cushing's%20syndrome
CUSHING'S SYNDROME
Cushing’s syndrome is a condition which is due to prolonged exposure of the body tissue to excess cortisol (glucocorticoid hormone).
Laboratory tests and radiological findings confirm diagnosis and determine the actual cause of Cushing's syndrome.
Endogenous adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome has adrenal hypersecretion due to adrenal adenoma, adrenal carcinoma, micronodular hyperplasia, and macronodular hyperplasia.
Exogenous ACTH-independent Cushing's syndrome has adrenal hypersecretion due to iatrogenic causes (eg drug-induced, corticosteroid use).

Surgical Intervention

Transsphenoidal Selective Adenomectomy

  • 1st-line therapy for Cushing’s disease
  • Usually performed after inferior petrosal sinus (IPS)
  • A potential cure which keeps pituitary function intact
  • Effects: Generally 80% cure rate (cortisol normalized or rendered hypoadrenal) after initial surgery
    • If 2nd surgery is necessary, it tends to be less successful
  • Different criteria for cure are used eg serum cortisol averaged from 5 readings taken in 1 day: 150-300 nmol/L
  • Patients will generally need glucocorticoid replacement therapy starting after surgery until the hypothalamic-pituitary-adrenal axis has recovered (4-12 months)
  • Complications: Hypopituitarism, diabetes insipidus

Adrenalectomy

  • Unilateral adrenalectomy
    • Cures adrenal adenoma & improves the prognosis of adrenal carcinoma
    • Possibility of remission for Cushing’s disease if pituitary radiotherapy is administered at the same time
  • Total bilateral adrenalectomy
    • A complete cure for adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome
    • Last-line therapy (for patients not cured by other surgical methods or pituitary radiotherapy)
    • May be needed for bilateral micronodular or macronodular hyperplasia
    • May be performed in malignant metastatic tumor of undiagnosed ectopic source
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
08 Jun 2018
Passive smoking at home and in the workplace as well as having a family history of diabetes mellitus increase the risk of gestational diabetes mellitus (GDM), according to a recent China study.
Pearl Toh, 05 Jun 2018
Asian patients with end-stage renal failure (ESRF) had almost triple the risk of death within 1 year after hip fracture surgery, making ESRF an independent predictor for 1-year mortality, a recent study found.
Stephen Padilla, 06 Jun 2018
The amount of added sugars in the diet, especially when present in processed foods, appears to increase the risk of frailty in older people, a recent study suggests. Low levels of physical activity and unintentional weight loss are the frailty components more closely associated with added sugars.
Dr Joslyn Ngu, 4 days ago

The transcultural Diabetes Nutrition Algorithm (tDNA) which involves a structured low-calorie meal plan, diabetes-specific meal replacements and enhanced physical activity, is effective for weight loss in patients with type 2 diabetes, a local study shows. [BMJ Open Diabetes Res Care 2017;5(1):e000384. Doi:10.1136/bmjdrc-2016-000384th]