Get Treatment For Cushing’s Syndrome

Great Surgical Care at Marina del Rey Hospital

Why Choose Cedars-Sinai Marina del Rey Hospital for Cushing's Syndrome Treatment?

At Cedars Sinai Marina del Rey Hospital, our specialists are highly skilled in the most advanced procedures for treating pituitary tumors. Our hospital offers a full range of advanced diagnostic and therapeutic services and techniques for people with neuroendocrine disorders such as Cushing’s syndrome. At Cedars Sinai Marina del Rey Hospital you can count on:

  • Getting an accurate diagnosis and a care plan tailored to your specific needs;
  • Care from board-certified neuroendocrinologists who specializes in Cushing's disease/syndrome;
  • Skilled neurosurgeons who use a minimally invasive approach to remove the pituitary and adrenal tumors that cause Cushing's syndrome;
  • Sophisticated technology, including targeted radiation therapy.

Cushing’s syndrome, also called hypercortisolism, is a debilitating endocrine disorder caused when the adrenal glands make too much of a hormone called cortisol. When the disorder is caused by the pituitary gland overproducing adrenocorticotropic hormone (ACTH) which in turn becomes cortisol, it's called Cushing's disease.

People with Cushing’s syndrome gain an excessive amount of weight, and develop thin, stretched skin. Fat will accumulate especially in the abdominal cavity, and the upper back or chest. Blood pressure may rise; excess hair can grow on the face, neck, chest, abdomen, and thighs.

Although it may occur in children, Cushing’s syndrome most commonly affects adults between 20 and 50 years of age. It is important to determine the underlying cause of excess cortisol because the treatments are different based on the source. Your doctor may prescribe some medication to help control cortisol levels and ease some of the symptoms. Untreated Cushing’s syndrome can cause osteoporosis, vascular disease (myocardial infarction/stroke), diabetes mellitus, and infections.

The treatment for Cushing’s syndrome depends on the cause of the cortisol overproduction. If the cause of the elevated level of cortisol is the result of the long-term use of hormones such as prednisone for the treatment of another disorder, gradually reducing the dosage of the medication can help reduce the effects of Cushing’s syndrome to a great extent.

It's common for some people with certain health conditions - such as inflammatory arthritis, lupus, and chronic obstructive chronic disease - to take corticosteroids to help them manage their symptoms. In these cases, your doctor will give you a schedule to gradually lower your dose.

Surgery to remove a tumor - Pituitary tumors may be surgically removed during an operation known as a trans-nasal or sub-labial transsphenoidal adenomectomy. Specific surgical procedures can vary greatly depending on the type and location of the tumor and the expertise of the surgeon.

Medications for Cushing’s syndrome include:

  • ketoconazole
  • mitotane (Lysodren)
  • metyrapone (Metopirone)
  • mifepristone (Korlym, Mifeprex)
  • pasireotide
  • cabergoline

While these drugs are effective, they do come with significant side effects. Don't take any medication before speaking with your doctor.

Radiation therapy - Sometimes your surgeon can't remove the entire tumor. If that happens, he/she may recommend a type of treatment that uses high-energy radiation to shrink tumors and/or destroy cancer cells. Radiation therapy may also be prescribed if you're not a candidate for surgery due to various reasons, such as the location or size of the tumor. Radiation therapy for Cushing's syndrome is typically given by a technique called stereotactic radiosurgery or gamma-knife radiation.

Exogenous Cushing’s syndrome - caused by factors outside the body, from long-term, high-dose usage of corticosteroid drugs, such as prednisone, dexamethasone, methylprednisolone, and joint steroid injections.

Endogenous Cushing’s syndrome, in which the adrenal glands produce too much cortisol - a powerful steroid hormone that helps maintain blood sugar levels, protects the body from stress, and suppresses inflammation.

Symptoms of Cushing’s Syndrome

The main signs of Cushing's syndrome include increased fat on your chest and tummy, but slim arms and legs, a build-up of fat on the back of your neck and shoulders, and a red, puffy, rounded face. Other symptoms and signs include:

  • high blood pressure
  • fatigue
  • muscle weakness
  • irritability
  • irregular menstrual periods in women
  • erectile dysfunction in males
  • easy bruising
  • skin ulcers
  • purple stretch marks
  • brittle bones

Diagnosis of Cushing’s Syndrome

To find out if you have Cushing's syndrome, your doctor will do a physical exam and ask you about your personal medical history. If you’re not taking medicines that cause it, you may need to have blood and urine tests.

