This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!) On episode 2 of season 8 (named “Transplant”), House treats the lungs of an 18-years old man who died in a motorcycle accident. The lungs were donated and planned to be transplanted in one of Wilson’s patients, but went bad just before the transplant, and House’s job was to find out what’s wrong with them. After ruling out cocaine abuse, a tumor in another organ (which affected the lungs) and even peanut allergy and heavy metal poisoning, House and his new and only team member find white blood cells in the lungs, and then diagnose the lungs with eosinophylic pneumonia

Photo by fox

Photo by FOX

Danger level: Medium

What is it?

Eosinophilic pneumonia is a group of diseases in which eosinophils (a type of white blood cells that are responsible for the body’s response in allergies and infections by parasites) accumulate in the lungs and interfere with their function.

Who gets it?

The disease isn’t common, but exactly how rare it is isn’t known. Different diseases in this group can be more common in men or women, and most of them develop in adults (usually not in elderly people).

What causes it?
Eosinophils are cells in our immune system that are active during allergic reactions and parasitic infections. When activated, eosinophils secrete chemicals that can cause inflammation. In people with eosinophilic pneumonia, eosinophils accumulate in the lung, are activated and secrete the chemicals – this causes the symptoms of the disease.
There are many causes for eosinophilic pneumonia. Some cases develop after the person is exposed to something outside the body – certain foods, drugs or even smoke (like in the House episode). Infections by parasites can also cause eosinophilic pneumonia. In other cases, the disease is related to changes inside the body – for example, it can be associated with another disease process. In some cases the reason for the disease is unknown.

An eosinophil, as seen under a microscope. Photo by Akay Miller

How does it feel?

The symptoms can be mild or severe, and include cough, wheezing and shortness of breath. When the disease is severe, it can cause the rate of oxygen in the blood to decrease and sometimes respiratory failure develops.

How is it discovered?

The doctor will suspect eosinophilic pneumonia if symptoms appeared shortly after exposure to foods or drugs that can cause the disease. Tests are performed to approve the diagnosis: blood tests to search for an elevated number of eosinophils in the blood; chest x-ray to see signs of pneumonia, and microscopic examination of lung secretions to search for eosinophils there as well.

How is it treated?

Usually, eosinophilic pneumonia is treated with steroids. If the disease appeared after exposure to foods or drugs – avoiding them will help with recovery, and if the disease is due to a parasitic infection – antibiotics are required.

What happens after treatment?

Most cases respond to medications (or even get better without treatment at all), but sometimes there’s severe lung failure which can be life threatening.

The bottom line – how do I avoid it?

If the disease appeared after exposure to a certain food or drug, avoiding them may prevent the disease from recurring. Also, people who had an attack of the disease should seek medical help right away if symptoms come back.

Related posts:

1. Your Questions Answered – Asbestosis – What Work Exposure Can Do To Your Lungs
2. Pleural Mesothelioma – Cancer of The Lungs Caused by Exposure to Asbestos
3. Deep Vein Thrombosis – Clots in Your Veins Which Can Travel To Your Heart and Lungs

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)

On the first episode of season 8 (named “Twenty Vicodin”, and featuring an interesting guest in the cast!), House is in prison after crashing his car into Cuddy’s living room. One of the prisoners has a fever, joint pain and a rash on his thigh, and House convinces the prison’s doctor that he has lupus. Later, after the prisoner breaks his arm from a minor hit and doesn’t stop bleeding from a small cut, House listens to his chest and discovers an “acoustic shadow”, meaning there is a mass in his lungs. After drinking some coffee the prisoner develops a severe allergic reaction (anaphylaxis) which causes his airway to swell up and almost kills him. House then realizes that the reason for the reaction was the high temperature of the coffee and diagnoses him with mastocytosis

Photo by fox

Danger level: Medium

What is it?

Our immune system is composed of many types of cells and partןcles. Mast cells belong to the immune system and are involved mostly in allergic reactions. These cells produce substances that cause some of the allergy symptoms, the most famous of them is histamine. In systemic mastocytosis  the amount of these mast cells increases significantly, causing the disease.

This is how a mast cell looks. Photo by Ed Uthman

Who gets it?

Systemic mastocytosis is an extremely rare disease – so rare that it’s frequency in the population is not known. It’s a bit more common in men than women, and appears mostly in children, though it may happen to adults (and then the most common age is 55).

What causes it?

