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Medical Forum / Diseases and Disorders / Diabetes / August 2007

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Article on difficulty with Cushing's diagnosis

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Jim Chinnis - 14 Aug 2007 22:06 GMT
Washington Post:

http://tinyurl.com/243orq
--
Jim Chinnis   Warrenton, Virginia, USA
Susan - 14 Aug 2007 22:39 GMT
> Washington Post:
>
> http://tinyurl.com/243orq
> --

Interesting to get coverage, but frustrating when so much is misrepresented.

Cushing's is not rare, it's rarely *diagnosed.*  At least 10% of all
type 2 DMs have undiagnosed Cushing's, according to a study that used a
test to screen for it that is false negative at least one out of three
times.

Some of us aren't fat, aren't red faced (though I was last year) and
aren't moon faced. Some of us spend so much time feeling adrenally low
that we have no appetite.

I did have an extra 20 unlosable lbs at one time, and exercise raises
cortisol, so it didn't help me at all, except to preserve muscle that
Cushing's causes to waste away.

Research has shown that a lot of psychosis, depression and bipolar
disorder respond well to cortisol lowering treatment.

Susan
Jim Chinnis - 14 Aug 2007 22:49 GMT
Susan <nevermind@nomail.com> wrote in part:

>x-no-archive: yes
>
[quoted text clipped - 20 lines]
>Research has shown that a lot of psychosis, depression and bipolar
>disorder respond well to cortisol lowering treatment.

I found it interesting that someone with virtually a textbook case (all the
signs) and seeing many doctors still had great difficulty getting diagnosed.
--
Jim Chinnis   Warrenton, Virginia, USA
Susan - 14 Aug 2007 23:15 GMT
> I found it interesting that someone with virtually a textbook case (all the
> signs) and seeing many doctors still had great difficulty getting diagnosed.

Most folks who get diagnosed have seen at least that many doctors.  Not
only do docs not diagnose them, they are brutal in their condemnation of
them for being fat.

It's so bad that recently, on Cushing board member who was at M.D.
Anderson for her surgery for pituitary tumor was told by the endo there,
the day before her surgery, that he would never have diagnosed her based
upon her test results and that she should just go home and lose weight
and exercise.  This is the DAY before her skull neurosurgery, by a
gifted neurosurgeon who had read her MRIs and seen all her myriad results.

Susan
Loretta Eisenberg - 14 Aug 2007 23:55 GMT
Susan and Jim, an interesing thing happened.

Last week I was at the moves wih a friend.  She said to me that I had
the thinnest legs she had ever seen.  I looked at them and they looked
thinner than they had been.

When I went to the endo, I mentioned this little incident to him and he
immediately said I should be tested for Cushings.  I have no symptoms
and I dont think I have it, but I didnt realize that skinny legs were a
sign. Have you ever heard that.   I have the apple body with the skinny
legs.  I dont have a moon face and I am not red.  I think he is just
taking precautions. but here is a thread on it.

Loretta
Emily - 15 Aug 2007 00:10 GMT
> Susan and Jim, an interesing thing happened.
>
[quoted text clipped - 10 lines]
>
> Loretta

Arms and legs both get quiet skinny with cushings from what I
understand. There is a lot of muscle wasting that causes this. It is the
 middle that gets big from the belly fat gained.  (at least that is
what I've learned from my research).

Emily
Susan - 15 Aug 2007 00:31 GMT
> Arms and legs both get quiet skinny with cushings from what I
> understand. There is a lot of muscle wasting that causes this. It is the
>  middle that gets big from the belly fat gained.  (at least that is what
> I've learned from my research).

Not necessarily skinny arms and legs, but muscle is lost with Cushing's
and replaced by fat due to cortisol's effects.

Susan
Loretta Eisenberg - 15 Aug 2007 17:03 GMT
Susan my upper arms are hadassah arms if you know what I eman.  and the
muscles in my arms or the bones are stronger than a thirrty year olds.
I dont think I have that, I wont think I have that, until someone says I
have
Julie Bove - 15 Aug 2007 04:13 GMT
> Arms and legs both get quiet skinny with cushings from what I understand.
> There is a lot of muscle wasting that causes this. It is the middle that
> gets big from the belly fat gained.  (at least that is what I've learned
> from my research).

