Therapy
If cortisol is given as a drug, a reduction of the dose may be considered to reduce the symptoms of the cushing-. syndrome. If the disease is based on a hormone-producing tumour, surgery should be performed for the causal treatment of Cushing’s syndrome: The adrenal gland or pituitary tumour is removed surgically.
The hormones produced by the adrenal gland must be replaced in tablet form for a period of time that varies from person to person after the operation, as the adrenal gland is no longer the hormone-producing organ and the production of hormones in the reciprocal adrenal gland may not be sufficient to meet the body’s needs. If surgery on the pituitary gland is not possible, it can be irradiated to destroy the tumour and reduce cortisol production. Cushing’s syndrome is an excess supply of the hormone cortisol.
This excess can have various causes, so that the therapy depends on the existing cause. One of these causes can be a benign tumour in the pituitary gland (hypophysis), which causes the adrenal cortex to be stimulated to produce cortisol without the pituitary gland reacting to negative feedback and continuing to stimulate the adrenal cortex. Autonomous tumours are not inhibited in their activity by the hormone produced, but produce the hormone continuously.
Such an autonomous tumour can be removed via the nostrils or via an incision at the inner edge of the eye. As this involves the complete removal of the pituitary gland, it is necessary for the patient to take medication after the operation to replace the cortisol in the blood. This is the cortisol-like substance hydrocortisone.
An autonomous tumour can also occur in the adrenal glands themselves, so that excess cortisol is produced there unhindered. The adrenal glands can also be removed surgically. As a result, all hormones that are synthesized by the adrenal glands are then missing.
A lifelong hormone substitution of these vital hormones is then necessary. If the hypercortisolism is caused by medication, it is sufficient to adjust the dose of the medication to stabilize the cortisol levels in the blood. If the reasons for the excessive production of the body’s own cortisol cannot be eliminated by surgery, drugs that reduce the production of hormones can be used.
As part of the therapy, the hormone level should be checked regularly throughout the patient’s life to ensure the effectiveness of the medication and to avoid hormone fluctuations. Due to the effects of Cushing’s syndrome on the body, such as obesity, high blood pressure, osteoporosis and blood sugar disorders, it may also be necessary to treat these side effects with medication. Since patients often suffer psychologically from the effects of the overproduced cortisol, depending on the patient’s situation, psychologically supportive therapy may also be necessary.