The disease develops when a mast cell starts dividing uncontrollably (like in cancer). Since the mast cells keep dividing, there are too many of them – and they can form a tumor, circulate in the blood or accumulate in organs. Also, substances that mast cells produce like histamine are released in larger amounts than usually. All these processes can cause symptoms.

How does it feel?

Symptoms can appear in any organ where mast cells accumulate. This can cause skin rashes, bone pain and problems with the liver, spleen or bone marrow.

Substances that are produced in mast cells and released in large amounts (like histamine) can cause itching, flushing and symptoms in the digestive system (for example: abdominal pain, diarrhea, peptic ulcers and problems with the absorption of food).

Another important symptom is severe allergic reactions (also called anaphylaxis) which can be dangerous and cause difficulty breathing or a very low blood pressure. The most severe allergic reaction in mastocytosis is to bee stings.

In some cases flushing and low blood pressure can develop in response to certain drugs against inflammation (like in the “aspirin test” at the end of the episode), and any symptom can be worsened by these drugs, alcohol or narcotics.

Mastocytosis in toddlers

How is it discovered?

The doctor can suspect mastocytosis based on the symptoms and blood work, but the only definitive test is a bone marrow biopsy, in which a bone sample is taken from the lower back. An important test which can support the diagnosis before performing the biopsy is measuring the levels of histamine in the blood or urine.

How is it treated?

There is no cure for mastocytosis. Treatment is aimed at reducing symptoms, and this is done mostly by different types of pills (for example, anti-histamines which are usually used for allergies).

What happens after treatment?

There are different types of mastocytosis which are dangerous in different levels. In some cases patients have the same life expectancy as the normal population, but in the more violent types (which are, luckily, more rare) patients survive for several months only.

The bottom line – how do I avoid it?

Unfortunately, there is no known way to avoid mastocytosis.

Related posts:

1. Sickle Cell Disease – When the Shape of Your Blood Cells Can Kill You (As Seen On House MD)
2. Astrocytoma (Butterfly Tumor)–A Brain Tumor That Spreads To Both Sides (As Seen On Grey’s Anatomy)
3. Pheochromocytoma – A Rare Tumor That Can Cause Hypertension (As Seen on House MD)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)

On episode 2 of season 7 (named “Selfish”), Della Carr collapses during indoor skating for a charity event for her brother’s disease – muscular dystrophy (which causes muscle weakness). Apparently she had an arrhythmia (problem with her heart rate). While the team prepares her for a test to see if she has a syndrome that causes arrhythmias, they find out she stopped producing urine, which means her kidneys are failing. Later she also starts to cough blood, and a lung biopsy finds she has a lung disease called LAM. She undergoes a lung transplant but the new lung is failing soon afterwards. After House talks to her brother, he reveals that for a year she had non-specific symptoms like ear pain, chest pain, hoarseness and a runny nose. He then diagnoses her with sickle cell trait.

[house 702 photo]

Photo by Fox

Photo by Fox

Danger level: Medium

What is it?

Sickle cell disease is an inherited disease which affects our red blood cells. It causes them to stick to each other and interrupt the blood flow in small vessels, so less blood gets to the organs.

Who gets it?

Sickle cell disease is a genetic disease, meaning that people inherit it from their parents. There is a defective gene in the disease (called “hemoglobin beta-chain”). When a person gets two defective copies passed on from their parents (one from the mother and one from the father) they are sick and have sickle cell disease. If they only inherit one copy (from their father or mother) they are carriers, and their condition is called sickle cell trait.

Sickle cell disease isn’t very rare – one out of 625 people in the United States has the disease.

It’s much more common in Afro-Americans – 8% have the sickle cell trait, compared to only 0.24% of white people. It’s also common in Africa, Greece, Turkey and India.

It can affect men and women alike.

What causes it?

Our red blood cells carry oxygen and bring it from our lungs to organs in our body. It’s necessary for them to survive. The molecule in the red blood cells that’s responsible for carrying the oxygen is called hemoglobin.

The defect in the gene in sickle cell disease causes hemoglobin to be distorted, meaning the red blood cells get distorted as well. They look like a sickle (hence the name of the disease).

Normal and distorted red blood cells. Photo by NIH.

This causes the red blood cell to be sticky. The red blood cells stick to each other inside small blood vessels and clog them, and so less blood gets to the organs.

How does it feel?

