Brief Answer:
Assuming diagnosis still not established; ??causes

Detailed Answer:
Hello ma'am and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. I understand how every doctor jumps to suspect Cushing's Syndrome on observing elevated cortisol levels, but this is wrong and although in most cases it does turn out to be Cushing's, as this is quite common. There are other conditions that can also cause an elevated level of cortisol, let me list these for you for your better understanding and so you can take them up with your doctor. Ruling them out one by one should help to narrow our search to find the cause for your presentation. They are:

-Tumor of the adrenal gland: As you have reported an adrenal mass, this could be suspected and should be adequately ruled out (biopsy can be used for this purpose)
-Hyperthyroidism: An over-active thyroid can be suspected, and should be ruled out as you have symptoms of varying heart rate, dizziness, weakness which all can be seen in hypothyroidism
-Obesity: Is not directly responsible but can result in damage of target-organs that can result in raised levels of cortisol
-Long term use of corticosteroids: As you have not mentioned the use of any medications in your query, I think we can rule this out. But it was worth mentioning as this is commonly encountered, and there could be a possibility of you having used steroids in the past (but not presently)
-Liver abnormalities: Many liver diseases can also contribute to an elevated cortisol level
-Kidney abnormalities: Can also contribute to elevated cortisol levels
-Birth control pills or contraception can also tamper with cortisol levels
-Depression: Although many doctors choose not to consider this amongst possible causes, it has been studied and proved to cause abnormalities in various body functions; including an elevated cortisol level
-Chronic illness
-Injuries, serious wounds, or surgeries can also change cortisol levels
-Infections: Mostly severe infections (eg. sepsis)
-Cancer of the adrenal gland (specific investigations like a CT or MRI can greatly help to conclude this diagnosis)

Above listed are all the conditions that can result in elevated levels of cortisol. Assuming you were looking for the possible cause for your presentation now that Cushing's has been ruled out. I have listed all the possible causes for an elevated cortisol level, please discuss them with your primary care doctor ma'am.

I would also like that waiting for such long durations for a follow-up with your doctor might not be advisable. Please forgive me if I have not provided the information you were looking for as you have not mentioned the question you wished to be addressed, so I assumed you were looking for possible causes for your presentation.

I hope you find my response both helpful and informative. Please feel free to write back to me for any further clarifications, I would be more than happy to help you.

Best wishes.

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Brief Answer:
Very few possibilities; tumor likely

Detailed Answer:
Hello once again ma'am.

Thank you so much for that information.

So based on the provided information, we are left with the following possibilities:
-Tumor or cancer of the adrenal gland
-Liver abnormalities
-Obesity? (could you provide me with your weight and height to calculate your BMI)
-Depression? (constantly feel sad, recent or past emotional trauma, etc.)

I would also like to ask why a biopsy has not yet been conducted when an adrenal mass has already been found? Was there any contraindication for a biopsy, or has it yet to be considered and scheduled by your doctor? Does it take time to be schedule in the US? The only contraindication would be cancer of the adrenal gland, which is why more extensive investigations need to be conducted to rule out cancer before going ahead with a biopsy.

I hope this helps. Please request your doctor for a more extensive investigation to rule out/confirm cancer, so we can move forward with a biopsy.

Best wishes.

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Brief Answer:
Obesity and thyroid abnormalities present

Detailed Answer:
Hello once again ma'am.

-Your TSH is still slightly on the higher side
-Your BMI computes to a level of 30.4 which places you in the category of 'obesity'
-Liver abnormalities
-Tumor or cancer of the adrenal gland

Above listed are the factors which are still present. Out of which, thyroid abnormality and obesity have been confirmed. Liver abnormalities can be diagnosed or ruled out with the help of a liver function test (blood test), leaving the adrenal mass for further evaluation. As I had recommended earlier ma'am, an MRI will have to be conducted to confirm or rule out possible cancer. Once cancer is ruled out, a biopsy can be conducted to make an accurate diagnosis and accordingly address the mass.

Please discuss all these details with your doctor. I hope you find my response both helpful and informative. Please feel free to write back to me for any further clarifications, I am always here to help.

Best wishes.

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