Question: Hello, I was recently diagnosed with a pituitary microadenoma following a brain MRI. I’m currently being evaluated for Cushings disease. I’ve gained over 60lb in the past year (mostly in my abdomen), have purple stretch marks, a small hump/fat deposit at the base of my neck, my face has become very round, I bruise easily and my skin seems papery and thin. I’ve also developed memory fog, trouble sleeping, acne, and am loosing my hair. I am also having muscle weakness/shakiness. I have received a hypothyroid diagnosis and been diagnosed with polycystic ovaries after an ultrasound was done due to severe intermittent pain in my pelvic area. All these diagnoses in less than six months (including the adenoma), but I’ve had symptoms for over a year. I had a positive low dose dexamethasone suppression test (3 when it should have been below 2), but normal urinary cortisol 24hr tests twice and a normal midnight saliva cortisol test. However I know Cushings can be cyclical and I have many of the symptoms. I’ve read that Cushings often appears as a darker area on the pituitary on an MRI, which I believe mine did. My endocrinologist will not refer me to a neurologist or neurosurgeon to further evaluate my MRI and symptoms and says she doesn’t see much of a need to continue testing for Cushings but I disagree given my symptoms and the adenoma and positive dexamethasone test. Is there anything you can tell from my MRI report that is indicative of Cushings or could otherwise explain my symptoms/diagnoses?

Thank you for your response. Quick follow up— my 24hr urinary cortisol levels were as follows:

#1. (Date: 8/13/20) free cortisol: 23mcg/24hr, creatinine: 1,356 mg/24hr, cortisol to CRT ratio: not on report

#2. (Date:10/10/20) free Cortisol: 29.7 ug/24hr, creatinine: 1,472mg/24hr, cortisol to CRT ratio: 20.2

#3. (Date: 11/23/20) free Cortisol: 13.1 ug/24hr, creatinine: 1,408mg/24hr, cortisol to CRT ratio: 9.3

I’m wondering why the most recent one could have been so drastically different from the first two—possible lab error, etc. or could it be an indication that my cortisol levels are fluctuating a lot and that if I do have Cushings it is cyclical— or just more generally how would you interpret these results and does the cortisol to creatinine ratio indicate anything?