Symptoms of sickle cell disease usually start when the baby is 6 months old. They include:

• Pain attacks (crises): This is the most common symptom. The pain can appear in the abdomen, bones, joints, and soft tissue. Each attack lasts for hours-days, it stars and ends suddenly. These crises are most common in small children . Some patients have lots of them and others have only a few or even none at all. Sometimes pain is accompanied by fever or general discomfort.
• Hand-Foot Syndrome: Swollen and painful hands and feet. This lasts 1-2 weeks and is common in very small children (6-18 months).
• Acute Chest Syndrome: Chest pain, fever, cough and difficulty breathing. This is a medical emergency, and if untreated can cause severe breathing problems and even death. It can happen in children and adults.
• Damage to internal organs: This happens when less blood gets to an organ- that organ might stop working. It can happen in many organs, like kidneys, liver and lung. When this happens in the brain, it can cause a stroke – 30% of the children with sickle cell disease have at least one stroke. When it happens in the spleen repeatedly, it causes it to stop working, and since the spleen is part of our immune system, this can cause frequent infections which can be life-threatening.
• Anemia: Sickle cells tend to break down and die, so there are less of them. Anemia causes paleness, weakness, difficulty in exercise and might cause a delay in growth and puberty. Since the anemia is chronic, most patients get used to it and don’t have a lot of symptoms.
• Jaundice: This is a yellowish shade of the skin and the white part of the eyes. It’s caused by the breaking down of sickle cells.

This video explains the disease and its symptoms.

How is it discovered?

A blood test can discover if there is an abnormal hemoglobin molecule in the blood. A genetic test can also be done, which tests for the bad gene. A genetic test can also be done during pregnancy, so it can be found if the baby will have the disease.

How is it treated?

The treatment focuses mainly on treating the symptoms and preventing pain crises – things such as treating infections with antibiotics, easing the pain with pain killers, etc. Also, a drug called hydroxyurea can help. It causes the body to create a different type of hemoglobin, which helps.

What happens after treatment?

The treatment isn’t meant to cure the disease but to help with the symptoms. The life expectancy in sickle cell disease is around 50-60 years, and the most common causes of death are organ failure (especially kidney) and infections.

And what about sickle cell trait? This is when only one copy of the gene is defected, and less then a half of the hemoglobin is distorted. They usually live normally without any symptoms, except in rare cases (like on the House episode).

The bottom line – how do I avoid it?

If both parents have the sickle cell trait or the disease itself, it’s important to perform a prenatal test as explained before.

People who have sickle cell disease already can sometimes avoid the pain crises: drink enough water (to avoid dehydration), avoid smoking and high altitudes (which cause a decrease in the level of oxygen in the blood), avoid cold places, and when exercising rest frequently and drink a lot.

Related posts:

1. Mastocytosis – It’s Not A Tumor, But Its Growth in Your Body Can Kill You (As Seen On House MD)
2. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells
3. Behçet’s Disease – Inflammation of Your Blood Vessels, Throughout the Body (As Seen on House MD)

This is part of our House MD Project series.

Make sure to tune in tomorrow for a medical recap of tonight’s finale!

Click here to read the connection to the episode (spoiler alert!)


On episode 22 of season 7, named “After Hours”, a woman named Darrien is bleeding after a stabbing to her body. Her blood pressure and heart rate are almost missing on one side of her body, meaning something is blocking one of the arteries there. She then starts hallucinating due to an interruption of blood flow to her brain. Fever also develops, hinting at an infection. Turns out her symptoms were due to an infection with entamoeba, a parasite, which was released to her bloodstream by the stabbing.

Photo by NBCUniversal

Danger level: Medium

What is it?

Entamoeba histolytica is a parasite which can infect humans. It can infect the large intestine and sometimes the liver and other organs, causing a condition called amebiasis.

Who gets it?

It’s estimated that about 10% of the world’s population are infected with Entamoeba histolytica. It’s more common in some areas of the world where sanitation is poor, such as Central and South America, Africa, and Asia. In the United States it is estimated that about 4% of the population are infected – most of them are immigrants or people who have traveled to countries where it’s more common.

What causes it?

The infection, as mentioned above, is caused by a parasite – an ameba named Entamoeba histolytica, seen under a microscope in this photo:

The parasite can exist in 2 forms: One active (called a trophozoite) and one dormant – called a cyst. Infection occurs when a person swallows cysts. They hatch in the body, releasing trophozoites. These in turn start multiplying and can cause wounds in the lining of the intestines. They can also spread to the liver and other places.

