hyperplasia (CAH) who are only slightly masculinized, as the clitoris often becomes less prominent as treatment to correct the underlying hormonal imbalance begins to take effect. A concealed vagina, however, will invariably need some surgery to bring its opening out onto the surface. When the vagina is hidden just under the skin, this is often carried out shortly after birth, although when it lies deeper in the pelvis, it is best delayed until one or two years of age.

Surgeons are becoming increasingly aware that it is important for girls to retain normal sexual sensation after genital surgery. Therefore, in cases in which the clitoris is greatly enlarged, necessitating removal of a portion of the erectile bodies to improve appearance, great care is taken to avoid injury to the sensory nerves and to preserve the blood supply to the glans. It must be acknowledged, however, that there are few long-term follow-up studies to determine to what extent surgeons have been successful in achieving these objectives. It is, however, well recognized that, after vaginal surgery, there is a tendency for the newly created opening to narrow down. This sometimes necessitates further surgery, although more often, simple dilatations begun during the teenage years prior to any sexual activity are all that is required.

Surgery for boys is usually successful in converting an ambiguous penis, which is usually tethered down with the urethral opening set well back towards the scrotum, into one that looks remarkably normal. Any separation of the scrotal sacs will usually be corrected at the same time. The operation is usually carried out between six months and 18 months of age and is frequently accomplished in one stage as an outpatient procedure. Once healed, the penis continues to grow in pace with the child’s physical development, and further surgery is rarely needed. The structures necessary for sensation and erectile function are undisturbed by the surgery.

In boys who harbor a uterus, this is usually removed when the diagnostic laparoscopy or laparotomy is carried out. An associated vagina, if large, will usually be removed at the same time, although rudimentary structures can be left undisturbed in the knowledge that their presence is unlikely to cause any problem.

Frequently asked questions:

Will my child be able to produce children as an adult?

Babies with congenital adrenal hyperplasia (CAH) or pseudohermaphroditism can be regarded as potentially fertile once the underlying hormonal imbalance is corrected. Babies with other conditions must be evaluated on a case-by-case basis. For example, those with true hermaphroditism also have the potential to be fertile. Other girls, for example those with testicular dysgenesis, may have had their gonads removed because of the risk of tumor development, yet a well-developed uterus will have been left in place so it can potentially nurture an implanted embryo conceived in the laboratory using modern assisted reproductive techniques. Boys having at least one testicle, which on biopsy is shown to be normal, have the potential to be fertile, although this is by no means certain.

Will my baby have psychological problems down the road, particularly with regard to sexual preferences or gender identity?

Among girls whose external genitalia were only slightly masculinized at birth or who have undergone modern feminizing surgery, experts have no reason to think they will later be displeased by the appearance of their genitalia. Similarly, provided the caliber of the vagina is checked prior to the onset of sexual activity and adjusted, if necessary, such girls should be able to have intercourse without any problem.

Among boys, the correction of even severe hypospadias should not compromise their ability to have satisfactory intercourse. Ejaculation, however, may be rather less forceful than normal, particularly when it was necessary to reconstruct much of the penile urethra.

We are on rather less certain ground when it comes to the long-term psychosexual outcomes, particularly with regard to gender identity. In the past few years, we have become increasingly aware that testosterone, the hormone responsible for producing masculinization of the external genitalia, may potentially have had an effect on the developing brain, programming such an individual to think along male lines and, perhaps, even develop a male gender identity. This clearly has important implications when the decision is made to raise any masculinized infant as a girl.

Further research is presently being undertaken to determine just how much weight should be given to such considerations when gender assignment of a baby with ambiguous genitalia is being considered. It is, though, very important to remember that human sexuality is a highly complex subject and that the long-term psychosexual functioning of any individual, even those born with perfectly normal appearing genitalia, can never be predicted with certainty.

Hydroceles and Inguinal Hernias Causes, Symptoms, Diagnosis, Complications, Treatment in India

Hydroceles and inguinal (groin) hernias can create problems in males. But do they cause pain and dysfunction? When and how should they be treated? The following information should help you talk to a urologist about these two conditions.

