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  1. By Tori Rodriguez, MA, LPC In the early 20th century, the term "pluriglandular syndrome" was coined by Harvey Cushing to describe the disorder that results from chronic tissue exposure to excessive levels of glucocorticoids.1 Now called Cushing's syndrome, the condition affects an estimated 10-15 million people annually, most often women and individuals between the ages of 20 and 50 years.2 Risk factors and common comorbidities include hypertension, obesity, osteoporosis, uncontrolled diabetes, depression, and anxiety.3 Presentation The clinical presentation of the disorder is heterogenous and varies by sex, age, and disease severity. Common signs and symptoms include central adiposity, roundness of the face or extra fat around the neck, thin skin, impaired short-term memory and concentration, irritability, hirsutism in women, fatigue, and menstrual irregularity.4 Because each of these features may be observed in a wide range of other conditions, it may be difficult to diagnose cases that are not severe. "It can be challenging to differentiate the milder forms from pseudo-Cushing's states," which are characterized by altered cortisol production and many of the same clinical features as Cushing's syndrome, according to Roberto Salvatori, MD, the medical director of the Johns Hopkins Pituitary Center, Baltimore, Maryland. These may include alcoholism, obesity, eating disorders, and depression. "Because Cushing's can cause depression, for example, it is sometimes difficult to determine which came first," he says. In these states, however, hypercortisolism is believed to be driven by increased secretion of hypothalamic corticotropin-releasing hormone, which is suppressed in Cushing's syndrome.5 Causes and Diagnosis If Cushing's syndrome is suspected on the basis of the patient's physical appearance, the diagnostic workup should include a thorough medical history, physical exam, and 1 or more of the following tests to establish hypercortisolism: the 24-hour urinary cortisol test, the low-dose dexamethasone suppression test, or the late-night salivary cortisol test. "We sometimes use 2 or 3 of these tests since 1 may not accurately reflect cortisol production in a particular patient," Dr Salvatori notes. The next step is to determine the source of the hypercortisolism, which may involve the high-dose dexamethasone suppression test, magnetic resonance imaging, or petrosal sinus sampling.2 Medication is the most common cause of Cushing's syndrome. These iatrogenic or exogenous cases typically result from corticosteroids administered for conditions such as asthma, allergies, and autoimmune disorders.6 More rarely, the disorder can be caused by the use of medroxyprogesterone. In these cases, corticosteroids should be reduced or discontinued under medical care, if possible. Endogenous Cushing's syndrome results from the presence of benign or malignant tumors on the adrenal or pituitary glands or elsewhere in the body. These tumors can interfere with the adrenal glands' production of cortisol that is usually prompted by the adrenocorticotropic hormone (ACTH) released by the pituitary gland.6 There are 3 different mechanisms by which the process can occur. Pituitary adenomas, which account for approximately 70% of endogenous cases of Cushing's syndrome, secrete ACTH and stimulate additional cortisol production. Because of the large proportion of cases this condition represents, it is specifically referred to as Cushing's disease. It is more common in women than men (with a ratio of 3 to 4:1), although in pediatric patients, it occurs more frequently in boys vs girls.5 Adrenal tumors (adenomas, malignant tumors, or micronodular hyperplasia) produce cortisol in their own tissue in addition to the amount produced by the adrenal glands. These tumors, which cause approximately 15% of endogenous Cushing's syndrome cases, are more common in children vs adults and in women vs men. Benign or malignant tumors elsewhere in the body, most often the lungs, thyroid, thymus, and pancreas, secrete ACTH and trigger the excessive release of cortisol. An estimated 15% of endogenous cases are attributed to these types of tumors. Treatment Surgery is the first-line treatment for Cushing's syndrome. "We first want to