Conley Cushing’s Disease Fund

Understanding Cushing’s Part Three: Diagnosis and Treatment

Diagnosis

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
  • IPSS

Treatment 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 Appendectomy 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.

Sources:

https://www.niddk.nih.gov/health-information/health-topics/endocrine/cushings-syndrome/Pages/fact-sheet.aspx
https://csrf.net/understanding-cushings/diagnostic-testing/
http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/diagnosis-treatment/diagnosis/dxc-20197891