Some trophozoites become cysts again, and are excreted in the feces, helping the infection spread.

Now how do people actually get to swallowing the parasite, or how do they infect themselves? The cysts can spread from person to person or through food or water. In places where there is poor sanitation, food and water can be contaminated with feces containing the ameba. If soil is polluted by human feces, fruits and vegetables growing in it will be infected as well. If someone doesn’t wash hands properly after going to the toilet, the infection can spread. You’re getting the idea…

How does it feel?

In many people (about 80%), the infection isn’t felt at all. When it is felt, symptoms start within about 2-4 weeks of ingesting the parasite, and can include flatulence, abdominal pain, diarrhea, or constipation. In some cases a dysentery may be caused, meaning there is blood and mucus in the feces. Fever may also develop. Blockage as well as perforation of the intestines can occur.

Sometimes the ameba may spread to the liver, causing an abscess (a localized collection of pus). The person would feel fever and chills, sweating, nausea and vomiting, and weight loss. Rarely, the ameba can spread to other areas of the body (even the brain).

This vivid video sums it up:

How is it discovered?

A stool sample has to be examined to find the ameba. Sometimes a tube with a camera (colonoscope) can be inserted to the colon to collect a sample from a wound caused by the ameba, to look at under a microscope.

To find a liver abscess, an imaging method such as an ultrasound, CT or MRI can be used. Blood tests can also help with the discovery of the parasite.

How is it treated?

An antibiotic is given that can kill the ameba. An example of such a drug is metronidazole (which was mentioned on House).

The bottom line – How do I avoid it?

When travelling to an area known to have poor sanitary conditions, make sure to drink only bottled water, tap water that’s been boiled for at least 1 minute, or bubbly water or soda drinks from sealed cans.

Do not drink fountain drinks or any drinks with ice cubes. Do not eat fresh fruit or vegetables you didn’t peel yourself. Do not eat dairy products that may not have been pasteurized. And don’t eat anything sold by street vendors.

If you have been infected, you can minimize risk of infection to others by washing your hands with soap and water after using the toilet, after changing diapers, and before handling food.

Related posts:

1. Malaria – A Deadly Infection Passed On By Mosquitoes (As Seen on House MD)
2. Gas Gangrene – An Infection That Can Rapidly Kill Your Muscles (As Seen on House MD)
3. Common Variable Immunodeficiency (CVID)–When a Cold Can Threaten Your Life (As Seen on House MD)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 17 of season 7, called “Fall From Grace”, a homeless man arrives at the hospital with dysosmia (an altered sense of smell). After that he has bleeding in his GI tract, “tunnel vision” (meaning he can’t see his peripheries, only what’s directly in front of him), and cerebellar ataxia (meaning a problem with his coordination). It’s found that the healthy food he has been eating in the hospital caused this since he has Refsum disease.

Photo by FOX

Danger level: Medium

What is it?

Refsum disease is an inherited condition causing mainly vision loss and a change in the sense of smell, as well as other things.

Who gets it?

It’s thought to be uncommon, with no one knowing how really widespread it is. It is known that in the UK and Europe it occurs in about 1 out of every 1,000,000 people, but it is probably more common than that.

The condition is inherited in families. Both parents have to carry a defective gene and transfer it to the child in order for the disease to be transferred to them.

What causes it?

The disease is caused by a defect in the genes, causing a buildup of a material called phytanic acid. You get this material from your diet, especially from beef and dairy products. This material is usually broken down by the body. In Refsum disease, this process doesn’t work properly, causing it to not break down and instead accumulate in the body. Since this material is toxic to our cells, it causes the disruption in sight and smell, as well as other symptoms.

How does it feel?

There are several things which occur in this disease:

• 1. Vision loss: It starts with loss of night vision, and later affects peripheral vision, making you see only what’s in front of you (a situation called “tunnel vision”).
  2. Anosmia (loss of the sense of smell) or dysosmia (smelling things differently than how they really smell).
  3. Problems with the bones in the hands and feet – This happens to about one third of patients.
  4. Muscle weakness and wasting
  5. Poor balance and coordination – This is called ataxia, and was shown on the House episode.
  6. Hearing loss
  7. Dry, scaly skin (called ichthyosis)
  8. Some develop an abnormal heart rhythm (arrhythmia) and other heart problems that can be life-threatening.

How is it discovered?

The disease is suspected in people showing up all or part of the symptoms above. In these people, a test is done which measures the blood level of phytanic acid. In people with the disease it will usually be exceptionally high.

