CUSHING'S SYNDROME

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What is a Cushing’s Syndrome?

Cushing’s syndrome is a disorder caused by the release of excessive amounts of steroid hormones from the adrenal gland into the blood.

Patients with high levels of steroid hormones develop a number of very characteristic symptoms, including obesity, particularly with the fat that is distributed over the chest and abdomen, they also have increased distribution of fat around their face causing rounding of the face, high blood pressure, stretch marks on the skin, increased amounts of hair in women on face, upper back and arms, development of diabetes and muscle wasting with atrophy of muscles.

Women often develop menstrual irregularities, a loss of their periods and a markedly increased susceptibility to infections. The bones are affected and patients develop osteoporosis or thinning of their bones that can give rise to fracturing of their bones very easily.

What is the cause for Cushing’s syndrome?

There are many causes for Cushing’s syndrome. Some of the important causes include:

  • Adrenal tumors: A tumor in the adrenal gland, that produces excessive amounts of steroid hormones.
  • Adrenal cancers: Adrenal cancers can produce excessive amounts steroid hormone that produce all the symptoms of steroid excess.
  • Pituitary tumor: A tumor in the pituitary gland in the brain that produces excessive amounts of a hormone called ACTH, that drives the adrenal gland to produce excess amounts of steroids.
  • Other tumors: Tumors such as lung cancer which produces the hormone ACTH that drives the adrenal gland to overproduce steroid hormones.
  • Abnormality in both adrenal glands: Abnormal enlargement of both adrenal glands producing an excessive amounts of cortisone
  • Steroid hormones: Patients who are taking steroid hormones for a long time develop all the signs and symptoms of Cushing’s syndrome.

What is the treatment for Cushing’s syndrome?

The treatment for Cushing’s syndrome depends on the underlying cause. Patients with pituitary or adrenal tumors should be evaluated by specialty surgeons. All pituitary and adrenal tumors should be removed if surgically feasible.

Adrenal tumors: The treatment of choice for adrenal tumors that are less than 6cm causing a Cushing’s syndrome is removal by a laparoscopic adrenalectomy. The laparoscopic procedure is associated with less pain and a shorter recovery period and is strongly recommended over the open procedure that produces much more pain both short term and long term and is associated with a much more prolonged recovery.

In patients with adrenal tumors that are larger than 6cm the decision to perform an laparoscopic removal of the adrenal gland should be carefully considered due to the risk of cancer in these patients. Patients should be evaluated by an experienced endocrine surgeon with experience in both open and laparoscopic adrenal surgery. New technology used at USC with a laparoscopic hand-access device may allow these larger tumors to be safely performed by laparoscopic techniques.

For patients with tumors larger than 10cm an open operation is preferred to remove the tumor that has a high likelihood of being a cancer.

Pituitary tumors: Patients should be evaluated by a neurosurgeon experienced in pituitary tumors. Where the tumor is not localized or is not removable, removal of both the adrenal glands may be required in patients with severe symptoms from steroid excess. Removal of both adrenal glands is best accomplished by laparoscopic removal of the adrenal gland.

Abnormality in both adrenal glands: In patients who have excess steroid production from abnormal tissue in both adrenal glands amy require removal of both adrenal glands. Removal of both adrenal glands is best accomplished by laparoscopic removal of the adrenal gland.

Adrenal tumor: benign (non cancerous) or cancer?

Adrenal tumors that causes Cushing’s syndrome usually grow from the cortex (outer part) of the adrenal gland. Almost all the adrenal tumors that are less than 5cm in size are benign. Tumors larger than 5cm may sometimes by malignant.

In patients with adrenal tumors that are larger than 6cm the decision to perform an laparoscopic removal of the adrenal gland should be carefully considered due to the risk of cancer in these patients. Patients should be evaluated by an experienced endocrine surgeon with experience in both open and laparoscopic adrenal surgery.

For patients with tumors larger than 10cm an open operation is preferred to remove the tumor that has a high likelihood of being cancer.



Contact information: USC Center for Pancreatic and Biliary Diseases
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Phone:
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PancreasDiseases@surgery.usc.edu
Programs: pancreatic cancer, pancreatitis, laparoscopic surgery, endocrine surgery,
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This web site provides select information about pancreatic and biliary disorders and is updated twice monthly. This information is not intended as a substitute for professional medical consultation with your physician.It is important that you consult with your physician for detailed information about your medical condition and treatment.The center will make every effort to update the site, however, past performance is no guarantee of future medical outcomes.
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