UT Southwestern: Patients with mild Cushing syndrome may benefit from adr...(syndrome. Dr. Auchus said the resul...),Health

Dr. Auchus said the results were telling. Diabetes and hypertension improved considerably in most affected patients after adrenalectomy. In addition, all eight patients who reported easy bruising before surgery noted resolution of the problem, and seven of the nine patients lost weight. Fat accumulation around the neck disappeared and muscle weakness improved, often markedly.

We cannot promise everybody the same results, Dr. Auchus said, but we found that adrenalectomy can dramatically help some patients.

Dr. Auchus said there are many caveats to their findings, chief among them that the study was not random.

It was a very select group, Dr. Auchus said. Because they had certain clinical symptoms, we offered them surgery.

We now have a handful of additional people who have biochemical indications of subclinical Cushing syndrome, but we havent recommended surgery because they dont have hypertension, obesity or easy bruising. Were continuing to repeat their blood and urine tests for cortisol function over time.

The classic manifestations of Cushing syndrome, such as purple stretch marks and paper-thin skin, occur only in severe cases. Patients with overt Cushing syndrome are generally diagnosed after a 24-hour urine collection for cortisol. Levels higher than 50 to 100 micrograms a day suggest Cushing syndrome.

It is more difficult to diagnose subclinical Cushing syndrome because patients symptoms are non-specific, such as fatigue, obesity and hypertension. Using the traditional diagnostic tests, patients with subclinical Cushing syndrome rarely have enough cortisol in their urine to raise concern.

The cutoff values are intentionally set high so that we minimize the false positives, Dr. Auchus said. But when you do that, you miss those with early or subclinical Cushing.

Dr. Fiemu Nwariaku, associate professor of GI/endocrine surgery and vice chairman of surgery, said the mess
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