A test of DNA can also be made, which finds the defective gene associated with this disease.

There are other tests as well, but they are beyond the scope of this article.

How is it treated?

There is no direct treatment. People with Refsum disease are advised to avoid foods that contain phytanic acid. These foods include dairy products; beef and lamb; and fatty fish such as tuna, cod, and haddock.

Some people will also have to undergo plasmapharesis, a procedure in which their blood is drawn and filtered and then returned to the body. This is done in order to lower the level of phytanic acid in the blood.

What happens after treatment?

Some symptoms, such as muscle weakness and the skin problem, disappear with treatment. Others, unfortunately, don’t. This includes the vision, smelling and hearing problems, that may persist.

The disease, if untreated, can also lead to death due to problems with the heart rhythm.

The bottom line – How do I avoid it?

Since the condition is genetic, there is really no way to avoid it. You can, however, avoid the symptoms if you restrict phytanic acid containing foods in your diet, once you discover that you have the disease.

Related posts:

1. Diverticulitis – Or Why A Diet Rich in Fiber is Important For You
2. Why Staying Up Late Isn’t Good for Your Diet

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On last night’s episode (season 7, episode 15), named “Bombshells”, a mass is found on Cuddy’s kidney. After seeing findings in her lungs on imaging it’s presumed she has a malignant tumor in her kidneys that has metastasized to the lungs. A biopsy from the tumor reveals something different, though: She has a benign tumor, called an oncocytoma.

Danger level: Medium

What is it?

Renal oncocytoma is a type of tumor that can be found in the kidney.

Who gets it?

There are many types of kidney cancers, the most common of which is called a renal cell carcinoma. Renal oncocytomas, on the other hand, aren’t that common. They account for about 3-7% of tumors in the kidney.

They are about 2-2.5 times more common in men than in women. They’re usually discovered around age 62.

What causes it?

Sometimes, renal oncocytomas can run in families. This tends to occur more in families in which a syndrome by the long name of Birt-Hogg-Dube syndrome (BHD) is running, due to a genetic mutation.

In other cases, the tumor just appears. There is currently no theory to explain why.

Our kidneys are made of little units called nephrons. There are about 1.5 million (!) nephrons in one kidney. The nephron itself has many tubules and parts, as can be seen in this drawing:

Renal oncocytomas arise from the collecting ducts of the nephron (called in the drawing “collecting tub.” (short for tubule)).

As in other tumors, it occurs when the cells in the area continue dividing without stopping, creating a mass.

How does it feel?

Most people don’t feel anything, and in most cases the tumor is found accidentally after taking an image of the abdomen for some other reason.

In other cases there may be bloody urine (called hematuria), or flank pain.

It’s important to note that this tumor is benign, meaning that it doesn’t tend to spread throughout the body like a malignant tumor does, and so poses less threat.

How is it discovered?

After such a tumor is found in imaging (such as ultrasound or a CT scan), a biopsy is usually needed to know which type of tumor it is. A biopsy is a procedure in which a piece of tissue (in this case, the kidney) is taken and looked at under a microscope. Each tumor has a distinct appearance which can differentiate it from other types. This is how a renal oncocytoma looks under the microscope:

Photo by Nephron

How is it treated?

Most patients are treated with surgery, in which the tumor (or the whole kidney) is taken out.

What happens after treatment?

Like mentioned above, this tumor is benign. Taking it out by surgery should provide cure.

The bottom line – How do I avoid it?

There is currently no known way to prevent this tumor.

Related posts:

1. Astrocytoma (Butterfly Tumor)–A Brain Tumor That Spreads To Both Sides (As Seen On Grey’s Anatomy)
2. Nesidioblastoma – A Tumor of the Pancreas That Can Secrete Hormones (As Seen on House MD)
3. TTP Explained Again (As Seen on House MD)

On Thursday’s episode of Grey’s Anatomy, a girl with no cheek bones needed a surgery so that she could start playing sports without the fear of getting her face harmed. The girl had a syndrome called Treacher-Collins syndrome, explained below.

Danger: Medium

What is it?

Treacher-Collins Syndrome (TCS for short), also called mandibulofacial dysostosis, is a rare genetic disease causing deformities in the facial bones of our skull, such as absent cheek bones.

Who gets it?

TCS is rare. It happens in 1 out of 40-70,000 births.

