Question: Do the symptoms of fatigue and weakness improve even more after replacement medication is discontinued?

Answer: One can assume that true replacement medication does not cause fatigue and weakness, because it is merely replacing the normal amount of hormone secreted by the adrenal glands. However, there are usually other factors at work. First, it takes most patients a full year to recover from all of the effects of Cushing's syndrome. The fact that they are taking replacement glucocorticoid does not alter this prolonged recovery. Second, during some phase of their recovery, they are actually taking less than a full replacement dosage (i.e., 10 mg vs. 25 mg of hydrocortisone) and thus may have some symptoms of glucocorticoid deficiency. Third, there are many causes of fatigue and weakness, including mild depression. If these symptoms persist, their cause should be investigated and, when appropriate, treated.