What causes hernias and hydroceles?

Testicles develop near kidneys in the abdomen and descend from that location to their normal position in the scrotum towards the end of pregnancy. In order for the testicles to leave the abdomen, a muscle ring in the groin on each side opens and allows the testicles to drop down to the scrotum. As the testicle descends, the lining of the abdomen also drops to line the scrotum. This channel closes in most boys. If that channel remains open, or reopens, a small amount of fluid can go from the abdomen to the scrotum through this passage. This results in hydrocele. If the channel remains opens or reopens widely, then a portion of the intestine can pass down the channel towards the scrotum. This results in an inguinal hernia.

Hydroceles can also develop due to inflammation or injury within the scrotum. These sometimes resolve over a few months but many remain and require medical attention. Hernias can also be the result of increased pressure that forces part of the intestines through a weak spot in the abdominal wall — straining during bowel movements, heavy lifting, coughing, sneezing or obesity.

What are the symptoms of a hernia?

Only about 25 percent of hernias cause pain or discomfort. However, you may be able to see and feel the bulge that often occurs at the junction of the thigh and groin. About 1 percent of boys develop hernias with premature infant males having a higher incidence. Sometimes, the protruding intestine enters the scrotum and causes pain and/or swelling in the scrotum.

What are the symptoms of a hydrocele?

About 10 percent of male infants have a hydrocele at birth. Seldom causing symptoms, this swelling of the scrotum does not bother a baby and usually disappears in the first year of life, even though the appearance may worry new parents. In older males, a hydrocele usually remains painless but may cause discomfort due to the increased size of the scrotum.

How are hernias treated?

Surgery to repair the muscle ring that did not close properly is recommended for a hernia in a child. Hernias do not go away on their own and may cause problems with digestion leading to emergency surgery. In infants and children, a small incision is made in the groin through which a urologist sutures or sews the channel shut and repairs the muscle ring. This procedure can be done in an outpatient setting. In teenagers and adults, laparoscopic surgery may be considered.

How are hydroceles treated?

Hydroceles require surgical repair if they cause symptoms, such as growing large or changing size significantly during the day. If the hydrocele is uncomplicated, an incision is made in the scrotum. The hydrocele is cut out, removing the tissues involved in the hydrocele. If there are complications, such as a hernia, an incision is made in the inguinal (groin) area. This approach allows repair of hernias and other complicating factors at the same time.

What can be expected after treatment for hernias and hydroceles?

After surgery, there will be discomfort that will require pain medication. In most cases, pain is reduced during the first week so that pain medication is no longer necessary. It may be necessary to restrict full activity for several weeks, depending on your child’s age and whether or not both sides were treated. If your son still plays on straddle toys, such as a rocking horse, he may have to avoid them for a time. The testicle and scrotum may stay swollen for several weeks after surgery before returning to normal. After surgery, less than 1 percent of cases have a hernia or hydrocele return.

Frequently asked questions:

Are hernias or hydroceles hereditary?

No. Hernias and hydroceles are common. And while several family members may experience them, there is no evidence that they are inherited.

Is there anything a parent did to cause a hernia or hydrocele in their child?


What is the likelihood of a hernia developing on the other side?

This depends on the age of the child. Younger children treated for a hernia are much more likely to develop a hernia on the other side than older children. In younger children, sometimes a laparoscope is used to look at and evaluate the opposite side. If the examination shows that a hernia is present or likely to occur, then surgical repair is done on both sides as a preventive course of action.

What is the risk of a hydrocele inguinal hernia surgery in India?

The risk of developing a hydrocele on the other side is about 5 percent. Because of this low risk, many times the laparoscopic evaluation is not performed.

Do girls develop hydroceles and hernias?

Girls do not develop hydroceles. They can develop hernias but because of their anatomy, girls are 10 times less likely than boys to develop hernias.


Blood in Urine – Hematuria Causes, Symptoms, Diagnosis, Complications, Treatment in India

There are many reasons why a person can have blood in their urine. This condition, known as hematuria, can be an indication of a serious problem or conversely, have no negative connotation. What should you do if you find out that there’s blood in your urine? Read the following to learn more.