It is genetic, and in 40% of cases runs in the family, meaning that the child inherits the defective gene from one of the parents in 40% of cases. The other 60% don’t depend on the parent, and the defective gene appears for the first time in the child.

What causes it?

When a fetus develops, its organs have many phases along the way to becoming adult organs. An example for that are the pharyngeal arches, grooves, and pouches. These are all structures that exist only in the fetus, while it’s developing in the womb. They develop slowly during pregnancy into adult organs.

For example – there are 6 pharyngeal arches, each developing into different organs or organ parts in our body.

A developing fetus. Three of the pharyngeal arches are labeled below (mandibular, hyoid, third).

In TCS, there’s a problem with growth of organs that derive from the 1st and 2nd arches (and grooves, and pouches) which are responsible for growth of structures in our face.

How does it feel?

Most people with TCS have underdeveloped facial bones, especially cheek bones, and a small jaw and chin (this is called micrognathia).

Sometimes an opening in the roof of the mouth can occur, called a cleft palate.

In severe cases, it may impair the baby’s airways and be life threatening.

In terms of appearance, people with TCS have eyes that slant downward, sparse eyelashes, and a coloboma, which is a notch in the lower eyelids. There can be other eye abnormalities, causing loss of vision.

The ears can also be affected and be absent, small, or have an unusual shape. This can also lead to hearing problems.

Here’s an example – this video is from a girl with TCS -

How is it discovered?

The looks of a child with TCS help diagnose the disease. The set of features unique to the condition help the doctor come at the correct diagnosis. Also, genetic testing can be done to see if the child has the defective gene.

If the doctor is in doubt, an facial image using x-ray or a CT scan can be used to help with the diagnosis.

How is it treated?

Plastic surgery can be used to treat certain deformities in the face (on Grey’s Anatomy, a bone graft was used to give the girl cheek bones).

Other things are also done to aid other problems that come with the disease, such as hearing aids for hearing loss, or help with breathing if the disease involves the airways.

What happens after treatment?

Children with this syndrome usually grow to become normally functioning adults. It’s important to address any hearing problems, so that the child can perform normally in school.

If there is a history of TCS in the family, genetic counseling may prevent the birth of a child with the condition.

You can learn more about the condition by reading the Reflections on Treacher-Collins Syndrome blog, written by Amie.

Related posts:

1. As Seen on Grey’s Anatomy – Tethered Spinal Cord Syndrome
2. Superior Canal Dehiscence Syndrome – Hearing Sounds Inside Your Own Body (As Seen on Grey’s Anatomy)
3. Osteoporosis – How Your Bones Can Get Thinner With Age And What You Can Do To Avoid It

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On Episode 16 of Season 1, called Heavy, a 10 year-old obese girl named Jessica is admitted to the hospital after having a heart attack. She later has low blood sugar, and after a few misdiagnoses and treatments starts bleeding from skin necrosis, which the team think is related to one of the treatments. Not a minute too late, House diagnoses her with Cushing’s syndrome due to a tumor in her brain.

Danger level: Medium

What is it?

Cushing’s syndrome is a condition in which there is too much of the hormone cortisol in the body.

Who gets it?

Cushing’s syndrome isn’t very common, and happens to about 13 out of every million people each year.

What causes it?

Cortisol is a steroid hormone produced in our body. It’s released in response to stress or when its level in the blood is low. Its function in our body is to raise blood sugar, suppress the immune system and help with the body’s metabolism.

To understand why Cushing’s syndrome happens, you first have to understand how our body releases and handles cortisol.

The brain makes a hormone called CRH, which tells a gland under the brain, called the pituitary gland, to make another hormone called ACTH. ACTH causes our adrenal glands (which sit above our kidneys) to produce cortisol.

Now what causes cushing’s syndrome?

1. Taking steroid medicine – These aren’t the steroids you may know that athletes take. Steroids are types of drugs used to suppress our immune system and that are given in diseases such as lupus, asthma, and rheumatoid arthritis. Taking these for a long time is the most common cause of Cushing’s syndrome.
2. Tumors on the pituitary gland – Like the case on the House episode. This is the second most common cause, and has a slightly different name: Cushing disease. This isn’t cancer and doesn’t spread like cancer does. What this tumor does is produce extra amounts of ACTH which cause the adrenal gland to produce more cortisol than it should.
3. Tumors on the adrenal gland – These can sometimes be cancer. These tumors produce extra amounts of cortisol themselves.
4. Tumors elsewhere – These can be lung tumors and others, that simply produce ACTH, causing the adrenal gland to produce extra cortisol.

