Cushing Syndrome (cont.)
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Cushing's Syndrome Treatment
Treatment of Cushing's syndrome depends on the primary cause of the syndrome. The aim of treatment is to reduce the corticosteroid secretion to normal. The treatment may include surgical removal of the tumor, radiation, or the use of corticosteroid-inhibiting drugs.
If the cause of Cushing's syndrome is long-term use of corticosteroids to treat another disease (for example, asthma or arthritis), your health care provider will gradually reduce the dose of corticosteroids to the lowest dose required for the control of that disease.
The primary therapy for pituitary tumors is trans-sphenoidal (through the sphenoid bone present at the base of the skull) surgery, and the primary therapy for adrenal tumors is adrenalectomy (surgical removal of the adrenal glands). When surgery is not successful or cannot be performed, treatment with medication may be attempted, however, medication failures are common. Pituitary radiation may be useful if pituitary surgery fails.
Drugs that inhibit the synthesis of corticosteroid, such as mitotane, ketoconazole, metyrapone, aminoglutethimide, trilostane, and etomidate, have been used to cause medical adrenalectomy. These medications are used rarely and often are toxic at the doses required to reduce corticosteroid secretion. Thus, medical treatment is initiated cautiously. Persons receiving the medications may require corticosteroid replacement to avoid adrenal insufficiency.
Drugs that decrease CRH or ACTH release have also been studied for the treatment of Cushing's disease. Such agents include bromocriptine, cyproheptadine, valproic acid, and octreotide. Currently, use of these drugs is investigational.
George P Chrousos, MD, FAAP, MACP, MACE
Shehnaz Shaikh, MD
Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS
Mary L Windle, PharmD
George T Griffing, MD
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