Cushing's Syndrome Treatments

If you have Cushing's disease, a doctor will remove the tumor from your pituitary gland. The surgery is usually a success. Radiation treatments are sometimes used after surgery. You'll need to take cortisone-like medicines for several months after the tumor is removed. You'll need to follow your treatment plan very carefully.

Treatment for Cushing's Syndrome caused by high doses of steriods

If the Cushing's Syndrome is a side effect of taking high doses of steroid hormones (iatrogenic), withdrawing these medicines will allow the body to go back to normal. The ability to taper or stop the steroids, however, depends on the type of disease being treated and the pattern of response. Sometimes, steroids cannot be totally stopped or may be reduced only to a limited degree because the illness being treated would worsen. In that case, some degree of persistent Cushing's Syndrome would remain as an unwanted side effect. Treatment of the effects of steroid excess would include management of high blood sugar with diet and medications, replacement of potassium, treatment of high blood pressure, early treatment of any infections, adequate calcium intake and appropriate adjustments in steroid doses at times of acute illness, surgery or injury.

Surgery as a treatment for Cushing's Syndrome

Cushing's disease is best treated with the surgical removal of the pituitary tumor, usually with a technique called transsphenoidal resection (behind the nose) by a neurosurgeon. Occasionally, the entire pituitary gland will need to be removed or injured in order to cure the Cushing's disease, leaving the person with a deficiency of ACTH and the other pituitary hormones. This can be treated by giving replacement hormones for cortisol, thyroid and gonadal (sex) hormones. Fertility can be restored with special hormonal therapies. If the pituitary tumor cannot be removed, radiation therapy to the pituitary can be used, but the improvement in the Cushing's Syndrome is much slower. Before transsphenoidal surgery became available, the surgical removal of both adrenal glands was common, but this always produced adrenal insufficiency and sometimes caused large ACTH producing pituitary tumors to grow (called Nelson's syndrome). That is why pituitary surgery rather than adrenal surgery is usually preferred for Cushing's disease.

Ectopic ACTH producing tumors are usually malignant (cancer). Removing this cancer or treating it with radiation or chemotherapy may help in improving the Cushing's Syndrome. If the tumor is benign, or it can be completely removed, surgery may be a cure. Most of the time, reduction of the cortisol production from the adrenals with medications such as metyrapone, amino-glutethimide or ketoconazole is useful while the ACTH-producing tumor is treated.

Adrenal adenomas are always treated by surgically removing the tumor with either an abdominal or side (flank) incision. The other adrenal is left in, and will grow back to normal size or function. After the surgery, replacement steroid hormones are given and slowly tapered over a few months as the remaining adrenal responds to the normal ACTH production from the pituitary.

Adrenal carcinomas (cancer) can be cured if removed early. Unfortunately, they are usually discovered after they have already spread beyond the adrenal gland and are then not curable. Chemotherapy including o, p'DDD and other medicines are often used to try to control the tumor but do not cure it. The excess cortisol production can be controlled with o, p'DDD or by other medications like those mentioned for ectopic ACTH production: metyrapone, aminoglutethimide and ketoconazole. These medicines can be used to treat any form of inoperable or incurable Cushing's Syndrome, including Cushing's disease, but they can have serious side effects and require very careful monitoring and balancing with steroid hormone replacement therapies. Surgical cure of the primary cause of the Cushing's Syndrome is always the best, if possible