Cushing’s Tips

Things I’ve learned and wanted to share

By LindaP, with a little help from other Cushing’s Message Board members. This is a continuing list, if you want to share.

I have learned so much on this Cushing’s journey, much of it from all of you and this site. I wanted to share those learnings, in the event that it helps anyone else.

Obviously – my own opinions here!

My best wishes to everyone on their Cushing’s journey.

Linda

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1. Trust your instincts.

2. Trust your instincts some more.

3. Do your research – read everything you can, talk to people, use this website and the message boards. Slog through research papers. Not all of it will make sense, but it is amazing how much you can learn, and how much it will help you on your diagnostic journey.

4. Not everyone will have every one of the “typically described” symptoms of the hump, moon face, straie, and central obesity. Some people get them all, some people get some, and others don’t develop these signs.

5. While substantial weight gain is very common with Cushings, there are some people who have only mild or moderate weight gain. What seems to be the common thread, however, is the inability to lose it in spite of diet and exercise.

6. You don’t need to test positive on every single test, or test positive on every type of test, to have Cushings. There is substantial variation in how we present with the disease, and in which tests will identify the excess cortisol in our bodies. Do not let a single negative result on any one test, or negative results on a particular type of test, prevent you from aggressively pursuing a Cushings diagnosis if there is strong suspicion. For example, it is possible for an individual to have proven Cushings without ever having a positive on a ufc or dex suppression test.

7. Do not waste time, energy and financial resources on unhelpful doctors.

8. Whenever possible, get to a true Cushings expert as soon as the disease is suspected.

9. When seeing a new endocrinologist, don’t be afraid to ask:

a. What is your opinion on cyclic or intermittent Cushings?b. When and how might you diagnose a mild or early case of Cushings? Do you recommend treatment in those cases?

c. Do you believe it is possible for someone to have Cushings without all or some of the commonly associated stigmata (straie, hump, moon face, substantial weight gain)?

d. What is your diagnostic criteria for Cushings?

i. Lab tests

ii. Physical symptoms

iii. Imaging

e. How many patients have you diagnosed with Cushings?

f. What surgeon(s) do you recommend and work with for your patients with tumors that are causing Cushings?

g. If Cushings is suspected, how can we work together to maximize testing to give us answers as quickly as possible? How can I most easily get my test results from your office?

10. Make sure your doctor is willing to support the amount of testing that may be necessary to allow you to begin to distinguish between high and low periods. Make sure your doctor is also willing to support multiple types of tests to appropriately rule in/out Cushings.

11. Create a binder and get copies of every single test. (Make additional copies of test results so that you have extra available to perhaps send in advance to a new doctor, or to be able to readily provide a copy during your appointment as necessary). Get copies of clinic notes as well. Organize them into the binder. My binder has the following tabs:

a. Spreadsheet that summarizes most relevant test resultsb. Current medical history/summary of symptoms

c. Imaging reports

d. Cortisol test results (serum, salivary, ufcS)

e. Other lab results (including EKGs and other relevant tests)

f. Eyes (visual field tests, letter from eye doctor, etc)

g. Clinic Notes

12. Research tests. It is not uncommon for a test to be ordered or interpreted incorrectly.

13. MRIs are only tools. They can be interpreted differently by different people and they may not accurately identify the extent or location of a tumor.

14. Create a spreadsheet, or use a journal, to track symptoms daily. Log test results so that you can begin to see patterns. Symptoms may be as subtle as canker sores, or cracked lips or skin, a single pimple, or may be more obvious such as severe swings in mood and energy levels, insomnia, bad acne, etc. Write it all down and track it.

15. Test whenever you feel different.

16. Symptoms of a high for you may or may not match what is typically described for a high. You may experience a high differently. For example, achiness is frequently described as a low symptom, but it may occur during a high in your case. Tracking symptoms and correlating test results help to identify patterns of a high.

17. Start testing your own blood sugar to identify any possible blood sugar problems and to look for possible correlation between episodes of high blood sugar and high cortisol levels. This won’t apply to everyone, and may not be useful in your case, but it was very helpful to me. A very good Walgreen’s brand glucometer is only $20.

18. Get a blood pressure cuff and start checking your own bp at home. Look for patterns there as well.

19. Summarize test results for your doctor (PCP, endocrinologist, or even surgeon). Create a simple table that shows your relevant test results over time.

20. Collect photos that illustrate how your physical appearance has changed.

21. When researching surgeons, learn as much as you can about the different techniques and approaches. Some may seem similar, but there are differences that are important to understand.

