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  1. #1
    Registered User thincyster85's Avatar
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    Default Cushings Disease vs. PCOS

    Cushings disease and PCOS have a lot of common symptoms.

    I was diagnosed a having PCOS but always wondered if it was right because I am thin and have no insulin problem. Any information would be helpful.

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    SoulCyster #1 KatCarney's Avatar
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    Your weight really isn't of issue when it comes to actually diagnosing either one.

    PCOS is a diagnosis of EXCLUSION...ie Other things like Cushing's should be EXCLUDED before arriving at a PCOS diagnosis. There is not definitive diagnosis for pcos.

    Here is more info on Cushing's. Your doctor should have excluded it as a possibility before arriving at PCOS:
    http://endocrine.niddk.nih.gov/pubs/...s/cushings.htm
    Last edited by KatCarney; 07-30-2007 at 06:29 PM.

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    A Brooklynite in Philly peppagrl's Avatar
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    Cushing disease is caused by a pituitary tumor. Cushing syndrome is caused by extensive steroid use or a tumor of the adrenal gland which both increase your cortisol. A lot of the characteristic symptoms of Cushings is not so similiar with PCOS such as the famous buffalo hump of the shoulders, an enlarged bdominal with dark strech mark lines on the belly, thinning of the skin and bones breaking very easily, muscle thining, fatigue and a moon face. They may also have psychosis, mental status changes, headaches, develop diabetes and high blood pressure.
    You haven't talked about your other symptoms that may suggest either PCOS or Cushing syndrome. The only thing that Cushing's may have in common with PCOS is the hirsuitism, acne, the amenorrhea (lack of periods) the diabetes, and high blood pressure.
    If you had Cushings disease, they would have measured your ACTH level and your cortisol levels. Cushings disease would have high ACTH and high cortisol. Cushing syndrome would have low ACTH and high cortisol. They would of also have done a CT to look at your pituitary gland to see if it is enlarged just to exclude it. PCOS has neither of these.
    There are women like myself that are 'ThinCysters' and don't have problems with their insulin. and have always had a regular periods. Part of the confusion and mystery of PCOS is that everyone that has it don't have the same symptoms and so it is hard to diagnose. As patients we can educate, our doctors about it more than they can, because it is not a typical text book diagnosis like Cushings.
    Last edited by peppagrl; 07-26-2007 at 03:20 PM.
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    A Brooklynite in Philly peppagrl's Avatar
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    I know for a fact that my mother developed Cushing's syndrome when she was on steroids for a long time during her treatment for Breast Cancer. She was of course very cachetic (thin), but she developed an enlarged belly, thinning of the skin, moon face, and she broke her clavicle just from sitting on the toliet.
    So Cushing's syndrome does not necessarily cause weight gain like one would see in PCOS (ie. coming off of birth controls, or have just given birth). You just see the distribution of the weight going to the belly, face (moon face), and shoulders (buffalo hump). You should also see thinning of the extremeties muscles (especially their legs). The high cortisol causes muscle wasting. This doesn't look like PCOS at all!!
    Keep in mind this is a conditon not a disorder like PCOS. People who are thin and overweight can develop Cushings. If there is any gain of weight in Cushing's, it's mostly water than fat. Google a picture of Cushings syndrome and you will see.
    Last edited by peppagrl; 07-26-2007 at 06:36 PM.
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    Still TTC #1 Beylia's Avatar
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    Doctors rule out things such as Cushings and Lupus before arriving at PCOS. And being overweight (obese midsection with normal arms and legs) is a requirement of Cushings where as PCOS has a thin category. PCOS is called a syndrome because it is a family of symptoms and not all cysters have the same ones. There are many thin cysters here who are not IR as well. Hope that helps.
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    Registered User serenity1981's Avatar
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    i am sure my mother has cushings disease i have told her many times to go to the doctors and even showed her the syptoms and she has loads of them.
    But she point blank refuse because she said she is over the doctors enough with her other medical conditions, so i can't stop worrying and just wish she would go to the doctors.
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    Registered User thincyster85's Avatar
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    Hey thanks for the info everyone. It is helpful. The reason I was starting to think it is that I was on steroids from when I was a baby to age three because of having underdeveloped lungs. I don't think my doctor did rule out the cushings and some other things that they should have. I've been through alot of not so good doctors. Maybe I'm still in denial about having PCOS

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    Still TTC #1 Beylia's Avatar
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    well hun if you are still wondering about it, ask the doctor if he checked already or to check you. i initially went to the docs and they thought i had cushings (thank god i don't). i'll take pcos over having cushings any day.
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    Registered User ~copacabana~'s Avatar
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    Default Cushing's is a hard diagnosis...

    Like PCOS, Cushing's can be a very hard diagnosis to make, sometimes testing for it can take years. This is because there is a type of Cushing's called Cyclical Cushing's. I was first diagnosed with PCOS, but I actually have Cushing's. It is possible that I have PCOS too, but the Cushing's is causing the severe symptoms such as very wide, dark stretch marks, terrible fatigue, buffalo hump, supraclavicular fat pads, and the wasting of muscle. Most people with Cushing's won't have every symptom, and that includes the weight gain, and many don't have the thinning arms and legs. Also, most of the weight gained with Cushing's is fat, because of the high cortisol, the body stores most of what you eat as fat. There is an Endo journal that tells why, but it has something to do with the stress response and the Hypothalamic-Pituitary axis and the stress response. Also, with Cyclical Cushing's, having a normal test CANNOT rule OUT Cushing's. There is a lot of confussion with this, as it was always thought that the overnight or low dose dexamethasone test was the "gold" standard. It isn't. AM and PM cortisol and ACTH is good to establish if there is loss of diurnal variation, and 24hr. urine for Cortisol, Creatinine and 1 7 hydroxycorticosteroids are very helpful too. Seeing a NEUROEndocrinologist is crucial, as MANY endo's dismiss OBVIOUS Cushing's patients. Also, if you were on steroids at one point, it is possible it set off something within the hpa axis. If you have any more questions, send me a message. Take care
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    Registered User SoulSista's Avatar
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    Quote Originally Posted by peppagrl View Post
    I know for a fact that my mother developed Cushing's syndrome when she was on steroids for a long time during her treatment for Breast Cancer. She was of course very cachetic (thin), but she developed an enlarged belly, thinning of the skin, moon face, and she broke her clavicle just from sitting on the toliet.
    So Cushing's syndrome does not necessarily cause weight gain like one would see in PCOS (ie. coming off of birth controls, or have just given birth). You just see the distribution of the weight going to the belly, face (moon face), and shoulders (buffalo hump). You should also see thinning of the extremeties muscles (especially their legs). The high cortisol causes muscle wasting. This doesn't look like PCOS at all!!
    Keep in mind this is a conditon not a disorder like PCOS. People who are thin and overweight can develop Cushings. If there is any gain of weight in Cushing's, it's mostly water than fat. Google a picture of Cushings syndrome and you will see.
    omg all my weight goes to my belly and my face.... I will ask my doctor about that when I see her in 2 weeks.. I should get tested jsut incase ..Thank you for the info!!
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    Registered User Annw's Avatar
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    Quote Originally Posted by ~copacabana~ View Post
    Like PCOS, Cushing's can be a very hard diagnosis to make, sometimes testing for it can take years. This is because there is a type of Cushing's called Cyclical Cushing's. I was first diagnosed with PCOS, but I actually have Cushing's. It is possible that I have PCOS too, but the Cushing's is causing the severe symptoms such as very wide, dark stretch marks, terrible fatigue, buffalo hump, supraclavicular fat pads, and the wasting of muscle. Most people with Cushing's won't have every symptom, and that includes the weight gain, and many don't have the thinning arms and legs. Also, most of the weight gained with Cushing's is fat, because of the high cortisol, the body stores most of what you eat as fat. There is an Endo journal that tells why, but it has something to do with the stress response and the Hypothalamic-Pituitary axis and the stress response. Also, with Cyclical Cushing's, having a normal test CANNOT rule OUT Cushing's. There is a lot of confussion with this, as it was always thought that the overnight or low dose dexamethasone test was the "gold" standard. It isn't. AM and PM cortisol and ACTH is good to establish if there is loss of diurnal variation, and 24hr. urine for Cortisol, Creatinine and 1 7 hydroxycorticosteroids are very helpful too. Seeing a NEUROEndocrinologist is crucial, as MANY endo's dismiss OBVIOUS Cushing's patients. Also, if you were on steroids at one point, it is possible it set off something within the hpa axis. If you have any more questions, send me a message. Take care
    I just got back from seeing an endocrinologist for the first time. I was never diagnosed with PCOS at any point. I have an old test with elevated androgen factor and now a 24hr urine collection test with elevated levels of cortisol. I suspect IR as well, since my family is full of diabetics. I only did a fasting sugar levels test so far and it came back ok (83). I asked this endo dude about IR and he just said "of course you have IR, I can see that by looking at you" (yes, I'm fat!) He wrote a note to my regular doctor asking for two more Urine collection tests this month, separated by one week, to see if maybe there was a problem with the test results. He wrote in the note that he suspects either cushings or pseudo-cushings, which I take to be just stress induced elevated cortisol levels.

    I guess fretting over the whole thing won't get my cortisol levels down either, sigh. I have been under a lot of stress lately, panic attacks and depression hitting back. I'm back to prozac too, but only 10mg a day, maybe I should up that to solve the cortisol issue (if it's indeed pseudo-cushings).

    Thanks for your insightful posts Copacabana - I hope you get some good news soon when you see your specialist in September.
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