Dowager Hump????

[Marilyn1959]

Always had particular problems with muscles in between shoulder blades walking slightly hunched. With the miracle of 15mgs pred following diagnosis of PMR this seemed to resolve. Stood straight for first time in years. Two days ago, I was experiencing pain in the area and swelling like a hump. Went to docs yesterday and he is unsure whether it is PMR or steroid induced hump. Anyone else experienced this?

A few days prior had tried alternate day reduction 12.5mgs /10mgs now on 12.5mgs daily last two days.

I also have swelling on sides and front of neck. But swelling at back is hump like, and swollen to degree of providing pillow for head!

Doc has suggested going back to 15mgs and seeing if that makes a difference and asking Rheumy for localised injection. He is not my normal GP. Any thoughts?

[Hidden]

I have a nice hump. It has reduced as pred went down and I lost a bit of weight. I could have balanced a large golf ball on it at one point but at large marble size now. It is tender.

I don't seem to have anything at front or side apart from occasional swollen glands that have a mind of their own.

Ps I suspect all golf balls are same size but you know what I mean.

[PMRpro Ambassador]

I think it is most likely to be the steroid-induced hump. Mine was quite tender but has mostly gone with cutting carbs and weight loss - still bit of a bump there because of a quite defined "ledge" caused by my spine.

Do ask the doctor for 1mg tablets - it is so much easier to reduce by going 1mg at a time and the same dose every day - and it will be critical from now on. I think if it were me I'd give 12.5mg a bit longer - after all, if it works it saves reducing back down again. But equally - I wouldn't reduce any further for now.

[Marilyn1959 in reply to PMRpro]

Hi PRMPRO. Just a thought which I thought I'd get your view on. This 'hump' is more like a swelling rather than lump across the base at the bottom of my neck. I also have swelling at sides of neck and to front of neck. Since doc seemed to have no idea I have Google some images and came across Cushing's syndrome. Went on nhs site and have most of symptoms and pics are more like my swellings than a dowager hump. Apparently Cushing's can be caused by steroids? Have you come across this in your travels? I have managed to reduce to 10mgs but am concerned if I go to docs and it is Cushings caused by steroids Rheumy will take me off steroids and then I won't have anything that will effectively manage the PMR. Your advice would be very much appreciated.

[PMRpro Ambassador in reply to Marilyn1959]

Your body (the adrenal glands) produces the equivalent of about 7.5mg pred daily to allow your body to function properly. Cushing's syndrome is only due to excess corticosteroid in your body. In Cushing's disease it is because your adrenal glands have something wrong and they produce too much cortisol or because you have a tumour that is producing cortisol, something called exogneous steroid, created in your body..

In your case you are developing the symptoms because you are taking what is called exogenous steroid - the pills you swallow every day. While you are taking more than about 8mg you have excess steroid present, you will develop the signs and symptoms of Cushing's. Yes, it is the pred that is doing it - but that is not a reason to stop it.

I was in hospital nearly 6 years ago and the top diagnosis on the discharge sheet was "Cushing's syndrome". I had the puffy hump and a lot of other things. I went on a low carb diet - and now all the signs of Cushing's have disappeared. I'm still overweight - but it is not the typical Cushing's shape and the Cushings bits have all disappeared. All the doctors agree there is no sign at all of Cushings now.

[Marilyn1959 in reply to PMRpro]

So it should go as I reduce pred and lose weight?

[Hidden in reply to Marilyn1959]

Mine has certainly reduced significantly as dose and carbs reduced.

[Hidden]

I tried going from 10 to 9mg a couple of times in recent weeks but legs protested. I have dropped to 9.5 this week and touch wood I have been ok after shoulder pain pred wthdrawl I always get. If someone told me that 0.5mg of a drug could make so much difference I wouldn't believe it never mind 1mg.

[PMRpro Ambassador in reply to Hidden]

I wrote a post on the Patient forum a few years ago entitled exactly that!!!!!!

[Jamie345]

I have also developed the hump so quickly as have only recently being diagnosed with polymyalgia/GCA , at one point I went thru a short phrase of feeling up right and not leaning over my frame/roller mainly because of the pain and effort I was doing, my partner had mentioned my stoping made me feel conscious of it! Must admit to being a bit vain but nothing wrong with that ! But I'm also reducing pred from 40mg down to 20 which is my goal today set by my rheumy and liver specialist so far felt bit better coming down, but still can't walk pain free or do housework not used to muddle around me either !