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Salivary Cortisol Test for Cushing’s Syndrome

Cushing’s syndrome — endogenous hypercortisolism — is characterized by a loss of normal 24 hour rhythm in cortisol secretion (circadian rhythmicity). In healthy patients, cortisol levels peak in the early morning hours and decrease to substantially lower levels at night. Rather than the normal decrease in late evening cortisol, patients with Cushing’s syndrome of anyContinue Reading

Summary of the Endocrine Society Clinical Guideline on the Treatment of Cushing’s Syndrome: Part 2

A previous issue of this newsletter covered the first line treatment options for Cushing’s disease and Cushing’s syndrome as outlined in the recently published Endocrine Society guidelines. This summary will discuss the options for treatment in cases of recurrent or persistent Cushing’s disease or in patients where surgery is not an option. Cushing’s Disease ReportedContinue Reading

Persistent Cushing’s Disease After Unsuccessful Surgery – Assessment and Strategies

One of the greatest disappointments, both for the patient and the surgeon, is when transsphenoidal surgery is done to treat Cushing’s Disease and there is failure to cure. Although about 90% of microadenomas and about 55% of macroadenomas are successfully treated by an initial transsphenoidal operation, failure to obtain remission and recurrence can develop inContinue Reading

Gamma Knife Radiosurgery for Cushing’s Disease

Pituitary adenomas represent 10 to 20% of all intracranial lesions. One of the most challenging pituitary adenomas from a treatment standpoint is ACTH-secreting adenomas. These tumors can be difficult to discern on MR imaging, and, even in the hands of an experienced neurosurgical team, some patients may not achieve remission after transsphenoidal or transcranial resectionContinue Reading

Treatment Options for Recurrent Cushing’s Disease

A patient who has been treated for a pituitary tumor is always at risk for recurrence of the tumor; this risk is usually small, but real. There is no way to predict in whom or when a pituitary tumor will recur. This statement is not made to frighten a patient, but to emphasize the need for continued regular medical care and follow up so that a recurrence can be detected early and treated promptly. The reported risk of recurrence of a pituitary adenoma varies Continue Reading