What're the treatments for Cushing's syndrome?
The treatment depends mostly on identifying the cause and removing it. If it is being caused by medications, these should be discontinued when possible. This is not always possible, because there may be no other medication that is effective. In other cases of Cushing's syndrome, the treatment is to find the direct (e.g. adrenal gland tumor) or indirect cause (e.g. pituitary tumor, lung tumor. etc.) and treat it either surgically, medically or by radiation. If the cause can not be found the
adrenal glands can be removed surgically or suppressed with medications that decrease the glands' production of cortisol. Treatments for Cushing's syndrome are designed to lower the high levels of cortisol in your body. The best treatment for you depends on the cause of the syndrome. Treatment options include:
Reducing corticosteroid use. If the cause of Cushing's syndrome is long-term use of corticosteroid medications, your doctor may be able to keep your Cushing's symptoms under control by reducing the dosage of the drug over a period of time, while still adequately managing your asthma, arthritis or other condition. For many of these medical problems, your doctor can prescribe noncorticosteroid drugs, which will allow him or her to reduce the dosage or eliminate the use of corticosteroids altogether. However, don't reduce the dosage of these drugs or stop taking them on your own. Do so only under your physician's supervision. Abruptly discontinuing these medications could lead to failure of your adrenal glands.
Surgery. If the cause of Cushing's syndrome is a tumor, your doctor may recommend its complete surgical removal. Pituitary tumors are typically removed by a neurosurgeon, who carries out the procedure through your nose and sinuses. If a tumor is present in the adrenal glands, lung or pancreas, the surgeon can remove it through a standard operation or in some cases by using minimally invasive surgical techniques, with smaller incisions and resulting in shorter recovery times.
After the operation, you'll need to take cortisol replacement medications to provide your body with the correct amount of cortisol. In most cases, you'll experience a return of normal adrenal hormone production, and your doctor can taper off the replacement drugs. However, this process can take up to a year or longer. In some instances, people with Cushing's syndrome never experience a resumption of normal adrenal function, and they need lifelong replacement therapy.
Radiation therapy. If the surgeon can't totally remove the tumor, he or she will usually prescribe radiation therapy to be used in conjunction with the operation. Radiation can be given in small doses over a 6-week period, or by a technique called stereotactic radiosurgery or gamma knife radiation. In the latter procedure, administered as a single treatment, a large dose of radiation is delivered to the tumor, and the radiation exposure to surrounding tissues is minimized.
Medical therapy. In some situations, when surgery and radiation don't produce a normalization of cortisol production, your doctor may advise medical therapy. The most commonly used drugs, ketoconazole (Nizoral) and mitotane (Lysodren), are taken orally and interfere with cortisol production. In some cases, the tumor or its treatment will cause other hormones produced by the pituitary or adrenal gland to become deficient, and your doctor will recommend hormone replacement medications.