22. When interviewing surgeons, the following questions may be helpful (mostly pituitary focused):

a. How will you approach the tumor?

b. What instruments are used? Endoscope? Microscope? Both?

c. What incisions are made?

d. Do you need to clear any kind of path within the nasal or sinus area for your instruments? How will you do that?

e. What stitches will I have?

f. Do you use a “fat plug”?

g. Do you use a lumbar drain?

h. Will there be any nasal packing?

i. How will my head be immobilized during surgery? (Is a “halo” used?)

j. Do you use Doppler to localize the carotid arteries? (not necessary in fully endoscopic procedure as I understand it)

k. Describe your approach to locating any tumor seen on the MRI, and what you will do to find any other tumors that may be in, on, or around the gland.

l. Under what circumstances might you find it necessary to remove either part of the pituitary gland, or all of it?

m. How many of these procedures have you done?

n. How long have you been performing this particular procedure?

o. What are some typical complications that occur with this procedure? How do you manage those complications?

p. Based on my MRI, is there anything in particular that might suggest greater risk of diabetes insipidous or other long term complications with this surgery?

q. Tell me what to expect in terms of post-operative pain and how it will be managed.

r. Is an ICU stay typically necessary?

s. How long can I expect to stay in the hospital?

t. Do you give steroids intra-operatively?

u. When do you test post-op cortisol levels? What is the cortisol replacement therapy protocol? If my endocrinologist is out of state, who will be monitoring that part of my testing and prescribing cortisol replacement as necessary?

v. When can I travel to return home?

w. What restrictions will I have once discharged? (Lifting, noseblowing, how I sleep, driving, exercise, etc)

x. How do I contact you if I should have any problems or concerns once discharged?

y. How will you communicate with my endocrinologist regarding the results of my surgery?

z. What is your protocol for following up with patients post-operatively?

aa. What is your rate of post-operative sinus infection?

bb. What is your rate of post-operative diabetes insipidous, both temporary and long-term?

23. These questions for your endocrinologist may be helpful once surgery is planned:

a. How will you determine my post-op cortisol replacement needs?

b. At what point will you recommend that I begin tapering my dose? What are your guidelines for each step in the weaning process?

c. Based on my case and your experience with other Cushings patients, what might I experience during the recovery period? How long before I feel “better”? What restrictions will I have?

d. When and how will you determine if other pituitary functions should be tested post-op? How will you test other pituitary functions post-op?

e. Do you provide a prescription for emergency injectable hydrocortisone?

f. Do you provide written instructions I may carry for Emergency Room staff in the event that I have an adrenal crisis?

g. How long should I expect to be off work?

h. How will you follow up with me post-op?

i. What is the best way to reach you if I have any questions or concerns after surgery?

24. Participate on the Cushings Boards to support yourself and others through the Cushings diagnosis and treatment journey. (You’ll also make some new friends.)

Where Can I Find…?

Also in the Cushings-Help family of websites

Cushing’s FAQ

A FAQ (Frequently Asked Questions).  Directions are in each category for adding your own question.

IMPORTANT: The information and material posted on this Web site is intended as general reference information only. Specific facts and circumstances may alter the concepts and applications of materials and information described herein. The information provided is not a substitute for professional advice and should not be relied upon in the absence of such professional advice specific to whatever facts and circumstances are presented in any given situation.

Please note that there are several questions waiting to be answered at this time. Your question will be answered as soon as possible.

This is a different website than the message boards and requires a different log-in, although you may use the same log-in name and password.

 

Adrenal Insufficiency

Adrenal insufficiency is a life threatening chronic illness. An active and vigorous lifestyle with normal life expectancy is possible as long as the prescribed medications are taken regularly and adjusted when indicated. As with most chronic diseases, adrenal insufficiency demands that the patients take responsibility and develop self-management skills and techniques.

Read an article on Adrenal insufficiency

Cushing’s Types

Cushing’s Disease/ Cushing’s Syndrome: Cushing’s is a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. Your adrenal glands, which are right above your kidneys, release cortisol when they receive a chemical message from your pituitary gland. The message comes in the form of adrenocorticotrophic hormone (ACTH), which travels through the bloodstream.

Cushing’s Disease Is the result of a pituitary tumor which causesthe emergence of secondary male characteristics (like hair growth, acne, etc.), and ovarian failure. Other symptoms usually include high blood pressure and water retention.