What is hematuria?

Hematuria is defined as the presence of red blood cells in the urine. It can be characterized as either “gross” (visible to the naked eye) or “microscopic” (visible only under the microscope). Microscopic hematuria is an incidental finding often discovered on urine tests as part of a routine medical evaluation, whereas gross hematuria could prompt you to visit the doctor. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate and urethra. It is estimated that hematuria occurs in 2.5 to 21 percent of the population. In many patients no specific cause is found; however, hematuria may be a marker for infection, stone disease or urinary tract cancer. Risk factors for significant underlying disease include: smoking, radiation, overuse of some pain medicines and exposure to certain chemicals.


What are the common causes of hematuria?

Blood in the urine is often not a sign of significant disease. Studies have shown that between nine to 18 percent of normal individuals can have some degree of hematuria. However, hematuria can be a sign of an important medical condition requiring treatment. Below is a list of common causes of hematuria:

  • Bladder Cancer
  • Kidney Cancer
  • Prostate Cancer
  • Ureteral Cancer
  • Urethral Cancer
  • Urinary Stone Disease
  • Urinary Tract Infection
  • Pyelonephritis (Kidney Infection)
  • Benign Prostatic Hypertrophy (Enlarged Prostate)
  • Renal (Kidney) Disease
  • Radiation or Chemical Induced Cystitis (Bladder Irritation)
  • Injury to the Urinary Tract
  • Prostatitis (Prostate Infection)
  • Exercise Hematuria

How is hematuria diagnosed?

Visible hematuria is often worrisome to the patient and prompts them to seek medical attention; however, microscopic hematuria can be just as severe. It often has no symptoms and is detected on a urine dipstick test. If the dipstick test is positive for blood the amount of blood is often determined by looking at the urine with a microscope. If three or more red blood cells (RBC) are seen per high power field on two of three specimens, further evaluation to determine a cause is recommended.

What additional tests are needed?

Any patient with gross hematuria or significant microscopic hematuria should have further evaluation of the urinary tract. The first step is a careful history and physical examination. Laboratory analysis consists of a urinalysis and examination of urinary sediment under a microscope. The urine should be evaluated for protein (a sign of kidney disease) and evidence of urinary tract infection. The number of red blood cells per high-powered field should be determined. In addition the shape of the blood cells should be evaluated. This can help determine where the bleeding is coming from. In patients with white blood cells in the urine, a urine culture should be performed as well. A urinary cytology is also obtained to look for abnormal cells in the urine. A blood test should also be done to measure serum creatinine (a measure of kidney function). Those patients with significant protein in their urine, abnormally shaped red blood cells, or an elevated creatinine level should undergo general medical evaluation for the presence of kidney disease.

A complete urologic evaluation for hematuria also includes X-rays of the kidneys and ureters to detect kidney masses, tumors of the ureters and the presence of urinary stones. This traditionally consisted of an intravenous pyelogram (IVP). In this study, a radiographic dye is injected into the blood stream and X-rays are taken as the kidneys excrete the dye. This study has trouble detecting small renal masses and is often combined with a renal ultrasound.

Many physicians may opt for other imaging studies such as a computerized tomography (CT) scan. This is the preferred method of evaluating kidney masses and is the best modality for the evaluation of urinary stones. Recently many urologists have been using CT urography. This allows the urologist to look at the kidneys and ureters with one X-ray test. In patients with an elevated creatinine or an allergy to X-ray dye, magnetic resonance imaging (MRI) or retrograde pyelography is used to evaluate the upper urinary tract. During retrograde pyelography, the patient is taken to the operating room and dye is injected up the ureters from the bladder and then images are taken.

The main limitation of these imaging studies is the inability to evaluate the bladder; therefore a cystoscopic evaluation is required. This is usually performed in the office under local anesthesia with either a rigid, or more commonly, a flexible cystoscope. After applying a topical analgesic to the urethra the urologist inserts an instrument called a cystoscope through the urethra and into the bladder. Looking through the cystoscope the doctor can examine the inner lining of the bladder and urethra for abnormalities.

