Question: I had Cushing’s due to a pituitary tumor and also have enlarged adrenal glands which I was told was due to excess exposure to ACTH over a long period of time. My question is, since I have enlarged adrenal glands, will my cortisol always run higher than normal?

Answer: It is correct that when the adrenal glands are over-stimulated by too much of ACTH hormone (from a pituitary or other site tumor), the adrenal glands in order to produce excess cortisol can become slightly larger on both sides (hyperplasia) or less often, when the stimulation was more intense or of longer duration, they may even develop nodules on the larger adrenals. This can result in cortisol levels that remain a bit higher than hoped despite complete removal of the ACTH-secreting tumor. However, if ACTH levels become low after surgery, the adrenal enlargement usually decreases quite rapidly over a few days or weeks and cortisol levels should become low. As this occurs, replacement with hydrocortisone is necessary until full recuperation of the normal remaining pituitary.

By Dr. Andre Lacroix MD (Summer, 2012)