DEAR DR. DONOHUE: Do your readers a favor by telling them about Cushing’s syndrome. It took six years before I was diagnosed. The delay cost me my job and my fiance. I gained weight and had stretch marks all over. Doctors told me to lose weight by dieting and exercise. I did both, but continued to gain weight. Then my blood pressure rose. Finally, a doctor, to whom I owe my life, came up with the correct diagnosis. I had an operation, and my life has changed for the better. — P.A.

ANSWER: Cushing’s syndrome is an overproduction of cortisone. People are surprised that they make cortisone. They think of it as a medicine. Our adrenal glands, sitting above the kidneys, turn out this hormone, which is essential to life.

At first, an overproduction of cortisone produces signs and symptoms that are quite subtle and go unrecognized. As time goes by, weight is gained, the face becomes round and red, the arms and legs remain thin, the chest and abdomen expand. The skin thins and is easily injured. Purple stretch marks appear. Menstrual irregularities occur. Women sprout facial hair. Muscles weaken, as do bones (osteoporosis). Blood sugar rises, and so does blood pressure. All of this comes from having too much cortisone.

The trouble can lie in either of two places, the pituitary gland on the underside of the brain, or the adrenal glands (above the kidneys) that make the hormone. The pituitary gland produces a hormone that stimulates adrenal-gland production of cortisone. Tumors of the adrenal gland, independent of the pituitary gland, can rev up their production of cortisone on their own. Most cases come from a small pituitary-gland tumor whose hormone stimulates the adrenal glands.

It’s treated by turning off cortisone production. Surgery is the answer to both causes of Cushing’s. With the pituitary gland, the approach can be through the nose or roof of the mouth to reach the pituitary gland and destroy the tumor. When the adrenal gland is the cause, surgery is more involved.

TO READERS: Questions on macular degeneration never stop. The booklet on that topic explains both kinds and how they are treated. To order a copy, write: Dr. Donohue — No. 701, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My artificial sweetener has a warning saying it contains phenylalanine. Why? Is it a dangerous material? — K.S.

ANSWER: Phenylalanine is an amino acid, one of the bricks from which the body builds proteins. It is not a dangerous material. However, a few individuals are born without the ability to metabolize this amino acid. They have a disorder called phenylketonuria, PKU. High blood levels of phenylalanine and phenylketones damage the brain. Discovery soon after birth is important so that phenylalanine can be eliminated or severely limited in these babies’ diets. Because of this importance, in most countries, newborns are tested for PKU. If the diet isn’t changed, the baby suffers mental retardation.

Brand names of this sweetener are NutraSweet and Equal.

DEAR DR. DONOHUE: My daughter is four months pregnant. Her doctor told her she could gain around 25 pounds. That surprises me. I was told not to gain more than 15 pounds. Have things changed? — W.C.

ANSWER: Today, the recommendations for weight gain during pregnancy for a woman of normal weight is 25 to 35 pounds (11.5 to 16 kg).

Maternal weight gain during pregnancy is an important determinant of the baby’s birth weight. That, in turn, is an important determinant of the newborn’s weight and health.

Things have changed.

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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