Cushing's Syndrome Treatment

In the case of Cushing's syndrome, treatment for the disorder depends on the reason why excess cortisol is being produced. For example, pituitary tumors that cause Cushing's syndrome might be handled differently from adrenal tumors or ectopic ACTH syndrome. Cushing's syndrome treatment options may include surgery, radiation therapy, and cortisol-inhibiting drugs. Surgery is the most widely used treatment for Cushing's syndrome.

 

Cushing's Syndrome Treatment: An Overview

Cushing's syndrome treatment depends on the specific reason for excess cortisol production. Treatment options for Cushing's syndrome may include:
 
  • Surgery
  • Radiation
  • Chemotherapy
  • Cortisol-inhibiting medicines
  • A combination of these treatments.
     

Glucocorticoids and Cushing's Syndrome Treatment

If the Cushing's syndrome cause involves long-term use of glucocorticoid hormones to treat another condition, the doctor will gradually reduce the dosage to the lowest dose adequate for control of that condition. Once control is established, the daily dose of glucocorticoid hormones may be doubled and given on alternate days to lessen side effects.
 

Pituitary Adenomas and Treatment of Cushing's Syndrome

Several Cushing's syndrome treatment options are available to treat the ACTH-secreting pituitary adenomas that can cause Cushing's disease. These options may include:
 
  • Surgery
  • Radiotherapy
  • Mitotane
  • Other medicines.
     
Surgery
The most widely used treatment method for Cushing's syndrome involving a pituitary adenoma is surgical removal of the tumor, known as transsphenoidal adenomectomy. Using a special microscope and very fine instruments, the surgeon approaches the pituitary gland either 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 for this procedure is over 80 percent when performed by a surgeon with extensive experience. If the 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.
(Cushing's Syndrome Treatment Continued: Page 2)
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Written by/reviewed by: Arthur Schoenstadt, MD
Last reviewed by: Arthur Schoenstadt, MD