T he stress-hormone cortisol is a key player in the fight-or-flight response, which is useful in emergency or disaster situations.

Like the hare in Aesop’s classic fable, however, cortisol doesn’t perform very well in the long haul. It’s a good jump-starter, but at consistently elevated levels, it wreaks havoc on the body.

Two and a half years ago, my wife, Sarah, started feeling tired and weak all the time and experiencing constant muscle pain. She visited numerous doctors and underwent the gamut of medical tests, but no one could offer any conclusive diagnosis. She pushed herself to continue working as a nurse in a Jerusalem hospital, but when she became so weak that she had to be pulled into the van that would take her home after her shift, I told her she had to quit her job.

One day, she happened to visit a dermatologist for a skin issue that was unrelated to her other symptoms.

“Are you taking cortisone?” the dermatologist asked, after noticing that her face was red and swollen.

“No,” Sarah answered.

“Then you should get yourself checked for Cushing’s,” he said.

None of the other doctors had thought to test for Cushing’s disease, in which the adrenal glands are stimulated, usually by a benign tumor on the pituitary gland, to produce excess cortisol. But testing showed that the diagnosis of the dermatologist, of all people, was correct.

The pituitary gland is located near the brain, just behind the eyes. This sensitive location makes surgery extremely dangerous. Yet leaving a tumor inside Sarah’s brain was also dangerous. In addition to the primary symptoms of fatigue, weakness, and muscle pain, the elevated cortisol had also caused Sarah to develop diabetes and experience all sorts of unpleasant symptoms, including swelling, fluid retention, weight gain, memory and concentration issues, high blood pressure, breathlessness, rapid heartbeat, and sleep disturbances. At times, she couldn’t even walk across the room.

Sarah took three MRI scans, but surprisingly, no tumor was visible on the resulting images. Blood samples drawn from near the brain showed, however, that there had to be a tumor near the pituitary gland.

Sarah’s endocrinologist prescribed medication to suppress the production of cortisol until surgery could be performed. But we were able to schedule surgery quickly, so Sarah did not have to begin taking medicine.

A year and a half ago, Sarah underwent surgery by one of Israel’s top neurosurgeons to remove the unmapped tumor. Sure enough, the offending adenoma was found and successfully excised — or so we thought. When Sarah’s cortisol levels did not go down significantly after the surgery, we realized that the tumor had not been removed entirely. (Excerpted from Mishpacha, Issue 667)