try to figure out the cause of the disorder," Dr Salvatori says. "Ideally, treatment involves surgery to remove the tumor that is causing it." When surgery is unsuccessful, contraindicated, or delayed, other treatment options include radiation or medications that inhibit cortisol, modulate the release of ACTH, or inhibit steroidogenesis.5 Bilateral adrenalectomy may be indicated for patients who do not respond to medication or other surgery. If surgical resection of the tumor is successful, then "all of the comorbidities reverse, but if it is unsuccessful or must be delayed, you would treat each comorbidity" with the appropriate medication; for example, antihypertensives for high blood pressure and antidiabetic medications for diabetes, Dr Salvatori advises. In severe cases, prophylactic antibiotics may be indicated for the prevention of severe infections such as pneumonia. It is also important to inquire about and address psychiatric symptoms related to Cushing's syndrome, even in patients who are in remission. It has been proposed that the chronic hypercortisolism and dysfunction of the HPA axis may "lead to structural and functional changes in the central nervous system, developing brain atrophy, particularly in the hippocampus, which may determine the high prevalence of psychiatric disorders, such as affective and anxiety disorders or cognitive dysfunctions," according to a recently published paper on the topic.7 Patients should be screened with self-report questionnaires such as the Beck Depression Inventory and the Hospital Anxiety and Depression Scale, and management of psychiatric symptoms may include patient education, psychotropic medications, and referral to a mental health professional. Future Directions Several trials are currently planned or underway, including a phase 2 randomized, double-blind, placebo-controlled study of an oral medication called ATR-101 by Millendo Therapeutics, Inc. (ClinicalTrials.gov identifier: NCT03053271). In addition to the need for novel medical therapies, refined imaging techniques could improve surgical success rates in patients with Cushing's disease in particular, according to Dr Salvatori. "A significant portion of these patients have tumors too small to be detected by MRI, and the development of more sensitive MRI could improve detection and provide a surgical target" for neurosurgeons treating the patients, he says. Summary Milder cases of Cushing's syndrome present diagnostic challenges are a result overlapping features with various other conditions. Diagnosis may require careful observation as well as biochemical and imaging tests. RELATED ARTICLES New Research Highlights Possible Genetic Cause of Cushing's Disease Endocrine Society Releases Guidelines on Treatment of Cushing's Syndrome Pediatric Endocrine Society Provides Guidance for Growth Hormone Use in Pediatric Patients References Loriaux DL. Diagnosis and differential diagnosis of Cushing's syndrome. N Engl J Med. 2017;376:1451-1459. doi:10.1056/NEJMra1505550 American Association of Neurological Surgeons. Cushing's syndrome/disease. http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Cushings-Disease. Accessed August 1, 2017. León-Justel A, Madrazo-Atutxa A, Alvarez-Rios AI, et al. A probabilistic model for cushing's syndrome screening in at-risk populations: a prospective multicenter study. J Clin Endocrinol Metab. 2016;101:3747-3754. doi:10.1210/jc.2016-1673 The Pituitary Society. Cushing's syndrome and disease–symptoms. https://pituitarysociety.org/patient-education/pituitary-disorders/cushings/symptoms-of-cushings-disease-and-cushings-syndrome. Accessed August 1, 2017. Sharma ST, Nieman LK, Feelders RA. Cushing's syndrome: epidemiology and developments in disease management. Clin Epidemiol. 2015;7:281-293. doi:10.2147/CLEP.S44336 National Institutes of Health: Eunice Kennedy Shriver National Institute of Child Health and Human Development. What causes Cushing's syndrome?https://www.nichd.nih.gov/health/topics/cushing/conditioninfo/pages/causes.aspx. Accessed August 1, 2017. Santos A, Resmini E, Pascual JC, Crespo I, Webb SM. Psychiatric symptoms in patients with Cushing's syndrome: prevalence, diagnosis and management. Drugs. 2017;77:829-842. doi:10.1007/s40265-017-0735-z From http://www.endocrinologyadvisor.com/adrenal/cushings-syndrome-diagnosis-treatment/article/682302/
