Treatment of Cushing Syndrome

Treatment

It is very important that patients with Cushing’s syndrome receive treatment for their disease process. Ideally, the tumor causing excess ACTH or cortisol is removed. In many cases, this is possible, but in some cases it is not. Each patient’s case is unique and the treatment plan is individually tailored for each person. 

Surgical treatment

In most cases, an operation has a high chance of curing Cushing’s syndrome. 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 your nose using a microscope. In unusual cases where pituitary surgery does not cure the disease, other treatments like radiation or removal of both adrenal glands can be considered.

For adrenal tumors causing Cushing’s syndrome, surgeons can remove the adrenal gland through the abdomen and sometimes the back. These operations are usually done using minimally invasive techniques like laparoscopy. Following surgery, patients will typically need to take replacement steroid medications that will gradually be tapered off over the course of months to years. In the event both adrenal glands are removed, patients will require steroids for the rest of their life.

Medical treatment

The medical management of Cushing’s syndrome generally consists of attempting to decrease cortisol levels and treat the signs and symptoms of the disease. Cortisol production can be decreased using several different medications. These include ketoconazole, metyrapone, mitotane in patients with adrenal cancer, and mifepristone. Treatment of diabetes includes the use of medications like metformin and other medications or injectable forms of insulin. Anti-hypertensive medications are used to treat high blood pressure.   

What happens if you do nothing?

In general, if Cushing’s syndrome is not treated with the appropriate operation, the disease will worsen over time. As the signs and symptoms worsen, your 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 include an inability to heal injuries and fight infection. There is a much higher risk of dying from cardiovascular events and infections in patients with untreated Cushing syndrome compared to patients without Cushing syndrome.

Adrenal Surgery Consultation Worksheet

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