Question: Does stress make it more difficult to discontinue replacement medication and does stress increase the likelihood of pituitary recurrences?

Answer: While it is my clinical impression that patients with Cushing's syndrome do not report more stress in their lives than patients with other medical disorders, to my knowledge, there are no data in the medical literature that address these questions. Replacement glucocorticoid therapy is usually discontinued when an ACTH (Cortrosyn) test response is normal; this is thought to indicate that the patient can "handle" stressors. We believe that pituitary recurrence occurs because of incomplete resection of the initial tumor, so that small, perhaps microscopic remnants of tumor may grow and eventually result in the clinical syndrome. Thus, in other words, the question asks whether "stress" increases tumor growth, and again, there are no data to answer this question.