Welcome back, and a Happy New Year to all! Today, we are going to discuss ways to diagnose and treat Cushing’s Syndrome and Disease.
There are quite a few methods used to diagnose Cushing’s, split into two major tiers.
Tier 1: For measuring cortisol levels
- Blood Tests
- 24 Hour Urine Tests
- Salivary Cortisol Tests
- Low-Dose Dexamethasone Suppression Testing
Tier 2: For differentiating between Cushing’s Disease and Cushing’s Syndrome
- MRI Scans of the Pituitary Region
- CT Scans of the Adrenals
- Corticotropin-Releasing Hormone Stimulation Test
For Cushing’s Disease:
- Minimally invasive surgical removal of the pituitary adenomas (transsphenoidal surgery) is the most widely used therapeutic approach.
- In the event that the tumor cannot be removed, radiation therapy is another option. However, treatment can take up to several weeks and is more effective in children than in adults
- Stereotactic radiosurgery is another viable option, delivering a precise high-dose burst of radiation to the tumor. However, the effects can be delayed for months or years.
For Cushing’s Syndrome:
- Minimally invasive surgery to remove an offending adrenal tumor.
- In the event of medication-caused Cushing’s Syndrome, lowering dosages of external glucocorticoids can stop Cushing’s.
For Both (these are usually done if all other options above are exhausted):
- Bilateral Adrenalectomy to remove both adrenal glands, thus stopping production of Cortisol.
- Medication, such as ketoconazole and pasireotide can be used to lower cortisol levels. However, they frequently can cause unwanted side-effects, such as increasing blood sugar.