You have landed on this webpage because the dexamethasone suppression lab test we ordered after your recent office visit is abnormal.
Below is the information on next steps:
- Your Condition
- Medication to Treat
- Required Monitoring
Your AM (morning) cortisol level should be zero following the dexamethasone tablet I gave you that you took the night before your labs. Yours is elevated – which means your adrenal glands are overactive and causing higher than normal levels of cortisol. This condition is called hypercortisolism. The symptoms this may be causing are difficult to treat diabetes, high insulin levels, increased insulin resistance, weight gain and/or difficulty losing weight, as well as fatigue, anxiety, and depression.
What is the difference in hypercortisolism and Cushing’s Disease?
- Hypercortisolism is the general term used to describe an excess of cortisol in the body, regardless of the underlying cause.
- Cushing’s Disease is a specific cause of hypercortisolism resulting from a pituitary tumor that produces excess adrenocorticotrophic hormone (ACTH).
Once we receive the results of your dexamethasone suppression test, we will order 2 additional lab tests (ACTH and DHEA-S). The results of these tests will determine if further testing is necessary to rule out Cushing’s Disease.
Korlym can cause your potassium level to drop while we work to treat your high cortisol levels. Low potassium can cause your heart to beat improperly, so to prevent this from happening we are going to start you on spironolactone 50mg every morning when you start Korlym. It’s okay to take at the same time as Korlym and it will prevent your potassium from dropping as part of the treatment process. It will also help keep your blood pressure and fluid levels stable. We will send the prescription to your local pharmacy.
Unless you have been instructed otherwise by your SSDIC healthcare provider, you must start spironolactone either before you start Korlym, or at the time of starting Korlym.
You must have a repeat potassium level 10-14 days after you start Korlym. We will continue to repeat your potassium level every 10-14 days until it stabilizes, at which time it can be monitored every 3-4 weeks if it remains stable.
Women of childbearing age must use birth control and practice safe sex using a barrier method (i.e. condom). Korlym will cause bleeding and termination of pregnancy.
Your healthcare provider may order additional lab tests, such as ACTH and DHEA-S, to assess your adrenal glands if you have hypercortisolism. Depending on the results of these additional lab tests, we may also order an abdominal CT scan to visualize your adrenal glands as needed.
Possible Side Effects
If you experience any of the symptoms below, call or text the office at 757-659-9903 for instructions:
- Women with an intact uterus may be experience menstrual spotting.
- You may experience symptoms of cortisol withdrawal during the first 3-6 months of Korlym therapy, which may include nausea, headaches, and extreme fatigue.
- For patients who use insulin, your insulin usage will drop – which may result in low blood sugars. If you are NOT on an automated insulin delivery pump, please contact our office if your sugars are dropping below 90.
- Patients who take medication for high blood pressure may require lower doses. Symptoms of low blood pressure include dizziness upon standing, weakness or fatigue, blurry vision, and fainting or passing/blacking out.
Duration of Therapy
The following is an informational resource from Corcept, the manufacturer of Korlym, that patients and their loved ones can access for additional information: Patient guide to starting Korlym | Korlym® (mifepristone) 300 mg Tablets. You can also discuss your questions or concerns with your Patient Advocate.
We are here with you every step of the way! Please call or text the office at 757-659-9903 or send us a message on the Patient Portal if you have any questions!
- Your Team at SSDIC
