More on Molly

The results of Molly's Low Dose Dexamethasone Suppression test came back and there's no doubt that she has Cushing's disease. From the results, we were also able to determine that Molly has the type of Cushing's caused by a problem with the pituitary gland as opposed to an adrenal tumor. Her type is the more common one. Once the diagnosis was confirmed, we ran yet another test called the ACTH stimulation test. It tells us the maximum amount of cortisol her adrenal glands can produce. The results of this test provide us with the baseline we'll use to monitor her response to therapy.

Molly started treatment with Lysodren yesterday. The drug selectively destroys those cells of her adrenal gland that are producing all those extra glucocorticoids. It's not a fun drug, with the potential for a bunch of side effects such as vomiting, diarrhea and weakness. There's also always the chance that the drug will knock out too much of the adrenal glands, causing the opposite problem of hypoadrenocorticism (Addison's Disease). A protocol actually exists where you purposely nuke the adrenal glands, resulting in Addison's disease. The theory is that it's easier and potentially less expensive to treat Addison's vs Cushing's. It's not a great idea though. If you miss a dose of Lysodren, it's not so bad, but miss a dose or two of the steroids that need replacing with Addison's disease and the patient is in big trouble!

Molly's initiating phase of the treatment continues until she starts to feel ill, stops drinking tons of water or at about the 8 day mark, whichever comes first. At that point we'll repeat the ACTH stimulation test to see how she's doing. Once her test results are where we want them, we'll be able to reduce her dose of Lysodren to the point where she'll only need it a few times a week instead of twice a day.