Treatment of Cushing’s syndrome depends on the cause of the raised levels of cortisol. Gradually reducing then stopping your dosage of corticosteroid medication can help in the treatment of Iatrogenic Cushing’s syndrome.
In order to reduce the levels of cortisol, one should gradually reduce the dosage of corticosteroids intake if you have been taking corticosteroids for a long time. This is because, if you have been taking corticosteroids for a long time, your body may stop producing natural steroids. And this sudden halt of corticosteroid dosage may lead to adverse effects such as fatigue, weight loss, feeling sick, dizziness, being sick and diarrhoea. Otherwise if you have been taking corticosteroids for a short while, it is possible to safely stop the dosage right away.
On the other hand, if you have endogenic Cushing’s syndrome that is caused by tumour, there are several treatment options. For example, cortisol-inhibiting medications, surgery and radiotherapy.
Cortisol-inhibiting medication
In order to stop the adverse effects of cortisol, one would have to take the cortisol-inhibiting medication. These are usually used on a short term basis to prepare for a surgery. Sometimes, the medication is also used for a short time after surgery or radio therapy to make those treatment more effective.
At times, cortisol-inhibiting drugs may be used on a long term basis on people who are not willing or unable to have surgery. Metyrapone and ketoconazole are two examples of widely used cortisol-inhibiting drugs.
Surgery
Removal or destruction of tumour in the pituitary gland or the adrenal gland can be done by surgery. However, removal of a tumour from the lungs is much more complicated and thus may not be possible.
Pituitary surgery
The removal of pituitary tumour is done under general anesthetic whereby the surgeon would do the removal through your nostril or an opening that is just above your front teeth. This method allows the surgeon to reach the pituitary gland without having to operate on the main part of your head. Therefore reducing the risks of complications.
Adrenal gland surgery
Removal of one of your adrenal gland is usually done using laparoscopic (keyhole) surgery. The surgeon makes a small incision in your abdomen and inserts tiny instruments to remove the adrenal gland.
Lungs
It would be more complex to remove a tumour which is located deep in the lungs, therefore it is unsafe to remove or destroy the tumour without seriously damaging the lungs. Thus, an alternative method is to use cortisol-inhibiting medicine or the complete removal of the adrenal glands.
Radio therapy
When pituitary surgery is unsuccessful, radio therapy can be used to shrink the tumour. Stereotactic radiosurgery (SRS) is increasing being used to treat pituitary tumours. SRS uses a series of movable frames to hold your head in a precise location where a computer then sends energy waves to the exact location of the tumour.
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