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Partial Recovery of Cortisol Production

Question: I had a pituitary tumor and after many years, was able to discontinue replacement medication. I now find that I make enough for normal day to day life, but not enough to handle stressful situations and get some normal exercise. What if any tests should I ask my doctor for, what would the results tell us?

Answer: Patients with Cushing’s disease will have prolonged adrenal insufficiency after surgery if the surgery was curative. Recovery of hypothalamic- pituitary- adrenal axis is variable from case to case and patients often require treatment with replacement glucocorticoids for months or years after successful surgery. Few patients can have permanent adrenal insufficiency after pituitary surgery.

Recovery can also be sometimes incomplete, with insufficient ACTH secretion overtime and subsequently just partial adrenal function, (meaning the adrenal glands produce some cortisol, but not enough), so supplementation with hydrocortisone (a glucocorticoid) is needed.

A Cortrosyn stimulation testing (CST, also called an ACTH stimulation test) combined with a full clinical evaluation will make the final diagnosis and determine the glucocorticoid replacement dose needed.

If CST is not normal, thus a diagnosis of adrenal insufficiency confirmed, patients will require emergency steroids for stress and an emergency card as per present Endocrine Society guidelines.

By Dr. Maria Fleseriu, Oregon Health Sciences University Pituitary Center, Winter, 2016

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