What happens if no abnormality is found?

In at least eight to 10 percent of cases no cause for hematuria is found. Some studies have demonstrated an even higher percentage of patients have no cause. Unfortunately, studies have shown that urologic malignancy is later discovered in one to three percent of patients with negative work-ups. Therefore, some form of follow-up is recommended. Recommendations regarding follow-up are sparse and no clear consensus has been agreed upon. Consideration should be given to repeating the urinalysis and urine cytology at six, 12, 24 and 36 months. Immediate re-evaluation with possible cystoscopy and repeat imaging should be performed in the face of gross hematuria, abnormal urinary cytology or irritating urinary symptoms such as pain with urination or increased frequency of urination. If none of these symptoms occur within three years, no further urologic testing is needed.


How will hematuria be treated?

Treatment will be based on a physician’s evaluation of the patient’s condition, symptoms and medical history along with the cause of the hematuria.


Extrinsic Obstruction of the Ureter Causes, Symptoms, Diagnosis, Complications, Treatment in India

The ureter is a thick-walled tube that transfers urine from the kidney to the bladder. It is approximately 10 inches long, with the upper half located in the abdomen and the lower half in the pelvic region. But what happens when the ureter becomes blocked? The information below should help you recognize this problem before it causes serious damage.

What is extrinsic obstruction of the ureter?

Extrinsic obstruction of the ureter is a condition caused by organs and diseases that press against the ureter and cause a blockage within the ureter. The resulting blockage affects the flow of urine out of the ureter and can eventually cause urine to build up, which can injure the kidney.

What causes extrinsic obstruction of the ureter?

Causes of extrinsic ureteral obstruction vary. Some of the causes are:

  • vascular disease
  • benign conditions of the female reproductive system, such as pregnancy, mass lesions of the uterus or ovary, Gartner’s duct cyst, endometriosis, uterine prolapse and intraoperative ureteral injury.
  • diseases of the gastrointestinal tract, such as granulomatous disorders (Crohn’s disease of the bowel), inflammatory disease of the appendix, diverticulitis and pancreatic lesions
  • diseases of the retroperitoneum

What are the symptoms of extrinsic obstruction of the ureter?

Frequently, the process is slow and causes no symptoms. However, if the obstruction is acute it will usually be accompanied by severe pain. Other symptoms may include fever, nausea, vomiting, difficulty urinating and bloody or cloudy urine.

How is extrinsic obstruction of the ureter diagnosed?

Extrinsic obstruction of the ureter is a common urologic problem for which the diagnosis may be difficult to establish. However, imaging studies are essential in establishing the diagnosis. Such studies include intravenous urography (IVP), ultrasonography, CT scans and MRIs. These studies will often define the presence and location of the obstruction and may be able to establish the cause of the blockage. Appropriate laboratory studies include urinalysis and serum studies to assess the degree of kidney function.

How is extrinsic obstruction of the ureter treated?

Treatment is often dependent on the nature of the obstruction. Initial efforts are to obtain drainage of the kidney(s) that is followed by more definitive approaches to resolve the underlying disorder. Drainage of the kidney can be accomplished by one of two ways: placement of a ureteral stent — a narrow, hollow plastic tube that runs between the kidney and bladder and holds the ureter open to allow drainage of urine — or by a procedure called a nephrostomy in which a catheter is placed, guided by X-ray imaging or ultrasound imaging, through the skin into the kidney to drain urine.

What can be expected after treatment for extrinsic obstruction of the ureter?

The outcome varies. Any kidney damage caused by the obstruction can be permanent. However, if the cause of the obstruction can be diagnosed and treated early, the damage may be temporary. If only one kidney is affected, the other kidney usually continues to function adequately and kidney failure does not occur.

Frequently asked question:

What are some of the risk factors associated with extrinsic obstruction of the ureter?

Risks may include stones and tumors in the surrounding areas.


