Cushing’s Syndrome Specialist

What is Cushing’s Syndrome?

Dr. Friedman specializes in Cushing’s Syndrome, a relatively rare condition that often goes underdiagnosed. While frequently attributed to a pituitary tumor, Cushing’s Syndrome can also stem from an adrenal tumor or other causes. Cushing’s Disease specifically refers to cases of Cushing’s Syndrome caused by a pituitary tumor, a scenario commonly encountered by Dr. Friedman in his practice.

The syndrome, characterized by elevated cortisol levels, can manifest in various ways and is notorious for mimicking other diseases, making accurate diagnosis crucial. Many individuals suffering from Cushing’s describe it as exceptionally challenging.

With his extensive experience, Dr. Friedman has encountered and treated more than 2000 Cushing patients since his fellowship at the NIH in 1989 while contributing significantly to the field with multiple published papers. Dr. Friedman is the best specialist to see if you suspect or are diagnosed with Cushing’s Syndrome.

Symptoms of Cushing’s Syndrome

Cushing’s syndrome manifests through a range of symptoms, with variations in their severity among patients.

The most common symptoms include:

Significant Weight Gain: Weight gain, notably concentrated in the abdomen or upper back, is a prominent indicator, occurring even in individuals adhering to a healthy diet and exercise regimen.
Round Face: Often described as a “moon face,” this is when the face becomes rounder and more full.
Skin Changes: The skin might get thinner, bruise easily, and heal slowly. Some folks also notice stretch marks, which are usually pink or purple, on their abdomen, thighs, arms, and breasts.
Fatigue and Muscle Weakness: Feeling tired all the time and experiencing muscle weakness, especially in the thighs, can be a telltale sign.
High Blood Pressure: Keep an eye on this, as Cushing’s can lead to higher-than-normal blood pressure.
Mood Changes: This can range from feeling irritable to suffering from anxiety or depression.
Osteoporosis: Bones becoming more fragile and prone to fractures is also common.
Glucose Intolerance: This refers to higher blood sugar levels and possibly even diabetes.
Irregular or Absent Menstrual Periods: Menstrual cycles might become irregular or even stop for women.
Decreased Libido and Fertility Issues: Both men and women might experience a reduced sex drive and fertility problems.
Increased Thirst and Urination: Feeling thirsty more often and needing to pee frequently can be symptoms, too.

Additional Symptoms

Additional symptoms include disrupted sleep patterns, restlessness before bedtime, and increased facial hair, acne, and head hair loss. Functional challenges, such as difficulty standing up, climbing stairs, performing routine tasks, and entering/exiting a vehicle, are reported by some.

Causes of Cushing’s Syndrome

Cushing’s syndrome can originate from various sources, each presenting unique challenges.

Pituitary Cushing’s: Also referred to as Cushing’s disease, this condition is associated with problems in the pituitary gland.
Adrenal Cushing’s syndrome: Characterized by issues stemming from adrenal tumors.
Ectopic Cushing’s syndrome: Results from tumors located in the lungs or other body parts, leading to elevated cortisol levels.
Pseudo-Cushing’s: Constitutes a distinct category where individuals display partial symptoms without the same intensity. This can be associated with factors such as depression or other psychological issues.

Although Cushing’s syndrome can manifest at any age, Dr. Friedman primarily sees patients in their 20s, 30s, and 40s. The female-to-male ratio for Cushing’s is around 4-to-1. Significantly, many of Dr. Friedman’s patients present with pituitary Cushing’s disease, a complex diagnosis compared to adrenal or ectopic Cushing’s due to the often higher cortisol levels in the latter cases, facilitating a more straightforward diagnosis.

Highlighting the imperative of early detection, Dr. Friedman stresses the need to identify Cushing’s before its devastating effects take hold.

How is Cushing’s Syndrome Diagnosed?

Cushing’s syndrome is typically diagnosed through tests confirming elevated cortisol levels. In a paper from the 1990s during his tenure at the NIH, Dr. Friedman highlighted that morning cortisol levels are unreliable indicators for diagnosing Cushing’s disease. High cortisol levels characterize Cushing’s disease and Cushing’s syndrome at night, while morning cortisol levels resemble those of healthy individuals.

