Treatment Of Cushings Disease
Microsurgical resection of an ACTH-secreting pituitary adenoma is the optimum treatment for Cushings disease with cure rates of 80-90 percent if a tumor is found. Surgery is most often done through a transnasal transsphenoidal approach, which will not leave a visible scar. This type of surgery may be performed, per the surgeons preference, using either a minimally invasive operating microscope or with the use of an endoscope. Partial removal of the pituitary gland may be used in patients without clearly identifiable adenomas.
In patients to whom a remission is not obtained after surgery, the use of various medications that can inhibit cortisol production may be used, such as:
These agents are not as effective as surgery and are considered a secondline course of treatment. In some patients who are particularly resistant to all forms of therapy, removal of the adrenal glands bilaterally may be considered.
Post-surgery, with successful tumor removal, the production of ACTH drops below normal. This decrease is natural and temporary, and patients are prescribed a synthetic form of cortisol such as hydrocortisone or prednisone to compensate this change. Most patients can discontinue replacement therapy within six to 12 months, but others may require the use of oral steroids for several years to, possibly, their lifetime. Patients who need adrenal surgery may also require steroid replacement therapy.
How Is The Test Done
For a 24-hour urine collection, all of the urine that you pass over a 24-hour time period must be collected. If you are in the hospital, a healthcare worker will collect your urine. You will receive a special container to collect the sample in if you are doing the collection at home. The following are directions for collecting a 24-hour urine sample while at home: In the morning scheduled to begin the urine collection, urinate in the toilet and flush away the first urine you pass. Write down the date and time. That is the start date and time for the collection. Collect all urine you pass, day and night, for 24 hours. Use the container given to you to collect the urine. Avoid using other containers. The urine sample must include the last urine that you pass 24 hours after starting the collection. Do not allow toilet paper, stool, or anything else to be added to the urine sample. Write down the date and time that the last sample is collected. The urine sample may need to be kept cool during the 24-hour collection period. If so, keep the closed container in a pan on ice. Do not put ice in the container with the urine.
Treatment Of Cushing’s Syndrome
Treatment of Cushings syndrome depends on the underlying cause of excess cortisol but may perhaps include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs. If the cause is iatrogenic, from long-term use of glucocorticoid hormones to treat another disorder, the physician will gradually reduce the dose of the externally administered steroid to the lowest dose adequate for control of that disorder. Once control is established, the dose of glucocorticoid hormones may be given on alternate days to lessen side effects for the patient.
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How Is A Cortisol Urine Test Performed
A cortisol urine test is a safe, painless procedure that only involves ordinary urination.
Cortisol is measured in a urinary sample collected over a 24-hour period. Your doctor will give you special containers to use for collecting urine samples. Theyll also explain how to collect the urine properly.
On the first day of the urine collection:
On the second day of the urine collection:
If your infant needs to have a cortisol urine test, youll collect their urine in a special bag.
The collection procedure is as follows:
Collect urine samples over a 24-hour period. It will be necessary to check the bag often throughout the collection period.
How It Is Done
This test is usually done at home. You must collect all the urine you produce in a 24-hour period.
- When you first get up in the morning, urinate into the toilet. Don’t save this urine. This marks the start of your 24-hour period.
- For the next 24 hours, collect all your urine. Your doctor or lab will give you a large container to store it in. Urinate into a separate small, clean container. Then pour the urine into the large container. Don’t touch the inside of the containers with your fingers.
- Keep the large container in the refrigerator.
- Empty your bladder for the last time at or just before the end of the 24-hour period. Add this urine to the large container, and write down the time.
- Do not get toilet paper, pubic hair, stool , menstrual blood, or anything else in your urine sample.
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Understanding Of Lab Tests Results
Please visit the page about cortisol on the site associated with The American Association for Clinical Chemistry for better understanding of tests. There you will find the most detailed and full information regarding lab tests. In “common questions” tab you will find answers on the most common questions.
In addition, you can use a special form to ask the question. It is useful, if there is no answer on your question on the web site. A laboratory scientist will answer your question. It is a part of voluntary service provided by the American Society for Clinical Laboratory Science.
Cortisol 24 Hr Urine Test
A cortisol urine test is also known as urinary free cortisol test or UFC test. This test measures the amount of cortisol in your urine for 24 hours. Cortisol is a hormone produced by adrenal glands that are located on top of kidneys. The glands release this hormone in form of a reaction given by the body for physical and emotional stress. Cortisol levels rise 9and fall naturally throughout the day. Usually the level of the hormone is highest during morning and lowest during midnight. This might vary from person to person. Cortisol urine test is performed to determine the reason of abnormal cortisol levels.
