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Wednesday, April 12, 2023

These glands churn out essential hormones

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Here is an unusually dark skin (hyperpigmented) hands of a child with adrenal insufficiency compared to his sibling. — Photo: Dr JEANNE WONG SZE LYN

 

adrenal glands loc­ated above the kid­neys.

 The adrenal glands and their hormones are vital for life

The adrenal glands are small triangle-shaped glands located on top of the kidneys. They produce hormones such as cortisol, aldosterone and adrenaline.

These hormones help to regulate essential body functions that include blood pressure, metabolism, salt homeostasis and the body’s response to stress and infections.

The release of hormones by the adrenal glands is controlled in part by the hypothalamus and pituitary gland in the brain. The kidneys and the body’s sympathetic nervous system also interact with the adrenal glands.

The adrenal glands are composed of two parts: the cortex (outer part) and the medulla (inner part).

Each part is responsible for producing different hormones. Cortisol, aldosterone and androgens are produced at the cortex and adrenaline and noradrenaline at the medulla.

Adrenal hormones

Cortisol: A glucocorticoid hormone that helps the body to respond to illness and injury. It also helps to maintain normal blood pressure, glucose levels and sleep-wake rhythm.Common symptoms of adrenaline insufficiency.Common symptoms of adrenaline insufficiency.  

The com­mon symp­toms of adrenal insuf­fi­ency

Aldosterone: A mineralocorticoid hormone that stabilises blood pressure, salt and water in the body.

Androgens: These hormones are also known as “male” hormones. The most commonly known androgen is testosterone. Androgens are usually thought of as male hormones, but the females produce a small number of androgens too.

Adrenaline (epinephrine) and noradrenaline (norepinephrine): These hormones are sometimes called the “fight or flight” hormones.

They make the heart pump faster and stronger, regulate blood pressure and glucose levels.

Like cortisol hormones, these hormones are released in larger amounts when the body faces stressful situations.

Can we live without adrenal glands?

The adrenal glands produce essential hormones that the body cannot function without.

Babies and children who do not make enough cortisol or aldosterone hormones can develop a life-threatening medical condition known as adrenal crisis.

In adrenal crisis, the blood pressure and glucose levels are low.

There is also an imbalance of essential salts in the body.

An adrenal crisis usually happens in times of stress such as during an acute illness, surgery or if a child with an adrenal disorder is not taking his or her medications appropriately.

What common conditions affect the adrenal glands?

Adrenal gland disorders happen when the adrenal glands make too much or too little of one or more hormones.

Some conditions are temporary whereas others are life-long.

Causes of adrenal disorders include:

> Genetic mutations which affects the production of adrenal hormones e.g. congenital adrenal hyperplasia, adrenal leukodystrophy

> Autoimmune diseases involving the adrenal glands

> Damage to the adrenal glands through injury, infection or blood loss.

> Adrenal tumours

> Hypothalamus or pituitary gland disorders in the brain which regulate release of adrenal glands hormones

> Certain medications, such as prolonged use of steroids.

The symptoms of adrenal gland disorders depend on which hormones are affected and if it is too much or too little.

Many of the symptoms may be similar to other illnesses and need to be correlated with the history and examination by the specialist doctor.

Adrenal insufficiency (not enough adrenal hormones)

Adrenal insufficiency is a condition in which the body is unable to produce enough cortisol and sometimes aldosterone.

This usually happens due to genetic conditions or damage to the adrenal glands following surgery, injury, blood loss or an infection.

Adrenal insufficiency can also happen when the pituitary gland in the brain fails to produce adrenocorticotrophic hormone (ACTH), which is the signal that regulates adrenal function.

Long-term steroid medications such as prednisolone, hydrocortisone or dexamethasone may also results in suppression of production of ACTH resulting in the adrenal glands producing less endogenous cortisol.

Hence children who had received prolonged or high doses of steroids need to have their adrenal function monitored.

A child with adrenal insufficiency may have these symptoms:

> Unexplained poor weight gain

> Easily tired

> Severe illness

> Low blood pressure and glucose levels, and

> Salt cravings.

They may also appear to have unusually dark skin pigmentation especially at the skin creases, and gums.

In certain adrenal condition, such as congenital adrenal hyperplasia, the baby or child may have abnormal sexual characteristics e.g. enlargement of the clitoris in girls and penile enlargement in young pre-pubertal boys.

Cushing syndrome

Cushing syndrome is a condition that is due to excess cortisol. It can be from an outside source for example taking long-term or high doses of steroid medications

 

The com­mon symp­toms of Cush­ing Syn­drome.

More rarely, Cushing syndrome can be due to excess production of the hormone by the body itself such as by an adrenal tumour or growth in the pituitary gland, which stimulates the adrenal glands to make too much hormones.

Common symptoms in children are:

> Weight gain, more prominent at the face and belly

> Poor growth despite weight gain

> Muscle wasting

> Increased hair growth over the body.

Complications include:

> High blood pressure

> Diabetes

> Prone to infections

> Thin, easily bruised skin

> Brittle bones, and

> Irregular menses in adolescent girls.