Ectopic Kidneys | Renal Ectopia – Causes, Symptoms, Diagnosis, Complications, Treatment in India

Most people are born with two kidneys, which are located in the back of the abdominal cavity on either side of the body covered by the ribs. But factors can occasionally interfere with the development of the kidneys as is the case for people with ectopic kidneys. The following information will help you talk to your urologist when your condition, or that of your child, belongs to this family of diseases.

What happens under normal conditions?

The kidney is the organ whose principal function is to filter toxins from the blood and maintain an appropriate chemical environment so that the body’s other organ systems can function properly. Other functions that the kidneys serve include maintaining appropriate blood pressure and ensuring that enough red blood cells are produced by the bone marrow. As a child develops in its mother’s uterus, the kidneys are formed lower in the abdomen and gradually ascend to their final position as they develop.

What is an ectopic kidney?

Renal ectopia or ectopic kidney describes a kidney that is not located in its usual position. Ectopic kidneys are thought to occur in approximately one in 1,000 births, but only about one in 10 of these are ever diagnosed. Some of these are discovered incidentally, such as when a child or adult is having surgery or an X-ray for a medical condition unrelated to the renal ectopia. Ectopic kidneys can be located anywhere along the path of their usual ascent from where they initially form to where normal kidneys lie in the upper abdomen. Simple renal ectopia refers to a kidney that is located on the proper side but is in an abnormal position. Crossed renal ectopia refers to a kidney that has crossed from the left to the right side (or vice versa) so that both kidneys are located on the same side of the body. These kidneys may or may not be fused. It is important to note that renal ectopia is frequently associated with congenital abnormalities of other organ systems.

What are the symptoms of an ectopic kidney?

The function of the kidney itself is generally not abnormal to begin with, but because of the change in the usual anatomic relationships, the kidney may have difficulty draining. Up to 50 percent of ectopic kidneys are at least partially blocked. Over time, obstruction can lead to serious complications, including urinary tract infections, kidney stones and kidney failure. Ectopic kidneys are also associated with vesicoureteral reflux (VUR), a condition where urine backs up from the bladder through the ureters into the kidneys. Over time, VUR can lead to infections that also can destroy the kidney. Interestingly, the non-ectopic kidney can also have functional abnormalities such as obstruction or VUR.

The most common symptoms related to the ectopic kidney that lead to diagnosis include urinary tract infections, abdominal pain or a lump that can be felt in the abdomen. 

What are some treatment options for ectopic kidney?

Treatment for the ectopic kidney is only necessary if obstruction or vesicoureteral reflux (VUR) is present. If the kidney is not severely damaged by the time the abnormality is discovered, the obstruction can be relieved or the VUR corrected with an operation. However, if the kidney is badly scarred and not working well, removing it may be the best choice. 

What can I expect after treatment for ectopic kidney?

It is possible to live a normal life after removal of a kidney provided that the remaining kidney functions well.


Cushing Syndrome: Signs, Causes, diagnosis Treatment in India

Many of us do not have to worry about our body suffering from prolonged exposure to the stress hormone, cortisol. But what happens to us when we do? How do we know that we are suffering from Cushing’s syndrome? And when should you get a urologist’s opinion and advice? The following information should help answer these questions.

What happens under normal conditions?

The adrenal glands are endocrine glands that are located on the top of both kidneys. Each adrenal gland is composed of two layers, an inner layer known as the medulla and an outer layer known as the cortex. Normally, the adrenal cortex secretes a variety of steroid hormones including cortisol, which helps the body respond to stress and change. It also regulates salt and water levels that affect blood volume and blood pressure. The secretion of cortisol is regulated by the pituitary gland, which is located inside the head at the base of the brain. Chemical signals from the pituitary are carried by the bloodstream and act on the cells of the adrenal cortex to promote the secretion of cortisol. This chemical messenger is called corticotrophin or adrenocorticotropic hormone (ACTH). When needed, ACTH is secreted by the pituitary and, as a result, cortisol is then secreted into the circulation. When cortisol is no longer required, the high levels of cortisol in the blood are detected by the pituitary. This feedback causes the pituitary to reduce ACTH secretion so that cortisol levels are reduced. The overall system acts like a thermostat and is highly regulated.

