Since you know that you have a tumor above your adrenal gland, has your endocrinologist done the very specialized tests for Cushing's Syndrome? I assume that this tumor is being watched for growth or other changes.

It is best to have an endocrinologist who is familiar with Cushing's. Unfortunately, many are not. The thyroid testing will not help with Cushing's diagnosis.

Of course, not every patient with Cushing's has all these tests, but some of the tests that help diagnose Cushing's are (click on any of the names for more information):

• BLOOD
  • 2-Hour Post-Prandial Plasma Glucose
  • Androstenedione
  • Blood Calcium (Ca+)
  • Calcium
  • Dexamethasone Suppression
  • Fasting Plasma Glucose
  • Insulin
  • Insulin Tolerance
  • Metyrapone
  • Plasma ACTH
  • Plasma Cortisol
  • Plasma Renin Activity
  • Total Carbon-Dioxide Content
• DEXAMETHOSONE TESTS
• PETROSAL SINUS SAMPLING (PSS) (for pituitary Cushing's)
• SALIVARY CORTISOL
• URINE TESTS
  • 17-Hydroxycorticosteroids (17-OHCS)
  • 17-Ketogenic Steroids (17-KGS)
  • 24 Hour Urine
  • Free Cortisol (UFC)
  • High Cortisol
  • Potassium

Directions for the Twenty-four Hour Urine Test Physicians have always relied upon analysis of urine specimens in order to diagnosis and treat many disease processes. Twenty-four hour urine collections are often employed to estimate the production rates of various hormones. The accuracy of test results depends entirely on the accuracy of the urine collection technique. These instructions are provided as a guide to ensure that your 24-hour urine collection is obtained in a manner that will permit reliance upon the test results.

You should collect every drop of your urine produced during a 24-hour period. You should begin the collection in the morning or else at a time specified by your physician. At that time, pass your urine, flush it down the toilet, and note the exact time. These measures permit you to start with an empty bladder and an empty collection bottle. Thereafter, collect every single drop of urine during the day and following night. The very next morning, exactly 24 hours from the start time, you should empty your bladder and add that urine to the collection bottle. This will complete the collection. There should be no more than a 5 or 10 minute variation between the start and stop time. If you find that you must urinate an hour or so before the appointed time, go ahead and do so, then drink a full glass of water so that you could urinate again at the time to end the collection.

Urine samples should be collected in a large cup or other container and then poured into the large bottle. Do not try to urinate directly into the bottle. Void urine prior to bowel movements in order to avoid losing urine that might normally be passed during a bowel movement.

Some patients are asked to collect more than one consecutive 24-hour urine sample. If that is the case, you should complete the first collection as instructed. Then, begin the second collection by adding any urine made in the next 24-hours to the second bottle. You should not discard any urine when starting the second or any subsequent collections. Simply change bottles at the stop and start times after adding that last sample required to complete the previous collection.

The bottles for some tests contain a weak acid as a preservative. Do not discard the acid. If you accidentally get acid or urine from the bottle on your skin or clothing, rinse the effected area immediately with plenty of cold water. Collection bottles must be refrigerated. This is best accomplished by using an ice chest, cooler, or if so inclined, your refrigerator.

If you forget to collect all of the urine or perform the test improperly, discard the specimen and start again on another day. If the bottle contained an acid preservative, you will need to obtain a new bottle from the laboratory or your physician's office. Otherwise, you may reuse the bottle after rinsing it with distilled water.

There are several types of Dexamethosone Suppression Tests, but all involve precise timing, both in thaking the dsxamethosone and in the blood draw. Some types of this test also incorporate urine collection. Please check with your endocrinologist to determine exactly what must be done, and at what time.

Adrenal Insufficiency is also known as Addison's Disease.

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.

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