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Cushing's syndrome (cortisol-producing adrenal tumor)

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Treatment: Surgical

In most cases, an operation has a high chance of curing Cushing's syndromeCushing's syndrome - a disease where too much cortisol is being made. Surgery will be aimed at removing the gland (either pituitary or adrenal gland) that is responsible for the syndrome. Pituitary surgery is performed by neurosurgeons who remove the pituitary gland through the patient's nasal cavity (i.e. nose) using a microscope. In unusual cases where pituitary surgery does not cure the patient, other treatments like Gamma knife (external beam radiation) or removal of both adrenal glands can cure the patient of Cushing's syndrome. For patients with adrenal tumors causing Cushing's syndrome, endocrine surgeons can remove the adrenal gland(s) through the abdomen. This operation is usually done using minimally invasive techniques like laparoscopy. (See How is adrenal surgery performed) It is important that patients with Cushing's receive extra steroids intravenously during the operation called "stress dose steroids" to help the body respond to the stress of the operation. Patients will typically need to be gradually tapered off their steroids over the course of many months to a year or two until the adrenal glands or remaining adrenal gland can produce enough cortisolCortisol - a glucocorticoid that controls glucose production and suppresses the immune system on its own. This is due to the fact that when a patient has longstanding Cushing's syndrome, the remaining adrenal gland(s) take a long time to wake up and function normally.4

Treatment: Medical

The medical management of Cushing's syndromeCushing's syndrome - a disease where too much cortisol is being made generally consists of treating the signs and symptoms of the disease. Examples include the use of insulin for diabetes and anti-hypertensive medications for high blood pressure. There are very few drugs that work by stopping the adrenal glands from making too much steroids. One such drug is mitotane which essentially destroys the adrenal glands.

Treatment: What happens if you do nothing?

In general, if Cushing's syndromeCushing's syndrome - a disease where too much cortisol is being made is not treated with the appropriate operation, the disease will get worse. As the signs and symptoms worsen, the patient's overall health can deteriorate. In particular, the worsening diabetes and high blood pressure can cause severe problems that may lead to strokes and heart attacks. Other potential side effects are an inability to heal injuries and fight infection (i.e. immunosuppression).

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