Diagnosis and testing

Diagnosis of adrenal disorders is based on the history, physical examination and blood test that measure the amount of adrenal hormones in the body.

Interpretation of adrenal hormone levels must be correlated with the probable cause and clinical picture.

Sometimes additional endocrine (hormone) stimulation tests or imaging of the brain and adrenal glands are needed.

Treatment options

If the adrenal gland does not make enough hormones, treatment consists of replacing these hormones with medication; e.g. steroid (glucocorticoids) medication is needed to replace cortisol.

Some children may also need to take Fludrocortisone medication to replace aldosterone.

During acute illness or surgery, the steroid medication needs to be taken in larger amounts. In rare cases where the adrenal gland is producing too much hormones e.g, certain adrenal tumours, medications are given to suppress the hormones or to relieve the symptoms.

The underlying cause for the adrenal disorder must also be addressed, e.g. surgical removal of tumours where indicated.

The duration of treatment depends on the underlying cause. Medications often need to be taken life-long in genetic causes.

In others, such as in adrenal insufficiency due to tapering off of long-term steroid use, treatment is only needed until the adrenal glands “wake up” and begin producing its own hormones again.

With treatment, the symptoms of adrenal insufficiency can be controlled enabling children with this condition to live normal lives.

However, regular specialist follow-up and blood testing are important for treatment adjustment to ensure proper growth, development and prevention of adrenal crisis.

Dr Jeanne Wong Sze Lyn is a consultant paediatrician and paediatric endocrinologist. This is the fourth article in a monthly series called Hormones and Kids. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. 

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Friday, March 17, 2023

US’ hooligan nature laid bare in forced divesting of TikTok

 

  Forcing TikTok to sell its shares is a shameless ... -


There has been an absurd development of the political farce surrounding the crackdown on TikTok, which has recently been playing out in the US and spreading to Canada and some EU countries.

The Biden administration has threatened to ban TikTok if its Chinese owners don't divest their stakes in the popular video app, Reuters reported on Wednesday.

Even though TikTok has tried its best and done almost everything possible within the technical range in response to the so-called national security concerns, it remains helpless in the face of Washington's economic vandalism. The message is clear: if Washington cannot see TikTok ending up in an American hand, it will shut it down. Judging by the various bans and legislation involving TikTok that US politicians have been working on, it is not impossible for the worst to happen.

Yet, the Emperor's New Clothes surrounding national security concerns cannot hide US politicians' selfish and hooligan nature. The US claims that TikTok threatens to undermine US national security, but there is no evidence at all supporting the killing or robbery of such a globally successful app on national security grounds. The fact that Washington can suppress and even rob TikTok without justification and only because it is owned by a Chinese company is the latest manifestation that in order to maintain the US hegemony, Washington can make any rogue behavior that is against the law and business rules. This could serve as a wake-up call to companies around the world about the political risks of doing business in the US. If they are successful enough to pose a real challenge to American business titans, a rogue government in Washington will start finding fault with them.

TikTok has been seeking various technical solutions to soothe the so-called national security concerns. For instance, it has committed to spend $1.5 billion on a plan known as "Project Texas," which would enact a stronger firewall between TikTok and employees of its Beijing parent company. It has also built what it called a Transparency Center in Los Angeles to help legislators and journalists understand how it safeguards data and how its algorithms work.

But what has happened to the company has laid bare that there is no way to play by the rules to address the US politicians' so-called concerns. This is because it is not national security issues, but TikTok's ability to challenge the supremacy of the US internet industry, that is what really upsets Washington.

With more than 1 billion active users, TikTok is the most downloaded Chinese app in the world last year. The US has 113 million active TikTok users aged 18 and above, and a 2022 Pew Research Center survey of American teenagers aged 13 to 17 found that 67 percent say they use the app, which would add up to about 17.4 million teenagers.

By comparison, the development of some American internet giants has been overshadowed. Facebook-parent Meta Platforms announced on Tuesday it would cut 10,000 jobs this year, marking a second round of mass layoffs following the first one in fall 2022. Since 2020, Meta CEO Mark Zuckerberg has spoken out on several occasions about TikTok's threat to American values and technological dominance.

Of course, the US government's crackdown on Chinese technology companies has not only aimed to rob economic interests off Chinese companies, but also to curb China's high-tech development and to maintain the US technological and financial hegemony.

However, it should be noted that the fact that Washington cannot allow a Chinese company to have the potential to beat American internet giants in market competition doesn't mean China will allow its hegemony to rob Chinese companies of core technology. Behind TikTok's success is the rise of a new algorithmic technology, which is the representative of Chinese high-tech companies gaining an advantage in international markets.

When the former Trump administration tried to push through a forced sale of TikTok in 2020, China's Ministry of Commerce already made adjustment to its catalog of technologies that are subject to export bans or restrictions, which includes certain advanced information process algorithms. It goes without saying China will resist any bully-like robbery of Chinese companies' core technologies. 

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 Forcing TikTok to sell its shares is a shameless ... - YouTube
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Forcing TikTok to sell its shares is an example of the US wanting to claim ownership of everything that is advanced and competitive.
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