Wednesday, 10 January 2018

Sure Treatments For Cushing's Syndrome + Diagnosis Methods


Cushing's syndrome is all about the stress hormone cortisol. When your body makes too much of it, the excess hormone can throw off your body's other systems.
Most cases of Cushing's syndrome can be cured, though it may take some time for your symptoms to ease up.


How Cushing's Syndrome Is Diagnosed
The early stages of Cushing's disease may be difficult to recognize, especially because the body changes develop slowly. Comparing old and recent photographs often shows the changes in facial appearance and physical characteristics of the body. The diagnosis may be difficult to make because sometimes the hormone elevations come and go: so called "cyclic" or "periodic" Cushing's disease.
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Diagnosis is based on a review of a person's medical history, a physical examination, and laboratory tests. X-rays of the adrenal or pituitary glands can be useful in locating tumors. Cushing's Syndrome can be diagnosed with the methods below :

  • Saliva test : Cortisol levels normally rise and fall throughout the day. In people without Cushing syndrome, levels of cortisol drop significantly in the evening. By analyzing cortisol levels from a small sample of saliva collected late at night, doctors can see if cortisol levels are too high, suggesting a diagnosis of Cushing syndrome.
  •  Hormone Testing : The testing for excessive cortisol levels can be complex and challenging. Blood tests may not detect the presence of excessive cortisol secretion because blood levels of cortisol naturally vary throughout the day. Therefore a simple measurement of the blood cortisol level is usually not definitive.

  •  Low-dose dexamethasone suppression test (LDDST) : In the LDDST, a person is given a low dose of dexamethasone, a synthetic glucocorticoid, by mouth every 6 hours for 2 days. Urine is collected before dexamethasone is administered and several times on each day of the test. A modified LDDST uses a onetime overnight dose. Cortisol and other glucocorticoids signal the pituitary to release less ACTH, so the normal response after taking dexamethasone is a drop in blood and urine cortisol levels. If cortisol levels do not drop, Cushing's syndrome is suspected.
  • Petrosal sinus sampling : This test can help determine whether the cause of endogenous Cushing syndrome is rooted in the pituitary or somewhere else. For the test, blood samples are taken from the petrosal sinuses veins that drain the pituitary glands. A thin tube is inserted into your upper thigh or groin area while you're sedated, and threaded to the petrosal sinuses. Levels of ACTH are measured from the petrosal sinuses, and from a blood sample taken from the forearm.
  • MRI Imaging : Once your doctor suspects Cushing's disease based on clinical findings and hormonal testing, a magnetic resonance imaging (MRI) scan of the pituitary gland is the best way to detect the presence of an adenoma in Cushing's disease. MRI detects a pituitary adenoma in about 70 percent of cases. It is important that you undergo these imaging tests at a Pituitary center with special expertise in imaging small tumors. At the UCLA Pituitary Tumor Program, we use powerful 3T (Tesla) MRI scanners that may offer improved chances of identifying very small tumors.

Treatments For Cushing's Syndrome
The only effective treatments for Cushing’s disease are to remove the tumor, to reduce its ability to make ACTH , or to remove the
adrenal glands . There are other complementary approaches that may be used to treat some of the symptoms. For example, diabetes, depression and high blood pressure will be treated with the usual medicines used for these conditions.

Adrenal Gland Removal by Surgery
Removal of both adrenal glands also removes the ability of the body to produce cortisol. Since adrenal hormones are necessary for life, patients must then take a cortisol-like hormone and the hormone florinef, which controls salt and water balance, every day for the rest of their life. An experienced pituitary- or neuro- endocrinologist can help to decide the best course of treatment.

Medications can be used to control cortisol production when surgery and radiation don't work. Medications may also be used before surgery in people who have become very sick with Cushing syndrome. Doctors may recommend drug therapy before surgery to improve signs and symptoms and minimize surgical risk.
Medications to control excessive production of cortisol at the adrenal gland include ketoconazole (Nizoral), mitotane (Lysodren) and metyrapone (Metopirone).
Mifepristone (Korlym) is approved for people with Cushing syndrome who have type 2 diabetes or glucose intolerance. Mifepristone does not decrease cortisol production, but it blocks the effect of cortisol on your tissues. Side effects from these medications may include fatigue, nausea, vomiting, headaches, muscle aches, high blood pressure, low potassium and swelling.

Pituitary Tumor Removal by Surgery
Removal of the pituitary tumor by surgery is the best way to treat Cushing’s disease. This is recommended for those who have a tumor that is not extending into areas outside of the pituitary gland , and who are well enough to have anesthesia. This is usually carried out by going via the nose or upper lip and through the sphenoid sinus to reach the tumor. This is known as transsphenoidal surgery and avoids having to get to the pituitary via the upper skull. This route is less traumatic for the patient and allows quicker recovery. Removing only the tumor leaves the rest of the pituitary gland intact so that it will eventually function normally. This is successful for 70–90% of people when performed by the best pituitary surgeons.

Other options for treatment include radiation therapy to the entire pituitary gland or targeted radiation therapy (called radiosurgery ), when the tumor is seen on MRI. This may be used as the only treatment or it may be given if pituitary surgery is not completely successful. These approaches can take up to 10 years to have full effect. In the meantime patients take medicine to reduce adrenal gland production of cortisol. One important side effect of radiation therapy is that it can affect other pituitary cells that make other hormones . As a result, up to 50% of patients need to take other hormone replacement within 10 years of the treatment.

Nutritious, wholesome foods provide a good source of fuel for your recovering body and can help you lose the extra pounds that you gained from Cushing syndrome. Make sure you're getting enough calcium and vitamin D. Taken together, they help your body absorb calcium, which can help strengthen your bones, counteracting the bone density loss that often occurs with Cushing syndrome.


Author: Richard Smith