Monday, April 23, 2012

Cortisol Production Post BLA

We are told that bilateral adrenalectomy is going to be "the cure" once and for all, and in most cases it truly is. But, I have been researching more on this subject sine Alex's recurrence. One of the articles I found click here states "Residual adrenocortical function have been demonstrated in 9/37(25%) after TBA for CD". At UCSF the endocrine department and tumor board told us "we don't know what normal cortisol levels are post BLA, no one ever checks". Their point being, people get better and there is no need to check for a hormone that should no longer be present

Once again, I have a theory. Assuming that the vast majority (90% ?) of  BLA patients had "florid" Cushing's (as opposed to cyclic) prior to BLA, then we could assume that any cortisol produced post BLA would be in a normal pattern as well. Based on this assumption, all it would take would be a decreased dose of steroid to solve any problem. 

In the cyclic patient population we are seeing a higher number of patients experiencing problems with cortisol production post BLA. Here, my assumption would be that the naturally produced cortisol levels are again fluctuating like they were prior to BLA. With this cyclic production, cortisol supplements can not be accurately determined and once again patients find themselves in limbo. 

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