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Suggest Treatment For Skin Thinning And Loss Of Bone Density
Question: Hello
I had surgery about 2 months ago for a pituitary tumor. I was diagnosed with cushings disease. My skin thinned out and i lost muscle as well as bone density. After treatment, do these things reverse and settle back to normal(thinning skin,bone loss) or is this something that is permenent?
Also,
My endocronologist said i can start to weightlift again. I am currenlty on hydrocortisone on a low dose of 10mg am and 5mg pm. Would the medication interfere with building muscle since its a catabolic steroid?
I had surgery about 2 months ago for a pituitary tumor. I was diagnosed with cushings disease. My skin thinned out and i lost muscle as well as bone density. After treatment, do these things reverse and settle back to normal(thinning skin,bone loss) or is this something that is permenent?
Also,
My endocronologist said i can start to weightlift again. I am currenlty on hydrocortisone on a low dose of 10mg am and 5mg pm. Would the medication interfere with building muscle since its a catabolic steroid?
Brief Answer:
Pituitary
Detailed Answer:
Whether or not, the impact on skin/muscle/bone will completely reverse to normal depends on if you are cured of the condition.
I sincerely hope your surgery was successful but statistically there are chances that there may not have been a complete cure. An experienced endocrinologist will be able to determine this for you by running appropriate tests.
Hydrocortisone in normal replacement doses like the one you are on does not cause any problems. It is not catabolic in these amounts. It is only when it exceeds the body's requirement that it can negatively impact health.
So weight lifting is not a problem
Pituitary
Detailed Answer:
Whether or not, the impact on skin/muscle/bone will completely reverse to normal depends on if you are cured of the condition.
I sincerely hope your surgery was successful but statistically there are chances that there may not have been a complete cure. An experienced endocrinologist will be able to determine this for you by running appropriate tests.
Hydrocortisone in normal replacement doses like the one you are on does not cause any problems. It is not catabolic in these amounts. It is only when it exceeds the body's requirement that it can negatively impact health.
So weight lifting is not a problem
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had a doctors appoinment today. I had urine and blood work drawn. How will someone know whether or not they are cured from cushings?
Brief Answer:
Follow up
Detailed Answer:
There are several options regarding how to go about doing this, as there are more than one ways.
First I check the 8 am (morning) cortisol after asking the patient to be off hydrocortisone for 24 hours. After the blood sample is taken I have them restart their regular hydrocortisone treatment.
If this value is below 6 then I surmise that the likelihood of cure is high. If it is less than 3, then it is even more likely that 'remission' has been achieved.
The latest trend is to avoid using the term 'cure' and instead use 'remission'. The reason is that Cushings can be a challenging condition that tends to return, sometimes even after many years. So periodic monitoring is warranted.
However, if morning cortisol is greater than 6, I deploy the following screening tests first such as
Midnight salivary cortisol
24 hour urinary cortisol
Overnight DST (Dexamethasone Suppression tests)
If 2 out of any 3 of these are positive then I proceed to the next round of tests to confirm the diagnosis of Incomplete cure.
An example of confirmation testing is the HDDS (High dose dexamethasone suppression test)
Follow up
Detailed Answer:
There are several options regarding how to go about doing this, as there are more than one ways.
First I check the 8 am (morning) cortisol after asking the patient to be off hydrocortisone for 24 hours. After the blood sample is taken I have them restart their regular hydrocortisone treatment.
If this value is below 6 then I surmise that the likelihood of cure is high. If it is less than 3, then it is even more likely that 'remission' has been achieved.
The latest trend is to avoid using the term 'cure' and instead use 'remission'. The reason is that Cushings can be a challenging condition that tends to return, sometimes even after many years. So periodic monitoring is warranted.
However, if morning cortisol is greater than 6, I deploy the following screening tests first such as
Midnight salivary cortisol
24 hour urinary cortisol
Overnight DST (Dexamethasone Suppression tests)
If 2 out of any 3 of these are positive then I proceed to the next round of tests to confirm the diagnosis of Incomplete cure.
