Suggest Treatment For Cushing's Disease With Uncontrolled Diabetes And Uncontrolled Hypertension

Posted on Mon, 8 Sep 2014

Question: I Am waiting to see a gastroenterologist in 3 months ( waiting list ). Brief History : I have Cushing's disease, had most of pituitary gland removed 5 /12 ago. I have Uncontrolled diabetes and uncontrolled hypertension. Surgery was not successful. Possibly having Radiation therapy. Anyway, i have chronic Nausea For last 12 months at least worse in last 6 months, sometimes vomiting and intermittant diarrhoea. My Liver function shows elevated ALP / ALT / GGT / AST also my globulins are elevated eGFR is low chloride is low Anion gap is high, CRP is high. In the last couple of days, nausea has become severe, two days of vomiting and i now have a constant dull ache in my upper rt abdomen going thru to my back ( no Urinations issues, ohhh except i do have Diabetes Insipidus treated with Desmopressin ). This ache has been keeping me awake, seems worse at night. I dont drink alcohol and due to nausea my diet is bland and just enough to allow me to take my insulin. I have no appetite. Ive lost 10 kg in 5 months ( not trying to lose). Any advice while i await my appointment in 3 months time? PS Gallbladder removed approx 10 yrs ago.

Answered by Dr. Shehzad Topiwala (32 minutes later)

Brief Answer:
Need prompt attention

Detailed Answer:
Sorry to learn about your condition.

I dont think it is at all a good idea to wait 3 months to address these problems you are experiencing.

You are likely on thyroid medication too such as levo thyroxine. See if the levels of FreeT4 are in the desirable range or mid to high normal.

You probably dont get menstrual cycles, do you?

Next, are you on any medication to treat Cushings such as ketoconazole? This can affect the liver too.

Further, high blood glucoses can cause symptoms like the ones you are describing. What is your most recent HbA1c?

Blood pressure control is vital too.

I strongly suggest you see an endocrinologist and gastroenterologist urgently.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (17 minutes later)

I am currently not on any hormone replacements other than desmopressin.
My thyroid function is normal.
No Menstrual cycles for 3 yrs now.
No medications for Cushing's, my endo said Ketoconazole wouldnt be good for my liver.
My last HbA1c was 8.9 up from 7.7 3 months ago.
I am on Insulin and Oral meds for diabetes and i am on 4 different Blood pressure, Amlodipine, Spiracton, Moxonidine, irbesartan-hydrochlorothiazide.

I doubt ill get to see a Gastroenterologist any sooner than my appointment.
I can see my Endocrinologist on the 9th of september.

If the pain gets worse of course i will go to ER.

Do you have any suggestions to Alleviate the nausea. My Blood sugars in the last 3 days have been stable around 8 to 12. Blood pressure is still sitting around 170/105 ( was 227/134 with last hospital visit, so much better ).And is the pain likely to be my liver or something else?

Answered by Dr. Shehzad Topiwala (13 hours later)

Brief Answer:
Follow up

Detailed Answer:
I have noted your responses.

Both your diabetes and blood pressure are not well controlled. You need to adjust medicine doses and perhaps work out a new regimen to get these 2 under better controlled.

Nausea can be from poorly controlled blood glucoses and blood pressure.
It is unsafe to keep running numbers like these.
Yes the pain is possibly form the liver and merits urgent attention such as more detailed blood tests and ultrasound / CT scan of the abdomen.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (4 hours later)

Ok thank you

I am heading off to the ER as no appointments can be changed

I had a bad night, increased pain and violent vomiting this morning. Cant keep going like that til 9th of september !

Thank you for your excellent responses :)

Answered by Dr. Shehzad Topiwala (4 hours later)

Brief Answer:
Second follow up

Detailed Answer:
It appears that you have inadvertently forgotten to close the query. Until you do so, it remains 'outstanding' on my dashboard, giving the wrong impression to the managers of this forum that I am not answering your follow up queries in a timely manner. Best wishes

Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar