Treatment

The goal of treatment in patients with Cushing's syndrome is reversal of hypercortisolism and management of the associated comorbidities, including the potential for long-

term sequelae such as cardiac hypertrophy. Surgical resection is considered the treatment of choice for Cushing's syndrome from endogenous causes if the tumor can be localized and if there are no contraindications. The treatment of choice for Cushing's syndrome from exogenous causes is gradual discontinuation of the offending agent.

Table 45-4 Etiologies of Cushing's Syndrome ACTH-Dependent

• ACTH-secreting pituitary tumor (Cushing's disease)—70% of cases of endogenous Cushing's syndrome

• ACTH-secreting nonpituitary tumors (ectopic ACTH syndrome)—15% of cases of endogenous Cushing's syndrome; usually from small cell lung carcinoma, bronchial carcinoids, pheochromocytoma, or from thymus, pancreatic, ovarian, or thyroid tumor. The tumor is usually disseminated (difficult to localize)

• CRH-secreting nonpituitary tumors (ectopic CRH syndrome)—rare ACTH-Independent—15% of cases of endogenous Cushing's syndrome

• Unilateral adrenal adenoma

• Adrenal carcinoma

• Bilateral nodular adrenal hyperplasia—rare (less than 1%)

Drug-Induced Cushing's Syndrome (ACTH-independent)—most common cause of

Cushing's syndrome

• Prescription glucocorticoid preparations (most routes of administration)

• Nonprescription and natural health products with glucocorticoid activity (e.g., non-prescription anti-itch products with hydrocortisone, natural health products with magnolia bark or those claiming to contain adrenal cortex extracts or other byproducts)

• Other drugs with glucocorticoid activity (e.g., megestrol acetate, medroxyprogester-one)

ACTH, adrenocorticotropic hormone or corticotropin; CRH, corticotropin-releasing hormone.

Table 45-5 Differences Among the Major Etiologies of Cushing's Syndrome

ACTH DE PEN DEFiT ACTH INDEPENDENT

Table 45-5 Differences Among the Major Etiologies of Cushing's Syndrome

ACTH DE PEN DEFiT ACTH INDEPENDENT

FHuifjry

E>rog»Tiouj

Dependent

Eti&pfC ACTH

Glueoeartleold

MrtAll

Adrenal

|CushlngJs 01 »i»!

iyndromo

Administration

Adenoma

Corcinonu

Ons« oi signs ifid ijnntïijûrtis

Gradual

R»] Id

■J->Jujl [O r l)i>J

Graftal

Bjpid

Symptûfni ifwrity

Mild modemU»

Alfllfcal

Mildio severe

Mid U) modurjle

Severe

(XHiiiiiiirr v'i/iflC

TidijIftJP 1<J|1Mi> ffsngo child hood

lil.ilo.jll JLIOS

Finns le

FOfTiaifJ children

Vii'lirarfcin

t

+

+

i

++t

AtxJominat truss

0

0

0

++

Plasma ACTH corxmBiltoii

yighiiy devjifio

Eicvjtfd

low

low

Lew

CRH stimulation lest

fflesfiomo

ftaie response

Decreased or no rCS^m1

Fia response

No response

Hkjh-iicjîe deaatneihrnone

flehween and

çiQrtlsol

H0{0l1lS0l

Noogrtbol

No Cortisol

suppression tes!

HPH:af[lsat njUmnmi

suppression

suppression

suppression

suppression

fllurlaryMRI

Tumor

Fionrial

tormjl

Norrrul

Noimjt

Adterul tjljndCT it MHI

ÎfcjllTulotlllIjtlljl

Noirtjlw luldftijl

No (liango

Mjwfri)

FAKSIM

hyfMff&iîiJ

hypwptasii

O, none; nuld; + niodeialip, 4-4 *■, prono<n*«i ML TH, adrenooorlkolrofx hoimone oi corticotropin C l!H,iorti<o«of)iii mleannq hoimone. From fiefi 1,4, I J, 1&

Stop Headache Drug Free

Stop Headache Drug Free

If you are suffering from headaches, you can make the pain stop just by following some basic but little known principles. Take 15 minutes browsing through this guide and you'll find dozens of tips to gain control in the battle against headache pain.

Get My Free Audio Book


Post a comment