Cushing’s Syndrome: Causes the same symptoms, but is a disorder marked by overproduction of adrenal hormones, which can cause a drop in LH and FSH.

An estimated 10 to 15 of every million people are affected each year. Cushing’s is an increased concentration of glucocorticoid hormone (ACTH) in the bloodstream that is being produced by an adrenal gland tumor (adenoma). Ectopic Cushing syndrome refers to the production of ACTH in a location other than the pituitary gland or adrenalgland. Examples of ectopic sites include thymoma, medullary carcinoma of the thyroid, pheochromocytoma, islet cell tumors of the pancreas, and oat cell carcinoma of the lung.Symptoms include weight gain, central obesity, moon face, weakness, fatigue, backache, headache, increased thirst, increased urination, impotence, mental status changes, and muscle atrophy.

Treatment varies with cause. If an ACTH secreting tumor is involved then it must be removed surgically.

More about Cushing’s.

Talk about Cushing’s with people who understand.

Subcategories:

Growth Hormone

Human Growth Hormone (hGH) is produced in the pituitary gland of humans, and the hormone is secreted throughout a person’s lifetime. It promotes growth in children and plays an important role in adult metabolism.

More about HgH

Where Can I Find…?

Can Anyone Help?

what is the most successful with the least amount of risks and side affects. What is the easiest to live with for the rest of your life in trying to cure cushing’s disease? Removal of an adenoma in my 7 year old son seems not to be successful, now we are trying to weigh our options to get him the cure that he needs, the cure that he deserves. They said we have 3 options….removal of the pituitary gland, removal of the adrenal glands, or radiation. I would like to know your first hand experiences and the pros and cons for everything…….

Please respond here or on Facebook

Helpful Hints for Dealing With Cushing’s

Hint For… What to do
Add Your Helpful Hints for Dealing with Cushing’s
 
Adrenal Crisis On the Message Boards
Adrenal Crisis, getting medical attention Before any crisis occures, contact the local ambulance service that would come to your home and/or work and find out if they have a protocol to treat you. My ambulance service could not give me the shot I needed even tho I not only had a medic alert bracelet, but a file of life on my refridgerator with physician instructions etc.

After my advent, we had to bring it to the governing body’s attention for change, and now ambulance personel are approved to use information like the file of life or the Medic Alert bracelet to treat anyone with not only in Adrinal crisis but anyone with documented medical information.

You could help a lot of other people besides yourself. You may need the help of your physican.

Kim Pulsipher/Dr. Dan

Emergency Kit Contact list: Primary and secondary.

Charged cell phone, all the time.

Directions for how to help. Print out info at http://www.cushings-help.com/911.htm

Medic alert bracelet or pendant. See what others have on theirs here.

Always carry a medical identification card that states the type of medication and the proper dose needed in case of an emergency.

Never omit medication. If unable to retain medication due to vomiting, notify the health care provider.

If there are places that you go often, be sure that those people know that you may have a problem. For a child, inform all of his/her teachers and other staff.

 
Body and Skin On the Message Boards
Brown Spots I have quite a few brown “age spots” on my face,  I accidentally discovered a way to camouflage them when I got a sample of Vaseline Healthy Body Glow. It “tans” your skin. In my case it made the skin dark enough to match the brown spots so they don’t show up as much.

I’ve noticed that there are now lots of similar products on the market and I’m sure that they will all work as well.

~ MaryO

 
Bones and Muscles On the Message Boards
Arthritis Water aerobics for people with arthritis is really helping. I do that twice a week.

~ MaryO

Arthritis Since I can’t take my arthritis meds anymore, I’ve gone back on a combo pill of glucosamine/chondroitin. This only works for osteoarthritis, so if you have any rheumatoid, it won’t work at all.

I was interested to see that The National Institutes of Health (NIH) is currently running a study of Glucosamine and Chondroitin Sulfate and Dr. Jason Theodosakis is heading this up.

There’s more info on “Dr Theo” on Power Surge.

Dr Theo outlined the complete plan in his Power Surge transcripts, saying that it wasn’t enough just to take the pills.

His plan is:

  1. Have a thorough consultation with a physician.
  2. Take glucosamine and chondroitin sulfates to repair damaged joints.
  3. Improve your biomechanics to counteract stress to your joints.
  4. Exercise regularly. (But the right kinds!)
  5. Eat a healthful, joint-preserving diet
  6. Maintain your ideal body weight.
  7. Fight depression.
  8. Use traditional medicine as necessary.
  9. Maintain a positive attitude.

