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Peggy (concerned for spouse), Pituitary and Adrenal Bio

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I’m married to my best friend who’s health has steadily declined for around 15 years.  High Blood Pressure, Diabetes, weigt gain, mood change are part of the decline.

He had a pituitary tumor removed in May 2012 after a diagnosis of Cushings.  We know that he still has an adrenal tumor that the endocrinologist thinks was fed by the pituitary tumor.

My husband, my best friend, thinks they have ruined him forever.  He feels worse than ever before.  The doctors say it may take up to a year, that this has been coming on for a long time.  His blood pressure is now controlled and he has gone from 12 blood pressure pills a day down to 2 1/2 pills per day.  Other that that, he has a poor quality of life with no energy, no happiness.

I wish I knew more and could help and support him better.  I am the fixer in our life, our family, our business that we have worked in together for 10 years and I’m so sad for him.

Diana B (Diana Brown), Undiagnosed Bio

4 Comments

Hi, My name is Diana. I have been sick for over two years now.

I have had kidney stones for the last 2 1/2 years, constantly passing them and have had three surgeries related to that.I still have seven stones left in both kidneys total. I didn’t feel well after the second surgery, and never recovered from the third which was last August. I have been to 3 urologists, thinking it was a urological problem. They all told me it was not connected to my stone problem.

I have been to two nephrologists and two endocrinologists and a cardiologist along with my Primary Care. The second nephrologist told me he knew what my problem was, Cushing’s Syndrome. That was when I went to my second endocrinologist because my own endo wasn’t on the same page, however she did no further testing and at first told me she thought I was borderline cushing’s followed by a phone call telling me she didn’t think I had it.

I have an adrenal adenoma in my left adrenal gland.I am going to see Dr. Theodore Friedman next month.

Here are my symptoms:

Easily out of breath (don’t know what you call the meter the doctors use to measure your oxygen but my oxygen is low on that meter)

Recently diagnosed with pre diabetes with random high glucose readings but did not test positive for Diabetes with a Glucose Tolerance Test

Tachycardia (never had this before getting ill) that wakes me up in the middle of the night, this started after my third surgery

Extreme fatigue/ as tired when I get up as when I go to bed.

Muscle weakness with any exertion, especially going up stairs and most days just walking across the room

Pallor

low grade fever on and off

blood pressure that fluctuates between 97/67 to 136/84 was always low and has increased frequently

Rising cholesterol over the last couple of years with no change in diet

Right flank pain

Low back pain

Burning pain in upper buttocks and upper back thighs

Stomach and groin pain

Extreme hip pain

Shaky and fine tremor in hands and sometimes my head also shakes

Mildly elevated cortisol (24hr urine cortisol test)

Have been diagnosed with osteopenia in the past

Hashimoto’s

I break out with clammy/flushing skin sometimes during the day but mostly at night.

Cannot tolerate carbohydrates (not for many years) /have many food intolerances

Easy bruising

So, that’s pretty much it. Thank you for letting me join!

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Deborah S, Undiagnosed Bio

6 Comments

undiagnosed

 

Hello all,

I do not know where to begin. For many years I have been struggling with these symptoms. I have proximal weakness, intolerance to stress, blood pressure fluctuations, hyperpigmentation, reactive hypoglycemia, sweating, severe dehydration, very bad confusion, vision, memory problems, physical body changes (hump, bruises), carb intolerance, and inability to exercise.

My endocrinologist did a workup for Cushing’s disease and the midnight saliva test was high. She brushed it off as “stress”. I am seeing a doctor now that says I have POTS and Dysautonomia. My doctor says I have inappropriate adrenaline rushes.

My body is falling apart because I haven’t found a doctor who will take my symptoms and test results serious. I would like to talk to others who are having trouble getting diagnosed and also to those who have gotten diagnosed who have a good doctor.

God Bless and Thank You,
Deborah

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Barbara S, Steroid Use Bio

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Have been experiencing symtoms since mid90s. Spent almost four years on high doses of steroids for brain tumor, snd diffilculty being weaned off.

Midsection has continued to grow,blood pressure and glucose levels have risen. Upper body muscle has all but disappeared, have the hump on back of neck. Developing facial hair, have lost upper body muscle

No answers till endocrinologist recently!

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Erica (Ericaop), Undiagnosed Bio

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golden-oldie

 

I am 33 years old and at the age of 17 I had a sudden onset of weight gain during my senior year of high school. I was a size 8 and graduated wearing a size 18. My weight was mainly in my face and my stomach. My legs were small so my pants would be big in the leg but I needed a large waistline. I began taking birth control & thought it was a side effect from that.

I stopped having my period completely when I went to college & doctors said it was stress & I just needed to diet & excercise. I never ate alot and was a normal active teen. over the last 15 years I have been treated for blood pressure, water retention, high cholesterol and symptoms of PCOS.

In 2003 I was sent to an endocrinologist for suspected metabollic syndrome (syndrome X) that was ruled out & after an ultrasound of my thyroid I was told I had an enlarged thyroid & was treated for hypothyroidism. I quit my job & moved to another city to return to college loosing my health insurance & so I was back at the University health center. Blood tests showed my TSH levels & malehormone levels to be fine so they would not continue to treat me for the thyroid issue. Just cholesterol & sent me to a nutritionist.

