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Welcome to the new Cushing's Help and Support FAQ (frequently asked questions) page. This new area will be a compilation of our visitors most frequent questions. Questions and answers are still being added.

Please select either a category on the left, or type in a keyword to search the database of questions and answers. Please note that there are several questions waiting to be answered at this time. Your question will be answered as soon as possible. If your question is very urgent, you might want to check the message boards to see if your question has been answered, or add it yourself.

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.



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  • Hi. I'm a nursing student and I recently had a male patient, 64 yrs. old, who is diagnosed with Diabetes Mellitus type 1, obesity, hypertension, a right below-the-knee amputation due to osteomyelitis, depression, chronic renal insufficiency, and a few other things, including poor wound healing. He has the typical Cushing's body type and the buffalo hump. He has no striae on his abdomen. I only had him as a patient for one day, and when I was thinking about him later, I was wondering how one would be able to tell (without a blood test for cortisol level) the difference between a pt with DM, hypertension, obesity, who never exercises (would account for the thin arms and legs) and a pt with Cushing's.

    Answers from the Message Boards:

    Deb, there is NO way to tell the difference without the biochemical testing, including cortisol. However, it must be more than one cortisol sample, it must be done at e proper times of day, and it must be done enough to see if he has the cyclical version of Cushing's. People don't get wasting arms/legs with obesity normally. They don't get buffalo humps for many reasons, and Cushing's is the main one. So, I suspect this poor man has probably had it for a long, long time.

    Kudos to you for recognizing that!! I hope you'll join us and get to know more about this disease. Not many doctors even know a lot about it.
    Deb, good for you for looking for more information. Like Robin said, there isn't much to tell without further testing. And further some doctors seem to be convinced that cushing's is so rare that they'll never see it... so in the "don't look for zebra's" theory it's not worth investigating.

    But the thin arms and legs that are seen in cushings patients are not from lack of exercise, it's from centripital obesity that does not extend to the extremities. And not all patients with cushings develop all the typical S/S.

    There can be multiple causes for chronic real insufficiency and in his case, esp. if the DM is not well controlled (what was his HbA1c?), can lead to damage to the kidneys. In this case that is something that the MDs might have looked into the pathology of.

    Osteo is serious stuff that (duh) does not develop overnight. My experience is that when you see it you've either got negligent doctors or non-compliant patients. A case that stands out in my mind was a non-healing surgical wound that the idiot with the M.D. after their name attempted to re-suture some 4 or 5 times before referring the patient to a specialist (and by then it was too late, she was going to loose a good portion of the foot).

    There is some crossover in symptoms with patients who have DM and undx Cushings Disease. It's more common to see type 2 diabetes in CD due to insulin resistance secondary to the elevated levels of cortisol (same reason that diabetics have to watch their sugar levels when they're under stress). IF someone went long enough with type 2 it is possible for the pancreas to just give up on insulin production.

    Endocrine based problems are complex and it's amazing the numbers of doctors that have no interest in things that they don't understand. Cushings is also not a lucrative diagnosis, but having to see a patient for constant follow-up for the affiliated syndromes (HTN, DM, Depression etc..) can be. It's truly sad the number of private practice physicians that consider that.

    Never forget that people that are hospitalized today are the sickest of the sick, and if they're there they deserve to have all avenues explored if they're not getting better.

    You're asking good questions and doing critical thinking which shows that you are thinking like a patient advocate should. Good luck in nursing school... keep asking the hard questions.

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  • What does Cushing's Syndrome have to do with kidney function? I have had 5 stones (uric acid) since the first of the year. I have just been diagnosed with Cushing's and I'm not sure if the Cushing's is causing the problem. Thanks!

    Cushing's syndrome patients have high glucocorticoid production. This glucocorticoid product causes your body to dissolve your bone. Your bone is made of calcium. Calcium is excreted in the urine and is available in the urine to form stones. Because of your Cushing's, you are at high risk for osteoporosis.

    Cushings is not common but other causes of kidneys stones are. Please try to see a urologist for a metabolic stone work-up. This should give you and your doctor the information to help prevent future stone formation.

    For now, remember to drink enough water to keep your urine the color of water. When your urine is yellow you are forming more stones.

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  • How are FMS and Cushing's related?

