Cushing Syndrome

WHAT YOU SHOULD KNOW:

• Cushing syndrome is also called hypercortisolism (hi-per-KOR-ti-sol-izm). It is where your body has too much of a hormone called cortisol. Cortisol is made in the adrenal glands, and the amount of cortisol to be made is controlled by the pituitary gland. Your adrenal glands are located above each kidney. The pituitary gland is located at the base of the brain. You are at a higher risk of having Cushing syndrome if you have a pituitary gland cancer. Using steroid medicine for a long time also increases your risk for having this syndrome. The most common symptom of Cushing syndrome is the sudden onset of weight gain. You may also have more fat in the trunk or puffiness and roundness of your face.
  
  
• Cushing syndrome is diagnosed by having a saliva (spit) test or a urine test to measure cortisol levels. Blood tests, a computerized tomography (CAT) scan, or a magnetic resonance imaging (MRI) test may also be done. Treating Cushing syndrome depends on what caused it, and the problems caused by the condition. Treatment may include changing your steroid dose, surgery, radiation, or chemotherapy. If the cause of Cushing syndrome is discovered, and treatment begins as soon as possible, Cushing syndrome can be cured in some people.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Treatment for Cushing syndrome may cause unpleasant side effects. You could get an infection or bleed too much if the cancer causing Cushing syndrome is removed with surgery. Chemotherapy can cause nausea, vomiting, hair loss, and diarrhea. Sometimes even with treatment, the cancer may spread or return. If Cushing syndrome is not treated, you may continue to gain weight or have increased levels of cholesterol and triglycerides in the blood. You may also have diabetes (high blood sugar) and hypertension (high blood pressure). Your health, quality of life, and ability to function may decrease. Ask you caregiver if you are worried or have questions about Cushing syndrome, care, or medicine.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Medicines:

You may be given the following medicines:

• Blood pressure medicine: This is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.
  
  
• Cortisol-inhibiting medicines:
  
  
  • Adrenal-acting inhibitors: These medicines block the adrenal glands from making cortisol. The effects of cortisol can be also changed with this medicine.
    
    
  • Glucocorticoid antagonist: The amount of cortisol made is decreased by these medicines.
  
  
• Hypoglycemic medicine: This medicine may be given to decrease the amount of sugar in your blood. Hypoglycemic medicine helps your body move the sugar to your cells, where it is needed for energy.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

Tests:

You may have one or more of the following tests:

• 24-hour urinary free cortisol level test: This test measures the amount of cortisol in your urine over 24 hours.
  
  
• Blood tests: You may have many different blood tests.
  
  
• Imaging tests:
  
  
  • Computerized tomography scan: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your head, chest, abdomen, or hip area. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps cancer show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
    
    
  • Magnetic resonance imaging test: This test is also called an MRI. During the MRI, computerized pictures are taken of your body using radio waves. Caregivers use these pictures to look for cancers on your lungs or pituitary or adrenal glands. You will need to lie still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
  
  
• Late night salivary cortisol test: This test is done at 11 PM on two separate nights to measure the amount of cortisol in your saliva. Glands in your mouth make saliva, the liquid (spit) that you regularly swallow.

Treatment options:

You may have one or more of the following:

• Surgery: The main treatment is to have the tumor causing Cushing syndrome removed by surgery.
  
  
• Chemotherapy:
  
  
  • This medicine, often called chemo, is used to treat cancer. It works by killing tumor cells. Chemotherapy may also be used to shrink lymph nodes that have cancer in them. Once the tumor is smaller, you may need surgery to cut out the rest of the cancer.
    
    
  • Many different chemotherapy medicines are used to treat cancer. You may need blood tests often. These blood tests show how your body is doing and how much chemotherapy is needed. Chemotherapy can have many side effects. Caregivers will watch you closely and will work with you to decrease side effects. Chemotherapy can cure some cancers. Even if the chemotherapy does not cure your cancer, it may help you feel better or live longer.
  
  
• Radiation: Radiation shrinks tumors and kills cancer cells with x-rays or gamma rays. Radiation may be given after surgery to kill cancer cells that were not removed. It may also be given alone or with chemotherapy to treat cancer.

Learn more about Cushing Syndrome (Inpatient Care)