Treatments for Cushing's symphalangism
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Cushing's syndrome:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment to restore hormone balance and reverse Cushing’s syndrome may necessitate radiation, drug therapy, or surgery. For example, pituitary-dependent Cushing’s syndrome with adrenal hyperplasia and severe cushingoid symptoms (such as psychosis, poorly controlled diabetes mellitus, osteoporosis, and severe pathologic fractures) may require partial or complete hypophysectomy or pituitary irradiation. If the patient fails to respond, bilateral adrenalectomy may be performed. Nonendocrine corticotropin-producing tumors require excision of the tumor, followed by drug therapy (for example, with mitotane, metyrapone, or aminoglutethimide) to decrease cortisol levels if symptoms persist.
Aminoglutethimide and ketoconazole decrease cortisol levels and have been beneficial for many cushingoid patients. Aminoglutethimide alone, or in combination with metyrapone, may also be useful in metastatic adrenal carcinoma.
Before surgery, the patient with cushingoid symptoms should have special management to control hypertension, edema, diabetes, and cardiovascular manifestations and to prevent infection. Glucocorticoid administration on the morning of surgery can help prevent acute adrenal hypofunction during surgery.
Cortisol therapy is essential during and after surgery, to help the patient tolerate the physiologic stress imposed by removal of the pituitary or adrenals. If normal cortisol production resumes, steroid therapy may be gradually tapered and eventually discontinued. However, bilateral adrenalectomy or total hypophysectomy mandates lifelong steroid replacement therapy to correct hormonal deficiencies.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cushing's syndrome:
Treatment
(Handbook of Diseases)
Primary treatment is transphenoidal hypophysectomy radiation and drug therapy, are secondary treatments used to restore hormone balance and reverse Cushing’s syndrome. For example, pituitary-dependent Cushing’s syndrome with adrenal hyperplasia and severe cushingoid symptoms — such as psychosis, poorly controlled diabetes mellitus, osteoporosis, and severe pathologic fractures — may require adenectomy or pituitary irradiation. If the patient fails to respond, bilateral adrenalectomy may be performed.
Nonendocrine corticotropin-producing tumors require excision of the tumor. Drug therapy follows (for example, with mitotane, metyrapone, or aminoglutethimide) to decrease cortisol levels if symptoms persist.
Aminoglutethimide and ketoconazole decrease cortisol levels and have been beneficial for many cushingoid patients. Aminoglutethimide alone or in combination with metyrapone may also be useful in metastatic adrenal carcinoma.
Before surgery, the patient with cushingoid symptoms should have special management to control hypertension, edema, diabetes, and cardiovascular manifestations and to prevent infection. Glucocorticoid administration on the morning of surgery can help prevent acute adrenal insufficiency during surgery.
Cortisol therapy is essential during and after surgery to help the patient tolerate the physiologic stress imposed by removal of the pituitary or adrenals. If normal cortisol production resumes, steroid therapy may be gradually tapered and eventually discontinued. However, bilateral adrenalectomy or total hypophysectomy mandates lifelong steroid replacement therapy to correct hormonal deficiencies. (See Dealing with lifelong treatment.)
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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