Question: I recently attended a patient education day and there were several people in the room who were slim.  The majority of us are still carrying excess weight, usually in the mid-section, regardless of where we are with active Cushing’s or in remission.  I know I am more active than it seems possible to still be carrying this weight.  Do you have any research that addresses this situation?  Only one of the slender patients I spoke with has an extremely active lifestyle – the rest sound more or less on par with everyone else when it comes to physical activity and diet.

Answer: Losing weight after normalization of cortisol level is not always an easy process. While some patients lose a significant amount of weight in the first few months after remission, others do not experience the same course. A thorough evaluation of other causes is necessary which may include, among other, insulin resistance and thyroid dysfunction. In addition, most patients who achieve remission after surgery require glucocorticoid replacement, usually hydrocortisone. Taking the physiologic amount is important and should be discussed at each endocrine visit. It is always a good idea to increase physical exercise as tolerated and to have a healthy diet. If desired results are not achieved, consultation with a weight loss specialist is the next step.

By Dr. Adriana Ioachimescu, Emory University Hospital, Atlanta, GA  (Winter-Spring 2018)