After graduating & moving to GA, I went to see a new doctor and went through my history to be told the same, my levels are normal. Because my insurance does not require a referral & knowing I had a previous diagnosis of hypothyroidism I scheduled an appointment with an endocrinologist. My firstvisit wasn’t with him but with his PA in which I went over my long drawn out history. Blood work was done & upon seeing him on the second visit I was told the same, my levels are normal & I havehigh cholesterol so he treated me for that. It wasn’t until I stressed to him that I had been on cholesterol medication until the previous endocrinolgist did the ultrasound and took me off of it & said the thyroid medication would take care of it that he said he would send me for an ultrasound. The ultrasound revealed small nodules, that were not there in 2003, but he says are too smallto be concerned with & he will check them in 6 months to see if they have grown, other than that I’m fine. I know this is not the case. I watch what I eat, I excercise for 2 hours 5 to 6 days a week & cannot loose any weight. I am frustrated & am noticing increases bouts of depression where I can’t control my emotions one day & the next I’m fine. I am always exhausted, and after excercising I need a nap, I thought excercise was supposed to give you energy.

I was just about to give up & begin to reconcile that its just me & I’m crazy as the doctors want me to think until two weeks ago I saw an episode of TLC’s Mystery Diagnosis where this woman was basically telling my story of the sudden weight gain & other symptoms & how she basically self diagnosed herself with Cushing’s Syndrome & went to an endocrinologist who confirmed it & she had surgery to remove a tumor. When I heard this, I knew this had to be it, but am wondering why my endocrinologist never mentioned this disease or tested me for it. I really do not like his lack of concern and care so I called another office to schedule an appointment which I cannot get until September 1st.

After doing further research I decided I really want to see someone who is knowledgeable about Cushing’s so I found the Pituitary center at Emory University hospital in Atlanta. I called today for an appointment & was asked my diagnosis. I told her I don’t have one yet, I was seeking a consultation for a diagnosis of suspected Cushings. She asked who my doctor was and about MRI results. I told her I haven’t had an MRI and that my doctor never did a cortisol test or any urine tests just only non fasting blood work. She told me to have my labs sent to them & that they would review them & call me to schedule an appointment. I faxed both my regular doctor & my endocrinologist a request for my records to be sent to this lady’s attention. I am scared that my labs will not show anything to warrant an appointment & I don’t know where to go from here.

I don’t have the money or time I feel to continue to wait months for an appointment to get an accurate diagnosis.

Does anyone out there have any suggestions on what I should do?

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Lisa (Lisa), Undiagnosed Bio

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undiagnosed4

 

44 yo female
have been overweight for a while
always fatigue, muscle aches, pain/joint all I related to weight
only history is hypothyroid been on synthroid since 15ish
recently had UTI that was resistant to lots of abx then developed a bronchitis to pneumonia
then the UTI came back was on prednisone at start of pneumonia for 14 days then developed pain in left side and arm cardiac negative and high blood pressure out of blue
been worked up for carcinoid syndrome – neg
VMA and metanephrine – Neg
Lupus – neg
they have no idea why bp so high all of sudden i have palp with it
always notice muscle weakness I never have any strength
extremities tingle at times
but face has had horrible red butterfly redness dr doesn’t like
now wants me to be worked for cushing going to do 24 urine tomorrow
but i have had ct scans of abd and chest and one ct angio of chest showed a tiny tiny adenoma on left adrenal gland the radiologist said so small that they may not even comment on it
i do have the fat in neck/ shoulder/back
i just feel off not myself almost shaky inside i have no desire to do any activity although i know i need to

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Neale O (NealeO), Pituitary Bio

2 Comments

pituitary-gland

 

I was diagnosed with Cushings Disease in September of 2015.

I used to be skinny. I was 160 lbs dripping wet. I had a thin face and exercised regularly. In fact, up until 2 years ago, I was doing CrossFit every morning at 5AM, and was pretty good at it!

I guess about 5-6 years ago, I started putting on weight. It started with what I thought was just a beer belly. I was dating a great girl and we went out a lot to eat and drink. I figured I was just getting fat and happy. Fast forward (got married to her) and we started to live our lives together. One day (2012) I was going in for a routine physical and was going over some things with my PCP. He suggested we do a finger prick to check my Glucose levels. The sample showed a 567. He was astonished, and immediately admitted me to the hospital. I ended up taking 5 IV bags as I was severely dehydrated. My PCP then schedule me in for the next day so that he could tell me I had Type 2 Diabetes (runs in family). They started me on drugs and insulin injections. So there I was, being treated for Diabetes (the Sugars as they call them) and High Blood Pressure (HBP).

This went on for a while and my wife and I decided to moved to Florida. In the mean time my undiagnosed Cushings was starting to rear it’s ugly head. Big belly, stretch marks, limb atrophy, fatigue, major depression, reduced libido, moon-pie face, thin skin and bruising easily. The depression caused a lot of issues with my marriage and we ended up getting a divorce. I moved back to Baltimore for support from my family.

I worked at my uncles shop for about a year, then was offered a new job with a great company and I jumped at the chance. By this time, the atrophy in my legs had started to really take effect. The job ended up being too physical for me and I had to resign after 1 one month.

I decided to see a new PCP as I was not happy with my previous one. Within the first 20 minutes of our initial consult, she recognized the Cushings symptoms and quickly referred me to the Endo Department (Dr. Taylor) at Mercy Medical. She had me do a bunch of blood work and urine tests. The cortisol numbers were off the charts.

She then referred me to Dr. Salvatori at John’s Hopkins Hospital (JHH). I was very lucky as she got me in there quickly. After speaking with him, he thought I had a Pituitary adenoma based on the crazy ACTH levels. We did and MRI, and an IPSS. The IPSS showed it was secreting from the right side mostly. The left had some high numbers, but nothing like the other side. In the MRI, they could not see the tumor.

Dr. Salvatori suggested on more thing before resorting to surgery. I am to have a “wet MRI” in January., 2016 This should give a much clearer scan. He also started me on Ketoconozale.

This is all happening very fast (diagnosed Sept 2015), and I am looking forward to the upcoming treatments.

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J Stone (J Stone), Pituitary Bio

1 Comment

 

Hi. I’ve been diagnosed with Cushings Disease since 2010.

My journey started in 2009: weight gain, headaches,high blood pressure, mood changes, insomnia every symptom except stretch marks.

I was in nursing school at the time, worked full time as well. I just started to feel “not right” I knew something was wrong, even mentioned all my symptoms to my nursing instructor and she said “ do you have Cushings?” Those words changed my life.

I started researching Everthing! I became obsessed. I started to visit my GP. The answer “you’re old and fat and need to diet” I was 42. Then it became “you’re premenopausal and fat” eat less, exercise more. I had been eating very well and was as active as I could be. He kept telling me the same thing for the 6months I kept going back to the MD office.

After all my research and reading I became convinced Cushings is what I possibly could have. I went to his office, sat down and told him I wasn’t leaving until I had an order for a 24 hr urine and serum cortisol. He laughed but gave me an order. Took the tests and what do you know,high levels. He promptly referred me to an Endo.

I will never forget the words she said to me on my first visit “ I’m very afraid for you” as all my tests were very high. She referred me to a specialist in Cushings which is in an other state. I traveled to see her and she confirmed and diagnosed me with Cushings disease. And then it became a whirlwind of tests and surgery. She told me I had a very advanced case and probably had Cushings for at least 5 years before seeing her.

It is now 2010, a year after I had first started to see my GP. I had my first Pituitary surgery in Nov. 2010. They removed the tumor and a bit of my pituitary. I recovered 2011. It took a very long time for my adrenal glands to wake up. I was on hydrocortisone for over a year before I @could taper off completely. I was back at work, loosing weight, getting my strength back and feeling hopeful this was the end.

Not so lucky. I had about 2 years of doing pretty good, but in 2014 I started to have all the signs again. Weight gain, pain, insomnia. My lab work had started to show all the Cushings signs again. MRI’s showed tumors, more of them are back. I tried the drugs available, all of them, none worked.

I had my second surgery June 2015. After surgery I was told it was unsuccessful plus I had even more tumors. One which is on my carotid artery. So I continued on trying the meds available, still no improvement. 2017: my symptoms getting worse, feeling terrible. Gaining weight. My tolerance to activity has greatly decreased and the headaches are constant. All the symptoms are back. I have been told I can not have any more pituitary surgeries because the tumor is on the carotid. I have altered my work, I now can only do a desk job and not work on the floor taking care of patients as it is too difficult for me.

I now have terrible high blood pressure, increased diabetes, osteoporosis with significant bone loss, weight gain, headaches constantly, insomnia etc. so the next step, I am seeing my provider who I have to travel across state lines to see and plan on discussing a BLA as I feel this is my last option to provide me relief and move on with life.

I will have to see what happens.

Cheers and thanks for reading.

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Correy D (Cushie Correy), Pituitary Bio

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pituitary-location
In the beginning:

This journey started long before I knew it did. I was healthy for the first 27 years of my life. Around 27 or 28 I started having problems. It started with high blood pressure. No problem, that runs in the family. Medication will solve that. Around 30 there was something more strange going on. I still produced milk even though my youngest was 5. My doctor sent me in for a galactogram (a mammogram with dye injected in my glands). It came back normal. My breast and mammary glands were fine.

Over the next few years came depression, weight gain regardless of diet and exercise, and random muscle strains. My doctor said to try a little harder and eat a little better. I threw my hands up in the air. I had already tried everything and still I was gaining. This went on from 2009 to about June of this year.

In June of 2013 I broke a rib when I was trying to crack my back. June of 2014 I broke another one on the opposite side when I was coughing. Finally, my doctor took notice. All the sudden my previous diagnosis were not individual issues, but symptoms of a bigger problem. Cushing’s disease has a laundry list of symptoms and I had almost all of them. I had already mentioned lactation, high blood pressure, depression, weight gain and brittle bones. I also had other symptoms I was not even aware of. My face had become round and red, most of my weight accumulated in my torso, there was a pronounced fat hump on my upper back, there were purple marks on my belly (striae) which I had thought were stretch marks, my face had become fuzzy, and I hadn’t had a period in at least 7 years.

The symptoms weren’t enough for a diagnosis. My doctor orders labs for hormone levels, cortisol levels, and I don’t know what else (about 5 blood vials worth). These came back with high cortisol levels and enough other oddities that I was referred on to an endocrinologist. This doctor did the first panel of tests over and added a few more. It seemed that everyone knew what it was but no one wanted to be the one to diagnose Cushing’s.

Now there are only a couple of things that can cause Cushing’s. The first is steroid abuse…ummm, no. The second is a tumor either on the pituitary gland or the adrenal gland. These marvelous tests determined that it was the pituitary version because if it was adrenal only cortisol would have been effected. The pituitary gland controls a myriad of chemicals in your body and all my levels were off.

OK, so they were convinced it was Cushing’s, now we just had to see the tumor to prove it…MRI time. I don’t know if you have ever had an MRI but I despise them. Reasons, I am claustrophobic and very large. It was a horrible experience resulting in fuzzy images, but they were clear enough to show a tumor sitting square on my pituitary gland. For those who have not looked it up by now the pituitary is on the front (face) side of your brain, settled in between the major artery and vein in your head, right behind your eye balls and sinus cavity. This is not a convenient place to have a tumor.

The endocrinologist then referred me to a neurosurgeon. The local surgeon referred my case to Mayo Clinic of Minnesota. So, we are talking tests and waiting from June through September. I was told to report to Mayo September 23rd. I was given the impression I would meet the doc and be scheduled for surgery Wednesday or Thursday. This was not so.

I brought a team with me: my sister, Amanda and her friend Athena and my bestie Lauren. We first met with the Mayo endocrinologist, Dr. Abboud. He decided he wanted to run his own tests there before there would be a surgery. He did blood test, urine tests, even saliva tests. In the meantime, I met the neurosurgeon up there, Dr. Von Gompel. He explained the surgery and scheduled it for September 30th 2014.

Here are my Facebook posts from this time:

9/23 First Mayo Update:

I met with Dr. Charles Abboud, Endocrinologist and we did an in-depth evaluation of my symptoms, physical characteristics, and medical history. There are so many things that I have considered normal for me over the past 8 years that are related to this disease. It’s nutso pants.

Anyways, it was determined before surgery they want to do more scans and testing because although it is likely the pituitary tumor is the cause, I may have other contributing tumors elsewhere. This means I will likely be up here longer than anticipated with surgery delayed for a minimum of 3 days to get results on this battery of testing. More to follow…

9/23 Second Mayo Update:

I have now received the schedule for the week. I will have more scans to be sure there are no tumors elsewhere. I will also have various test on bodily fluids, secretions, swabbings and their reactions to different medications throughout the week.

I met with the neurosurgeon, Dr. Jamie Van Gompel this afternoon. This was the appointment in which they gave me the assessment of what the surgery would entail for my case specifically, risks, odds of complications and most importantly a date. The trans sphenoidal endoscopic surgery (I feel so smart) will be next Tuesday now. Until then more waiting…and testing…and more waiting.

Sept. 24

Yesterday was information overload. Between consultations and running floors 1-19 of the clinic multiple times then making extended hotel arrangements and Walgreen’s runs I was exhausted x12.

~~~~~~~~~~~~~~~~~~~~~~

On to today: I am finally closing out day one of excessive testing. Upon arrival at the clinic I turned in samples of #’s 1 and 2 and saliva (all separate, thank gods). Due to my claustrophobia, we opted for wheelchair when using the elevators (I had collapsed yesterday when one got too full on me.)

At 8 am there were 6 vials of blood drawn, 9:30 a chest x-ray, then a info session for my sleep study tonight, next a midsection CT scan with contrast (holy warm sauce) and finally another blood draw for my PM cortisol levels. Whew…donsies!!!

Sept 24

I have difficulty sleeping without a fan. I have not slept well the past couple of nights because of lack of air movement. I was all ready to run to Target and buy one when Lauren was like, I’ll just call the front desk and see if they have them. This is me being used to self-reliance vs actual customer service. My sleep study is saved. Now we’ll see if I legitimately stop breathing.

Sept 26

Friday update:

The past couple of days have been kind of slow compared to the first couple here. Yesterday completed my sleep study and CT looking for additional Timons, results still pending. Today I had a bone density test. This shit gave me osteoporosis. That’s why my ribs kept breaking. Over the weekend, I’ll have more ‘sample collections’ and blood draws and attempt to not be bored to death in between.

On the plus side the weather has been gorgeous, I have had muchos girl/sissy time, and in a town like this survival stories abound.

Have a GREAT weekend!!

Sept 29

Case of the Mayo Mondays:

Today began with another blood test. This one, the lab tech had to get an IV which is generally not an issue for me. This time the guy blew out two veins. The 3rd try he “kind of” a clear one in my hand. Through this he had to do medication injections and blood draws at 15 minute intervals for an hour and a half. This resulted in knots in 3 places where veins used to reside.

Next up was a head CT to map my brain. This was interesting to me. I got another IV (a clear one this time) for contrast dye, nodes stuck all over my face and head, and run through a CT scanner. From this they will make a map of the blood vessels through my head to help the surgeon navigate tomorrow. They removed the nodes but left dots in permanent marker and tape over them so they do not get wiped off before tomorrow. It will be interesting walking around town tonight.

I am done with appointments for the day. Whoop!

The good news of the day: The chest CT showed “multiple healing rib fractures” but no more Timones. Yay!!

At 8:30 tonight I will call an automated system, enter my patient ID, and find out what time to report for duty tomorrow. I must find distraction. I am starting to get anxious. Can it be next week already?

Sept 29 Post 2

Reporting for duty at 5:45 am central.

Tomorrow determines if I get to continue to eat vegetables or become one…

Sept 30 I registered at St. Mary’s Hospital and got settled in. Surgery began at 9:25. I was done around 13:00.

Oct 1

My first post-surgery post

Timone is gone. I am tired.

Oct 2

Hey all, got behind on the updates because a lot has changed very quickly. I have “complications”. Please keep positive energy pointed this direction. I may be up here for a while now.later Oct 2

If medical stuff makes you icky, keep scrolling.

So here’s the run down after surgery. The tumor removal itself went well. They believe they got the whole thing without much damage to the pituitary gland. The two issues that remain are post-surgery my cerebral spinal fluid (csf) sprung a leak and the Cushing’s disease that the tumor caused kicked in.

A few hours after surgery I started dripping/ running clear “snot” from my nose. It only happened when I was upright or leaned forward. The fluid was tested and determined to be csf. Now a person cannot just go around leaking brain juice so action had to be taken. The doctors put in a lumbar puncture and are draining spinal fluid every two hours. This will take the pressure off my head and give it a chance to heal. This means I am here at least till Sunday. If this does not work, they must go back in and manually patch the leak.

The Cushing disease also kicked in full effect today. That meant today with the tumor gone the excess amounts of cortisol my body was used to stopped and I crashed. This would be like a meth head going cold turkey. This morning was spent trying to find the right steroid/ dose to balance me back out. With luck, I will be able to wean off these eventually.

As they steroids are currently wearing off again I’m going to sleep because I don’t really have a choice. NITE ALL!!!

Oct 6

So I know it’s been a while….

The day after my last update they put in a lumbar puncture and connected a drain to it. 10 ml of csf was drained every 2 hours for 2 days. This took the pressure off my brain= no more leakage= time to heal. I have also been sleeping almost nonstop. It seems to have worked, no more nose leakage. They drained 30 ml this morning and will do one more drain tomorrow AM and if no more leakage I will get all my departing instructions and GET TO LEAVE.

Next challenge: re-balancing my chemical physiology.

Oct 7

This morning I woke up in Minnesota, still in the hospital. They stole more blood, drained more csf, and pulled that thing out of my back. Best news of the day: After they pulled out the drain my nose did not start leaking again. This meant I was clear to leave…woot!

Paperwork, discharge instructions, shower because ewww hospital, prescriptions, freedom. Oh no, not yet, doctor appointment with my favorite endocrinologist of all time, Dr. Abboud. So, it took a while but home we came.

I have a fuzzy head but full heart. Thank you all so much for your kind words.

Home at last and then the real Cushing’s journey began.

Home Sweet What?!?!?

I came home from Mayo October 7. Home to me may be considered a madhouse to others. My house contains my children (17-year-old girl, 10-year-old boy), my sister, 3 dogs, 4 cats, and 3 turtles. Upstairs contains my dittos and 2 of the cats; the basement homes my sister, her two dogs, and the other 2 cats; and the main level is myself, my dog (Toby), and the stupid turtles. I was happy to be going home to my madhouse.

Before the surgery I had done quite a bit of research about the symptoms of Cushing’s, the causes, the surgery itself. I had not, however researched much about Cushing’s recovery. While still in the hospital I remember sleeping, in between all the intermittent blood draws, vitals checks, and med administering. There was not much else. Once home I was initially just concerned with watching for brain juice leakage. I was not prepared for reality.

Read reality:

http://csrf.net/doctors-articles/recovery/recovery-from-cushings-and-coping-with-recovery/

My reality also included my madhouse. For as full as my house is I spend most of my days alone. My sis works nights so she is sleeping during my waking hours and gone overnight, the dittos are in school and the girl works nights. The cats are on their respective floors. It’s just me and my Toby since the turtles are not for me. When I’m awake, I look around and see all the things I could be doing if I was mobile. The floors need swept, dishes need done, general tidying and dusting required. It’s not that these things never get done but they could be done faster if I were able.

I have now been home a month. Physically, I was more ok when I got home than now. At that point I was still tapering down prednisone. I was still sleeping quite a bit, especially after dropping my dosage, but by the end of the week I was moving around more. After a few weeks, the tapering was done and I crashed once again. I am sleeping till the afternoon. I am weak to the point that moving from room to room is exercise, painful exercise. I stopped taking the prescribed pain killers so I am depending on Tylenol. Tylenol sucks ass. I also still lose words. Often, I cannot complete a sentence. I know exactly what needs to be said but the term, phrase, or name is completely gone. In my “before Cushing’s life” I was pretty flipping eloquent so this is extremely frustrating. To be honest the whole thing is frustrating. I am a strong intelligent independent woman reduced to incapable and not so eloquent blob.

A series of unfortunate events…the sequel.

I suppose I should start at the end of my last post which was flippin January for gods sake. I don’t know why I felt the need to stop writing when things started getting bad again. Documenting my recovery was so much more positive than writing about a relapse but now it’s time to catch up. Cushing’s is a journey with highs and lows. Jump on the coaster with me.

At the end of January I was on the way over a big hill on the coaster. I was doing water aerobics, getting more mobile, working with dogs again. I had my appointment with the local endo and she was dismissive. She basically said the tumor was gone and I should be losing weight faster. This is the exact reason that not just any endo should deal with Cushing’s patients. They don’t get it. Removing the tumor is only step one. Next is re-balancing hormones, then dealing with all the havoc Cushing’s has left behind. My January cortisol labs had been normal, as in recovered norm which was a recovery from the crash post op 0. It is not usual to be at normal range so soon after weaning of prednisone, but we took it for good news anyways.

By mid Feb I was starting to get nervous. I was starting to feel things, previous symptom kind of things. My skin started to break out again, I had headaches again, and I started to gain weight to spite moving more than I had in over a year. I had a follow-up MRI in February. There was the post op variances they expected and then, there it was, a new 2 mm regrowth. FML!

I did not feel good about continuing with the local endo. I could not shake the feeling she had blown me off as just another fat hypochondriac. My GP referred me down to U of I where I met Dr. Christina Ogrin. Our first appointment she took a whole afternoon to listen to my story. She told me she had never dealt with Cushing’s before but she wanted to help and she would work with her colleagues and research to see where we needed to go from if the tests confirmed a recurrence. We repeated the cortisol and other hormone tests that had just been performed in January and there was the confirmation. My cortisol was back above normal range. Dr. Ogrin contacted Dr. Abboud, my Mayo endo, to get his take on the situation. After consulting the U of I team, Dr. Abboud, and her own research, Dr. Ogrin laid out the options.

1. Operate again

2. Go on ketoconazole and get radiation

3. Try a newer medication (Signifor) to counter the cortisol and possibly shrink the tumor.

As I was just coming off of my first trans sphenoidal adenectomy, I was not eager to jump on that again. I had heard horrible things about ketoconazole so that was not a happy thought. Signifor sounded like my best option.

There were many baseline tests that had to be performed to start this process. We tested cortisol levels from blood, pee, and spit. We did a new MRI (April) which showed Marty* had already grown. I had an EKG and ultrasound of my gallbladder because Signifor can affected the heart and cause gallstones. When we did the gallbladder ultrasound there were already about 9 good sized stones present. At that point it was decided I should have it removed prior to starting the medication. Signifor also causes an increase in blood sugar and since mine was already borderline high they started me on Metformin. They tell me my gallbladder has to come out, a preventative measure since the odds if it causing problems if it stayed were close to 100%. Sweet. Here I am taking it all in stride. If that’s the next step, then that is what we will do. My coworkers were supportive and told me to put my health first. I would not lose my job. Woot!

May came in like a whirlwind. I had a pre-op appointment with general surgery to set up my gallbladder removal. A couple of days after that I was in my garage leaving for work when I lost my balance and fell forward catching myself with my arms outstretched. My balance, muscles, and bone strength had all taken a hit from the Cushing’s so my arm snapped. The break was bad, right above the elbow, there was one clean break and another longer break up the bone. One ambulance ride and many pain pills later I was admitted at St. Luke’s and informed they would have to operate. I am now the proud owner of hardware in my arm.

At this point I was already scheduled for my Laparoscopic Gallbladder Removal (Cholecystectomy) so in the beginning of June we went ahead and did that too. What is supposed to be a simple surgery went sideways when they nicked my liver. I had to have a icky drain for the bleeding. A couple weeks later I went to have the drain removed and everything looked fine. That night I starting to get sick. My temp went up, I started vomiting and my stomach hurt so much I thought I would pass out which would have been a blessing because I wanted to sleep till it was over but I could not due to the pain. I know, run on sentence, but it was a run-on couple of days. My stubborn behind would not go to the doctor because I had just been and everything was ok. Or not…

I ended up in the ER again. They transported me from St Luke’s to U of I because my liver levels were ridiculous high and the local hospital did not want to deal with my issues. Once at the U, I was admitted, poked, and prodded. By the end it was determined that I was passing a gallstone that had gotten stuck on the wrong side of the clip when they took my gallbladder. This can only happen in my world. Who passes a gallstone when they no longer have a gallbladder? This girl.

This took us to July. Dr. Ogrin was out of the country. She wanted me to take the month to recover and get used to the Metformin. We would meet when she returned to start the Signifor. And so we did. Signifor is very expensive as it is rare and there are no generics for it. Dr. Ogrin successfully fought the insurance company because there is no other FDA approved medication for pituitary Cushing’s. The first month I was on it there was little relief. My brain fog was back along with my other returned symptoms and now I also had extreme digestive issues. These were three part. Gallbladder removal itself affects digestion. The Metformin is known to cause such problems. Now the Signifor injections themselves cause nausea. After a month, I got a 2-week reprieve because the insurance company denied my renewal so now we are starting over. I will retest cortisol levels in November to see if the Signifor is doing anything aside from making me nauseous.

I have also spoken with the radiology oncology department at U of I. They have reviewed my case and I am awaiting word on whether they would recommend a single dose (gamma knife) radiation or a five-week treatment. Either way I would continue on the Signifor because the radiation results can take up to a year to show.

There you have it. The last nine months in 1500 words ish. Some have babies in 9 months. Not I, I have a series of unfortunate events.

*I named Timone’s sequel Marty for a few reasons. Marty is the zebra in Madagascar. Zebras are the animal mascot for Cushing’s because doctors have this awesome mantra that is drilled into them when they are in medical school, “If you hear hoof beats, think horses.” Well Cushing’s is one of the most misdiagnosed illnesses because our symptoms may be hoof beats but zebras have hooves too. Sorry for the tangent but it is important to the Marty explanation. In Madagascar 3, Marty has a moment that mimics the overactive distractedness that a Cushie brain knows so well. He sings and dances for his new circus friends. “Afro circus, afro circus, polka-dot, polka-dot, afro!”

https://www.youtube.com/watch?v=aZYFqle7GvA (the submitted video is unavailable)

Radiation Oncology- Dr Smith

I got a call back from Dr. Smith today. University of Iowa is a teaching hospital. As such, they have interdisciplinary case meetings on Tuesdays to discuss the more complicated patients coming through the U. It is a very “5 heads are better than one” approach which I appreciate. In my case, they discussed radiation vs Trans sphenoidal adenectomy. Radiology put the case up and although it is a viable option neurosurgery believes there is a better chance for better quality of life with their option. Each specialty believes strongly in their course of action. Of course, it is all up to me.

The risk of gamma knife radiation would be hypopituitarism (disorder in which your pituitary gland fails to produce one or more of its hormones) Ironically the symptoms of hypopituitarism are like what I am already experiencing with Cushing’s. I could end up on replacement therapies for the rest of my life.

The drawbacks of the surgery are the surgery itself is traumatic, the recovery is difficult, and the failure rate is high. My first surgery left me bedridden for a couple of months. I could not afford to take that much time off again. At this point taking a day off impacts but a month…impossible.

I am torn but I did agree to meet with the neurosurgeon before going ahead with the radiation treatment. I am still processing. Neither is a very high success rate and both have negatives. The drug therapy I am on is a temporary situation. The longest it has been reported to work is 5 years. Cushing’s has a high mortality rate with no intervention. I am only 36 and have an 11-year-old son. Five years is not enough.

What do you do when all options available are just buying time?

Neurosurgery- Dr Greenlee

Today I had my neurosurgery appointment. The surgeon came in, looked at my scans and reviewed my history. This is the same doctor who had been so sure surgery would be better than radiation. He told me this time the tumor is wrapped around my carotid artery. He told me there would only be a 60% “cure rate” by going through that horrendous surgery again. Along with a higher fail rate, it would also be much higher risk of complications or death due to the position of the tumor. Looks like radiation is in my future.

I do have a follow up appointment with my endocrinologist, Dr Ogrin coming up. We will be checking my cortisol (24-hour urine Yay!) to see if the Signifor injections are having any effect. We shall see.

Testing testing…1 2 3

Every Cushie knows the frustration of testing. Cushing’s is one of those really hard to prove diseases. Our hormone levels are tested at every junction of diagnosis and treatment. Cortisol is the main hormone tested for. Cushing’s can affect several chemicals but cortisol is the steroid that causes the most damage. There are several ways cortisol is tested. Saliva- you suck on a cotton swab in between 11pm and midnight and send it off to the lab. Blood- soooo many blood tests, AM cortisol, PM cortisol, and dex suppression. And of course, the pee- most often 24 hour urine.

Every result comes with mixes emotions. When testing for a diagnosis, if you get abnormal results you are happy that you are not crazy, there really is something wrong. So many people are told there is nothing wrong with them for so long, they start to actually feel crazy. When you are testing during treatment and get a bad result, then comes the fear. What next? What does this mean for my treatment options? Am I out of options? This fear is only slightly amplified by the anxiety that comes along as a wonderful side effect of the disease itself.

Results time:

Cortisol, Urine Free – per 24 h Result

175.5 Normal Range

<=45.0 Measure

ug/d

Last week I did a 24-hour urine test. This is seriously collecting every drip for 24 hours, the results of which I got today. Considering the recent consulting appointments, I’m once again not sure which direction to go. The test show my cortisol is still high, not as high as it had been in the past. My last 24 hour was May 10th and 263.4 ug/d. At that rate 175.5 looks pretty good. The question now would be can my body take those levels long enough for the radiation to take effect? Is the immediate result of the surgery worth the 60% success rate if it can’t?

More questions than answers when test results arrive. This makes me long for the days of pass/fail pregnancy tests. At least then there was a definite answer and knowledge of options to follow.

Radio Roller Coaster

“The question now would be can my body take those levels long enough for the radiation to take effect? Is the immediate result of the surgery worth the 60% success rate if it can’t?”

These were the questions I had after receiving my last test results. My 24-hour urine cortisol had still been high. I had a follow up with Dr. Ogrin (endo). She was quite encouraged. My results were still above normal range but were much lower than my pre-medicated levels and my blood cortisol and ACTH were back down to normal range. This meant I got to stay on the Signifor and radiation was still a go.

FF to yesterday. I went to meet with Dr. Smith’s office for my pre-radio-surgery patient education and MRI. We went through the procedure and the nurse stepped out to grab whoever was taking me down to MRI. No one came back…we waited for just over an hour. I have never waited at this office before so I knew it was not good. Finally Dr. Smith comes in. I actually hadn’t expected to see him yesterday so my suspicions were confirmed. He sat down and told me my weight disqualified me from the gamma knife radiation. My options now are the full 6-week course of radiation or the trans sphenoidal adenectomy. The same surgery that I was told there was only a 60% change of success. To me, this is just not a viable option.

Every time I think there is a plan, it gets squashed. Have you gotten whiplash from my roller coaster yet? This disease got so far gone that I am too fat to be treated. I would not wish Cushing’s on my worst enemy. This thing might just kill me. All of my systems are stressed from the extra weight. My blood pressure cannot be regulated. Signifor has made me officially diabetic. Grrrrrrrrrrr!!!!!!!!!!

Reverse: Part way through this post Dr. Smith called. After discussing my case with his colleagues, he was reminded they were upgrading one of the radio surgery stations and it would no longer have the weight restrictions. I’ll have to wait till mid-December but Gamma Knife is still a possibility. This is truly good news because the success rate with radio surgery is so much higher than standard ration treatment.

Every disappointment is just a moment in time. You stay because you get the counter moment eventually. BUT if my life were a movie, I wouldn’t watch it, I’m just sayin…

Signifor

Signifor is the supposed miracle treatment for pituitary Cushing’s, the only drug officially approved to treat the disease. When my first surgery failed, I was not really wanting to get right into another one, Dr. Ogrin did some research and jumped on this as an option for me. My endo is not a Cushing’s specialist but she is very enthusiastic and willing to put in the work so her excitement was infectious (haha). There were a couple of hurdles to overcome before actually starting treatment. The medication is a twice daily injection. The cost is approximately 12,000 per month. In order to get the insurance company to cover it we had to do many preliminary tests and baselines for future tracking. There were the normal cortisol level tests (blood, urine, and saliva), EEG, and ultrasound of my gallbladder as Signifor often caused gallstones. During the ultrasound, it was found that I already had about a dozen gallstones. The stones were not irritated but since they were only going to get worse it was decided to remove the gallbladder proactively. OK, so about two months later we were ready to go.

I started the injections knowing that the major side effect would be the increase of blood sugar generally causing diabetes so when my blood sugar went up it wasn’t a surprise. As big as I am, I had never actually crossed the line to diabetic before. We started Metformin which made me sick as a dog. I still stayed on it for almost 2 months. It kept my blood sugar in normal range but I basically lived in the bathroom. YUCK! Now we are trying a Glipizide. It has been ok but I take it with food and my spikes are post injection so my sugars never stay level. The other side effects nausea and hair loss, I can live with I guess. Not a fan of seeing my own scalp but due to overheating I can’t do hats.

Also, the insurance will only pay for the drug 3 months at a time and then require proof it is working before they will agree to the next 3. I was really nervous because I really didn’t know if it was working. Some of my initial symptoms were easing up but nothing was cured and I was still gaining weight. Time for test again. Blood, urine, and saliva all told the same tale. My cortisol was lower than initial levels. It had been cut in half but was still well above “normal” range. I just got word that it was enough for insurance to approve to continue treatment. Woo HOO!

This is not a long term solution. It’s a treatment not a cure. It only works as long as I am able to get the injections and the side effects are hard on the body. About 20 minutes after every shot I get waves of nausea. No way around that one. I am now diabetic which may or may not go away. The expense is also not realistic long term. I currently have Medicaid but if I ever had to pay $12,000 a month myself it just wouldn’t happen. I am only 36 so we are talking just under $150,000 every year for a long time still and that is just the injections. My other maintenance meds (blood pressure, depression, anxiety) are a whole separate thing. When my cortisol does get to normal we may be able to ween off some of them, thank god.

So, for long term I still have to do either the trans-nasal or radio surgery to get rid of the hormone producing tumor. I’m pretty set on radio surgery. I spoke to Dr. Smith’s office today and they say the 14th or 21st. I’ll hear soon for a set date.

So, with all of the above you may be asking why bother with Signifor at all. I must admit I ask myself the same thing sometimes but then I consider what has improved since starting.

• My mental clarity has improved. I was getting increasingly foggy.

• I am on NO pain meds. The muscle pain just for pain sake is gone.

• I am stronger. I no longer feel as if I cannot get out of bed or off the couch. I may not have lost any weight but I can carry it around now.

• My ‘sweats’ are getting fewer and farther between. Before I would break into a drenching sweat regularly for no reason at all. It’s now down to only about once a day unless I’m at a store or get to cleaning my house and overexert.

• I can sleep through the night.

• I no longer am constantly fatigued.

• I have hope that one day I could be normal again.

These are the things I must remind myself of when I have a rough day. The kind of sick I am now is much better that my previous disheartening misery. 🙂 So I’ll continue until a cure or insurance stops paying.

Feb 2016 I had the gamma knife radiation…bunches of fun. No changes…

…except it is now January 2017. My symptoms are returning, levels back up, whatever Signifor was doing, it doesn’t seem to be any longer.

My doctor who was so excited for challenge in the beginning is starting to throw around gastric bypass, Korlym, and BLA, There is no end to the bullshit.

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Mary H (Marietta), Adrenal Bio

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In 1976, I was (finally) diagnosed with Cushing’s disease and after the up the nose surgery, which was ineffective, I had bilateral adrenalectomy.

It all started in late 1974, when I started having lots of illnesses and was depressed.  I was crying a lot and going back and forth to my doctor, who treated every illness and gave me anti-depressants.

Then the weight gain started, ( I was 185 at my highest, which was usually 115-120) actually I had been gaining weight, but by now it was rapid and uneven– only my trunk and face.

All through late ’74 and 1975, I was back and forth, even with a dx of pregnant,  (which made evryone happy, as I was married Feb 1974.  But the mental problems continued, I was under psychiatric care and had 2-3 in-patinet stays of about 2 weeks.  Each time, after the observation and evaluation, I was discharged with no dx. I would also fall asleep at the strangest places and times, all very suddenly.
In March of of 1976, I  had what was then called a “nervous breakdown,” so again I was hospitalized.  THAT probably saved my life, as it was my psychiatrist who finally dx Cushing’s and decided on treatment. He later told me that I had him very confused, as each time he thought he had the DSM dx (he knew I was in the mh field), I would change and thus, he could not fit me in any DSM DX.   Then, because of my appearence (moon face, foot-ball player shape, with skinny limbs, losing my hair and all the secondary dx (high blood pressure, insulin diabetes that could not be controlled– up, down, up down, losing hair, on my head but growing on my face and back), he said he remembered something from medical school.

He did a lot of research, ordered a lot of tests and VOILA– I had Cuhing’s disease.  It was very rare and at that time, he said there were no more 300-400 (known) cases in medical history; also, I was the youngest dx at 26, because most cases were in those age at least 50.

I had the nose surgery, very new at the time,  but it didn’t “work,” so I had to have my adrenal grand removed– they were 5x the normal size and producing 25x the normal amount of steroids. I had the surgery in Novemver 1976, which took from 7 am to 5 pm (I have the 2 long scars on my back).  I did not know at the time that there was an 85% chance of surviving that surgery.

Post surgery, all but 3 of my fingernails fell off, my hair was in tight curls (previoulsy straight) and I had cystic acne on my face, neck and back. I started taking cortisone and florinef and was told I had to take  it the rest of my like.  I was under close dr care for about a year, and by April 1977, the weight was gone (I was back to 115) and all secondary symptoms were gone.  I believe that the surgery was a real “cure” for my Cushing’s disease and after, it was/is maybe somewhat like diabetes, in that it is managed and controlled.  There are some things that I have to watch carefully, like a comprommised immune system (increase the prednisone if infection seems likely) and some depression (never hospitalized again).  I have had some adrenal crises, that landed me in the ER, maybe 5-6 over the years (how strange, no doctor ever told me or gave me a prescription for an injection for such occurences).
In 1990-1991, I had what ended up being appendicitis.  After 4x in the ER, I vomited blood and collapsed.  It turned out to be a (dead) grangrenous appendix, which should have been removed the first t ime.  Supposedly, the prednisone that I take “masked” the symptoms and since my blood showed no infection, I was sent home from the ER each time.  I spent 2 weeks in the hospital with 3 strong intravenous antibiotics to remove all the toxins in my body that almost killed me.

In 2000, I was dx with diabetes, which runs in my family, and at  64 years  old, the problems I have now are severe allergies/sinus problems (no one believes that I am sick when this makes me sick) and I seem to always be hotter or much colder than anybody (which the doctor warned me about right after the major surgery).

Also, I started out with cortisone; in 1990, a new doctor in NYC gave me hydrocortisone and I gained 10-20 lbs.  Another doctor quickly put me back on cortisone and said that the hydrocortisone was only for injections when I have adrenal crisis– it is quick actiing.  The cortisone was 25 mg daily and around 1993-94, I started gaining weight.  A new docotr in Chicago, switched it to prednisone 5mg., the equivalent of the 25 mg cortisone.  He said the prednisone did not cause weight gain– he was right.  I also take Florinef, now Fludrocortisone (the generic, Florinef is VERY expensive, as is the generic, but less).  I started out with this at .1 mg  once every other day and sometime in the 90s, the same dr who put me on prednisone, changed the Fl to one x daily.

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