Terry Streetman (Host): Welcome back to Well Within Reach. I'm Terry Streetman, marketing and communications rep. We're here today with Dr. Jabiz Behzadpour, Riverside Endocrinologist to discuss adrenal disorders, hormonal imbalances, and how endocrinologists help manage and treat these conditions. Thanks for joining us.

Jabiz Behzadpour, DO: Yeah, happy to be here.

Host: Before we get started, we're going to take a quick break for a message about MyChart.

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Host: Okay, Doctor, this is, I think, your first time with us. Can you tell us about your background and your role here at Riverside?

Jabiz Behzadpour, DO: Yeah, so I'm an endocrinology physician. I work in our outpatient endocrinology and metabolism clinic in the fitness center. I've been there for almost three years now. I work only outpatient, so I see patients from 8:00 AM to 5:00 PM regarding any hormone concerns that they have.

Host: Awesome. Well, we're really glad to have you on the team here. You talked about, you know, some of the treatments you do. What kinds of conditions do our endocrinologists here treat?

Jabiz Behzadpour, DO: That's a good question. So, when people think of endocrinology, I tell them to think of us as doctors of hormones. So there's a lot of different hormones in a lot of different parts of the body, so we're not just focused on the lungs or not just focused on the heart. Diabetes is a hormonal problem related to insulin.

You have a thyroid gland that can make too much or too little thyroid hormone. So those are also conditions that we see patients for. Osteoporosis is actually a hormonal disorder because there's hormones that relate to your bone strength. So we see patients for osteoporosis. Polycystic ovarian syndrome is something that's more prevalent in our younger female population, and that's a hormonal issue related to reproduction and those kinds of concerns, so we'll see those patients as well. Then you also have your adrenal glands and your pituitary glands.

Your adrenal glands sit on top of your kidneys. Your pituitary gland is in your brain, and those two also produce different hormones. So it's quite a big variety, which keeps it interesting day to day.

Host: Yeah, that's a really expansive field of practice. So we're going to focus in a little bit just because that would be a lot to cover. We're going to talk specifically about the adrenal glands and these adrenal disorders. So, can you talk a little bit more about what the adrenal glands are and what they do in the body?

Jabiz Behzadpour, DO: Yeah. So you have two types of glands. You have glands that make hormone internally, and then you have glands that secrete like your salivary glands or your salivary glands make saliva and they send it outside of the body.

Host: Hmm.

Jabiz Behzadpour, DO: But then you have other glands that make hormones that stay in the body. So your adrenal gland is a gland that makes hormones that stay inside of your body. There's four categories of hormones that your adrenal gland makes. One is a stress hormone called cortisol. One is a hormone related to blood pressure called aldosterone. Then you have your fight or flight hormones, which are norepinephrine and epinephrine.

You can think of that as your adrenaline hormones, and it also makes a small amount of sex hormones like testosterone.

Host: All right. So, With these adrenal glands, obviously those categories of hormones, what are some of the symptoms or conditions that people might think of or maybe might not know of that result from problems with the adrenal glands?

Jabiz Behzadpour, DO: That's a good question. So I kind of like to break it down. We can go one by one. So your cortisol hormone, you can either have not enough or too much of. So if you don't have enough cortisol hormone, it's called adrenal insufficiency. Because your adrenal gland is insufficient at making the hormone that your body needs to function.

If you have too much cortisol hormone, that's something called Cushing Syndrome, which has a lot of different symptoms because it's the opposite of adrenal insufficiency. If your body makes too much aldosterone hormone that's related to blood pressure. So a lot of people with high blood pressure who are on three or four different medications and they can't seem to get their blood pressure down; that's a good thing to check for, to see is your body producing so much hormone and that's what's keeping your blood pressure up.

Another problem not related to hormones with your adrenal gland is you can have what's called an adenoma, which means it's just excess tissue that doesn't belong, that's growing on your adrenal gland. So that if it's on your adrenal gland, it's called an adrenal adenoma. Sometimes those are found by happenstance. Like you're going to get a CT done for something else in your stomach and the radiologist picks up that you have an adrenal nodule. So those patients get referred to us too, and that's separate than the hormone abnormalities.

Host: Okay. But it sounds like you work really well with other units within the organization then for some of those things that maybe people don't know they're having and then they get discovered while they're having other procedures.

Jabiz Behzadpour, DO: Absolutely.

Host: Awesome. Well when it comes to the hormones and the adrenal glands, those kind of things, is there a difference between just a hormonal imbalance? Can you have just sort of an imbalance that maybe is more transient or temporary versus an adrenal disorder that's maybe a little bit more long term?  

Jabiz Behzadpour, DO: So, when I diagnose patients with adrenal insufficiency, sometimes they have received a lot of chronic steroids from the outside. So that's a patient demographic that I would see more often where they're getting a lot of steroid injections for their joints or they're on inhaled corticosteroids, so they take a lot of steroid nebulizers.

And when your body gets so much steroids from the outside, it stops making its own steroids from the inside. Because it says, why would I need to make something that I'm getting from the outside? Because it sees it as the same. So when that happens and those patients come and see me, they'll be on hydrocortisone or prednisone, which is a pill, and what I'll sometimes do is see if we can decrease that dose. And if they're no longer on their inhaled corticosteroids or they're no longer getting steroid injections and they're not getting those steroids from the outside, there is a chance that they can get off their medications.

So I guess to answer your question for adrenal insufficiency. Sometimes that can be temporary if the body wakes up and is able to do its job on its own.

Host: Okay.

Jabiz Behzadpour, DO: But for like Cushings and aldosterone and all of those stuff, that's generally more chronic.

