Cushing's syndrome occurs when the levels of an adrenal hormone called cortisol get too high. Adrenal glands secrete cortisol under stimulation by a pituitary hormone called ACTH, which itself is stimulated by a hormone from the hypothalamus of the brain. Corticosteroids taken as medication over a long time can also elevate levels of cortisol. Excess cortisol, the "stress hormone," causes skin problems, mood changes, high blood pressure and high blood sugar, muscle and bone weakness, and a characteristic pattern of fat deposits in the face, neck and upper back, says the National Institute of Child Health and Human Development. The appropriate treatment for Cushing's syndrome depends on the underlying cause for the excess cortisol.
Chanigng Medications
If you developed Cushing's syndrome because you take corticosteroid medications for a condition such as asthma, arthritis or lupus, your doctor might decrease your dosages and/or prescribe another non-corticosteroid drug. Abruptly stopping corticosteroid drugs can cause severe side effects from too little cortisol, says the Mayo Clinic, so slowly reduce the dosage under your doctor's supervision to reach and maintain a normal level of cortisol.
Surgery
When Cushing's symptoms results from a pituitary tumor or a tumor outside of the brain that produces ACTH, a condition called Cushing's disease, surgery to remove the tumor might be the best option. Neurosurgeons remove pituitary tumors, often accessing them through the nose. The Mayo Clinic says that ACTH-producing tumors or adrenal tumors can be removed by a general surgeon using standard procedures, or sometimes minimally-invasive procedures. After surgery, the patient needs corticosteroid drugs until the adrenal gland resumes normal cortisol production. The corticosteroid drugs help to avoid a dangerous abrupt drop in cortisol levels.
Radiation
If the ACTH-producing tumor cannot be completely removed by surgery, or if the patient has a medical condition that makes surgery too risky, radiation therapy might be an option. Radiation kills the tumor, removing the source of ACTH and reducing the secretion of cortisol. As outlined by the Mayo Clinic, options for radiation therapy include gamma-knife radiation, which delivers a large dose in a single treatment, or treatment with smaller doses over 6 weeks.
Adrenal Medications
According to the Merck Manual, in the case of severe symptoms of Cushing's syndrome caused by a hyperactive adrenal gland that are not controlled by surgery or radiation, doctors might prescribe drugs such as mitotane, metyrapone or ketoconazole to block secretion of cortisol. Although ketoconazole is primarily used as an antifungal agent, at high doses it suppresses the production of steroid hormones, says the Merck manual. Ketoconazole can cause liver damage, so not everyone can take it. All of these drugs can cause the paradoxic problem of too little cortisol, so dosages and symptoms must be monitored closely.
