CUSHING’S SYNDROME – Treatment



Treatment of Cushing’s syndrome depends on its cause. Pituitary microsurgery employing the transsphenoidal approach is now the treatment of choice for patients with suspected pituitary ad­enomas. In experienced hands an adenoma maybe localized in some 90 per cent of patients and removed with a low morbidity. This approach has the advantage of preserving the surrounding pi­tuitary tissue so that hypopituitarism is a rare complication. Pituitary irradiation using either conventional sources or heavy particle beams is also successful in many cases, but the incidence of hypopituitarism is higher than with trans­sphenoidal hypophysectomy. This may be an im­portant consideration in women in the child-bearing years or in children who have not yet achieved adult height. Bilateral adrenalectomy, once performed commonly, is associated with a high incidence of subsequent enlargement of the pituitary neoplasm and hyperpigmentation (Nel­son’s syndrome) and should be reserved for pa­tients who do not respond to the other ap­proaches. Treatment of patients with primary adrenal neoplasms generally consists of surgical removal of the affected adrenal gland. Even those with carcinoma in whom cure is rare should have the tumor removed in an effort to control the hy-percortisolism. Surgery is also recommended in patients with ectopic ACTH syndrome due to well localized ACTH-secreting tumors. In those with benign ACTH-secreting tumors such as bronchial carcinoid, pheochromocytoma, or thymoma, such an operation is frequently curative. In patients with ectopic malignancies that are already meta­static as well as in those who have inoperable ad­renal carcinoma, medical inhibition of adrenal Cortisol secretion by drugs such as mitotane, ami-noglutethimide, and metyrapone, maybe helpful.





Page 1 of 812345»...Last »