Our Summary

Cushing’s syndrome is a serious illness that can cause many other health problems and lead to death if not treated. The most effective way to treat it is generally through surgery to remove the problem areas. However, additional treatments are often needed to manage other health issues that come along with the disease, both during its active phase and after the overproduction of cortisol (a hormone) has stopped. If surgery isn’t enough, other treatments like medication, a procedure to remove both adrenal glands, and radiation therapy for tumors in the pituitary gland can be used. Deciding on these treatments is a complicated process that should be done by a team of experts and tailored to each individual patient. It’s also important for the patient to be involved in the decision-making process.

FAQs

  1. What is the first-line and most effective treatment for overt Cushing’s syndrome?
  2. What are some second-line treatments for Cushing’s syndrome if surgical resection is not effective?
  3. What is the role of a multidisciplinary expert team in the treatment of Cushing’s syndrome?

Doctor’s Tip

A doctor may advise a patient undergoing adrenalectomy to follow a healthy diet and exercise regularly to help manage their cortisol levels post-surgery. They may also recommend regular follow-up appointments to monitor hormone levels and overall health. It is important for patients to communicate any changes in symptoms or concerns with their healthcare team.

Suitable For

Patients who are typically recommended adrenalectomy include those with severe and persistent hypercortisolism due to adrenal tumors or bilateral adrenal hyperplasia. Adrenalectomy may also be considered in patients with Cushing’s syndrome who have failed other treatments such as medication or pituitary surgery. Additionally, patients with adrenal cancer or adrenal metastases may also undergo adrenalectomy as part of their treatment plan. It is important for these patients to be evaluated by a multidisciplinary team of experts to determine the most appropriate course of treatment.

Timeline

Before adrenalectomy:

  1. Patient presents with symptoms of Cushing’s syndrome such as weight gain, hypertension, muscle weakness, and mood changes.
  2. Diagnosis is confirmed through blood tests, imaging studies, and possibly a dexamethasone suppression test.
  3. Patient may undergo preoperative medical management to control symptoms and optimize surgical outcomes.

After adrenalectomy:

  1. Patient undergoes surgical removal of one or both adrenal glands.
  2. Recovery period in the hospital may range from a few days to a week, depending on the extent of the surgery.
  3. Patients may experience temporary hormonal imbalances and require hormone replacement therapy.
  4. Follow-up appointments are scheduled to monitor hormone levels, symptoms, and overall health.
  5. Long-term outcomes may include resolution of Cushing’s syndrome symptoms, improved quality of life, and reduced risk of associated comorbidities.

What to Ask Your Doctor

  1. What are the risks and benefits of adrenalectomy for my specific case of Cushing’s syndrome?
  2. What are the potential complications of the surgery and how likely are they to occur?
  3. How long is the recovery period after adrenalectomy and what can I expect during this time?
  4. Will I need to take any medications or undergo any additional treatments after the surgery?
  5. How will adrenalectomy affect my hormone levels and overall health in the long term?
  6. Are there any lifestyle changes or precautions I should take after the surgery?
  7. What is the success rate of adrenalectomy for treating Cushing’s syndrome?
  8. How often will I need to follow up with you after the surgery?
  9. Are there any alternative treatments or procedures that I should consider?
  10. Can you provide me with information on the experience and outcomes of your previous patients who have undergone adrenalectomy for Cushing’s syndrome?

Reference

Authors: Ferriere A, Tabarin A. Journal: Best Pract Res Clin Endocrinol Metab. 2020 Mar;34(2):101381. doi: 10.1016/j.beem.2020.101381. Epub 2020 Jan 30. PMID: 32035797