  2. Diagnosing Cushing’s syndrome can take 24 hours of complicated and repeated analysis of blood and urine, brain imaging, and tissue samples from sinuses. But that may soon be in the past: National Institutes of Health (NIH) researchers have found that measuring cortisol levels in hair samples can do the same job faster. Patients with Cushing’s syndrome have a high level of cortisol, perhaps from a tumor of the pituitary or adrenal glands, or as a side effect from medications. In the study, 36 participants—30 with Cushing’s syndrome, six without—provided hair samples divided into three equal segments. The researchers found that the segments closest to the scalp had the most cortisol (96.6 ± 267.7 pg/mg for Cushing’s syndrome patients versus 14.1 ± 9.2 pg/mg in control patients). Those segments’ cortisol content correlated most closely with the majority of the initial biochemical tests, including in blood taken at night (when cortisol levels normally drop). The study was small; Cushing’s syndrome is rare, and it’s hard to recruit large numbers of patients. Still, the researchers believe it is the largest of its kind to compare hair cortisol levels to diagnostic tests in Cushing’s patients. “Our results are encouraging,” said Mihail Zilbermint, MD, the study’s senior author and an endocrinologist at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development. “We are hopeful that hair analysis may ultimately prove useful as a less-invasive screening test for Cushing’s syndrome or in helping to confirm the diagnosis.” The authors suggest the test is also a convenient alternative with the “unique ability” for retrospective evaluation of hypercortisolemia over months. Download PDF From https://www.ptcommunity.com/journal/article/full/2017/4/271/research-briefs-april-2017
  3. Clinical trials are research studies that test new treatments to see how well they work. Our Pituitary and Skull Base Tumor Center is leading clinical trials investigating new medical therapies for patients with Cushing’s disease and acromegaly. They are also involved in quality-of-life studies aimed at improving long-term follow-up care for patients who need it. Our experts can help determine which clinical trials are right for you. The following clinical trials for pituitary tumors are currently enrolling new patients. To learn more about a particular study, choose from the list below. For more information about our research and clinical trials, call us at 212-639-3935, or talk with your doctor. A Phase III Study of COR-003 to Treat Cushing's Syndrome Diseases: Adrenal Tumors, Pituitary Tumor Locations: New York City Eligibility Eliza B. Geer A Phase III Study of LCI699 (Osilodrostat) to Treat Cushing's Disease Diseases: Adrenal Tumors, Pituitary Tumor Locations: New York City Eligibility Eliza B. Geer
  4. Rank Status Study 1 Recruiting Study to Evaluate CORT125134 in Patients With Cushing's Syndrome Condition: Cushing's Syndrome Intervention: Drug: CORT125134 2 Recruiting Cushing's Disease Complications Condition: Cushing's Disease Intervention: Other: Exams and questionnaires 3 Recruiting The Accuracy of Late Night Urinary Free Cortisol/Creatinine and Hair Cortisol in Cushing's Syndrome Diagnosis Condition: Cushing Syndrome Intervention: 4 Recruiting Treatment for Endogenous Cushing's Syndrome Condition: Endogenous Cushing's Syndrome Intervention: Drug: COR-003 5 Recruiting Saliva Cortisol Measurement as a Screening Test for Suspicious Cushings Syndrome in Children. Condition: Cushings Syndrome Intervention: Other: Children refered to the obesity clinic 6 Recruiting Safety and Efficacy of LCI699 for the Treatment of Patients With Cushing's Disease Condition: Cushing's Disease Intervention: Drug: LCI699 7 Recruiting Treatment of Cushing's Disease With R-roscovitine Condition: Cushings Disease Intervention: Drug: R-roscovitine 8 Recruiting A Study of ATR-101 for the Treatment of Endogenous Cushing's Syndrome Condition: Cushing Syndrome Interventions: Drug: ATR-101; Drug: Placebos 9 Recruiting Evaluation of 68Ga-DOTATATE PET/CT, Octreotide and F-DOPA PET Imaging in Patients With Ectopic Cushing Syndrome Condition: Cushing Syndrome Interventions: Drug: F-DOPA PET Scan; Drug: Mifepristone; Drug: Ga-DOTATATE; Drug: Octreoscan; Other: CT, MRI 10 Not yet recruiting Endocrine Cardiomyopathy in Cushing Syndrome: Response to Cyclic GMP PDE5 inhibitOrs Condition: Cushing's Syndrome Cardiomyopathy Intervention: Drug: Tadalafil 11 Recruiting Long-term Beneficial Metabolic Effects of Adrenalectomy in Subclinical Cushing's Syndrome of Adrenal Incidentaloma Condition: Cushing Syndrome Intervention: Procedure: surgery 12 Recruiting Long Term Safety and Efficacy of Pasireotide s.c. in Patients With Cushing's Disease Condition: Cushings Disease Intervention: Drug: SOM230 13 Recruiting New Imaging Techniques in the Evaluation of Patients With Ectopic Cushing Syndrome Condition: Cushing Syndrome Interventions: Drug: Pentetreotide; Drug: 18-F-fluorodeoxyglucose; Drug: (18F)-L-3,4-dihydroxyophenylalanine (18F-DOPA) 14 Not yet recruiting Targeting Iatrogenic Cushing's Syndrome With 11β-hydroxysteroid Dehydrogenase Type 1 Inhibition Condition: Iatrogenic Cushing's Disease Interventions: Drug: AZD4017 and prednisolone; Drug: Placebo Oral Tablet and prednisolone 15 Not yet recruiting Assessment of Persistent Cognitive Impairment After Cure of Cushing's Disease Condition: Cushing's Disease Intervention: Device: Virtual radial task in 3D 16 Recruiting Biomarker Expression in Patients With ACTH-Dependent Cushing's Syndrome Before and After Surgery Condition: Cushing's Syndrome Intervention: 17 Recruiting Efficacy and Safety Evaluation of Osilodrostat in Cushing's Disease Condition: Cushing's Disease Interventions: Drug: osilodrostat; Drug: osilodrostat Placebo 18 Recruiting Effects of Metyrapone in Patients With Endogenous Cushing's Syndrome Condition: Cushing's Syndrome Intervention: Drug: metyrapone 19 Recruiting Adrenal Venous Sampling in Patients With Overt or Subclinical Cushings Syndrome, and Bilateral Adrenal Tumors Condition: Cushing Syndrome Intervention: Radiation: Adrenal venous sampling 20 Recruiting Glycemic Fluctuations in Newly Diagnosed Growth Hormone-Secreting Pituitary Adenoma and Cushing Syndrome Subjects Condition: Pituitary Adenoma Intervention: Device: continuous glucose monitoring Rank Status Study 21 Recruiting Targeted Therapy With Gefitinib in Patients With USP8-mutated Cushing's Disease Conditions: Cushing's Disease; Corticotrophin Adenoma Intervention: Drug: Gefitinib 22 Recruiting Cardiac Steatosis in Cushing's Syndrome Conditions: Endocrine System Disease; Cardiovascular Imaging Intervention: Other: 1H magnetic resonance spectroscopy and CMRI 23 Recruiting Study of Management of Pasireotide-induced Hyperglycemia in Adult Patients With Cushing's Disease or Acromegaly Conditions: Cushing's Disease; Acromegaly Interventions: Drug: Pasireotide s.c.; Drug: Sitagliptin; Drug: Liraglutide; Drug: Insulin; Drug: Pasireotide LAR; Drug: Metformin 24 Recruiting Study of Efficacy and Safety of Osilodrostat in Cushing's Syndrome Conditions: Cushing's Syndrome; Ectopic Corticotropin Syndrome; Adrenal Adenoma; Adrenal Carcinoma; AIMAH; PPNAD Intervention: Drug: Osilodrostat 25 Recruiting Effects of Hormone Stimulation on Brain Scans for Cushing s Disease Condition: Pituitary Neoplasm Intervention: Drug: Acthrel 26 Recruiting Does Serum-DXM Increase Diagnostic Accuracy of the Overnight DXM Suppression Test in the Work-up of Cushing's Syndrome? Conditions: Cushing's Syndrome; Adrenal Incidentalomas; Alcoholism; Obesity Intervention: 27 Recruiting Adrenalectomy Versus Follow-up in Patients With Subclinical Cushings Syndrome Condition: Adrenal Tumour With Mild Hypercortisolism Intervention: Procedure: Adrenalectomy 28 Recruiting Study of Adrenalectomy Versus Observation for Subclinical Hypercortisolism Conditions: Hypercortisolism; Cushing Syndrome Interventions: Procedure: Adrenalectomy; Other: Observation 29 Not yet recruiting Dynamic Hormone Diagnostics in Endocrine Disease Conditions: Adrenal Insufficiency; Congenital Adrenal Hyperplasia; Cushing Syndrome; Growth Hormone Deficiency; Acromegaly; Primary Hyperaldosteronism Intervention: Other: 27 hour subcutaneous fluid sampling 30 Recruiting An Investigation of Pituitary Tumors and Related Hypothalmic Disorders Conditions: Abnormalities; Craniopharyngioma; Cushing's Syndrome; Endocrine Disease; Pituitary Neoplasm Intervention: 31 Recruiting Ga-68-DOTATOC -PET in the Management of Pituitary Tumours Condition: Pituitary Tumours Intervention: Procedure: Gallium-68 DOTATOC PET 32 Recruiting Efficacy of Mifepristone in Males With Type 2 Diabetes Mellitus Conditions: Type 2 Diabetes Mellitus; Insulin Resistance Interventions: Drug: Mifepristone 600 mg daily; Drug: Placebo 33 Recruiting Targeted Therapy With Lapatinib in Patients With Recurrent Pituitary Tumors Resistant to Standard Therapy Conditions: Pituitary Adenomas; Prolactinomas Intervention: Drug: Lapatinib 34 Recruiting Mutations of Glucocorticoid Receptor in Bilateral Adrenal Hyperplasia Condition: General Glucocorticoid Resistance Intervention: Genetic: blood collection for mutation characterization 35 Recruiting Defining the Genetic Basis for the Development of Primary Pigmented Nodular Adrenocortical Disease (PPNAD) and the Carney Complex Conditions: Cushing's Syndrome; Hereditary Neoplastic Syndrome; Lentigo; Neoplasm; Testicular Neoplasm Intervention: 36 Not yet recruiting Reduction by Pasireotide of the Effluent Volume in High-output Enterostomy in Patients Refractory to Usual Medical Treatment Condition: Enterostomy Interventions: Drug: Pasireotide; Drug: Placebo 37 Recruiting Mifepristone for Breast Cancer Patients With Higher Levels of Progesterone Receptor Isoform A Than Isoform B. Condition: Breast Cancer Intervention: Drug: Mifepristone 38 Recruiting SOM230 Ectopic ACTH-producing Tumors Condition: Ectopic ACTH Syndrome Intervention: Drug: Pasireotide 39 Recruiting Decreasing Rates of Intraurethral Catheterization Postoperatively in Spine Surgery Condition: Post-operative Urinary Retention Interventions: Drug: Tamsulosin; Drug: Placebo 40 Recruiting Adrenal Tumors - Pathogenesis and Therapy Conditions: Adrenal Tumors; Adrenocortical Carcinoma; Cushing Syndrome; Conn Syndrome; Pheochromocytoma Intervention:
  5. The Surgeon, 03/04/2013 Clinical Article Toniato A et al. – The purpose of this study was to ascertain whether minimally–invasive surgery is a safe and effective treatment for adrenal carcinoma and metastases. This study shows that laparoscopic resection is inappropriate for patients with known or suspected adrenocortical carcinoma, while the laparoscopic approach can be justified and is feasible in case of adrenal metastases. Read this article at http://www.mdlinx.com/endocrinology/newsl-article.cfm/4458602/ZZ4747461521296427210947/?news_id=561&newsdt=030413&utm_source=Newsletter&utm_medium=DailyNL&utm_content=General-Article&utm_campaign=Article-Section
  6. From http://www.cushie.info/index.php?option=com_content&view=article&id=1146:dr-theodore-F.-interviews&catid=10:media&Itemid=18 Theodore C. F., M.D., Ph.D. has opened a private practice, specializing in treating patients with adrenal, pituitary, thyroid and fatigue disorders. Dr. F. has privileges at Cedars-Sinai Medical Center and Martin Luther King Medical Center. His practice includes detecting and treating hormone imbalances, including hormone replacement therapy. Dr. F. is also an expert in diagnosing and treating pituitary disorders, including Cushings disease and syndrome. Dr. F.'s career reflects his ongoing quest to better understand and treat endocrine problems. With both medical and research doctoral degrees, he has conducted studies and cared for patients at some of the country's most prestigious institutions, including the University of Michigan, the National Institutes of Health, Cedars-Sinai Medical Center, and UCLA's Charles Drew University of Medicine and Science. Read Dr. F.'s First Guest Chat, November 11, 2003. Read Dr. F.'s Second Guest Chat, March 2, 2004. Listen to Dr. F. First Live Voice Interview, January 29, 2009. Listen to Dr. F. Second Live Voice Interview, March 12, 2009. Listen to Dr. F. Third Live Voice Interview, February 13, 2011. This post has been promoted to an article
