Diagnosis and treatment:
A patient with cushing’s syndrome may have a few of the symptoms and not all. It becomes hard to diagnose due to so many overlapping signs and symptoms with other diseases or conditions such as polycystic ovary syndrome. The first plan of action is to find out what is causing the high levels of cortisol before it can be treated, this requires expertise from experienced endocrinologists, neurosurgeons, and vascular radiologists.
Tests used to diagnose:
1) Urinary test- Urine samples are collected over a 24-hour period and sent off to the lab to analyse the level of cortisol present.
2) Salivary test- Normally cortisol production levels drop just after we fall asleep but in Cushins’s disease this doesn’t happen. Hence why saliva is collected late in the evening for this test.
3) The dexamethasone-CRH test- A shot of CRH hormone and dexamethasone, a type of glucocorticoid, is administered. Blood sample is taken a few hours later. Cortisol levels should have dropped, if they don’t, it is an indication of Cushing’s disease.
4) Blood tests- If ACTH levels are low, the cause is probably an adrenal tumor.
5) Imaging test- Show the shape and size of the pituitary and adrenal gland along with a clearer image of any tumours if present. Examples of the medical devices used here would be computerized tomography (CT) scanners and a magnetic resonance imaging (MRI) machine.
Treatment depends on the cause and may include surgery, radiation, chemotherapy, or cortisol-reducing medicines.
In the case of a tumour being present, it is usually removed by surgery using a special microscope and fine instruments to access the gland by going up the nasal passage. The patient is then prescribed with cortisol medicine as the gland does not produce enough ACTH for the first six months post-surgery. If the surgery failed, radiation therapy is also an option to reduce the size of the tumour. In severe cases where the tumour is too big and both adrenal glands must be removed, the patient would remain on cortisol medication for life to maintain the level of hormones originally released by the glands.
A type of radiotherapy known as stereotactic radiosurgery (SRS) is increasingly being used to treat pituitary tumours. This approach is less invasive than surgery and reduces the risk of accidental damage to other parts of the brain.
The use of Cortisol-inhibiting medication is a popular treatment and they are designed to block the adverse effects of cortisol. Two examples are ketoconazole and metyrapone. These drugs do however have side effects such as bad acne, dizziness, excessive hair growth on the face, lack of interest in sex, swelling of breasts in men and irregular periods in women.
Diagnosis and treatment: