zhen

I still have those symptoms a year post-op.  The pain can be managed with tramadol or opiate pain medications.  These also effect the endocrine system and will slow recovery or introduce a new dependency which would have it's own withdrawal syndrome later when they are removed.  OTC pain meds don't seem to be much help.  Cymbalta, Lyrica or antidepressants may help, but these also effect the endocrine system.   Hydrocortisone dose can be increased to reduce symptoms, but this may delay or inhibit recovery too. 

This article explains the issue and offers some limited choices.  http://edrv.endojournals.org/content/24/4/523.full.pdf+html  The key remark in the article is:

D. Therapeutic approaches to glucocorticoid withdrawal

Gradual tapering of high-dose glucocorticoid therapy has

become the standard of practice. However, the glucocorti-

coid withdrawal syndrome, which develops after correction

of endogenous hypercortisolism, is largely ignored or con-

sidered as a separate entity. In attempting to minimize post-

operative withdrawal symptoms and signs, the clinician is

faced with two options: the first is to normalize cortisol

secretion before surgery, employing medical suppression of

steroidogenesis. This has to be done gradually, or else with-

drawal symptoms might ensue. The second option is to re-

institute high-dose glucocorticoid replacement therapy after

surgery and taper it off gradually. It sounds reasonable,

although untested, to resume a dose that would result in

pretreatment urinary free cortisol levels as the basis for ta-

pering off. The disadvantage of this therapy is the very likely

prolongation of Cushing’s symptoms and signs, as well as

adrenal suppression. These preventive options await well-

designed clinical studies. With a decrease in CRH and the

central dopaminergic and POMC-peptide systems, the ra-

tionale is there for correcting these derangements gradually

in cases of severe withdrawal syndrome.

Anyone know the cure rate for this drug?

It's more complicated than a cure rate. There's a comprehensive report about the success and adverse event rates on the fda website.

http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/UCM326812.pdf

Are there any long term reproductive implications due to use of Korlym?

I can't imagine that anyone with Cushing's would want to chance passing this gene along.

Neuroendocrinology. 2010;92 Suppl 1:107-10. Epub 2010 Sep 10.

Pituitary radiotherapy for Cushing's disease.

 

Losa M, Picozzi P, Redaelli MG, Laurenzi A, Mortini P.

 

Source

 

Department of Neurosurgery, Istituto Scientifico San Raffaele, Università Vita-Salute, Milano, Italy. losa.marco@hsr.it

 

Abstract

 

BACKGROUND:

 

The treatment of choice for Cushing's disease is pituitary surgery. Second-line treatments include repeat pituitary surgery, radiation therapy, medical therapy, and bilateral adrenalectomy. The most used modalities to irradiate patients with Cushing's disease include fractionated radiotherapy and single-dose Gamma Knife. We aim to review the efficacy and safety of radiotherapy in patients with persistent or recurring Cushing's disease.

RESULTS:

 

Remission of Cushing's disease after radiotherapy ranges from 42 to 83%. There seems to be no clear difference according to the technique of radiation used. Most patients experience remission of disease within 3 years from treatment, with only few cases reaching normal cortisol secretion after a longer follow-up. Control of tumor growth varies from 93 to 100%. Severe side effects of radiotherapy, such as optic neuropathy and radionecrosis, are uncommon. New-onset hypopituitarism is the most frequent side effect of radiation, occurring in 30-50% of patients treated by fractionated radiotherapy while it has been reported in 11-22% of patients after Gamma Knife.

CONCLUSION:

 

Radiotherapy is an effective second-line treatment in patients with Cushing's disease not cured by surgery. Consideration of the advantages and disadvantages of radiotherapy in comparison with other therapeutic options should always be carried out in the single patient before deciding the second-line therapeutic strategy for persisting or recurring Cushing's disease.

Copyright © 2010 S. Karger AG, Basel.

The full text article can be found at: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=000314299&Ausgabe=254530&ProduktNr=223855&filename=000314299.pdf

I think anything that gives an early warning of AI would be highly desirable, even if it's not perfect or useful for clinical diagnosis. Forty years ago, we would pee on a paper strip to learn of glucose was spilling. It wasn't as powerful as glucometers, but it was lifesaving.

hope,

do you think endocrine tumors may run in your family?