What is Cushing’s syndrome?

Cushing’s syndrome (CS) occurs when there is excessive production of cortisol that is not controlled by the normal regulatory system. It can also be caused by excessive or prolonged use of steroids.

What causes Cushing’s syndrome?

Cushing’s syndrome (CS) is a rare disorder that can be caused by a number of different problems. The most common cause (65 to 70 percent) is a benign pituitary tumor called an adenoma. Cushing’s syndrome due to a pituitary tumor is sometimes called Cushing’s disease (named after Dr. Harvey Cushing, who provided the initial disease description). The second leading cause of CS is an adrenal tumor (20 to 30 percent), which may be benign or malignant. Lastly, CS can be produced by a variety of cancers originating in other organs due to over secretion of ACTH (10 to 15 percent). This is termed ectopic ACTH.

What are the symptoms of Cushing’s syndrome?

The signs that signal the development of Cushing’s syndrome appear slowly in time. The symptoms are subtle. Some patients may only display a few symptoms while others may have a variety of symptoms. The most noticeable symptom would be a change in physical appearance. The face becomes round, rosy and puffy (the Campbell’s soup girl), there is abdominal weight gain and development of fatty deposits just below the back of the neck. Patients may experience thinning of the skin, with easy bruising and pink or purple stretch marks. Some patients may develop high blood pressure or diabetes. Since cortisol is secreted in response to the normal waking and sleep pattern, patients may experience sleep disturbance. Others may experience rapid emotional changes. Some patients experience a specific type of muscle weakness that makes it difficult to arise from a seated to standing position. Since the signs and symptoms may develop slowly over the course of years, serial photographs of a person’s appearance are often a way to document the changes. Signs of virilization (masculinization) may occur in women.

How is Cushing’s syndrome diagnosed?

Since the signs and symptoms of the disease are subtle and may overlap with other disease processes, a trip to the doctor may be necessary to clarify whether Cushing’s syndrome (CS) is a possibility. The first step to treatment is making the diagnosis. Therefore, the evaluating doctor must recognize CS as the possible cause for the pattern of signs and symptoms. The most widely used test is measurement of the total amount of cortisol contained in a whole day’s urine collection. Medically, this is known as the 24-hour urinary free cortisol test. Another important test is the dexamethasone suppression test where dexamethasone (steroid) pills are given by mouth then blood and urine are collected to assess the levels of cortisol the body. Under normal circumstances, the excessive dexamethasone will suppress the body’s ability to secrete cortisol. In the body of a person with CS, the levels of cortisol will not be suppressed and will remain abnormally high.

Once the diagnosis of CS is made, then the cause must be identified. This requires the distinction between pituitary tumor, adrenal tumor or ectopic ACTH. A blood test for the determination of both cortitrophin and cortisol taken in the late afternoon is the next step.. When corticotropin is very low or undetectable, it indicates an adrenal tumor. A CT scan or MRI usually confirms the diagnosis. Mildly elevated cortitrophin is associated with pituitary tumors. An MRI of the brain can usually confirm this diagnosis. More sophisticated testing may be needed in some cases when the pituitary tumor is so small that it cannot be seen by conventional imaging techniques. Very high levels of ACTH are associated with the ectopic ACTH syndrome. Testing to look for an underlying tumor should be performed.

How is Cushing’s syndrome treated?

If Cushing’s syndrome is a side effect of taking high doses of prescribed steroid hormones, withdrawing these medicines will allow the body to go back to normal. The ability to reduce or stop the steroids, however, depends on the type of disease being treated and the pattern of response.

Pituitary tumors can be treated with surgery. Usually, an operation can be done through the nose (transsphenoidal surgery). This is performed by a neurosurgeon.