Before the test is conducted it is important to inform the doctor regarding prescribed drugs or ay over the counter medicines you are taking. There are certain medications that can affect the accuracy of the test. Your doctor may ask you to stop taking the medicines however it is not advised to stop the medicines without doctors consultation.
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What Do My Test Results Mean
Many things may affect your lab test results. These include the method each lab uses to do the test. Even if your test results are different from the normal value, you may not have a problem. To learn what the results mean for you, talk with your healthcare provider.
Urinary cortisol is measured in micrograms per 24 hours . The normal range varies between labs. Your provider can give you normal reference values.
When cortisol and ACTH are measured together:
-
High ACTH with high cortisol may mean a problem in your pituitary gland.
-
High ACTH with low cortisol may mean a problem with your adrenal gland.
-
Low ACTH with high cortisol may mean a problem in your adrenal glands.
-
Low ACTH with low cortisol may mean a problem in your pituitary gland.
What Affects The Results Of The Cortisol 24
Food does not have any effect on the levels of cortisol in your urine. However, you need to share with your doctor if you are taking medications whether prescription drugs or over-the-counter medicines. These may have an effect on the accuracy of the results. Medications that may sabotage your results include diuretics, estrogens, glucocorticoids, ketoconazole, lithium, or tricyclic antidepressants. You will be instructed to stop taking such medications before the test.
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What Abnormal Results Mean
A higher than normal level may indicate:
- Cushing disease , in which the pituitary gland makes too much ACTH because of excess growth of the pituitary gland or a tumor in the pituitary gland
- Ectopic Cushing syndrome , in which a tumor outside the pituitary or adrenal glands makes too much ACTH
- Severe depression
- Tumor of the adrenal gland that is producing too much cortisol
A lower than normal level may indicate:
- Addison disease in which the adrenal glands do not produce enough cortisol
- Hypopituitarism in which the pituitary gland does not signal the adrenal gland to produce enough cortisol
- Suppression of normal pituitary or adrenal function by glucocorticoid medicines including pills, skin creams, eyedrops, inhalers, joint injections, chemotherapy
Pituitary Adenomas Cushings Disease
Pituitary adenomas are benign tumors of the pituitary gland that secrete increased amounts of ACTH causing excessive cortisol production. Most patients have a single adenoma. First described in 1912 by neurosurgeon Harvey Cushing, MD, in his book The Pituitary Body and Its Disorders, Cushings disease is the most common cause of spontaneous Cushings syndrome, accounting for 60-70 percent of all cases.
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Will I Need To Do Anything To Prepare For The Test
The preparations will depend on the type of test you are having. Be sure to follow all the instructions that your provider gives you.
Stress can raise your cortisol levels, so you may need to rest before your test. A blood test will require you to schedule two appointments at different times of the day. Before a saliva test, you may need to stop using certain medicines. Let your provider know about all medicines you use, including skin creams. But don’t stop using any medicines without talking with your provider first.
Why The Test Is Performed
The test is done to check for increased or decreased cortisol production. Cortisol is a glucocorticoid hormone released from the adrenal gland in response to adrenocorticotropic hormone . This is a hormone released from the pituitary gland in the brain. Cortisol affects many different body systems. It plays a role in:
- Metabolism of fats, carbohydrates, and protein
- Nervous system function
and Addison disease , can lead to either too much or too little production of cortisol. Measuring urine cortisol level can help diagnose these conditions.
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What Are Normal Results For This Test
Laboratory test results may vary depending on your age, gender, health history, the method used for the test, and many other factors. If your results are different from the results suggested below, this may not mean that you have a disease. Contact your healthcare worker if you have any questions. The following are considered to be normal results for this test:
- Radioimmunoassay:
- Adults: 20-70 mcg/24 hours
- Low dose dexamethasone suppression test
When To Suspect Cushing Syndrome
A complete history and physical examination are critical in determining the pretest likelihood of a diagnosis of Cushing syndrome. Patients present with a wide range of clinical features ,2 and no single symptom is necessary to the diagnosis. A high positive likelihood ratio for Cushing syndrome has been found in the presence of ecchymoses , osteopenia or fracture , proximal muscle weakness and hypertension .3 Many of the signs and symptoms of Cushing syndrome are common in the general population. But if they occur at an unusual stage of life or if multiple and progressive features are present , then a diagnosis of Cushing syndrome should be considered.2
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What Should I Do After The Test
When 24-hour urine collection is complete, close the container and seal the lid tightly. Return the sample in the urine container to the facility or healthcare worker as instructed. If you had the sample in an ice bath, return the sample within two hours after removing the container from the ice bath.
How To Prepare For The Test
You may be asked not to do any vigorous exercising the day before the test.
