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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest treatment for subclinical Cushing's syndrome

Answered by
Dr.
Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1418 Questions

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Posted on Mon, 28 Sep 2015 in Thyroid Problem and Hormonal Problems
Question: I had a laparoscopic adrenalectomy on August 24 2015 to remove a non functioning benign mass found previously on my right gland. The operation was successful and i was able to go home the next day.
I have not had any problems with adrenal glands before operation (i.e, Addisons disease Cushing disease pheo, etc..). I have a hx of prostate cancer and hypertension; however, cancer was treated in 2007 with seed implant and hypertension is controlled with lisinopril medication. I also take 500 mg of metformin for diabetes which is under control. I have had no problems with diet, sleep or energy level since this surgery My only concern is that i noticed that the week following the week i was released from the hospital, my weight dropped going from 155 to 151 pounds then following week 148 to now at 145. I had pre-operative test (ACTH, Cortisol, etc.) biopsy full body CT scan done before surgery; no abnormalities or malignancies found. I am trying to eat nutritiously but not regaining any weight. When I saw endocrinologist a week after surgery,I was told that due to surgery you will lose weight and it should normalize in about 3 weeks; surgeon I saw the same day did not seem to be concerned; simply said I need to eat. I understand that I will lose weight after surgery but this consistent drop in weight over the last 2 1/2 weeks has me real concerned ; need advice so I 'll know what questions to ask when I see new endo doctor.
doctor
Answered by Dr. Binu Parameswaran Pillai 24 minutes later
Brief Answer:
Subclinical Cushing;s syndrome from the mass

Detailed Answer:
Good day,
Noted your concern.

Did you have any increase in weight prior to surgery or any striae ( stretch marks)in abdomen ? Any facial puffiness prior to surgery??

What was the size of adrenal mass and what did post operative biopsy report show?

It is common to lose some weight after surgery. The other possibility is that, you might have had subclinical cushing's syndrome which sometimes will be missed in routine testing.

I am not sure if you ever had a dexamethasone suppression test or a 24 hour Urine free cortisol test done prior to surgery. Just doing a cortisol and ACTH, you may miss subclinical Cushing syndrome. So if you had subclinical cushings due to the adrenal mass, after surgery, you are cured and weight loss could be due to that.

It is worth to do an 8 AM serum cortisol at this stage. If it is low, it is possible that, you had subclinical cushing's prior to surgery.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 59 minutes later
Sir, I had a dexamethasone suppression test and 2 hour urine free cortisol test done prior to surgery. I did not have any atypical cushing syndome symptoms (puffiness,stretch marks in abdomen, etc.) I however had some unexplained weigh loss problems before surgery; however, my weight was beginning to stabilize (weight was between 155 and 158 pounds) The biopsy was done before surgery the mass was determined to be 4.8 cm and was removed due to its size. The mas was
determined to be non malignant before and after surgery.
doctor
Answered by Dr. Binu Parameswaran Pillai 15 hours later
Brief Answer:
May take some time to improve weght

Detailed Answer:
Sorry for the delay . Good to know that the mass was not malignant. 4 cm is the threshold for surgery in Adrenal masses. So malignancy is not the cause of weight loss.

As the tests were negative, cushing's syndrome was unlikely . People with Cushings syndrome tend to lose weight following surgical removal of adrenal mass.

In your case, since the above 2 causes are ruled out, please do not worry. In due course your weight will improve.

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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