Cushing's Syndrome: Symptoms, Treatment, and Steroid Use

Q: Cushing's Syndrome: Symptoms, Treatment, and Steroid Use

Hello： The adrenal tumor was discovered in 1998, and now the adrenal function may have recovered. <br>It is necessary to confirm adrenal insufficiency before considering the need for steroid supplementation.

Cushing's syndrome

Hello, Doctor: I was diagnosed with Cushing's syndrome in 1998 and had my left adrenal gland removed.
Currently, my adrenaline secretion should be normal, but over the past few years, I sometimes feel fatigued in the mornings, even though I believe I am getting enough sleep.
I can't think of any reasons for this.
Could it be possible that I occasionally have insufficient adrenaline secretion? Would I need to supplement with corticosteroids? I once went to the pharmacy to buy corticosteroids, but the pharmacist advised me to consult a doctor first.
If supplementation is necessary, which type should I purchase, and what would the dosage be? Thank you.

Mei Mei, 40~49 year old female. Ask Date: 2005/09/19

Dr. Yang Hongzhi reply Internal Medicine

Hello: The adrenal tumor was discovered in 1998, and now the adrenal function may have recovered.
It is necessary to confirm adrenal insufficiency before considering the need for steroid supplementation.

Reply Date: 2005/09/19

More Info

Cushing's syndrome is a complex endocrine disorder characterized by excessive levels of cortisol in the body, often due to an adrenal tumor, pituitary adenoma, or prolonged use of corticosteroid medications. The symptoms can vary widely but commonly include weight gain, particularly around the abdomen and face, thinning skin, easy bruising, muscle weakness, and mood changes. In your case, having undergone left adrenalectomy for Cushing's syndrome, it is crucial to monitor your adrenal function closely.

After adrenalectomy, the remaining adrenal gland may not produce sufficient cortisol, especially during times of stress or illness, leading to a condition known as adrenal insufficiency. This could explain your feelings of fatigue upon waking, despite adequate sleep. It is essential to differentiate between normal post-surgical recovery and potential adrenal insufficiency, which can occur if the remaining adrenal gland is not compensating adequately for the loss of the other gland.

Regarding your question about the need for steroid supplementation, it is vital to consult with your healthcare provider before making any decisions. Self-prescribing corticosteroids can lead to serious complications, including exacerbation of underlying conditions and potential side effects. If your doctor determines that you have adrenal insufficiency, they may recommend glucocorticoid replacement therapy, typically with hydrocortisone, prednisone, or dexamethasone. The specific medication and dosage would depend on your individual needs, which can be assessed through clinical evaluation and possibly laboratory tests.

In terms of dosage, it varies widely based on factors such as body weight, the severity of adrenal insufficiency, and individual response to treatment. A common starting dose for hydrocortisone might be 15-30 mg per day, divided into two or three doses, but this should be tailored to your specific situation. Regular follow-up appointments are essential to monitor your symptoms and adjust the dosage as necessary.

Additionally, if you experience any acute stressors, such as illness or surgery, your doctor may advise increasing your steroid dosage temporarily to mimic the body's natural response to stress. This is crucial because your body may not be able to produce adequate cortisol during such times.

In summary, while your symptoms may suggest a potential issue with adrenal function, it is essential to work closely with your healthcare provider to evaluate your condition properly. They can perform the necessary tests to assess your adrenal function and determine if steroid supplementation is appropriate. Self-medication with steroids is not advisable due to the risks involved. Always consult your physician for personalized medical advice and treatment options.

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