Cushing’s syndrome or too much cortisol is probably the one disease that confuse the most doctors, nurses and patients. But when it comes to adrenal Cushing’s syndrome, it is actually quite straightforward. Adrenal Cushing’s syndrome means too much cortisol that originates from the adrenal gland. This is either from one adrenal tumor or from both adrenal glands, called bilateral adrenal Cushing’s syndrome.

Another name for Cushing’s syndrome due to masses of the adrenal glands is ACTHindependent Cushing’s syndrome. This differentiates it from Cushing’s Disease which is ACTHdependent. The problem then is a tumor in the pituitary gland of the brain overproducing ACTH.

To diagnose Cushing’s syndrome, lab tests prove that the patient have too much cortisol production. This can be done through a number of tests including the lowdose dexamethasone suppression test, a salivary cortisol test, or a 24hour urine collection for cortisol. If the ACTH level (which is the pituitary hormone that controls the adrenal) is on the low side or frankly suppressed that proves that the problem originates in the adrenal glands.

The patient is a doctor from Southern California. He has for many years had adrenal Cushing’s syndrome. His ACTH level has always been low, but his cortisol level has been high. This has been proven multiple times through 24hour urine collection and low dose dexamethasone suppression test.

He had many very difficult symptoms with muscle weakness, decreased sex drive, problems with concentration and memory, anxiety, low potassium, high blood pressure. He was required to take multiple medications including blood pressure medication and extra potassium although otherwise, he was a very fit and healthy person. All these symptoms affected his quality of life and his work as a doctor.

His doctor had started him on a medication called Korlym. Korlym is a drug that blocks the cortisol effect. This medication does not fix the problem. It is not a cure for Cushing’s syndrome. It does not remove the tumors in the adrenal glands.

However, sometimes it can treat the symptoms and make life a little bit more bearable for the patients until they can have surgery and get cured of the disease.
So, he was started on Korlym until he could come to me in Tampa for his adrenal gland removal.

A couple of months ago, I performed bilateral cortexsparing adrenalectomy on him. This was done by the Mini Back Scope Adrenalectomy (MBSA) approach. I removed almost all adrenal tissue except leaving about 30 to 50% of one adrenal gland. This is because he had bilateral tumors, meaning tumors on both the right side and the left side. This left the perfect amount of adrenal tissue such that he was cured of his Cushing’s syndrome, but also has enough cortisol production that he does not need to take longterm steroid hormone supplementation. This is a “Goldilocks” operation, meaning the amount of adrenal tissue remaining is “just right”.

Now the patient is cured of his Cushing’s syndrome and is doing very well. He required a short period of time (a few weeks) to take supplementary cortisol (Prednisone) until the remnant adrenal gland tissue produced enough cortisol by itself.