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
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