How does it feel?

• The most common symptom is weight gain, especially around the waist, and around the upper back (something called a buffalo hump). It also caused a rounding of the face called moon face.
• Fatigue
• Muscle weakness
• Flushing of the face
• Skin changes: The skin bruises easily. You get acne. You get pink or purple stretch marks (called striae) on the belly skin, thighs, breasts, and arms.
• Slow healing of wounds and infections
• Mood changes, such as depression, anxiety and irritability.
• Thicker or more visible body and facial hair.
• Irregular or absent periods in women.
• Diabetes
• High blood pressure
• Bone loss, which can lead to fractures

And more…

This video from The National Geographic shows an excellent example and explains it:

httpv://www.youtube.com/watch?v=vxSAhLyKVqw

How is it discovered?

There are blood tests that can find out if you have Cushing’s syndrome. Once these are done, a CT scan of your adrenal and an MRI of the pituitary gland are done to find a possible tumor.

Other tests may be possible, which are beyond the scope of this article.

How is it treated?

If the condition is caused by steroid medicine, your doctor will lower your dose or stop them altogether. You should never stop taking steroids on your own, as that can be dangerous to your health.

If a tumor is causing it, it can be removed in surgery, or by other means.

What happens after treatment?

If the surgery removes the tumor completely, people may be cured, although it can sometimes return.

The bottom line – How do I avoid it?

If you take steroids, awareness of the signs of the condition can help you avoid its continuation down the road.

Related posts:

1. Muckle-Wells Syndrome – When Being Cold Gets You Warm (As Seen On House, MD)
2. Your Hair Could Predict an Upcoming Heart Attack
3. Turner Syndrome – The Missing X

On Thursday’s episode of Grey’s Anatomy (titled “Shiny Happy People”), a teenage patient called Hayley is thought to have schizophrenia after trying to claw her own eyes out. Not unlike a House episode we recently covered, the diagnosis turns out wrong and instead she is found to have a condition called superior canal dehiscence syndrome.

Photo by ABC

Danger level: Medium

What is it?

Superior canal dehiscence syndrome (SCDS) is a rare condition affecting the ear which causes the person having it to hear sounds inside their body, among other things. It was first described in 1998.

Who gets it?

Since the condition was first described only in 1998, not much is known in that area. A study conducted on cadavers (dead bodies) found ears matching the condition in about 0.5% of bodies checked.

It appears to affect women and men alike. The condition usually affects people around the age of 40, although it may start earlier or later.

What causes it?

Our ear, as we described here before, is divided into 3 parts: The outer ear, middle ear, and inner ear. Our inner ear is the innermost part, and it’s responsible for hearing and balance.

The inner ear.

Our inner ear is composed of 3 canals filled with fluid that sense our position in 3D, which helps us keep our balance. Just like a gyroscope that tells our brain the position of our head in real time. The superior canal is one of those canals.

Overlying the superior canal is one of our bones, called the temporal bone. In SCDS that bone is thinner than usual since it hasn’t developed properly.

Through a mechanism too complicated for this article, the symptoms of SCDS develop due to this bone defect.

How does it feel?

There are typical symptoms people with SCDS may experience:

1. Autophony – This means the person can hear their own speech or other noises inside their body (such as the heartbeat, eye movements, chewing, etc.) very loudly.
2. Dizziness/vertigo – Problems with balance, since, as mentioned above, our inner ear is responsible for keeping our balance. (You can learn about head spinning in our article published a while ago).
3. Tullio phenomenon – In this case, sound can cause the patient to lose balance. Sound can also cause rapid movement of the eyes, called a nystagmus.

These are the main symptoms, although there are others as well. This fascinating video shows a true story:

httpv://www.youtube.com/watch?v=f6vAkdGw8T4

How is it discovered?

One way is doing a CT scan of the temporal bone, which will show its thinning (or dehiscence).

There are other ways. Among them is the method shown in the Grey’s Anatomy episode, called a videonystagmography (VNG). In this method, hi-tech video goggles with infrared cameras are worn while doing things that can provoke rapid eye movements in the condition.

How is it treated?

The condition can be treated by a surgery, which repairs the gap in the temporal bone. Another surgical method is plugging the superior canal.

What happens after treatment?

The success rate of the operation is quite high. Most patients don’t have their old symptoms after the operation.