Adrenal tumors can be removed surgically by a urologist. When the adrenal tumor is small (less than six centimeters), the tumor is more likely to be benign. These small tumors can be removed using laparoscopic techniques. Several small cuts are made in the abdomen to pass instruments that dissect and remove the tumor. In less than 5% of operations, the laparoscopic approach may not be feasible and may be converted to an “open” operation. Tumors larger than six centimeters are more likely to be malignant. These tumors are often removed using a larger, open incision. During removal of a large adrenal tumor, adjacent organs such as the spleen, kidney or a portion of the colon may need to be removed to ensure complete tumor removal.

What can be expected after treatment for Cushing’s Syndrome?

Recovery from laparoscopic surgery is rapid. Most patients are discharged within one to two hospital days. Full recovery back to normal activity is three to five weeks. There are usually no physical restrictions after recovery from surgery. It takes longer to recover from open surgery with hospital recuperation between five and 10 days and full recovery taking up to eight weeks.

An important distinction for adrenal tumors is whether or not they are malignant. This is important because the prognosis is very different for benign and malignant tumors. Small adrenal tumors are usually benign and are called adenomas. While size is an important criterion, careful pathologic review of the tumor is the only certain way to determine benign and malignant tumors.

The high levels of cortisol secretion from one adrenal gland suppress the function of the other gland. Postoperatively, patients require supplemental steroids to avoid steroid deficiency. The other adrenal usually recovers, but may take up to a year to do so. In 25 percent of patients, the other adrenal gland never recovers and there may be a need to take steroids as replacement treatment.

Malignant tumors are adrenal cancer. The three-year survival rate is 40 percent and the five-year survival rate is 30 percent. These tumors may recur in the abdominal cavity or spread to the liver, lymph nodes, lungs or bones. Therefore, follow-up CT scans and chest X-rays will be needed at regular intervals if this diagnosis is confirmed. If recurrent disease causes symptoms of Cushing’s syndrome to return, there are drugs that may be used to control this.

Frequently asked questions:

If a person has been diagnosed with Cushing’s syndrome, how normal can they expect their life to be?

The symptoms, disabilities and lifestyle of a person with Cushing’s syndrome (CS) depend on the degree of cortisol excess, the duration of the disease, the basic health of the person and especially the type and curability of the syndrome. If it is cured, all of the features of the disease can subside, but this may take as long as two to 18 months. During that time, most people get annoyed and frustrated by the slow improvements in physical changes. The combination of CS and adrenal insufficiency signs and symptoms (e.g., dizziness, weakness, nausea and loss of appetite) decrease as replacement steroid hormones are tapered and adrenal hormone production slowly improves toward normal. Frequent calls and visits to a physician are necessary.

If the CS is incurable, or if medically-induced CS remains, these individuals will have to cope with persistent fatigue, muscle weakness, abdominal and facial weight gain, depression, mood swings and all the other signs and symptoms mentioned earlier. Drugs are available to moderate these residual symptoms. Regular visits to a physician for examinations, blood tests and treatments of infections and complications will be necessary and are often viewed as a severe burden.

What is the difference between Cushing’s syndrome and Cushing’s disease?

Any condition that causes the adrenal gland to produce excessive cortisol results in the disorder known as Cushing’s syndrome (CS). CS is characterized by facial and torso obesity, high blood pressure, stretch marks on the belly, weakness, osteoporosis and facial hair growth in females.

CS has many possible causes, including tumors within the adrenal gland, ectopic cortitrophin produced from cancer such as lung cancer and cortotrophin excessively produced from a pituitary tumor within the brain. Corticotrophin is normally produced by the pituitary gland (located in the center of the brain) to stimulate the adrenal glands’ natural production of cortisol, especially in times of stress.

When a pituitary tumor secretes excessive cortitrophin the disorder resulting from this specific form of CS is referred to as Cushing’s disease.

As an aside, it should be noted that doctors sometimes describe certain patients with features identical to CS as having “Cushingoid” features. Typically, these features are occurring as side effects of cortisone-related medications, such as prednisone and prednisolone.

Can stress cause Cushing’s syndrome?

Stress-related increased cortisol production by the adrenal glands is normal and physiological, and does not lead to Cushing’s syndrome.