An example of confirmation testing is the HDDS (High dose dexamethasone suppression test)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok are there any signs i should look out for if the treatment was successful? Physical/mental etc
My energy does fluctuate and on some days i feel better than others. Current dose of medication is 10mgb morning 5mg evening. Ive heard that your suppose to feel worse after surgery if the surgery was a success.
My energy does fluctuate and on some days i feel better than others. Current dose of medication is 10mgb morning 5mg evening. Ive heard that your suppose to feel worse after surgery if the surgery was a success.
Brief Answer:
Second follow up
Detailed Answer:
It is difficult to go by how one feels. It can be misleading and result in missing out on diagnosing the condition, if it has re-occurred. The best way is to under regular testing as per the discretion of the treating endocrinologist.
Your dose seems just about adequate. However, individualization of the dose is necessary.
I give my patients an extra dose of 5 mg at in early afternoon/ lunch time.
Discuss with your endocrinologist if this is appropriate for you too
Second follow up
Detailed Answer:
It is difficult to go by how one feels. It can be misleading and result in missing out on diagnosing the condition, if it has re-occurred. The best way is to under regular testing as per the discretion of the treating endocrinologist.
Your dose seems just about adequate. However, individualization of the dose is necessary.
I give my patients an extra dose of 5 mg at in early afternoon/ lunch time.
Discuss with your endocrinologist if this is appropriate for you too
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the reply Doctor
I want to start weightlifting again and possibly lose some weight. I gained about 25lb and would like to get back in shape. Would it be ok to go on a diet for fat loss? I know hormones can change during a fat loss phase. The type of diet i would go on would be a slow approach towards fat loss. It would not be anything excessive.
I want to start weightlifting again and possibly lose some weight. I gained about 25lb and would like to get back in shape. Would it be ok to go on a diet for fat loss? I know hormones can change during a fat loss phase. The type of diet i would go on would be a slow approach towards fat loss. It would not be anything excessive.
Brief Answer:
Third follow up
Detailed Answer:
I woud like to believe that if your endocrinologist has advised you that it is safe for you to star weight lifting again, (s)he must have ensured your pituitary hormone axes are fine.
This particularly entails thyroid and testosterone testing, in addition to the cortisol for which you are already taking hydrocortisone.
If these are fine, you are free to embark upon appropriate dietary changes to lose fat.
If I were you, I would consult a dietitian first
Third follow up
Detailed Answer:
I woud like to believe that if your endocrinologist has advised you that it is safe for you to star weight lifting again, (s)he must have ensured your pituitary hormone axes are fine.
This particularly entails thyroid and testosterone testing, in addition to the cortisol for which you are already taking hydrocortisone.
If these are fine, you are free to embark upon appropriate dietary changes to lose fat.
If I were you, I would consult a dietitian first
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the reply and well written answers
Is there any ongoing research as to what causes ACTH producing tumors(cushings disease)? Diet,stress, genes etc
Before i had symptoms or cushings i was really healthy and was weight training. I started weight training 8 years ago and lived a healthy lifestyle.?
Is there any ongoing research as to what causes ACTH producing tumors(cushings disease)? Diet,stress, genes etc
Before i had symptoms or cushings i was really healthy and was weight training. I started weight training 8 years ago and lived a healthy lifestyle.?
Brief Answer:
Fourth follow up
Detailed Answer:
Research in medicine is always ongoing. Yet it is unclear as what exactly causes these ACTH producing tumors. Genetic tendency has been considered. The role of diet and stress is even less clear.
At this moment, scientific evidence does not suggest a major role of lifestyle in the causation of Cushings disease. So there is nothing one can do to prevent it from that perspective
Fourth follow up
Detailed Answer:
Research in medicine is always ongoing. Yet it is unclear as what exactly causes these ACTH producing tumors. Genetic tendency has been considered. The role of diet and stress is even less clear.
At this moment, scientific evidence does not suggest a major role of lifestyle in the causation of Cushings disease. So there is nothing one can do to prevent it from that perspective
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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