Jdinc,
Treatment for Cushing's Syndrome depends on the cause of the disease.
The syndrome is caused by too much cortisol, which may be because the
patient is taking a corticosteroid (which can be stopped), has a tumor
of the pituitary (which may be surgically removed), or a tumor
elsewhere in the body (such as the lungs or the adrenal glands). You
want to consult with an endocrinologist, particularly a specialist in
pituitary disorders, to determine your best course of treatment.
Using the MedlinePlus consumer health database (www.medlineplus.gov),
I found three overviews of Cushing's that I think you'll find helpful.
I simply did a search for "cushing's syndrome". I'm listing them in
order from most helpful/detailed to least helpful/detailed, and am
including the information on treatment for the case of the pituitary
tumor. There is more information after these three pages, so please
keep reading!
National Institute of Diabetes and Digestive and Kidney Diseases:
Cushing's Syndrome
http://www.niddk.nih.gov/health/endo/pubs/cushings/cushings.htm
Note: This page is by far the most complete yet succinct. It's a bit
clinical, too, so be careful. Be sure check out the "What Research is
Being Done on Cushing's Syndrome" section as well as those on further
information and contacts.
"Several therapies are available to treat the ACTH-secreting pituitary
adenomas of Cushing's disease. The most widely used 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 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 fails, 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.
For patients in whom transsphenoidal surgery has failed or who are not
suitable candidates for surgery, radiotherapy is another possible
treatment. Radiation to the pituitary gland is given over a 6-week
period, with improvement occurring in 40 to 50 percent of adults and
up to 80 percent of children. It may take several months or years
before patients feel better from radiation treatment alone. However,
the combination of radiation and the drug mitotane (Lysodren®) can
help speed recovery. Mitotane suppresses cortisol production and
lowers plasma and urine hormone levels. Treatment with mitotane alone
can be successful in 30 to 40 percent of patients. Other drugs used
alone or in combination to control the production of excess cortisol
are aminoglutethimide, metyrapone, trilostane and ketoconazole. Each
has its own side effects that doctors consider when prescribing
therapy for individual patients."
Mayo Clinic: Cushing's Syndrome
http://www.mayoclinic.com/invoke.cfm?id=DS00470
"- 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 may perform the procedure
through your nose. 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. 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; they then need
lifelong replacement therapy.
- Radiation therapy. If the surgeon can't totally remove the pituitary
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 six-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. Medications to control excessive production of
cortisol include ketoconazole (Nizoral) and mitotane (Lysodren).
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."
National Institute of Child Health & Human Development: Cushing's Syndrome
http://www.nichd.nih.gov/publications/pubs/cushings.htm
"If Cushing's syndrome is the result of taking hormones as treatment
for another disease, the doctor will adjust the dosage. If Cushing's
syndrome is caused by the body producing too much cortisol, treatment
may include:
- oral medication
- radiation
- surgery to remove a tumor, or
- a combination of treatments. The treatment used will depend on the
cause of the extra cortisol."
I also found this page by doing a Google search for "cushing's
syndrome" (with the quotation marks):
EndocrineWeb.com: Cushing's Syndrome of the Adrenal: The Obesity Tumor
http://www.endocrineweb.com/obesity.html
There are currently nine clinical trials underway in the United States
and recruiting participants to study Cushing's. I found this list at
the ClinicalTrials.gov website by browsing through the conditions
alphabetically: http://clinicaltrials.gov/ct/gui/action/FindCondition?ui=D003480&recruiting=true
. The details of these trials show some of the research that is being
done into symptoms and solutions for this disease.
If you are looking for a doctor to diagnose and treat Cushing's, you
will want to choose a pituitary specialist. You can search for an
endocrinologist specializing in Cushing's disease at the Hormone
Foundation website: http://www.hormone.org/resources/specialist.php3.
Note that they seem to be having some problems with their website
right now - you may want to contact them directly by emailing to the
address on that page.
In addition, you may find some of the information at the Pituitary
Network Association page useful. They suggest that you use a surgeon
who performs the transphenoidal surgery on a regular basis. They have
a list of pituitary centers in the US that you may wish to consult:
http://www.pituitary.org/memberdirectory/hospitals.aspx as well as a
physican finder by general specialty by state and specialty:
http://www.pituitary.org/memberdirectory/finder.aspx (you will have to
pick the specialty from the box).
In both cases of the Endocrine Society/Hromone Foundation and the PNA,
the physicians listed have declared that they are specialists in
endocrine disease and are accepting new patients.
I hope the above information has fully answered your question - if
not, please let me know (before rating the answer!) how I can
clarify/supplement it.
Yours,
Librariankt |