Terry Streetman (Host): Okay. Alright. Thank you. No, that's okay. I know it's a complicated topic and I appreciate you shedding some light on that. Yeah. And obviously we can only cover so much in a short podcast, so thank you for that. So, you mentioned then, there are times people come in directly to you all, you know, if they're having these issues or even some of these screenings like an abdominal x-ray. What are some of the screenings that you can do then that can help with early detection of these issues? 

Jabiz Behzadpour, DO: With endocrinology and hormones, it's really just lab based. So if your doctor is looking to see whether or not you're making enough cortisol, they'll check a morning fasting cortisol level because your levels are highest during the day, and then they come down as the day goes on.

So to see how much your body can make on its own, it's best to check in the morning. If your body is making too much cortisol, then your body would do a different test, either like a blood test, saliva test, urine test, which works a little bit differently to see if your body's making too much cortisol. If you have high blood pressure and aldosterone is a question, those are mainly just lab orders as well. And then with imaging, I would say it's more picked up on CT scans than x-ray and MRI.

Host: Okay. And then if you don't mind, I guess a sub question of this that makes me think of is, how would somebody then know to ask for this kind of screening? What are some signs or symptoms people might notice that would bring them in?

Jabiz Behzadpour, DO: Yeah, so if your body is not making enough steroids, usually there's a reason for it. It doesn't just happen out of nowhere. Like I said, if you're on a lot of steroid inhalers, if you're on a lot of steroid injections, sometimes even steroid creams that dermatology give you can cause your body to shut down, making its own steroids. Symptoms that you would get are nausea or decrease in appetite, just because your body's not making the cortisol hormone that it needs to. So those are symptoms related to the adrenal insufficiency. And then Cushing syndrome is a little bit more nuanced.

Like you can have high blood pressure, be overweight, have diabetes, have osteoporosis, and there's a lot of patients that have all four of those and don't have too much cortisol production.

Host: Oh, okay.

Jabiz Behzadpour, DO: So, there's a little bit more nuances to checking for that. And if you have high blood pressure and are on three or four different medications and you can't seem to get it under control, that would be a good time to check your aldosterone level.

Host: All right. Well thank you for that. I think that's really helpful for folks who are listening. Before our next question, we're going to take a moment to talk about primary care.

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Okay, so we're back and we've got a few more questions. I'm wondering, are there lifestyle changes that people can make to help manage these conditions?

Jabiz Behzadpour, DO: Yeah, so for patients whose body is not making enough of that cortisol hormone, I prescribe steroid pills that they can take to make up for what their body's not making. So I would just say finding a regular routine to where you're taking your pills on a regular basis and not missing any is key. And I also educate patients that if you're sick, like if you have a fever bad enough to go to urgent care, like more than just a cold or something like that, when you're sick, your body is under stress. And when your body is under stress, its natural response is to produce more cortisol. So since patients with adrenal insufficiency, their body isn't able to produce more cortisol because it's not producing any; those patients need to know to double or triple their steroid dose pills to help give them the same amount of cortisol that their body would be making to get through that illness. Because the illness is a stressor on their body. If you're making too much cortisol and you have Cushing syndrome, it's really managing the symptoms.

So managing the diabetes, managing the blood pressure, managing the weight control, and taking care of that will help with the Cushings, and then it's trying to figure out why is your body making too much cortisol? Is it because your adrenal gland is working in overdrive and is doing its own thing? Or is it because, there's a signal in your pituitary gland in your brain that tells your adrenal gland how much cortisol to make. So is the problem the signal in your brain is over communicating with your adrenal gland. Or has your adrenal gland gone rogue and is doing its own thing, is kind of what to ask for about that.

Host: Okay. You touched on this a little bit, but I'm wondering if there's any more detail or any more that you'd like to talk about when it comes to the treatments that people can receive for these kinds of conditions?

Jabiz Behzadpour, DO: Yeah, so there's two main types of steroid pills I prescribe for adrenal insufficiency. Prednisone is a once a day medication when prescribed for adrenal insufficiency. Hydrocortisone is a twice a day medication. It's either one or the other that can help with adrenal insufficiency. Aldosterone, it's really just blood pressure control. There's a blood pressure medication, specifically spironolactone that helps decrease aldosterone levels, so that might be a good one.

But other blood pressure medicines are also effective in bringing down your blood pressure. Then if you have Cushing syndrome, it's not really as much pills as it is trying to figure out what the cause is, if it's your adrenal gland or your pituitary gland. And then going after that.

Host: Okay. Well we've covered a lot here today. Is there something specific that you think would be the biggest thing listeners should take away from this episode?  

Jabiz Behzadpour, DO: I think hormones can be kind of complicated. Because there's a lot of different symptoms that can come from a lot of different things, either hormonal or not.

So I would say if you're not feeling well, tell your doctor everything that's not going well. And as a medical professional, they can kind of tease out what's related to hormones and what's not, and they'll make sure that they get the testing that you need. But it's up to you to kind of advocate for yourself and tell your doctor what you feel is wrong so they can order the right test. 

Host: Okay. Yeah. So kind of going back to that message of like, primary care, go see your provider. Be honest. Be open with them, talk about what's happening.

Well thank you very much. If you're interested in learning more about Riverside Endocrinology Specialists, you can visit Riverside's website at riversidehealthcare.org and, please take a moment and rate the Well Within Reach podcast on Apple Podcast, Spotify, or anywhere you get your podcasts. And thank you again for joining us for Riverside Well within Reach and thanks for joining us, Doctor.

Jabiz Behzadpour, DO: Absolutely. Thank you for having me.