Cushing's Disease Treatment
There are usually several healthcare providers involved in a person's treatment. The doctor may refer patients to doctors who specialize in treating Cushing's disease, or patients may ask for a referral. Specialists who treat Cushing's disease include:
- Medical oncologists
- Radiation oncologists
Sometimes, it is helpful to have a second opinion about the diagnosis and associated Cushing's disease treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it.
The doctor is the best person to describe the treatment options for Cushing's disease, as well as the expected results. The patient and the doctor can work together to develop a Cushing's disease treatment plan that best meets the patient's needs.
Depending on the type and extent of Cushing's disease, people may have:
- Surgery to remove the tumor (usually transsphenoidal surgery), with or without radiation therapy
- Radiation therapy alone
- Drug therapy to stop the tumor from making ACTH.
The most widely used Cushing's disease treatment is surgical removal of the tumor, known as transsphenoidal adenomectomy. Using a special microscope and very fine instruments, the surgeon approaches the pituitary gland through a nostril or through an opening made below the upper lip. Because this is an extremely delicate procedure, patients are often referred to centers specializing in this type of surgery.
The success, or cure, rate of this procedure is over 80 percent when performed by a surgeon with extensive experience. If surgery is unsuccessful or only produces a temporary cure, surgery can be repeated, often with good results.
After curative pituitary surgery, the production of ACTH drops two levels below normal. This is a natural, but temporary, drop in ACTH production, and patients are given a synthetic form of cortisol (such as hydrocortisone or prednisone). Most patients can stop this replacement therapy in less than a year.