Professor of Medicine Director of Endocrine Research Laboratory St. Luke's Medical Center Investigative Interests: Cushing's syndrome, adrenal tumors, fetal and neonatal endocrinology and metabolism Clinical Research: My clinical research has two major areas of interest. The first is the development of new methods in the diagnosis and differential diagnosis of Cushing's syndrome. We have developed and championed the use of bedtime salivary cortisol measurement to diagnose endogenous hypercortisolism. The patients sample saliva at home using a special device and mail the samples back to our lab. There are now 10 major studies from the US and Europe demonstrating the accuracy and cost-effectiveness of this approach. My laboratory receives clinical samples (through ACL Reference Laboratories) from all over the US. Our group at St. Luke's Medical Center is a national referral center for the differential diagnosis of Cushing's syndrome. We have developed the inferior petrosal sinus sampling for ACTH technique to differentiate pituitary from ectopic ACTH-dependent Cushing's syndrome. We also developed the method to verify catheter placement using prolactin measurements. Finally, our translational research is evaluating the biochemistry and molecular biology of human steroidogenic adrenal tumors. Laboratory Research: The major interest of my laboratory is to evaluate the endocrine and metabolic adaptations of the fetus, neonate, adolescent, and adult rat to perinatal hypoxia. We have studied the hypothalamic-pituitary-adrenal axis showing a non-ACTH mediated increase in steroidogenesis apparently mediated by a novel neural pathway to the adrenal cortex via sympathetic nerves. We have also demonstrated dramatic effects on the lipid profile (metabolome), hepatic and gastrointestinal function, bone metabolism, growth and the growth hormone axis, and adipokine expression. We have recently demonstrated a potential epigenetic effect of perinatal hypoxia on subsequent HPA axis activity in the F1 and F2 generation. We have also started to evaluate the role of the mammary gland and components of milk in the development of the neonate exposed to hypoxia.