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Forum Name: Endocrinology Topics

Question: Hypercortisolism but not Cushings?


 lalique - Sat Jun 02, 2007 6:20 pm

My daughter is 20, with no past surgeries, taking only Lutera birth control pills to keep her having periods. Without them, they stop. Recent visit with our famliy dr. brought up several symptoms that were indicative of Cushings, ie, weight gain, moon face, buffalo hump, irregular menstrual, moodiness, acne, fatty neck, hyperpigmentation around neck, on knuckes and underarms and stretch marks that began around age 11. This child did have spondylosis and spondolysthesis that fused with a year of being braced at age 11 also. The doctor ordered a 24 hour free cortisol test...result was 112. ACTH level was 87. Referred to endocrinologist who ordered a three day dex suppresion test. Day one, 81.5, at the end of day 3, it was 12. Abdominal CT scan, lung base and Brain/Pituitary MRI were unremarkable. The endocrinologist said she has hypercortisolism but not Cushings and says there is nothing that can be done until a tumor begins to show. Is that right? I wonder if he has done all the tests he could to pin this down better. Are there other possible causes we should be looking for? Sitting and waiting for it to get worse while the high cortisol levels could cause other problems just doesn't seem to be the right thing to do.
 Dr. Chan Lowe - Wed Jul 11, 2007 9:18 pm

User avatar The terminology of this condition can be confusing. Hypercortisolism is basically synonymous with "Cushing Syndrome". This is not the same thing as Cushing Disease. Cushing Disease is hypercortisolism from a pituitary adenoma.

Based on her symptoms, she may very well have Cushing syndrome. Based on the ACTH suppression test, MRI and her other tests she does not have Cushing Disease. Her 24 hour cortisol level is really inconclusive. Her being on an estrogen regimen can elevate her cortisol level also making the borderline result even more inconclusive.

I would recommend her adrenal glands be evaluated if they have not yet been.

There are several medications that can be used to help inhibit cortisol production. However, given her borderline status I understand the hesitancy of her endocrinologist to put her on such a medicine. Too low levels of cortisol can be quite dangerous as well.

You may want to get a second opinion simply for a fresh look at her case. Sometimes this can be quite helpful and should not be viewed as mistrust of your first doctor.

Best wishes.

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