Dr. Friedman employs two extensively validated diagnostic tests:

Late-night salivary cortisol tests, usually conducted between 11 PM and 12 AM
24-hour urine tests, specifically the urinary free cortisol (UFC) test

Additionally, cortisol metabolites known as 17-hydroxysteroids (17-OHS) are measured. Notably, some patients with Cushing’s disease or Cushing’s syndrome may exhibit elevated 17-hydroxysteroid levels alongside normal urinary-free cortisol levels.

Dr. Friedman orders midnight serum cortisol levels for in-person consultations at his Tuesday night clinic. He emphasizes the importance of having at least two of these tests show high values for a more reliable diagnosis. However, he acknowledges that some patients with Cushing’s disease may display relatively mild test results, challenging the assumption that severity correlates directly with test outcomes.

Contrary to many other doctors who use a dexamethasone suppression test, Dr. Friedman argues that it is not highly accurate for patients with mild Cushing’s. He specializes in episodic Cushing’s, where patients exhibit intermittent high cortisol values mixed with normal or even low values. His research indicates that episodic Cushing’s is more common than previously thought. Consequently, Dr. Friedman advocates for multiple tests of urinary-free cortisols and salivary cortisols, as these provide a more comprehensive assessment.

Dr. Friedman uses imaging, particularly pituitary MRIs, as part of the diagnostic process. Collaborating with neurosurgeon colleagues, he ensures proper interpretation and execution of the MRI, providing a checklist to ensure its accuracy.

Given that most patients Dr. Friedman encounters have episodic symptoms and fluctuating cortisol levels, he emphasizes the importance of timing in conducting tests. This unique approach is crucial for accurately diagnosing Cushing’s.

Quality of Life for Patients with Cushing’s

Untreated Cushing’s patients often experience a significantly diminished quality of life, with studies suggesting a shortened lifespan and a higher risk of succumbing to heart attacks and blood clots. However, Dr. Friedman’s patient population primarily consists of individuals with relatively mild cases, and mortality is not a common outcome. In a published case study, he detailed a patient with Cushing’s syndrome for 33 years, who, despite having only a small 4 mm pituitary tumor, did not face fatal consequences.

While the life expectancy for most individuals with Cushing’s is normal, their daily lives are marked by considerable challenges. Weight gain, a focal point of societal concern, is a prominent issue, often occurring despite adherence to a healthy diet and regular exercise. Additionally, patients struggle with severe fatigue, irregular periods, depression, mood swings, and irritability, collectively contributing to a pervasive sense of misery among those with Cushing’s.

Why Should Patients Concerned About Cushing’s See Dr. Friedman

Consider consulting with Dr. Friedman if you suspect Cushing’s syndrome, as he comes highly recommended. Most general practitioners and gynecologists might struggle with an accurate diagnosis, while some endocrinologists might rely on outdated tests, like the single dexamethasone test, possibly dismissing you if the results appear normal.

Dr. Friedman takes a personalized approach, carefully determining the best testing methods and scheduling for your situation. He’s a strong advocate for early treatment, believing in the initial use of medical interventions to help patients feel better. Though surgery might be an option down the line for some, Dr. Friedman places great confidence in the effectiveness of medications for Cushing’s disease, considering them a primary mode of treatment. In your discussions with him, expect a thorough exploration of all available treatment options.

How Patients Concerned about Cushing’s Should See Dr. Friedman

If you think you have Cushing’s disease or syndrome or were told you could have it, please schedule an appointment through Dr. Friedman’s website at goodhormonehealth.com. You can schedule a telemedicine appointment or, if you prefer, an in-person appointment. The advantage of the in-person appointment is that you can get blood tests done for cortisol around midnight, which also helps make the diagnosis, in Dr. Friedman’s office in Beverly Hills. You should not have to suffer from Cushing’s disease. Come and see the expert.

Dr. Friedman’s web site does not offer medical advice. These materials are offered for information purposes only. Do not act or rely upon information from goodhormonehealth.com without seeking professional medical advice. Additionally, the transmission of information from the website, goodhormonehealth.com to you, is not intended to create nor does create a physician-patient relationship between you and Dr. Friedman.