Tests are done to confirm Cushing’s syndrome, sometimes called hypercortisolism, then to determine the cause.

Tests to confirm Cushing’s syndrome:

  • 24-hour urine cortisol
  • 24-hour urine creatinine
  • Dexamethasone suppression test (low dose)
  • Serial serum cortisol levels
  • Nighttime saliva cortisol levels

Tests determine the cause of Cushing’s syndrome:

  • Serum ACTH levels
  • Cranial MRI scan that shows macroadenomas and microadenomas of the pituitary gland
  • CRH test
  • Petrosal sinus sampling
  • Dexamethasone suppression test (high dose)

Risk Factors for Cushing’s Syndrome

Incidence: more than 10 million Americans receive pharmacologic doses of glucocorticoids each year, but it’s not known how many of them develop Cushing’s syndrome;

Age: It typically affects adults aged 20 to 50;

Sex: it is not yet fully understood why, but Cushing's syndrome occurs up to three times more often in women.

Familial Cushing’s syndrome - although most cases of Cushing’s syndrome are not genetic, some individuals may develop the condition due to an inherited tendency to develop tumors of one or more endocrine glands.

Gene mutations associated with other diseases - for example, a person may have an inherited gene mutation, such as Multiple Endocrine Neoplasia Type 1 or MEN-1, which increases the risk of developing pituitary and adrenal tumors.

Causes of Cushing’s syndrome

The most common cause of elevated cortisol levels is taking corticosteroid medications in high doses and for a long period. Increased cortisol levels can occur for reasons other than ingesting excessive amounts of steroids, including:

  • Pituitary tumor - when a tumor arises in the pituitary gland and begins to secrete ACTH;
  • Adrenal tumor - when a tumor arises in one of the two adrenal glands produces too much cortisol;
  • Ectopic tumor - approximately 10-15% of patients with Cushing’s syndrome have ectopic cancer. Most cases of extra pituitary tumors that produce cortisol or a similar and equivalent steroid hormone include small-cell lung cancer (SCLC) and bronchial carcinoid tumors.

Less common causes of elevated cortisol levels:

  • Type 2 diabetes
  • High blood pressure
  • Obesity
  • Pseudo-Cushing's syndrome - chronically elevated levels of cortisol due to severe major depressive disorder, alcohol use disorder, or high estrogen levels

The chronic glucocorticoid excess can significantly affect how the body processes nutrients. The following healthy diets can help limit or counteract some symptoms.

Foods that reduce inflammation - Because people with Cushing's disease are at an increased risk for other health problems, including bone loss, consuming food high in calcium, vitamin D, magnesium, vitamin K, will be beneficial for bone health. Lowering intake of artificial ingredients, processed grains, sugar, sodium, tobacco, and alcohol can help ease symptoms associated with Cushing's syndrome.

Healthy fats and omega-3 fatty acids - wild-caught fish like salmon or sardines contain omega-3 fatty acids which can reduce inflammation and help stabilize moods. Healthy fats are linked to a great brain boost and also help the body absorb some nutrients and produce important hormones. You can also include nuts and seeds such as flaxseed, chia seeds, and walnuts, avocado, olive oil, and coconut oil in your diet regularly.

Consume foods high in B vitamins to combat adrenal fatigue that occurs as a result of chronic stress and adrenal insufficiency.

Home remedies for Cushing’s syndrome:

  • Burdock tea helps to modulate the adrenal function;
  • Fish oil and avocados give relief from inflammation;
  • Magnolia bark reduces levels of stress and anxiety;
  • Ginseng and reishi mushrooms help to lower stress levels.

Cushing's syndrome caused by an abnormality of the adrenal glands, such as an adrenal tumor, may be prevented by an awareness of the associated symptoms so that early detection can be made.

The only way to prevent exogenous Cushing's syndrome is to avoid taking corticosteroid medication, if possible. If your doctor plans to treat any of your health issues with oral steroids, creams or injections talk to him/her first. Discuss how long you will have to take these cortisone-like medicines and ask him/her if there’s a possibility it will cause Cushing’s syndrome.

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