Basics: Testing: Dex Tests Sunday Jun 29
Dexamethasone suppression test measures whether adrenocorticotrophic hormone (ACTH) secretion by the pituitary can be suppressed. How the Test is Performed
Home cortisol tests: 3 of the best Monday Jun 30
There are several home cortisol tests available to purchase over the counter or online. These allow a person to take a sample of blood, urine, or saliva before sending it off for analysis. After taking a home cortisol test, people can usually receive their results within 2–5 days online or via a telephone call with a healthcare professional. However, there are currently no studies investigating the reliability of these home cortisol tests. Therefore, people should follow up on their test results with a healthcare professional. Read more at https://cushings.invisionzone.com/topic/55639-home-cortisol-tests-3-of-the-best/ Treatments: Adrenalectomy and BLA (Bilateral adrenalectomy) Monday Jun 30
Some pain is normal after any surgery. Different people have different levels of sensitivity to pain. In general, you should experience a little less pain every day. Pain is usually worse in the evening when you are trying to go to sleep. Do not be afraid to take the pain medicine prescribed for you, particularly before you go to sleep, but you can stop taking it if you are comfortable. Most pain medications cause constipation and they can also cause drowsiness. Do not drive or operate power tools after you take narcotic pain medications. If you have only mild discomfort, try taking extra-strength Tylenol® as directed. https://cushings-help.com/2024/10/30/adrenalectomy-and-bla/ Cushing’s Syndrome Masquerading as Fibromyalgia: A Case Series Monday Jun 30
Three young female patients with a history of generalized body pain were diagnosed with fibromyalgia. They visited several specialities which related patients' symptoms to their previous diagnosis of fibromyalgia and were treated symptomatically. These patients developed a multitude of clinical features including fractures, hypertension, abnormal weight gain, proximal myopathic pain and bruising. They were seen by rheumatologists whose assessment was that their clinical features were not entirely due to fibromyalgia and suspected that patients have a possible underlying endocrine cause. Patients were referred to an endocrinologist for further tests with suspicion of Cushing’s syndrome. Laboratory tests and imaging confirmed a diagnosis of Cushing’s syndrome. Two of them had adrenal adenoma and one had iatrogenic corticosteroid use. These cases emphasize the need for thorough clinical evaluation for patients who are thought to have fibromyalgia. Fibromyalgia is a diagnosis of exclusion. Read more at https://cushings.invisionzone.com/topic/57756-cushing%E2%80%99s-syndrome-masquerading-as-fibromyalgia-a-case-series/
Add or update Your Bio Tuesday Jul 1
The Add Your Bio form has been updated so that it no longer requires Flash. Your information will help others.
I would like to add that if anyone would like to do something for the Cushing's Awareness Challenge but you don't have (or want to have) a blog, why not consider adding your bio to the website this month?
More info at https://cushingsbios.com/2018/08/28/we-have-a-new-bio-form/ Ectopic ACTH-secreting Pheochromocytoma Without Typical Signs of Cushing Syndrome Tuesday Jul 1
Abstract This case report describes a 42-year-old female with a rare pheochromocytoma presenting without classic Cushingoid features but with uncontrolled hypertension, type 2 diabetes, and recurrent headaches. Despite the absence of typical signs, biochemical analysis revealed elevated cortisol and ACTH levels, and imaging showed a 6 cm adrenal mass. The patient was stabilized preoperatively with alpha-blockers and metyrapone before undergoing a successful laparoscopic adrenalectomy. Histopathology confirmed pheochromocytoma with aggressive features. Postoperatively, her blood pressure and symptoms improved, and her cortisol levels normalized. This case underscores the diagnostic challenges of ACTH-secreting pheochromocytomas without classic hypercortisolism signs and emphasizes the need for thorough endocrine and imaging assessments. Surgical resection remains the definitive treatment, with long-term follow-up essential to monitor for recurrence. This case contributes to the limited literature on the coexistence of pheochromocytoma and ectopic ACTH secretion. https://cushings.invisionzone.com/topic/57818-ectopic-acth-secreting-pheochromocytoma-without-typical-signs-of-cushing-syndrome/