~ MaryO

Arthritis Question: Will the glucosamine/chondroitin that supposedly helps arthritis help with the pain and stiffness of steroid withdrawal? Is there any harm in trying it?

Answer: Glucosamine and chondroitin are chemical components of cartilage, tendons, ligaments, and other connective tissues that form the joints and muscle attachments. Some people with arthritic joint pain appear to benefit from taking these chemicals as dietary supplements (supplements because they are in a normal diet that contains meat). I am unaware of any report of their effect on the musculoskeletal symptoms of steroid withdrawal. However, I see no reason to anticipate any more risk for their use in this setting than in any other.

~ David Orth MD

Diet Top 10 healthiest foods for spring

  1. Asparagus. Rich in vitamins A and C, calcium, iron and folate (the world’s most common vitamin deficiency), asparagus has been prized for its culinary and medicinal purposes since ancient times.
  2. Green beans. Harvested while still immature when the inner bean is just beginning to form, they are one of the few bean varieties that can be eaten fresh..
  3. Spring Chinook salmon. The health benefits of eating fatty, cold-water fish are widely known, but salmon contains the highest volume of omega-3 fatty acids, essential for maintaining good heart health.
  4. Spinach. A Mediterranean favorite since the 16th century, spinach is a rich source of vitamin A (for cardiovascular health) and vitamin K (for bone health).
  5. Apricots. The true fruits of spring, apricots were first discovered in China and have been cultivated for more than 3,000 to 4,000 years. They are also rich with beta-carotene and lycopene, two carotenoids important in reducing the artery-clogging LDL cholesterol and maintain a healthy heart.
  6. Spring onions. Onions have been the subject of new research linking them to lower incidence of certain cancers. They also provide vitamins A and C, calcium and iron.
  7. Green peas. Green peas are a rich source of folate and a wide range of B vitamins, essential for the proper metabolism of fats, proteins and carbohydrates.
  8. Basil. A popular herb that can enhance the flavors of your favorite pasta sauce or spring salad, basil is a wonderful source of vitamin A.
  9. Avocados. Previously avoided by dieters due to their high fat content, avocados have made a comeback as a great source of heart-healthy monounsaturated fats to help lower cholesterol. By volume, avocados are also 50 percent higher in potassium than bananas.
  10. Spring greens. Choose from arugula, romaine, mesclun, bok choy and watercress to mustard, collard and dandelion greens. All are rich in lutein, beta-carotene, vitamin C, folate, minerals and fiber and excellent for digestion.

~ msn.com

Diet Nutrition for Patients with Cushing Syndrome (National Institutes of Health, Clinical Center) – PDF File

~ NIH, National Institutes of Health, Clinical Center

Diet / Exercise Question: While my cortisol levels are still high, is there anything I can do with my diet or exercise to keep my weight from increasing and loosing more strength? Is protein intake important?

Answer: With excessive cortisol levels, diet and exercise are important to keep from gaining weight and losing more muscle strength. A nutritious diet with a multivitamin supplement is recommended, usually the diet should not exceed 1000 to 1200 calories per day. It is important that the balanced diet contain adequate protein, however excessive protein intake probably will not make much difference in muscle strength since excessive cortisol causes protein (muscle) breakdown. Since patients are usually treated soon after diagnosis, no studies have evaluated the effect of a high protein diet.

Regarding exercise, the best type of exercise is that which is not stressful to the skeletal system. For example, swimming and bicycle riding are good exercises. Jogging and lifting weights are probably not a good idea since this does place stress on the skeleton (bones). Additionally, a calcium supplement is important. The recommended amount of approximately 1500 mg of elemental calcium per day can be achieved by taking 4 Tums Ultra or 3 tablets OsCal 500.

~ Mary Lee Vance MD

Headache I choose to just eat salt like it’s a candy. I have a little container of plain sea salt (you don’t want the iodized stuff) and I lick my finger and just dip it! Gross I know… but it’s cured many a headache. My sodium remains low… but it never ceases to amaze me how salt will taste good, and then just stop tasting good. That’s how i know I’ve had enough.

~ ADDflower

Muscles Question: My Cushing’s has been cured for about 3 years, but my muscle strength is still not like it used to be. I work out at a gym regularly, but is there anything else that I can do to try and recover my strength?

Answer: Deterioration of muscle function is a common consequence of Cushing’s syndrome. The majority of patients recover full muscle strength and performance after cure of their Cushing’s syndrome. Physical therapy and a high protein diet have both been shown to improve muscle strength in patients with steroid-induced muscle damage. After cure, most patients recover normal muscle strength within 1-2 years.