The bottom line – How do I avoid it?

There is no known way to prevent the condition.

If you happen to have SCDS, there’s a support group for you.

Related posts:

1. Meniere’s Disease – From Head Spinning To Hearing Loss
2. Treacher-Collins Syndrome – Being Born Without Cheek Bones (As Seen on Grey’s Anatomy)
3. As Seen on Grey’s Anatomy – Tethered Spinal Cord Syndrome

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 5 of season 1, called “Damned If You Do”, a nun by the name of Augustine appears at the clinic with rash on her hands. After attempting to treat a supposed allergy and almost killing her (due to a type of tea she drinks), Dr. House faces the challenge of diagnosing the source of her allergy. After a long episode of trial and errors, it is found that she is allergic to copper. More specifically – to a copper IUD implanted in her.

Dr. Chase and Sister Augustine on the “Damned If You Do” episode

Danger level: Medium

What is it?

Allergy is an abnormal response of our body’s immune system. The immune system contains types of cells that are supposed to fight infections in our bodies. That is, it’s designed to attack germs, viruses, and other harmful critters.

When you have an allergy to something, that something is usually harmless – like pollen, mold, animal dander. Yet the body recognizes it as something bad and starts the whole attacking process.

Who gets it?

Not everyone gets allergies. The tendency to develop an allergy is tied to several factors:

• Heredity – Allergic conditions tend to run in families. If neither one of your parents has allergies, you have about 15% chances of being allergic. If one of them is allergic, your risk rises to 30%. If both – 60%.
• Environment – It’s not enough to have a tendency to allergic reactions. You have to be exposed to the material you’re allergic to.

What causes it?

When you’re exposed to something you’re allergic to (called an allergen), the body produces antibodies. These are molecules designed to attack foreign intruders. There are all sorts of antibodies. The ones in an allergic reaction are of the IgE type.

Those IgE antibodies attach to a type of cells called mast cells. They, in turn, release chemicals (like histamine) into the blood that cause the symptoms.

This video shows this nicely (although a little more elaborately) -

How does it feel?

When you’re allergic to something you inhaled or something that touches your skin, common reactions include -

• Itchy, watery eyes
• A runny nose and sneezing
• Rashes
• Feeling tired or ill

When you’re allergic to a certain food you may feel stomach cramps, vomit or have diarrhea. When you’re allergic to an insect bite, you may see local swelling, redness or pain.

Anaphylaxis is a severe reaction as part of an allergy which is also life threatening. It includes reactions in your skin, respiratory system (you may choke), digestive system, your heart and blood vessels and your nervous system. You get the picture…

On that episode of house, the nun had an anaphylaxis when staying in the clean room.

Copper allergy / IUD allergy

In the House episode, the nun had an allergy to copper, and specifically to an IUD device implanted in her.

Problem is – the device was implanted years before. So how come she wasn’t allergic till now?

Allergies can be tricky that way. People can have a first exposure to an allergen, which causes the reaction described above. From then on, there’s a period of sensitization, which can take from months to years, after which another exposure to the allergen can cause an allergic reaction.

In the House episode, the nun was first exposed to copper in her IUD, but a reaction didn’t happen until she was exposed to copper again – this time through contact with copper cookware she washed.

How is it discovered?

When the doctor suspects you have an allergy, they can run a skin test. In it, an extract of an allergen is applied to your skin (after scratching your skin or pricking it to expose it to the material. That’s why it’s called a prick test). If your skin reacts to the allergen it will show as an inflammation in that area.

Skin prick test. Photo by Lindspetrol

Another option is a blood test – which can identify IgE’s specific to certain allergens.

How is it treated?

There’s no cure for allergies, but there are medications that can ease the symptoms. Covering all of them is beyond the scope of this article. Their names contain antihistamines, corticosteroids, and others.

Besides that, the treatment for anaphylaxis (see above) is epinephrine, which can save your life. Sometimes people with tendencies to severe reactions find themselves with no hospital in their vicinity. For that matter an epinephrine pen was invented, which you carry with you in your pocket and can save your life.

The bottom line – How do I avoid it?

Once you know you’re allergic to something, avoiding that allergen can prevent the symptoms.

Related posts:

1. Mastocytosis – It’s Not A Tumor, But Its Growth in Your Body Can Kill You (As Seen On House MD)
2. In The News – Swine Flu (Influenza) – All You Wanted To Know
3. All You Wanted To Know About Sleep [Infographic]