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CORTISONE OVERPRODUCED IN CUSHING'S DISEASE

Question: I am a 68-year-old woman. I would like some information on Cushing's disease. I have been told I have it. I also have osteoporosis. I am being treated but am getting discouraged. Thanks for any help.

- H.W.Answer: Cushing's disease has to do with the adrenal glands and overproduction of their hormone, cortisone.

The body needs cortisone for its normal function, but overproduction leads to all sorts of symptoms, notably an unusual fat accumulation pattern. Thus, the Cushing's patient may have a fatty chest, abdomen and face, while the legs and arms become thin. Also, blood pressure rises and purplish scarlike streaks appear on the body, especially on the abdominal skin. The patient has easy bruising and muscle fatigue. Osteoporosis - bone thinning - is common.

The physician first would want to treat the cause of the cortisone rise. Often, that is due to a small tumor of another gland, the pituitary, which lies at the base of the brain. The pituitary produces the hormone messenger ACTH, which regulates the adrenal's cortisone production.

If a pituitary tumor is the cause, it can be removed. But that is not the only scenario for Cushing's disease. Sometimes, the adrenals begin overproducing cortisone hor-mone on their own.

Question: Please write in your column about hiatal hernia, how it happens, where it is located and what to do about it. Many people have it apparently. Why is it always mentioned with acid heartburn attacks? Does it have to be operated on?

- J.R.

Answer: You almost have to talk about hiatal hernia in connection with stomach acid reflux, but only because so many automatically lump the two together. They are distinct, sometimes related ailments.

A hiatal hernia is an upward bulging of the stomach at a point where the esophagus passes through the diaphragm to link up with the stomach. All of us have such a gap - a hiatus - of varying size, but not all of us have a stomach herniation there.

Sometimes the hernia causes heartburn, and sometimes it doesn't. Acid reflux causes heartburn, with or without the esophagus condition. All you need for heartburn is stomach acid presence in the sensitive esophagus. The actual upsplashing can be due to a relaxation of the sphincter muscle that guards the esophagus-stomach opening.

The answer for the heartburn is either antacids or drugs to limit the acid production. Corrective surgery, as I recently noted to another reader, is gaining some popularity.

See the report I am sending you. Others can order my heartburn report by writing: Dr. Donohue - No. 18, Box 5539, Riverton, NJ 08077-5539. Enclose $3 and a self-addressed, stamped (52 cents) No. 10 envelope.

Question: Can you take a few more questions on bunions? I have one on my big toe. How can I stop it from growing larger? Does diet play a role?

- S.K.

Answer: You can stop the bunion from enlarging by relieving the pressure on the toe. Wear a wide shoe. Many bunion-sufferers prefer sandal footwear.

You can see a podiatrist to have protective padding designed and at the same time be briefed on what's involved in surgical foot bone correction, the ultimate answer for bunions.

Diet plays no role whatever. Bunions tend to run in families.