    They aren't related, although some of the symptoms may be the same. It is possible to have both conditions, so if you think that you have one or both, you should talk to your doctor. Usually it takes a knowlegeable endocrinologist to diagnose and treat Cushing's disease. The Cushing's Checklist includes many of the possible symptoms of Cushing's and some of FMS, so you can see how they relate. Also, some members of the Cushing's Help Message Boards have FMS, if you're interested in reading about their experiences. Best of luck to you and talk to your doctor about your concerns.

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  • My doctor thinks that I might have Fibromyalgia and not Cushing's after all. What are the symptoms of that?

    These are some of the symptoms of Fibromyalgia:
    • Widespread pain and muscle stiffness, especially on waking
    • Feeling of swollen extremities
    • Nonrestorative sleep; waking feeling unrefreshed or more tired than before sleep
    • Irritable bladder syndrome, characterized by frequent and/or painful urination and low abdominal discomfort in the absence of infection
    • Irritable bowel syndrome, characterized by painless diarrhea, constipation, bloating or hypersensitivity
    • Numbness or tingling in arms or legs
    • Chest pain that is not cardiac-related, such as pain in the cartilage or muscles
    • Dry eyes and mouth
    • Cognitive problems, such as difficulty concentrating or remembering
    See the Checklist of Symptoms to compare how these Fibromyalgia symptoms relate to Cushing's and other diseases.

    Note: All of these symptoms can be indicative of other problems, so it is important to consult with your doctor and avoid self-diagnosis.

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  • What are the symptoms of a pheochromocytoma?

    The most prominent symptom of a pheochromocytoma is high blood pressure, which may be very severe. In about 50 percent of the people, the high blood pressure is persistent. In the rest, the high blood pressure and other symptoms come and go, sometimes triggered by pressure on the tumor, massage, medication (especially anesthesia and beta-blocking drugs), emotional trauma, and on rare occasions the simple act of urination. Other symptoms include any or all of the following: a fast and pounding heart rate, excessive sweating, light-headedness when standing, rapid breathing, flushing, cold and clammy skin, severe headaches, chest and stomach pain, nausea, vomiting, visual disturbances, tingling fingers, constipation, and an odd sense of impending doom. When these symptoms appear suddenly and forcefully, they can feel like a panic attack.

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  • I think I might have Adult GH deficiency syndrome. Can you tell me more about it?

    I think I might have Adult GH deficiency syndrome. Can you tell me more about it? There are three components to the adult GH deficiency syndrome. These are body composition changes, blood lipid (cholesterol and fat) changes, and psychological changes. Because GH maintains muscle and fat, loss of this hormone results in a decrease in muscle and in an accumulation of fat. The decrease in muscle translates to poor muscle function and decreased exercise capacity. The increase in fat occurs under the skin, but also in the abdomen or, more specifically, inside the abdomen. This location is referred to as visceral fat. Medical science has discovered that visceral fat accumulation is especially dangerous because it is associated with an increase in the aging of blood vessels, referred to as atherosclerosis. The blood lipid changes reflect the fat deposit changes and are all in the wrong direction. More specifically, there is an increase in the "bad" cholesterol ("LDL cholesterol") and a decrease in the "good" cholesterol ("HDL cholesterol"). There is also an increase in the blood triglycerides, another circulating fat, which is associated with blood vessel aging.

    The psychological changes associated with GH deficiency have been extensively studied. Patients who develop GH deficiency seem to lose energy. Loss of energy is often the guiding symptom which prompts further investigation. Many individuals with pituitary disease, especially those with other hormone deficiencies, realize that something is missing. Frequently, it turns out to be a deficiency of GH. Individuals with this problem, or their spouses, also notice a loss of interest in their usual hobbies or activities. A decrease in sociability referred to as social isolation is another symptom. Patients suffering with this symptom do not like to go out and meet with their friends or social acquaintances. Patients may also develop mild depression or decrease in sexual function.

    HGH deficiency shares MANY of the same symptoms of Cushing's. A decrease in the level of growth hormone in adults may result in:

    • weakened heart muscle contraction and heart rate
    • increased arterial plaque and blood pressure
    • elevated lipids or fats in the blood:
    • cholesterol
    • low density lipoproteins (LDL)
    • triglycerides
    • decreased exercise capacity due to decreased cardiac output
    • decreased energy due to decreased metabolic rate
    • abnormal body composition:
      • increased abdominal obesity (waist to hip ratio)
      • decreased bone density due to decreased synthesis of bone
      • increase in fractures and osteoporosis
      • decreased muscle strength and muscle size
      • decreased lean body mass
      • increased fat mass
    • problem with sleep quality
    • decreased social contact
    • symptoms of low blood sugar:
      • weakness or tiredness
      • headaches
      • poor concentration or memory

    From GH Deficiency

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  • What are the symptoms of empty sella syndrome?

    Each individual may experience symptoms differently. Besides high fluid pressure in the skull, which occurs in about 10 percent of patients, another symptom is a chronically runny nose.

    The symptoms of empty sella syndrome may resemble other conditions or medical problems. Consult a physician for diagnosis.

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  • What are the symptoms of a pituitary tumor?

    This depends on the type of tumor and the size of the tumor. A large tumor may cause loss of vision, particularly peripheral vision, if it compresses the optic chiasm (where the optic [eye] nerves converge). Headache may also occur; the type of headache varies from patient to patient. Headache may occur with a large or a small tumor. A tumor may interfere with normal pituitary function causing hypothyroidism (low thyroid hormone level), adrenal insufficiency (low cortisol level), hypogonadism (loss of sexual function in men, loss of menstrual periods or infertility in women). Occasionally a pituitary tumor causes diabetes insipidus, which results in frequent urination and excessive thirst. Diabetes insipidus is not high blood sugar levels; it is a problem with the ability of the kidney to retain fluid because of a deficiency of the pituitary hormone, vasopressin (also called antidieuretic hormone).

    Specific types of tumors cause various symptoms and changes in body function.

    Prolactinoma: most commonly causes loss of sexual function and infertility in men. Men may also have enlargement of the breasts. In women of reproductive age a prolactin producing tumor may cause milk in the breasts, a change in menstrual periods or loss of menses or infertility. Women who have gone through menopause do not have a change in menstrual periods to signal the problem; in this situation, headache and loss of vision may be the first indicator of a prolactinoma.

    Cushing's: The term "Cushing's Disease" refers to the overproduction of cortisol by the adrenal glands caused by a pituitary tumor producing an excessive amount of the hormone, ACTH. Dr. Harvey Cushing, a neurosurgeon, first described this condition. Excessive cortisol production causes weight gain (particularly in the abdomen and neck), loss of muscle mass (legs, arms) and muscle weakness, depression, thinning of the skin with easy bruising, hypertension, diabetes mellitus, loss of calcium from the bones (osteoporosis) with a risk for bone fractures and weakening of the immune system with a higher risk of developing infections.

    TSH Secreting Tumor: This is the least common type of hormone-producing pituitary tumor. Excessive TSH stimulates the thyroid gland to produce an excessive amount of thyroid hormone (hyperthyroidism). Symptoms of hyperthyroidism include weight loss, nervousness, rapid heart beat, difficulty sleeping, frequent bowel movements and in women, scant menstrual periods.

    Non Secretory Tumor: This refers to a tumor that does not produce an excessive amount of a pituitary hormone. This type of tumor most commonly causes sexual dysfunction in men and loss of regular menses in premenopausal women. This type of tumor is usually detected after it has become a large tumor causing loss of vision and/or headache and/or hypothyroidism or adrenal insufficiency.

    Craniopharyngioma/Rathke's Cleft Cyst: These tumors are congenital - a defect in the development of the pituitary gland which is present at birth but may not cause a problem until adulthood. This is not a malignant (cancerous) tumor but it may interfere with normal pituitary function causing hypopituitarism. These tumors may also cause diabetes insipidus, frequent urination and excessive thirst.

    Pituitary Cyst: Any endocrine gland may develop a cyst. This occurs commonly in the ovaries and thyroid gland; cysts are benign but cause problems because of enlargement causing headache and interference with normal pituitary function. Most common symptoms are headache and, if the cyst is large, loss of vision and loss of normal pituitary function.

    The answer to this question about pituitary tumors was developed by Mary Lee Vance, M.D., Professor of Medicine and Neurosurgery at the University of Virginia. Dr. Vance is an endocrinologist specializing in the treatment of pituitary diseases.

    For more information from Dr Vance, see Pituitary Tumors Frequently Asked Questions

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  • What are the symptoms of craniopharyngioma?