  7. October 1, 2012 at 6:30 PM eastern, Dr. Amir Hamrahian will answer our questions about Cushing's, pituitary or adrenal issues and Korlym (mifepristone) in BlogTalkRadio at http://www.blogtalkr...s-our-questions You may listen live at the link above. The episode will be added to the Cushing's Help podcast after the show is over. Listen to the podcasts by searching for Cushings in the iTunes podcast area or click here: http://itunes.apple....ats/id350591438 Dr. Hamrahian has had patients on Korlym for about 4 years. Please submit your questions below or email them to CushingsHelp@gmail.com before Sunday, September 30. From Dr. Hamrahian's bio at http://my.clevelandc...x?doctorid=3676 Amir Hamrahian, M.D. (216) 444-6568 http://my.clevelandc...5&DoctorID=3676 Appointed: 2000 Request an Appointment Research & Publications † ( † Disclaimer: This search is powered by PubMed, a service of the U.S. National Library of Medicine. PubMed is a third-party website with no affiliation with Cleveland Clinic.) Biographical Sketch Amir H. Hamrahian, MD, is a Staff member in the Department of Endocrinology, Diabetes and Metabolism at Cleveland Clinic's main campus, having accepted that appointment in 2005. Prior to that appointment, he was also a clinical associate there for nearly five years. His clinical interests include pituitary and adrenal disorders. Dr. Hamrahian received his medical degree from Hacettepe University in Ankara, Turkey, and upon graduation was a general practitioner in the provinces of Hamadan and Tehran, Iran. He completed an internal medicine residency at the University of North Dakota, Fargo, and an endocrinology fellowship at Case Western Reserve University and University Hospitals, Cleveland. In 2003, he received the Teacher of the Year award from Cleveland Clinic's Department of Endocrinology, Diabetes and Metabolism. Dr. Hamrahian speaks three languages -- English, Turkish and Farsi -- and is board-certified in internal medicine as well as endocrinology, diabetes and metabolism. He is a member of the Endocrine Society, Pituitary Society and the American Association of Clinical Endocrinologists. Education & Fellowships Fellowship - University Hospitals of Cleveland Endocrinology Cleveland, OH USA 2000 Residency - University of North Dakota Hospital Internal Medicine Fargo, ND USA 1997 Medical School - Hacettepe University School of Medicine Ankara Turkey 1991 Certifications Internal Medicine Internal Medicine- Endocrinology, Diabetes & Metabolism Specialty Interests Cushing syndrome, acromegaly, pheochromocytoma, prolactinoma, primary aldosteronism, pituitary disorders, adrenal tumor, adrenocortical carcinoma, MEN syndromes, adrenal disorders Awards & Honors Best Doctors in America, 2007-2008 Memberships Pituitary Society Endocrine Society American Association of Clinical Endocrinologists American Medical Association Treatment & Services Radioactive Iodine Treatment Thyroid Aspiration Thyroid Ultrasound Specialty in Diseases and Conditions Acromegaly Addison’s Disease Adrenal disorders Adrenal insufficiency Adrenal Insufficiency and Addison’s Disease Adrenal Tumors Adrenocortical Carcinoma Adrenoleukodystrophy (ALD) Amenorrhea Androgen Deficiency (Low Testosterone) Androgen Excess Calcium Disorders Carcinoid Syndrome Conn's Syndrome Cushing's Syndrome Empty sella Erectile Dysfunction Familial Multiple Endocrine Neoplasia Fasting hypoglycemia Flushing Syndromes Galactorrhea Goiter Growth hormone deficiency Growth hormone excess Gynecomastia Hirsutism Hyperaldosteronism Hyperandrogenism Hyperprolactinemia Hypertension - High Blood Pressure Hyperthyroidism Hypocalcemia Hypoglycemia Hypogonadism Hypoparathyroidism Hypophysitis Hypopituitarism Hypothyroidism Mastocytosis Menopause, Male Menstrual Disorders Paget's Disease Panhypopituitarism Parathyroid Cancer Parathyroid Disease and Calcium Disorders Pheochromocytoma Pituitary Cysts Pituitary Disorders Pituitary stalk lesions Pituitary Tumors Premenstrual Syndrome (PMS) Primary Hyperaldosteronism Primary Hyperparathyroidism Prolactin Excess States Prolactinoma Thyroid and pregnancy Thyroid Cancer Thyroid Disease Thyroid Nodule
  8. Leiana (islandgirl) was diagnosed with autoimmune adrenal insufficiency in 2009 and put on 30mg of Cortef for the rest of her life. Her cortisol levels were below normal of -1. She has been trying to wean off the steroids with no success. She had a 3.9 adenoma on the right adrenal gland removed in Sept 2010 is waiting for the left adrenal gland to kick in. She is extremely skinny and bony and eats around 3000 to 4000 calories a day. Read Leiana's bio here. Listen Live at http://www.blogtalkr...om/CushingsHelp The Call-In number for questions or comments is (646) 200-0162. Archives will be available after the interview
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