Basics: The Pituitary Gland: Small But Mighty Friday Jul 4
“The pituitary is commonly referred to as the ‘master’ gland because it does so many important jobs in the body,” says Karen Frankwich, MD, a board-certified endocrinologist at Mission Hospital. “Not only does the pituitary make its own hormones, but it also triggers hormone production in other glands. The pituitary is aided in its job by the hypothalamus. This part of the brain is situated above the pituitary, and sends messages to the gland on when to release or stimulate production of necessary hormones.” Read more at https://cushings.invisionzone.com/topic/56334-the-pituitary-gland-small-but-mighty/
Basics: Meds - Isturisa Saturday Jul 5
Cushing’s disease is a progressive pituitary disorder in which there is an excess of cortisol in the body. While the disease can be treated surgically, this option is not possible for all patients. This is one of the approved medications that assist in controlling cortisol levels in people with Cushing’s disease. Isturisa was approved in 2020 to treat adults with Cushing’s disease for whom pituitary surgery is ineffective or not an option. Read more at https://cushings.invisionzone.com/topic/56571-meds-isturisa/ We Thought Dad Would Be Alright But We Were Wrong Saturday Jul 5
A loving dad with ‘boundless energy and positivity’ died unexpectedly of a rare condition. Dave Whitfield was 59 when he died in December 2023. His son Archie, 23, explained that his dad had been diagnosed with several brain tumours throughout his life but they had always been treatable by doctors. This changed in early 2023 however. Another brain tumour led to Dave being diagnosed with Cushing’s syndrome, a rare condition caused by excessive cortisol in the body. Often this overproduction is due to a benign tumour in the pituitary or adrenal glands. Cortisol helps the body cope with stressful situations, as well as reducing swelling and fighting off infections. Cushing’s syndrome is also much more common in women than in men. Because of this, Archie and the wider family were taken aback about what happened to Dave. Speaking to the ECHO, Archie said: “Dad had brain tumours come and go over the last 15, 20 years. “He was always able to either get the tumour operated on or have radiotherapy to have them removed. However, a couple years ago, a tumour came back, causing Cushing's syndrome. https://cushingsbios.com/2025/04/05/pituitary-we-thought-dad-would-be-alright-but-we-were-wrong/ Cushing's Basics: What is Cortisol? Saturday Jul 5
Cortisol is a hormone which produced by the adrenal gland (cortex) to control blood sugar. The production of cortisol is triggered by the pituitary hormone ACTH. Cortisol is a glucocorticoid which stimulates an increase in blood glucose. Cortisol will also stimulate the release of amino acids from muscle tissue and fatty acids from adipose tissue. The amino acids are then converted in the liver to glucose (for use by the brain). The fatty acids can be used by skeletal muscles for energy (rather than glucose) thereby freeing up glucose for selective utilization by the brain. Cortisol levels are often measured to evaluate the function of the pituitary or adrenal glands. Some of the cortisol is metabolized by the liver to produce 17 hydroxycorticosteroids, which is then excreted in the urine. Read more at https://cushings.invisionzone.com/topic/56255-what-is-cortisol/ Basics: Workup for Incidental Pituitary Adenoma Saturday Jul 5
A 35-year-old woman is seen in the outpatient clinic for evaluation of an incidental pituitary macroadenoma. Her medical history is significant for hypertension, diabetes, hyperlipidemia, polycystic ovary syndrome, and obesity. She initially presented to the emergency department (ED) a week ago after an episode of right visual field changes that she described as waviness in her right eye and right hemibody sensory changes without motor deficits. While in the ED, she underwent a full workup for possible stroke, which was negative. Magnetic resonance imaging (MRI) of her brain without contrast revealed a 12-mm pituitary lesion; a repeat MRI with contrast was then ordered (Figure). No serum hormonal panel was available for review from ED records. Read more at https://cushings.invisionzone.com/topic/56643-workup-for-incidental-pituitary-adenoma/
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