You may also be told to temporarily stop taking medicines that can affect the test, including:
- Anti-seizure drugs
- Human-made glucocorticoids, such as hydrocortisone, prednisone, and prednisolone
- Metabolism of fats, carbohydrates, and protein
- Nervous system function
- Stress response
Different diseases, such as Cushing syndrome and Addison disease, can lead to either too much or too little production of cortisol. Measuring urine cortisol levels can help diagnose these conditions.
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What Follow Up Should I Do After This Test
Ask your healthcare worker how you will be informed of the test results. You may be asked to call for results, schedule an appointment to discuss results, or notified of results by mail. Follow up care varies depending on many factors related to your test. Sometimes there is no follow up after you have been notified of test results. At other times follow up may be suggested or necessary. Some examples of follow up care include changes to medication or treatment plans, referral to a specialist, more or less frequent monitoring, and additional tests or procedures. Talk with your healthcare worker about any concerns or questions you have regarding follow up care or instructions.
What Is Cortisol And The Cortisol 24
Cortisol is a glucocorticoid that is formed by the cortex of the adrenal glands. It is the primary hormone that is linked to stress and, is part of the fight-or-flight hormone. When you are doing something that your body is perceiving as a threat, your body releases into your brain a hormone called the adrenocorticotropic . This hormone triggers your adrenal glands and leads to the formation and release of both cortisol and adrenaline. Cortisol release is a very normal reaction of the body and, can be triggered by something as little as hearing a dog barking at you or a fire alarm in your apartment. This hormone production is how your body reacts to such a stimulus, which will give it more energy and strength.
When your body is experiencing a fight or flight response, this means that adrenal glands are releasing their cortisol. As a result, unnecessary and detrimental functions of the body, that are not need it for this response, get suppressed. Responses normally involve having a rapid heart rate, dry mouth, upset stomach and diarrhea, and panic. In addition, during a fight or flight response, cortisol can also suppress any processes related to growth, your digestive system, your reproductive system, and make alterations to your immune system functions.
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Symptoms Of High Cortisol Levels
Cushing syndrome is a collection of symptoms associated with high cortisol levels. The most common symptoms include:
- increased urination
- fatty tissue deposits, especially in the midsection and upper back
- pink or purple stretch marks on the skin
- tricyclic antidepressants
Your doctor may instruct you to stop taking medications that could affect the results. However, you should never stop taking your medications unless your doctor tells you to do so.
Cortisol Free 24 Hour Urine
Suggests clinical disorders or settings where the test may be helpful
Preferred screening test for Cushing syndrome
Diagnosis of pseudo-hyperaldosteronism due to excessive licorice consumption
Test may not be useful in the evaluation of adrenal insufficiency
Special Instructions
A short description of the method used to perform the test
Liquid Chromatography-Tandem Mass Spectrometry
NY State Available Indicates the status of NY State approval and if the test is orderable for NY State clients.
Lists a shorter or abbreviated version of the Published Name for a test
Lists additional common names for a test, as an aid in searching
Cortisol Free Urine
Describes the specimen type validated for testing
Urine
| Urine Volume |
Specimen Required Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Supplies: Urine Tubes, 10-mL
Submission Container/Tube: Plastic, urine tube
Specimen Volume: 5 mL
1. Collect urine for 24 hours.
2. Add 10 g of boric acid as preservative at start of collection.
Urine Preservative Collection Options
Note: The addition of preservative must occur prior to the start of the collection or application of temperature controls must occur during collection.
|
Ambient |
Specimen Minimum Volume Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory
3 mL
| Specimen Type |
|---|
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Cortisol Urine Test Urinary Free 24
A Cortisol Urine Test, Urinary Free is used in the diagnosis of Cushing syndrome requires evidence of cortisol hypersecretion. While serum cortisol levels fluctuate unpredictably and are strongly dependent on concurrent cortisol-binding globulin levels, a 24-hour urine specimen integrates the cortisol production for an entire day and is not affected by CBG. Urinary cortisol reflects the portion of serum-free cortisol filtered by the kidney, and correlates well with cortisol secretion rate.
Also Known As: Urinary Free Cortisol
Methodology:
Liquid chromatography/tandem mass spectrometry
Preparation:
You must take your lab order to the lab to obtain a proper specimen container before collection. No fasting required. Urinate at 8am and discard the specimen. Then collect all urine in 24-hour period, ending with final collection at 8am the next morning. Refrigerate the collected urine between all voidings or keep it in a cool place. Screw the lid on securely. Transport the specimen promptly to the laboratory. Container must be labeled with full name, date and time collection started, and date and time collection finished.
Test Results:
3-4 days. May take longer based on weather, holiday or lab delays.
Also Known As: Urinary Free Cortisol
Methodology:
Liquid Chromatography/Tandem Mass Spectrometry
Preparation:
Test Results:
4-5 days. May take longer based on weather, holiday or lab delays.
Details:
Includes the Creatinine, 24-Hour Urine.