DEAR DR. DONOHUE: What can you tell me about Cushing’s disease? Is it hereditary? What are the symptoms? What tests are done to diagnose it? Is it treatable? – J.C.

ANSWER:
Cushing’s disease is an illness in which the adrenal glands put out too much of their hormones – principally cortisol, one of the cortisone hormones. The result is deposition of fat in the stomach and chest. The face looks like a full moon because of fat deposits there. Stretch marks appear on the skin. Muscles weaken. Bones might develop osteoporosis. Women sprout facial and chest hair, and their periods diminish or stop. Men often develop erectile dysfunction. Blood pressure often rises.

Trouble can be in two places, either the pituitary gland or the adrenal glands.

The pituitary gland – located at the base of the brain – is the body’s master gland. It releases hormones that stimulate other endocrine glands – the thyroid, ovaries, testes, adrenals – to produce their unique hormones. The pituitary gland makes ACTH, adrenocorticotropic hormone – the hormone that spurs adrenal gland production of cortisol. If the pituitary gland has a tumor that’s secreting too much ACTH, the adrenal glands make too much cortisol, and Cushing’s disease results.

The adrenal glands can also be the site where the problem lies. One of the adrenal glands can house a tumor that’s making too much cortisol, independent of ACTH.

The diagnosis is made by checking hormone blood levels and scanning the pituitary and adrenal glands for tumor.

In either case, whether it’s the adrenal gland or the pituitary gland, surgery can cure Cushing’s disease. It is not an inherited illness.

There’s another cause of Cushing’s. A person who has to take one of the cortisone medicines, like prednisone, in large doses for long periods can come down with the signs and symptoms of Cushing’s disease.

DEAR DR. DONOHUE: My daughter has panic attacks quite often. Sometimes they can last three days. All she takes is Valium. What causes these attacks? Isn’t there something that can prevent them? I am very worried about my daughter. – H.H.

ANSWER:
Everyone’s brain is wired to detect danger. When danger presents itself, the brain shifts the body into an alert mode. The heart pounds faster. The mouth dries. Blood pressure rises. Muscles tense. People get ready to do battle or to retreat.

People with panic attacks are put into the all-alert mode in circumstances that don’t call for such body changes. They might be shopping, driving a car or watching TV when the brain suddenly throws the body into a state that is prepared for danger. The danger, however, doesn’t exist. Most panic attacks last from a few minutes to half an hour. People might feel the aftereffects of an attack for some time, but the body adaptations that occur during an attack are gone.

Your daughter’s medicine quiets anxiety and can be used to calm a person having panic attacks. She obviously needs more than medicine. She needs the help of a professional who can help her identify the false signals that cause her brain to throw her into a state of high arousal. When she has learned what those signals are, her attacks will become less and less frequent. The family doctor is the one who can recommend a therapist for her.

DEAR DR. DONOHUE: I would like your advice on low blood pressure. Sometimes mine is 100 over 65. Is that bad? – J.K.

ANSWER:
How do you feel when your pressure dips to those levels? If you don’t have any symptoms – dizziness, faintness, disorientation – then the pressure is not a matter of concern. People with pressures in that range live longer lives than the rest of us.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com


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