By PAUL G. DONOHUE, M.D.
DEAR DR. DONOHUE: My daughter is 36. Two years ago, she fractured her hip. While recovering from that, she fractured a bone in her foot. Ever since, she has had a lot of swelling in her body, especially her face and stomach. She has a fatty hump on the back of her neck. Doctors have checked her for many things. The tests for Cushing's disease have come back positive. She takes a water pill. Her blood pressure is a little high. Please explain this.
Thin, fragile skin, a rise in blood pressure, a moon face, an increase in abdominal fat, muscle weakness and facial hair in women are some of the signs of Cushing's disease. A mound of fat below the back of the neck is another sign, and it's called a buffalo hump. Osteoporosis — fragile bones that break easily — is another Cushing's consequence. The swelling of your daughter's face and stomach might actually be fat, and, as I mentioned, it's a typical Cushing's sign. All of these signs and symptoms result from an overproduction of cortisone, something many people think is found only in medicine form. Our adrenal glands make it, and it's necessary for life. Too much of it, however, causes all sorts of mischief.
If her doctors say she has Cushing's disease, their next job is finding its source. It could be her pituitary gland, a small gland at the base of the brain. It makes the hormone ACTH, which stimulates the adrenal glands' production of cortisone. Tumors of the pituitary gland release too much ACTH, with the result being too much cortisone. Or, in fewer instances, the adrenal glands themselves might, on their own, be the overproducers of cortisone, with the same resulting signs and symptoms.
Surgical removal of the tumor — pituitary or adrenal — is the cure in most instances. Your daughter must undergo more tests to locate the source of the trouble: the pituitary or the adrenal. Scans and ultrasound pictures can pinpoint the correct site.