Well, I'm all disproportional.  Skinny legs but big arms.  At least my arms
are muscular.
Andrew B. Chung, MD/PhD - 15 Aug 2007 12:18 GMT
> > Arms and legs both get quiet skinny with cushings from what I understand.
> > There is a lot of muscle wasting that causes this. It is the middle that
[quoted text clipped - 3 lines]
> Well, I'm all disproportional.  Skinny legs but big arms.  At least my arms
> are muscular.

Your arms would become much less muscular if you were to start low-
carb dieting.

Be hungry... be healthy... be happy... be blessed:

http://TheWellnessFoundation.com/PressRelease

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
Cardiologist
Susan - 15 Aug 2007 00:30 GMT
> When I went to the endo, I mentioned this little incident to him and he
> immediately said I should be tested for Cushings.  I have no symptoms
> and I dont think I have it, but I didnt realize that skinny legs were a
> sign. Have you ever heard that.   I have the apple body with the skinny
> legs.  I dont have a moon face and I am not red.  I think he is just
> taking precautions. but here is a thread on it.

Yes, Loretta, the conventional description is that central obesity with
skinny arms and legs is a Cushingoid appearance.  There is no such thing
as a single test that can rule it out, since hormone secretion in
Cushing's is so sporadic.

You sound very adrenally suppressed to me from your descriptions often;
statins, bp meds, insulin and insulin sensitizers can all lead to
adrenal suppression.

Susan
Julie Bove - 15 Aug 2007 04:12 GMT
> Susan and Jim, an interesing thing happened.
>
[quoted text clipped - 8 lines]
> legs.  I dont have a moon face and I am not red.  I think he is just
> taking precautions. but here is a thread on it.

I am not Susan or Jim, but it is a symptom.  I have really skinny legs too.
Even at my heaviest, my legs were relatively thin, but now they are like
sticks.  My chiropractor said he marveled that they could even be carrying
me around.
Loretta Eisenberg - 15 Aug 2007 17:04 GMT
JUlie do you have cushings

Loretta
Julie Bove - 15 Aug 2007 20:59 GMT
> JUlie do you have cushings

Not that  I know of.  I was tested for it.
KC - 15 Aug 2007 08:24 GMT
> Susan and Jim, an interesing thing happened.
>
[quoted text clipped - 10 lines]
>
> Loretta

I have skinny limbs too, and a red face, but not a moon face.   I have only
seen a handful of women in my life with as thin of limbs as mine, but with
upper body obesity.  Those of us who become obese in my family have long
thin limbs before we become obese.  I say that we are the ones who don't
grow muscle well.  This sublinical hypercortisolism does always interest me
because I fit the profile somewhat, but it sounds like it is really tough to
get diagnosed with overt cushings, so it would probably be darn near
impossible to get diagnosed with subclinical hypercortisolism.

The L-tryptophan that I wrote about in another thread was also said to
decrease stress induced cortisol levels in animals.  But as I said in the
other thread there is some controversy about the safety of L-tryptophan
since it had been banned years ago when bad batches of it were sent to the
US from Japan and made quite a few people sick, and even killed some.

I have one thing that I can't help but wonder if it is associated with
hypercortisolism.  When my thyroid function is low, I tend to have an easier
time losing weight than when it is adjusted to normal.  That seems so
backwards, but I did read that hypothyroidism reduces cortisol levels, so I
can't help but wonder if it is related to that.

KC
Andrew B. Chung, MD/PhD - 15 Aug 2007 12:10 GMT
> > Susan and Jim, an interesing thing happened.
> >
[quoted text clipped - 33 lines]
>
> KC

Low-carb dieting causes muscle wasting...

... **both** skeletal and cardiac.

The body sacrifices muscle to make the glucose to feed the brain.

Be hungry... be healthy... be happy... be blessed:

http://TheWellnessFoundation.com/PressRelease

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
Cardiologist
KC - 15 Aug 2007 18:30 GMT
>> > Susan and Jim, an interesing thing happened.
>> >
[quoted text clipped - 46 lines]
>
> The body sacrifices muscle to make the glucose to feed the brain.

I've had thin limbs since childhood, so I doubt low carbing did it.

