I’m adjusting my Cushing’s disease treatment to improve liver health

Troubling lab work pointed to possible liver problems for this columnist

Noura Costany avatar

by Noura Costany |

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Note: This column describes the author’s own experiences with ketoconazole, spironolactone, tirzepatide, and several supplements. Not everyone will have the same response to treatment. Consult your doctor before starting or stopping a therapy.

Cushing’s disease has multiple treatment options. During my first occurrence in 2020, I had a pituitary tumor removed with transsphenoidal pituitary resection surgery. When a tumor reappeared last year, we decided to treat it medically for a while before moving to surgery. I’m currently being treated with ketoconazole, spironolactone, tirzepatide, and several supplements.

During a round of testing a few months ago, we noticed that my liver was in trouble. All of my numbers were off the charts. The lab flagged high levels of alkaline phosphatase, aspartate aminotransferase, and alanine transaminase. Of course, it can be alarming when any lab work is off during treatment. I tried to remain calm, but I was a little freaked out by just how bad my liver seemed.

I met with my doctor to discuss it, and we decided to take three months to focus on my liver. The first decision was to cut my Cushing’s disease medication in half. I was taking 400 mg of ketoconazole twice a day, and I now take 200 mg, so there is less for my liver to process. A 12.5 mg tirzepatide shot was dropped to 10 mg.

From there, we decided to add supplements to support my liver. Every evening, I take milk thistle and vitamin E.

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Avocado toast, fish, and berries

I also decided to stop drinking alcohol. I wasn’t much of a drinker in the first place, but I did have an occasional cocktail or a glass of wine. I dropped that and have been embracing mocktails. I don’t miss alcohol at all, and it’s been a really fun change in my life.

I added foods to my diet that are known to help the liver. Avocados lower blood cholesterol levels and increase detoxifying enzyme activity. I’ve been making guacamole and avocado toast, which are delicious. Berries can help prevent liver damage, so I have a scoop of them every morning. I add them to oats and occasionally to yogurt. Lastly, fatty fish helps to protect the liver, too, so I’ve been trying to add salmon to my diet as much as possible.

In the past three months, my liver health has improved tremendously. My lab results are back to normal, and I can breathe more easily. Even so, I plan to keep up with everything I’ve been doing. I feel healthier, and honestly, having health-based goals keeps me motivated.

Do health-based goals help you? Please share in the comments below! You can also follow my journey on TikTok and YouTube.

Note: Cushing’s Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Cushing’s Disease News or its parent company, BioNews, and are intended to spark discussion about issues pertaining to Cushing’s.


Susan Scotti avatar

Susan Scotti

Thank you for sharing your journey! I have had two surgeries, multiple meds, and finally, radiation. That will take a while to work, however. I began Isturisa in January 2022, and it has been incredible for me with very few side effects.

Noura Costany avatar

Noura Costany

I am so happy that's been working for you!!! I know it can be so daunting to have multiple tumors. Sending love your way!


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