Thanks for waiting dear friends and readers. Since this is also a chronicle of my journey with Cushing’s syndrome I’ll take just a moment for an update. My sonogram came up negative for any tumors. That doesn’t mean there weren’t any micro tumors there, just that if there were they were too small for the scan to visualize. They did find another problem which will require me to go back to my urologist. So my endocrinologist wants to do more testing to see where things are at.
Surgery is out, of course, since they couldn’t see anything to justify it. There is only one surgery which is often done in cases where adenomas can’t be located, that’s the bi-lateral adrenalectomy or BLA for short. The BLA is performed when they find tumors in both adrenal glands, in the case of recurring pituitary tumors and in the case of ectopic tumors. The BLA is simply the removal of both adrenal glands. The idea in the case of ectopic Cushing’s and recurring pituitary tumors is to shut of the production of the cortisols at their source. Since tumors generally produce ACTH, the hormone which signals the adrenals to produce cortisols that is considered the logical way to deal with the problem in many cases. After the two glands are taken out the patient is put on hormone replacement therapy or HRT for short.
The adrenal glands sit on top of the kidneys and are protected by the lower ribs. Not many years ago the surgeon had to break the ribs over the adrenal glands to get at them for removal. But now days, at least here in the United States of America, a new method is used to remove them. The surgeon uses a laparoscope which requires relatively small incisions and which snakes up under the ribs to get to the adrenal glands. Another great aspect of this kind of surgery is that the patient isn’t placed on their stomach for the procedure, which is contraindicated in my case. The advantages of this kind of surgery are low recovery time with less pain and less time in the hospital.
After the surgery the hormones which the adrenal glands produce have to be replaced or there will be trouble. So the patient goes on HRT which involves testing and adjusting the hormone levels through time. The patient is also subject to going into Adrenal failure (AI), which I’ve discussed in two other posts, and having to seek emergency treatment for that problem. So a BLA is a surgery with serious consequences and the patient and their family have to be familiar with what to watch out for and always ready to take them for emergency treatment.
Although one has to be watchful, the surgery does cure the Cushing’s and the patient will generally lose weight, even achieving normal weight in some cases and they will have a more normal life when compared to what they had with Cushing’s. So while it is a procedure with serious consequences, including death in some cases, it is a surgery to consider in many cases. According to a study done by doctors in Oregon, it is a surgery which can result in a good quality of life for most. I’ll link the study at the bottom.