A young friend of mine, a 15YO girl, has recently been told she *might* have
Cushing's Syndrome, but tests won't be performed until early next year. I've
been looking for information on the web, but I have one important question
which isn't answered there, hence this post.

The girl in question has been suffering from Type I diabetes since the age
of seven, her specialists have been unable to keep her sugar levels or her
{*filter*} pressure under control, and irreversible kidney disease may be just
around the corner.

Now the question. If her condition *is* a result of Cushing's Syndrome,
which can be cured through surgery, will that also "cure" her diabetes?

It almost seems too much to expect, because we're conditioned to think of
diabetes as an incurable condition, but if the diabetic symptoms turn out to
be the result of another, curable condition, then it seems to be implied.

TIA for any contributions or suggestions.

Luke

Luke,
I looked up Cushing's Syndrome....sounds like a bad deal.

If the girl is truly T1, then I would seriously doubt that curing the
Cushion's Syndrome would cure her diabetes.  Since she has been T1 since the
age of 7, I imagine that she is honestly T1.  It may, however, make her
diabetes easier to control.  Any other illnesses can strongly affect control
of sugars.

If the girl is not truly T1, but simply exhibits the symptoms of T1 due to
the effects of Cushing's Syndrome, then I would think that fixing the
problem (Cushing's) would also fix her symptoms of T1.  I really have no
idea.

I hope you will post again and let us know how it goes for her.  I hope your
friend will be okay.
Steph

There was a woman who used to post here who was eventually diagnosed with
Cushing's Syndrome.  In her case, I don't think there was an operation, but
she was given steroids which would then eventually bring on diabetes.  I
wasn't aware that there was a cure for Cushing's.

--
Type 2
http://www.***.com/ ~jbove/

Cushing's syndrome, or Cushing's disease?  They aren't the same thing.
The former is a set of symptoms that resembles those of the latter, and
may or may not be caused by the latter.  Only the latter is ever treated
with surgery (the former is treated by treating the cause of the
symptoms).

Type I diabetes is caused by destruction of the beta cells in the
pancreas, not by Cushing's disease.  Even if Cushing's disease is
present, curing it will not cure the DM.

Cushing's disease is associated with Type II DM, which is in turn part
of Cushing's syndrome.

Not if it is Type I.  If it is Type II, it may, depending on how much
damage has already been done.  She's young, so if the disease is not too
severe, chances would be good.

Type I diabetes mellitus is incurable currently, because there is no way
to replace the damaged function of the pancreas; it can only be treated
by injections of insulin.

Type II DM may be cured if an underlying cause can be found and
corrected.  More often, it is sent into remission by treatments such as
major weight loss (obesity is the major cause of Type II DM).  The
remission is pretty much the same as a cure, except that the patient
will develop clinical DM again if he gains weight or returns to the
state that caused the DM the first time.  Some Type II DM can only be
treated on a continuing basis with hyperglycemics or insulin, and in
these cases it is pretty much like Type I DM in its incurability, except
that a few problems like DKA and other acute manifestations are a bit
less likely in Type II DM (unfortunately, long-term complications are
just as common, as they depend only on the degree of long-term
hyperglycemia, not its cause).

Diabetes mellitus is really a set of clinical abnormalities, the essence
of which is chronic hyperglycemia.  The causes of Type I are very few
and incurable--they amount essentially to physical destruction of
insulin-producing cells, and there is no way currently to replace those
cells.  The causes of Type II are many and somewhat poorly understood;
if the cause for a specific patient can be successfully treated, then
the DM itself will disappear.

In people with Cushing's disease that has not been severe enough or
longstanding enough to cause permanent damage to glucose metabolism,
curing the Cushing's disease should eliminate any concomitant DM (i.e.,
it will cure the diabetes as well).

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Cushing's syndrome is just a set of symptoms.  Curing it depends on
curing whatever is causing the symptoms.  Steroids are _not_ used to
cure the syndrome; it's an excess of steroids that is usually the
_cause_ of the syndrome.  People who take steroids over long periods, as
for allergies, may develop Cushing's syndrome.

Cushing's _disease_ is one cause of Cushing's syndrome.  In Cushing's
disease, the adrenal glands produce too much steroid, and this excess of
steroids is what produces the symptoms of Cushing's syndrome.  One way
to treat Cushing's disease is to remove part of the adrenal glands, thus
reducing their output of steroids; if this is done correctly and
successfully, the disease is cured.  Sometimes the glands produce too
much because of tumors (benign or malignant); removing the tumors cures
the disease.

Anything that produces an excess of steroids in the body will produce
Cushing's syndrome.  Steroid administration used to treat other diseases
is a very common cause of the syndrome.

The symptoms of Cushing's syndrome include chronic hyperglycemia, i.e.,
diabetes mellitus.  Eliminating whatever causes the symptoms will
eliminate the hyperglycemia, and thus will eliminate the DM.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Many thanks for a truly helpful post. It seems wierd to be *hoping* that a
friend has Cushing's, but given the alternative, it sounds like a walk in
the park.

Thanks again,
Luke

<snip>

Hmmm...  Perhaps my memory is faulty then.  I could have sworn she said she
was put on steroids as a treatment.  I stand corrected.

--
Type 2
http://users.bestweb.net/~jbove/

"Steroid" is a general term including many different molecules which cause
different effects.  ....not just "steroids."

When Cushing's syndrome can be easily treated, it's not much of a
problem.  When it cannot, it produces a constellation of problems, and
may be incompatible with life, either short-term or (especially)
long-term, depending on the severity of the syndrome.  Severe, untreated
Cushing's syndrome is like having ten diseases at once, any one of which
is likely to end life early.

It's really nothing more than the problems you get with long-term
administration of steroids.  This is why steroids are usually used with
great care and only for short periods.

Incidentally, severe cases of Cushing's syndrome can be very readily
recognized by simply looking at the patient.  Search the Web for images
to see a few striking examples.  However, the syndrome can present with
a complete range of severities, from subclinical (it may never be
recognized or may never merit any special treatment) to
life-threatening.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Looking around, I see that Cushing's disease is usually due to
microtumors in the pituitary, much more often than neoplasms in the
adrenals themselves.  Sorry about that.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Glucocorticoids, cortisol.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Will creatin ratio abnormalities lead to diagnosing this?

I don't know.  There are specific tests that can isolate Cushing's
disease, but even they are subject to some false positives, as there are
a few situations in which results consistent with Cushing's disease may
appear in the absence of that disease (obesity, depression, etc.--these
may be effects or causes).  Other tests may be consistent with Cushing's
syndrome, but they don't necessarily indicate the presence of the
disease.

In the case of Cushing's syndrome, then, obviously it's a matter of
clinical interpretation, since it isn't a disease itself.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Cushing's *disease* is a disease of the pituitary gland, not of the
adrenals.  The pituitary produces too much ACTH, usually from a tumor
(usual benign by cel type), and this stimulates the adrenals
excessively to cause the "syndrome".  Cushing's "syndrome" is due to
excessive intake of steroids *from the outside*.

If there is no "outside" cause for the Cushing's symptoms, you are
dealing with Cushing's *disease*.  A good endocrinologist is needed,
followed by a neurosurgeon to deal with the pituitary tumor.

Best,

Bob

Robert A. Fink, M.D., FACS, P. C.
2500 Milvia Street   Suite 222
Berkeley, California  94704-2636  USA
Telephone:  510-849-2555
FAX:  510-849-2557
<http://www.rafink.com>

"Ex Tristitia Virtus"