And It's About Time There Was Some Support For Cushing's!
Treatment depends on the specific reason for cortisol excess and may include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs. If the cause is long-term use of glucocorticoid hormones to treat another disorder, the doctor will gradually reduce the dosage to the lowest dose adequate for control of that disorder. Once control is established, the daily dose of glucocorticoid hormones may be doubled and given on alternate days to lessen side effects.
Several therapies are available to treat the ACTH-secreting pituitary
adenomas
of Cushing's disease. The
most widely used treatment is surgical removal of the tumor, known as transsphenoidal adenomectomy.
Using a special microscope and very fine instruments, the surgeon approaches the
pituitary
gland through a
nostril or an opening made below the upper lip. Because this is an extremely delicate procedure, patients
are often referred to centers specializing in this type of surgery. The success, or cure, rate of this
procedure is over 80 percent when performed by a surgeon with extensive experience. If surgery fails, or
only produces a temporary cure, surgery can be repeated, often with good results. After curative
pituitary
surgery, the production of ACTH drops two levels below normal. This is a natural, but temporary, drop in
ACTH production, and patients are given a synthetic form of
cortisol (such as hydrocortisone or
prednisone). Most patients can stop this replacement therapy in less than a year.
Click here to learn what happens after the Transsphenoidal.
For patients in whom transsphenoidal surgery has failed or who are not suitable candidates for surgery, radiotherapy is another possible treatment. Radiation to the pituitary gland is given over a 6-week period, with improvement occurring in 40 to 50 percent of adults and up to 80 percent of children. It may take several months or years before patients feel better from radiation treatment alone. However, the combination of radiation and the drug mitotane (Lysodren®) can help speed recovery. Mitotane suppresses cortisol production and lowers plasma and urine hormone levels. Treatment with mitotane alone can be successful in 30 to 40 percent of patients. Other drugs used alone or in combination to control the production of excess cortisol are aminoglutethimide, metyrapone, trilostane and ketoconazole. Each has its own side effects that doctors consider when prescribing therapy for individual patients.
To cure the overproduction of cortisol caused by ectopic ACTH syndrome, it is necessary to eliminate all of the cancerous tissue that is secreting ACTH. The choice of cancer treatment--surgery, radiotherapy, chemotherapy, immunotherapy, or a combination of these treatments--depends on the type of cancer and how far it has spread. Since ACTH-secreting tumors (for example, small cell lung cancer) may be very small or widespread at the time of diagnosis, cortisol-inhibiting drugs, like mitotane, are an important part of treatment. In some cases, if pituitary surgery is not successful, surgical removal of the adrenal glands (bilateral adrenalectomy) may take the place of drug therapy.
Surgery is the mainstay of treatment for benign as well as cancerous tumors of the adrenal glands. In Primary Pigmented Micronodular Adrenal Disease and the familial Carney's complex, surgical removal of the adrenal glands is required.
From NCI/PDQ Patient Statement: Pituitary tumor
How pituitary tumors are treated
There are treatments for all patients with pituitary tumors. Three kinds of treatment are used:
Surgery is a common treatment of pituitary tumors. A doctor may remove the tumor using one of the following operations:
Radiation Therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation for pituitary tumors usually comes from a machine outside the body (external radiation therapy). Radiation therapy may be used alone or in addition to surgery or drug therapy.
Certain drugs can also block the pituitary gland from making too many hormones.
Treatments for pituitary tumors depend on the type of tumor, how far the tumor has spread into the brain, and the patient's age and overall health.
Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.
Clinical trials are ongoing in some parts of the country for patients with pituitary tumors. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); or TTY at 1-800-332-8615.
Treatment may be one of the following:
Treatment may be one of the following:
Treatment may be one of the following:
Treatment may be one of the following:
Treatment of recurrent pituitary tumor depends on the type of tumor, the type of treatment the patient has already had, and other factors such as the patient's
general condition. Patients may want to take part in a clinical trials of new
treatments.
From NCI/PDQ Patient Statement: Pituitary tumor