~ James Findling MD

Muscle fatigue and weakness From the message boards

Question: A really big problem for me (and seems like a lot of people) is the muscle weakness and fatigue. Does anyone have any tricks that work for them?

Answer: One thing that has helped me is eating more salt. Of course if your blood pressure is really high already, you shouldn’t do this. But mine runs pretty low and I have a hard time keeping my liquids….I am in the bathroom constantly. This is something Dr. F recommended after finding that I have low aldosterone and renin. Also, I am taking vitamins and iron. It seems to help sometimes and sometimes I am as fatigued as can be, but I figure it can’t hurt. Hope this helps!

~ Mertie

Answer: If you are cyclical, it is SUPER important to chart. Part of the problem is that for some folks a Low symptom is another person’s High. After awhile you should be able to see a pattern showing itself.

And yes, when I’m low like that, I did eat salt out of the shaker (I even have 5 different flavored salts, I know, i’m a whacko!)

But when I’m in a Low, I haven’t found a way to pop out of it, or force a High. It’s something I’m working on though.

….If I eat lots of pasta or bread, I have lots of muscle aches and pains. A big bowl of mac’n’cheese will make me feel like I’m having a fibro flair most days

~ vinesqueen

Answer: You’re right. I choose to just eat salt like it’s a candy. I have a little container of plain sea salt (you don’t want the iodized stuff) and I lick my finger and just dip it! Gross I know… but it’s cured many a headache. My sodium remains low… but it never ceases to amaze me how salt will taste good, and then just stop tasting good. That’s how i know I’ve had enough.

~ ADDflower

Answer: One thing to try to find is Sea Salt to replace your normal salt with in the house. It is better for you than regular table salt.

I crave salt and sugar. I can’t get enough of either one.

I need to pick up some DHEA and try it out, it is a precursor hormone and I hear people say it help them feel better.

I can’t seem to find any way to feel better lately, so I am working on a strategy also. I’m back to taking Flintstones vitamins with Iron and an extra Vitamin B6 also.

~ LisaMK

Add your suggestion on the message boards

Osteoporosis Question: I have osteoporosis due to Cushing’s. Will this improve over time?

Answer: A recent study has shown substantial improvements in bone density within several years after the successful cure of patients with pituitary Cushing’s. Bones have the best possible chance for recovery when the replacement steroid dosage is as low as possible. If you are on replacement therapy following surgery, you should be working with your doctor to taper the steroid dose at a rapid , but tolerable rate.

Bones can also benefit from a healthy diet and intake of at least 1 gram of calcium per day. Exercise has also been shown to be beneficial, but is best started under the supervision of a physician. Most patients with osteoporosis can undertake exercise such as walking or swimming without risk of injury. Exercise that is weight bearing, such as weight lifting, or exercise that involves a risk of falling, such as skiing, would not be advisable unless under the direction of a physician or physical therapist.

~ David Orth MD

Swelling Question: Following surgery for Cushing’s, I have had a lot of swelling in my hands, feet and face. Is there anything that can be done to help this problem and is it anything to be concerned about?

Answer: Swelling, or edema, may often accompany Cushing’s syndrome. Following surgical treatment of Cushing’s, some patients will continue to experience edema for some time following the surgery. This may be related to the frequent need for steroid therapy following curative surgery. This is really nothing serious, but can be uncomfortable. I usually treat patients with a water pill or decrease the dose of steroids.

~ James Findling MD

 
Eyes, Ears, Nose,
Sinus, Throat
On the Message Boards
   
 
Hair On the Message Boards
   
 
Heart and blood On the Message Boards
   
 
Psychological On the Message Boards
   
 
Sleep and Fatigue On the Message Boards
  For insomnia try Bach Rescue Sleep. Two sprays on the tongue really seem to help. It is available in most health type stores and markets.
 
Miscellaneous On the Message Boards
  ALWAYS TRUST YOUR INSTINCTS!!

Read ~ Susan’s bio

  What pointed me in the cushing’s disease direction were the symptoms such as buffalo hump; hair growth on specific areas; weight gain around my neck, face, abdomen, chest and back; my pituitary adenoma and the last results from my test that showed high levels of cortisol.

Read ~ Gina’s bio

  Get a copy of ALL your lab test results and copies of imaging reports and the actual images….on CD and films.

