Cushing’s disease best treated by endocrinologist

Dear Dr. Roach: I was told that I have Cushing’s disease, which has caused diabetes, high blood pressure, hunger, weight gain and muscle loss. I was never sick before this, and I did not have any of those things. I am told I have a tumor on my right adrenal gland. I have been to numerous doctors, but most have not been too helpful. They seem to try to treat the diabetes or blood pressure, but nothing else. They seem not to be familiar with Cushing’s. I tell them which medication works, but they still give me new medication. I have an endocrinologist and am scheduled to meet a urologist.

I have managed to go to physical therapy, exercise every day and lose over 50 pounds. I am not happy with the advice I’m getting. I was told that surgery to remove the tumor will fix everything, but that I would need to take steroids for either a short term or for life. My body is already making too much cortisol. I have 50 more pounds to lose. I work hard to keep the weight down. I feel like a science experiment. Within a week, I have had three different medications. I could not tell which was causing the side effects and making me dehydrated. I am not sure surgery is right for me, because they said it can be done laparoscopically, but if they can’t do it that way, they will have to cut me all the way across, which may take a long time to heal and may get infected.

Do you know what tests will confirm the diagnosis? Would surgery fix all these problems? I had the 24-hour urine test, the saliva test and blood tests. I want to know if it may be something else instead of Cushing’s. I’m not on anything for the high cortisol levels.

– A.L.

A: It sounds very much like you have Cushing’s syndrome, which is caused by excess cortisone, a hormone that has many effects. It is called Cushing’s disease when the underlying cause is a pituitary tumor that causes the adrenal gland to make excess cortisone. (Cortisone and cortisol are different names for the same chemical, also called a glucocorticoid.) Cushing’s syndrome also may be caused by an adenoma (benign tumor) of the adrenal gland, which sounds like the case in you.

The high amounts of cortisone produced by the adrenal tumor cause high blood pressure, glucose intolerance or frank diabetes, increased hunger, obesity (especially of the abdomen – large bellies and skinny limbs are classic), dark-colored striae (stretch marks), easy bruising, a reddish face and often weakness of arm and leg muscles. When full-blown, the syndrome is easy to spot, but many people don’t have all the characteristics, especially early in the course of the disease.

Your endocrinologist is the expert in diagnosis and management, and has done most of the tests. I am somewhat surprised that you haven’t yet seen a surgeon to have the tumor removed. Once it is removed, the body quickly starts to return to normal, although losing the weight can be a problem for many.

I have seen cases in my training where, despite many tests, the diagnosis was still uncertain. The endocrinologist orders a test where the blood is sampled from both adrenal veins (which contain the blood that leaves the adrenal glands on top of the kidneys). If the adrenal vein on the side of the tumor has much more cortisone than the opposite side, the diagnosis is certain.

By DR. KEITH ROACH For the Herald & Review at http://herald-review.com/news/opinion/editorial/columnists/roach/dr-roach-cushing-s-disease-best-treated-by-endocrinologist/article_38e71835-464d-5946-aa9c-4cb1366bcee3.html

Does Coffee Trigger Cortisol Release?

coffee-prescription

 

Cortisol is the infamous hormone you release when you’re stressed. In high doses it inhibits brain function, slows metabolism, breaks down muscle, and increases blood pressure. Have you ever felt panicked before a public speech and forgotten everything you were going to say? That’s what a big bump in cortisol feels like. And if you’re looking for stress relief, lowering cortisol helps.

Cortisol isn’t all bad, though. In fact, it’s necessary for you to function. Cortisol peaks in the morning, helping to wake you up, and it can be a useful as an indicator of strain, letting you know when to slow down or stop something that’s stressing you out. Cortisol also decreases inflammation – that’s part of the reason your body releases it in response to, for example, a workout that tears your muscle tissue.

Low cortisol is an issue, too. Insufficient cortisol can leave you feeling tired, emotional, and anxious. As long as you avoid chronically elevated or depleted cortisol you can make the little hormone work to your advantage.

A common argument against drinking coffee is that it triggers cortisol release, but (forgive us for getting nitpicky) that may not be true. Caffeine definitely triggers cortisol release. In fact, the increase in cortisol is part of the reason caffeine makes you feel more alert.

Remember a few paragraphs ago, when we were talking about how you build a tolerance to some of caffeine’s effects but not others? Cortisol release is one of the effects to which you build tolerance. If you only take caffeine now and then, it causes a big boost in cortisol. But if you get caffeine daily (by drinking coffee every morning, for example) your body tempers the cortisol response. You still release cortisol, but not enough to worry about unless your cortisol is already out of whack.

Does coffee itself (separate from caffeine) cause cortisol release? Mycotoxins do, at least in mice, and they cause inflammation (a common trigger of cortisol release) in humans. It’s difficult to say whether mold-free coffee increases cortisol.

Regardless, studies suggest that cortisol release from caffeine is mild if you drink it daily. For most of us, that little bump shouldn’t be a problem.

From https://www.yahoo.com/health/caffeine-and-cortisol-does-coffee-1276507994071094.html

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