Cushing Syndrome (cont.)
- Pituitary tumor
- The treatment of choice in persons with pituitary tumor is trans-sphenoidal
surgery by an experienced neurosurgeon. The goal of surgery is to remove the
tumor, preserving as much pituitary function as possible.
- Pituitary irradiation is used when trans-sphenoidal surgery is not
successful or not possible. The procedure is less successful than surgery in
adults, with a 45% cure rate in adults and 85% cure rate in children. Late-onset
side effects include hypopituitarism.
- Surgical removal of both adrenal glands is an option if trans-sphenoidal
surgery, pituitary irradiation, and medical therapy fail or if rapid
normalization of corticosteroid levels is required. Nowadays, the removal of the
adrenal glands is done laparoscopically. This has decreased both the morbidity
and mortality of this procedure, and the postoperative recovery of the patients
is much faster than after open surgery.
- ACTH production by tumors present elsewhere in the body
- Surgical removal of the tumor producing ACTH may not always be possible
because they are often difficult to locate.
- Medical therapy or surgical removal of both the adrenal glands may be
- Adrenal tumor
- The adrenal gland in which the tumor is located may be surgically removed.
- Carcinomas should be resected for cure if found early or for palliation
(alleviation of symptoms without curing the underlying disease).
George P Chrousos, MD, FAAP, MACP, MACE
Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS
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