Read ~ Gina’s bio

  It is absolutely critical for your physical and emotional health for you to have a doctor with expertise and experience with Cushing’s! Inexperienced doctors all too often misdiagnose, insult and frustrate, preventing prompt and proper diagnosis. Misdiagnosis can be lethal!

Obviously, it is also crucial for you to have a surgeon with experience in order to minimize the likelihood of errors that can lead to complications or death. Wouldn’t you prefer someone who performs the surgery 5 days per week over someone who may have done it a total of 5 times in his or her career?

On the other hand, doctors with experience are most likely to be more thorough and precise in recommending and offering the proper tests and treatments, and more aware of the subtle nuances and possible complications of the syndrome, learning from each Cushing’s patient s/he treats, to the benefit of others.

Investigate your insurance, and if necessary (and possible), change your coverage in order to be able to afford to go to doctors who are Cushing’s experts. Because Cushing’s is often caused by a tumor, some insurance (including United Health Care) covers Cushing’s related medical expenses including travel to facilities they consider “cancer centers for excellence” if you need to travel over 100 miles to these experts. United Health Care covers medical expenses with no co-pay, including travel, lodging and meals for myself and a travel companion so that I am able to afford the best medical care possible from doctors who are experienced with Cushing’s.

~ Judi

  The most important advice I have to give is this:

1) GO TO A TEACHING/RESEARCH HOSPITAL!!!

2) If you have kids, think twice before eating disorder treatment. I went into the program with pain and a method of coping. I came out with an eating disorder psyche, bad experiences, and a truckload of pills that were making me crazy.

3) IF YOU THINK YOU HAVE FOOD DEPENDANT CUSHINGS, HERE IS HOW I COPE;

• the cortisol goes up with too much of any protein, fat or carbs. I eat small turkey/cheese sandwiches at every meal (enough to be full, but well balanced).

• I use stevia instead of sugar because its natural (health food aisle.)

• alcohol really hurts now, so only a little wine occassionally.

• lots of yogurts.

• every couple days a mixture of senna laxative and stool softener (not too often)

4) Remember the squeekiest wheel gets the grease.

~ Magdalena’s bio

 
Men On the Message Boards
Sex Drive Question: Since having Cushing’s, my sex drive is next to nothing. Is this common, will this problem remain forever or get better? Is there anything that can help?

Answer: A decrease in libido or sex drive is common in patients with Cushing’s. Several factors influence a person’s sex drive.

In women, regular menstrual periods or adequate estrogen and progesterone replacement is important.

In men, if the testosterone level is low, this indicates the need for testosterone replacement. In pituitary dependent Cushing’s, once the normal pituitary gland has recovered, the adrenal glands should be producing an adequate amount of both cortisol and male hormones (important in women for sex drive).

If a woman has had 1 adrenal gland removed, the other adrenal should make an adequate amount of male hormones once the entire pituitary adrenal axis has recovered (this may take several months as well). In the situation of bilateral adrenalectomy, there is loss of adrenal male hormone production. If the ovaries are functioning normally, male hormones are also produced and this should provide an adequate amount for normal libido.

If a woman does not have normal menstrual function and requires estrogen and progesterone replacement, sometimes a small dose of testosterone is added to improve libido. A common preparation is Estratest.

~ Mary Lee Vance MD

 
Women On the Message Boards
Sex Drive Question: Since having Cushing’s, my sex drive is next to nothing. Is this common, will this problem remain forever or get better? Is there anything that can help?

Answer: A decrease in libido or sex drive is common in patients with Cushing’s. Several factors influence a person’s sex drive.

In women, regular menstrual periods or adequate estrogen and progesterone replacement is important.

In men, if the testosterone level is low, this indicates the need for testosterone replacement. In pituitary dependent Cushing’s, once the normal pituitary gland has recovered, the adrenal glands should be producing an adequate amount of both cortisol and male hormones (important in women for sex drive).

If a woman has had 1 adrenal gland removed, the other adrenal should make an adequate amount of male hormones once the entire pituitary adrenal axis has recovered (this may take several months as well). In the situation of bilateral adrenalectomy, there is loss of adrenal male hormone production. If the ovaries are functioning normally, male hormones are also produced and this should provide an adequate amount for normal libido.

If a woman does not have normal menstrual function and requires estrogen and progesterone replacement, sometimes a small dose of testosterone is added to improve libido. A common preparation is Estratest.

~ Mary Lee Vance MD

 
Children On the Message Boards

Help Yourself