KC
Andrew B. Chung, MD/PhD - 15 Aug 2007 18:46 GMT
> Andrew, in the Holy Spirit, boldly wrote:
> >>
[quoted text clipped - 50 lines]
>
> I've had thin limbs since childhood, so I doubt low carbing did it.

Indeed, had you been low-carb dieting since childhood, we would not be
having this written discourse.

Be hungry... be healthy... be blessed:

http://TheWellnessFoundation.com/PressRelease

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
Cardiologist
Susan - 15 Aug 2007 14:09 GMT
> I have one thing that I can't help but wonder if it is associated with
> hypercortisolism.  When my thyroid function is low, I tend to have an easier
> time losing weight than when it is adjusted to normal.  That seems so
> backwards, but I did read that hypothyroidism reduces cortisol levels, so I
> can't help but wonder if it is related to that.

YES, hypothyroidism is a frequent consequence of hypercortisolism.
IIRC, correctly, excess cortisol lowers TSH and T3.

Susan
Susan - 15 Aug 2007 14:10 GMT
> Susan and Jim, an interesing thing happened.
>
[quoted text clipped - 8 lines]
> legs.  I dont have a moon face and I am not red.  I think he is just
> taking precautions. but here is a thread on it.

Loretta, I want to revisit this to mention the obvious in your case:
statins are associated with muscle loss, too, and I think you take one.

My mother's muscles started to just dissolve from statin use (that she
never even needed) and Bill Wagner, who recently began posting here,
lost much of his leg muscle.

Susan
Loretta Eisenberg - 15 Aug 2007 17:07 GMT
Susan, and everyone, I want to tell you that I have had skinny legs all
my life,  I do believe that when we get older they get thinner so I am
not worrying.   They are quite shapely hahahahahahaha

I am on lipitor, but they were thin before,  al the woman in my family
have thin legs.  I think it is an inherited trait.

Loretta
Susan - 15 Aug 2007 18:44 GMT
> Susan, and everyone, I want to tell you that I have had skinny legs all
> my life,  I do believe that when we get older they get thinner so I am
> not worrying.   They are quite shapely hahahahahahaha
>
> I am on lipitor, but they were thin before,  al the woman in my family
> have thin legs.  I think it is an inherited trait.

Loretta, if you've always had skinny legs with a larger, round upper
body/stomach, then you very well could have subclinical Cushing's at the
root of your DM, depression, bp and lipids. Your recent tale about being
completely wasted by the heat is also a mark of the disease for me;
sunlight suppresses adrenal function.

Susan
Loretta Eisenberg - 15 Aug 2007 23:16 GMT
Susan, I will be taking care of this with the doctor.  I dont believe I
have that kind of problem.  All the woman have skinny legs from my
mother to my cousins, to nieces to my daughter.

I am not going to think I have another condition until someone tells me
I have it.

I cant drive myself crazy.

I have enough on my plate driving me nuts. :-)

Loretta
Alan S - 16 Aug 2007 00:50 GMT
>Susan, I will be taking care of this with the doctor.  I dont believe I
>have that kind of problem.  All the woman have skinny legs from my
[quoted text clipped - 8 lines]
>
>Loretta

Forget about it until you next see the doc.

Cheers, Alan, T2, Australia.
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
--
http://loraltraveloz.blogspot.com/
latest: Mossman Gorge in the Daintree Rainforest
http://loraldiabetes.blogspot.com/
latest: Self-Testing and Type 2 Management
Susan - 16 Aug 2007 01:06 GMT
> Susan, I will be taking care of this with the doctor.  I dont believe I
> have that kind of problem.  All the woman have skinny legs from my
[quoted text clipped - 6 lines]
>
> I have enough on my plate driving me nuts. :-)

Hey, Loretta, YOU said your endo mentioned it, I didn't bring it up!!

Susan
Andrew B. Chung, MD/PhD - 15 Aug 2007 17:01 GMT
> Washington Post:
>
> http://tinyurl.com/243orq

The complaint of "an awful metallic taste in her mouth" tells us that
she had not been hungry so that something other than overeating has
been happening.

Be hungry... be healthy... be happy... be blessed:

http://TheWellnessFoundation.com/PressRelease

Prayerfully in Jesus' awesome love,

Andrew <><
--
Andrew B. Chung, MD/PhD
Cardiologist
 
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