    The symptoms produced by a craniopharyngioma vary depending upon the tumor's location. If it compresses the pituitary stalk or involves the area of the pituitary gland itself, the tumor can cause partial or complete pituitary hormone deficiency. This frequently results in one or more of the following: growth failure, delayed puberty, loss of normal menstrual function or sexual desire, increased sensitivity to cold, fatigue, constipation, dry skin, nausea, low blood pressure, and depression.

    Pituitary stalk compression can also cause diabetes insipidus and may increase prolactin levels causing a milky discharge from the breast (galactohhrea). If the craniopharyngioma involves the optic tracts, chiasm, or nerves, then visual disturbances can result. Involvement of the hypothalamus, an area at the base of the brain, may result in obesity, increased drowsiness, temperature regulation abnormalities, and diabetes insipidus (DI). Other common symptoms include personality changes, headache, confusion, and vomiting.

    More information on craniopharyngioma is available at Other Pituitary Tumors.

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  • What are the symptoms of the various types of pituitary tumors?

    This depends on the type of tumor and the size of the tumor. A large tumor may cause loss of vision, particularly peripheral vision, if it compresses the optic chiasm (where the optic [eye] nerves converge). Headache may also occur; the type of headache varies from patient to patient. Headache may occur with a large or a small tumor. A tumor may interfere with normal pituitary function causing hypothyroidism (low thyroid hormone level), adrenal insufficiency (low cortisol level), hypogonadism (loss of sexual function in men, loss of menstrual periods or infertility in women). Occasionally a pituitary tumor causes diabetes insipidus, which results in frequent urination and excessive thirst. Diabetes insipidus is not high blood sugar levels; it is a problem with the ability of the kidney to retain fluid because of a deficiency of the pituitary hormone, vasopressin (also called antidieuretic hormone).

    Specific types of tumors cause various symptoms and changes in body function.

    Prolactinoma: most commonly causes loss of sexual function and infertility in men. Men may also have enlargement of the breasts. In women of reproductive age a prolactin producing tumor may cause milk in the breasts, a change in menstrual periods or loss of menses or infertility. Women who have gone through menopause do not have a change in menstrual periods to signal the problem; in this situation, headache and loss of vision may be the first indicator of a prolactinoma.

    Cushing's: The term "Cushing's Disease" refers to the overproduction of cortisol by the adrenal glands caused by a pituitary tumor producing an excessive amount of the hormone, ACTH. Dr. Harvey Cushing, a neurosurgeon, first described this condition. Excessive cortisol production causes weight gain (particularly in the abdomen and neck), loss of muscle mass (legs, arms) and muscle weakness, depression, thinning of the skin with easy bruising, hypertension, diabetes mellitus, loss of calcium from the bones (osteoporosis) with a risk for bone fractures and weakening of the immune system with a higher risk of developing infections.

    TSH Secreting Tumor: This is the least common type of hormone-producing pituitary tumor. Excessive TSH stimulates the thyroid gland to produce an excessive amount of thyroid hormone (hyperthyroidism). Symptoms of hyperthyroidism include weight loss, nervousness, rapid heart beat, difficulty sleeping, frequent bowel movements and in women, scant menstrual periods.

    Non Secretory Tumor: This refers to a tumor that does not produce an excessive amount of a pituitary hormone. This type of tumor most commonly causes sexual dysfunction in men and loss of regular menses in premenopausal women. This type of tumor is usually detected after it has become a large tumor causing loss of vision and/or headache and/or hypothyroidism or adrenal insufficiency.

    Craniopharyngioma/Rathke's Cleft Cyst: These tumors are congenital - a defect in the development of the pituitary gland which is present at birth but may not cause a problem until adulthood. This is not a malignant (cancerous) tumor but it may interfere with normal pituitary function causing hypopituitarism. These tumors may also cause diabetes insipidus, frequent urination and excessive thirst.

    Pituitary Cyst: Any endocrine gland may develop a cyst. This occurs commonly in the ovaries and thyroid gland; cysts are benign but cause problems because of enlargement causing headache and interference with normal pituitary function. Most common symptoms are headache and, if the cyst is large, loss of vision and loss of normal pituitary function.

    The answer to this question about pituitary tumors was developed by Mary Lee Vance, M.D., Professor of Medicine and Neurosurgery at the University of Virginia. Dr. Vance is an endocrinologist specializing in the treatment of pituitary diseases.

    For more information from Dr Vance, see Pituitary Tumors Frequently Asked Questions

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