CUSHINGS DISEASE SPECIALIST LOS ANGELES

• Wired at night
• Trouble sleeping-trouble falling asleep or frequent awakenings
• Severe fatigue-new onset
• Abrupt weight gain without other cause such as decreased activity or depression
• Decreased ability to exercise
• Menstrual abnormalities
• Cognitive changes- “brain fog”
• Decreased libido-low interest in sex
• Symptoms of adrenal insufficiency-joint pains, can’t get out of bed, nausea and vomiting
• Depression, anxiety, mood-swings
• Muscle atrophy
• Central obesity
• Thin skin
• Buffalo hump
• Round, red face
• Bruising
• Extra hair growth
• Acne
• Loss of hair on head
• Stretch marks

1. Careful history and physical
2. Change in weight and body habitus
3. Look at old pictures
4. Not all patients have all signs and symptoms, especially “early” and “episodic” patients.
5. Important to diagnose early before devastating sequelae develop.
6. Initial diagnosis most difficult aspect of Cushing’s syndrome.
7. “Gestalt” with as much information as possible
8. Episodic Cushing’s common, so one positive test may be worth more than 10 negative tests
9. Best tests are 24 hour urines for urinary free cortisols (UFC) and 17-hydroxysteroids (17-OHS, only done at Labcorp and 11 PM-12 midnight salivary cortisols are the best tests and multiple tests should be done to catch “highs”
10. Midnight serum cortisols are also good and can be done in a medical center, hospitals or emergency rooms.
11. Dr. Friedman does not recommend the dexamethasone suppression test or the DDAVP stimulation test. Too many patients who end up having Cushing’s disease suppress to dexamethasone and have a normal response to DDAVP.

Endocrinologist, Dr. Friedman, often uses medications to treat Cushing’s syndrome. Unlikely other doctors that may take a long time to diagnose a patient with Cushing’s and then send the patient directly to surgery, Dr. Friedman puts all patients that he has diagnosed with Cushing’s syndrome on cortisol-lowering medications prior to pituitary surgery.

Cortisol-Lowering Health Medications Are Used for 4 Reasons:

1. Medications that lower cortisol can get the patient feeling better right away
2. The medications can determine if the patients’ symptoms are due to high cortisol. If the Cushing’s symptoms resolve with medications, they will likely resolve with pituitary surgery. If they do not resolve, the patient is unlikely to improve with surgery and the diagnosis of Cushing’s may need to be re-assessed.
3. Lowering cortisol before surgery decreases the risks of surgery, which includes blood clots and infections.
4. Lowering cortisol before surgery decreases the drop in cortisol after successful surgery, so cortisol withdrawal symptoms are less.

Dr. Friedman especially recommends ketoconazole; an in-depth article on ketoconazole can be found on goodhormonehealth.com. He also uses Isturisa (osilodrostat), often in combination with ketoconazole. Many patients feel so well on the medications, they don’t want surgery. Dr. Friedman has patients that have done well on ketoconazole for over 10 years.

Read more on Medications to treat Cushings here.

Dr. Friedman has the most experience of using medications to treat Cushing’s disease of any Endocrinologist in the country.

For more personalized information, please click below to make an appointment.

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Diagnosing Cushing’s Disease

When Cushing’s Persists