Cushing syndrome due to adrena... Health Article

Signs and tests

Tests to confirm Cushing syndrome:

• 24-hour urine sample to measure the following:
  • Urine cortisol
  • Urine creatinine
• Dexamethasone suppression test
• Serum cortisol levels

Tests to determine cause:

• Abdominal CT
• ACTH
• High-dose dexamethasone suppression test

Other findings may include:

• High cholesterol
• High fasting glucose
• Low bone density, seen by dual x-ray absorptiometry (DEXA)
• Low serum potassium

Treatment

Cushing syndrome due to an adrenal tumor is treated with surgery to remove the tumor and often the entire adrenal gland.

Glucocorticoid replacement treatment is usually needed until the other adrenal gland recovers from surgery. You may need this treatment for 9 - 12 months.

If surgery is not possible (such as in cases of adrenal cancer), medicines can be used to stop the release of cortisol. These include:

• Aminoglutethimide
• Ketoconazole
• Mifepristone
• Mitotane

Radiation therapy usually does not work for cancerous adrenal tumors and is not appropriate for noncancerous tumors.

Expectations (prognosis)

Patients with an adrenal tumor who have surgery have an excellent outlook. Surgery success rates are very high with this type of tumor.

For adrenal cancer, surgery is sometimes not possible. When surgery is performed, it does not always cure the cancer.

Complications

Cancerous adrenal tumors can spread to the liver or lungs.

Calling your health care provider

Call your health care provider if you develop any symptoms of Cushing syndrome.

Prevention

Appropriate treatment of adrenal tumors may reduce the risk of complications in some patients with tumor-related Cushing syndrome.

References

Stewart PM. The adrenal cortex. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Elsevier; 2008:chap 14.