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Replacement after adrenalectomy
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Replacement after adrenalectomy

I have three questions I hope you can shed some light upon. Thank you in advance for your patience and that you share so much knowledge.

Please recall that I have a 4+/- cm adrenal tumor found incidentally.

The first question is this:

1) tests so far show hypercortisolism, however I have not received the result of (2) 11pm salivary swabs, so I don't know if I show a normal diurnal pattern. If my 11pm salivary cortisol results ARE normal, what weight does that carry in the whole picture. ?

2) How strong is the influence of high estrogen on cortisol level? I know that high estrogen causes a high cortisol level in a ""normal"" female, but would that influence still exist following dexamethasone suppression?

3) If I have a left adrenal tumor that is independently secreting cortisol, its almost certain that my right adrenal is near to, or completely non-functioning. So I understand the need to replace cortisol for several months after adrenalectomy and taper slowly down to stimulate the right adrenal to start functioning again.

Whew, finally, my 3rd question is: since the adrenal gland (cortex and medulla) secretes much more than cortisol, would I not also need to replace everything it secretes if my remaining gland is non-functioning???? ie. aldosterone, DHEA, other androgens????

Your thoughts are appreciated.
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1. They are point in time tests... so you may or may not be high at the very moment of testing. As for weight - hopefully your doc will look at the full picture.

2. I think you have that backwards - cortisol raises estrogen, not the reverse. I am not sure why you think a test would change that?

3. Your doc should test - but as it is, since only cortisol has been suppressed, hopefully the rest of your adrenal is working. Plus you have other sources of androgens as the body as other sources.
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