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Cheeks sinking in and turning blackish, weight loss, stress. Is it Addison's disease or Cushing syndrome?

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General & Family Physician
Practicing since : 1980
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My cheeks are quickly sinking in and turning blackish. I've lost considerable volume in my overall face as well.Every morning I wake up and it's a little worse. I've been under intense emotional stress for over a month. Could this be related in anyway? I'm wondering if Cushings Syndrome or Addison's Disease induced by my extreme stress could cause this. My new health insurance doesn't start until the 1st but I don't know if I can even wait that long. Please help. What should I do. Should I get to the emergency room asap regardless if I have insurance?
Posted Thu, 19 Apr 2012 in General Health
 
 
Answered by Dr. Rahul Tawde 16 hours later
Hi,
Thanks for posting your query.
As per your history, your symptoms could be related to Addison’s disease. Addison's disease can be associated with weight loss, nausea, vomiting, abdominal pain, weakness and hyperpigmentation of gums and exposed areas of body and emotional changes (as well).
However, I would also like to emphasize that Addison's disease cannot be caused by emotional stress alone. I would suggest that you consult a general practitioner who can examine you and record your blood pressure and pulse. A few investigations like a plasma glucose level and a serum electrolyte level would also be required. If they are normal, then you can wait till the 1st. If symptoms are debilitating and interfering with your daily routine or if you think your emotional stress requires urgent attention and care, then you should contact emergency immediately.
I hope I have answered your query. I will be available for follow up queries.
Regards
Above answer was peer-reviewed by
 
Follow-up: Cheeks sinking in and turning blackish, weight loss, stress. Is it Addison's disease or Cushing syndrome? 15 hours later
Hi Dr. XXXXXXX C

Is it possible for pseudo-cushings syndrome caused by extended high stress levels after a certain period of time to cause collagen breakdown resulting in facial volume loss due to high cortisol levels and then also a real case of Addison's Disease due to Adrenal gland over exertion? Depression over the initial situation as well as what it seems like I've done to myself is becoming an issue now too.Thanks for your time.

XXXXXXX
 
 
Answered by Dr. Rahul Tawde 6 hours later
Hi,
Thanks for reverting.
No, pseudocushing syndrome of any form will be characterised by facial puffiness and plethora (which is marked by a florid complexion) rather than volume loss.
The manifestations of collagen breakdown in Cushing's syndrome are the striae which are typically seen over abdomen and thighs.
Cushing's syndrome is associated with facial puffiness and is due to excess cortisol levels in blood, whereas, Addison's disease can be associated with facial volume loss and is due to low cortisol levels in the blood. Cushing’s syndrome is associated with weight gain and the latter is associated with weight loss.
Addison's disease is not due to adrenal overexertion but due to diminished adrenal reserve. However stress can precipitate adrenal crisis in patients with borderline reserves which however is typically associated with nausea, vomiting and weakness rather than hyperpigmentation and other chronic manifestations of XXXXXXX disease.
I hope I have answered your query. Please accept my answer if you have no further queries.

Regards
Above answer was peer-reviewed by
 
Follow-up: Cheeks sinking in and turning blackish, weight loss, stress. Is it Addison's disease or Cushing syndrome? 16 hours later
Thank you doctor. Sorry but I have just one more query. You mentioned it tends to attack belly fat. Therein may lie the problem. I've always been a very athletic person with a low body fat %. I believe that at least partially because of this as well as just plain aging a few years ago my my face began to become a bit gaunt. It began to bother me at such a young age so I had a fat grafting procedure done, and the fat was taken from my abdomen and grafted into my face. My fear is that the cushings is destroying these transplanted fat cells, which intern is killing the rest of my original cells. Thanks for your time and would appreciate your thoughts.
 
 
Answered by Dr. Rahul Tawde 33 hours later
Hi and thanks again,

Striae are due to breakdown of subcutaneous “collagen tissue” and not due to destruction of adipose (fat cells) tissue.

Cushing's patients have typical central distribution of fat. They have fat accumulation in abdomen, torso, face and neck. This leads to classic pot belly and plethoric facial appearance.

Your facial volume loss is definitely NOT due to Cushing's disease.

Hope it is clear to you now. Yet should you have any further clarification, I will be glad to assist you further. Do accept the response if you do not have any further queries.

Regards
Above answer was peer-reviewed by
 
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