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Ask Dr. Gott: Cushing's difficult to diagnose


MaryO

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Dear Dr. Gott: Is it possible to have Cushing's syndrome if your lab results are negative? I've included my results for your review. About 30 years ago, I became hyperthyroid and lost a tremendous amount of weight. I then became hypothyroid, and my menses stopped abruptly, never to reappear. I was told my thyroid condition was responsible for both.

 

I've developed a very large stomach, although my arms and legs are thinner. I've been tested several times for uterine cancer, with consistent negative results. My face is also puffy and more rounded.

 

I've had periodic backaches that are so severe I can hardly walk. I've become diabetic and two years ago was put on insulin. This year, my high blood pressure became permanent, even though my stress and anxiety levels are low, and lately I am always tired. It seems some of my symptoms are escalating while others ? the backaches, depression and anxiety ? have disappeared. I would think the insulin is responsible for my sleepiness and exhaustion after slight exertion, but I've had most of these symptoms for 10 to 30 years.

 

Until I read about Cushing's, I felt hopeless, alone and resigned to the fact that these were side effects of my medical conditions. Can the tests be wrong, and, if not, do you have any idea what could be occurring? I'd like to have some energy so I can at least function the way I did two years ago.

 

Dear Reader: The common signs and symptoms of Cushing's include abdominal weight gain, fatigue, a rounded face, depression, anxiety and high blood pressure. The most common cause is the use of oral corticosteroid medication. The main issue here is that Cushing's is difficult to diagnose since it shares many symptoms with other conditions. Symptoms of hypothyroidism include weakness, a cessation of menstruation, fatigue, an extended abdomen and facial puffiness. Symptoms of diabetes include fatigue, weight loss, blurred vision and poorly healing wounds. Sound familiar?

 

I fear I am removing any hope you might have of putting a diagnosis to your symptoms, but I do not believe you have Cushing's. Rather, the laboratory work you included with your letter indicates you do have diabetes and hypothyroidism, exactly as you pointed out. The problem is that neither condition is under complete control, despite the insulin and Glucophage for your diabetes and the Levothyroxin for your hypothyroidism.

 

Return to your primary-care physician for referral to an endocrinologist, if you aren't already seeing one. Sit down with your list of questions to determine together what can be done to bring both conditions under control. Once that happens, your blood pressure should drop, your fatigue should disappear, your energy should return, and life should be back to a more normal state. It's often difficult to hit upon the right dose for a particular condition, but through the process of trial and error, it can be done.

 

To give you related information, I am sending you a copy of my Health Report: Living with Diabetes Mellitus." Other readers who would like a copy should send a self-addressed, stamped, No. 10 envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

 

 

 

Write to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, N.Y. 10016.

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