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Cushing's Syndrome

Adrenal glands are triangular-shaped organs located on top of each kidney. They are primarily responsible for the release of hormones that have a stimulating effect on the heart, blood flow and dilation of arteries.

Each adrenal gland is divided into an outer cortex and an inner medulla. The adrenal cortex produces steroid hormones that maintain blood pressure and salt balance. The adrenal medulla is derived from nerve cells and is a source of catecholamines (adrenaline and noradrenaline), which are “stress hormones” that increase alertness, strength and speed in an emergency.

Cushing's Syndrome is characterized by the overproduction of cortisol, a hormone released by the adrenal glands that aids in stress response and maintains blood pressure and heart function, among other things, although it goes undiagnosed in many people. Women are three times more likely to be affected than men.

The most common cause of Cushing's Syndrome is a benign adenoma (tumor) in the adrenal gland that produces too much cortisol. Some patients have a similar condition known as Cushing's disease, which is caused by a tumor in the pituitary gland. The tumor produces adrenocorticotropic hormone (ACTH), which in turn signals the adrenal gland to produce cortisol.

Other less common causes include long-term use of corticosteroid medications (such as prednisone) to treat rheumatoid arthritis, lupus or asthma; and benign or malignant tumors in other areas of the body that produce ACTH (ectopic ACTH syndrome).

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Tumores sólidos. Antiemesis Estudio fase III, multicéntrico, aleatorizado, doble ciego, con control activo para evaluar la seguridad y eficacia de Rolapitant en la prevención de náuseas y vómitos por la quimioterapia (NVIQ) en pacientes que reciben quimioterapia altamente emética (QAE). A phase III, multicenter, randomized, double blind, placebo controlled study of the safety and efficacy of Rolapitant for the treatment of Chemotherapy-induced nausea and vomiting in subjects receiving highly Emetogenic Chemotherapy (HEC)
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Ensayo clínico en fase I de determinación de dosis del antiangiogénico multidiana Dovitinib (TKI258) más paclitaxel en pacientes con tumores sólidos.
  • Excess fat in the neck, upper back and face
  • Thin skin that bruises easily and heals slowly
  • Purple-red stretch marks on the abdomen, thighs or breasts
  • Fatigue
  • Insomnia or other sleep disorders

Surgery
Surgery is the frontline treatment for cancers and other diseases of the adrenal gland. Normally, the entire affected adrenal gland is removed (adrenalectomy). If both adrenal glands are removed, patients will have to be on hormone therapy the rest of their lives.

 
Laparoscopic Adrenalectomy
Some carefully selected patients may be eligible for laparoscopic adrenalectomy, a minimally invasive surgical technique. Three or four one-centimeter incisions are made in the abdomen or the back to insert the laparoscope, which is a camera on the end of a long, slender tube, and tiny instruments that move nearby organs out of the way and excise the diseased adrenal gland. Surgeons watch their progress on video monitors mounted over the operation table. The adrenal gland is cut away from the kidney and placed in a plastic bag for removal through one of the surgical incisions. Patients who are obese or who have had prior abdominal surgery are good candidates for a retroperitoneal procedure, where incisions are made in the back rather than the abdomen.

Laparoscopic adrenalectomy usually takes about one to two hours, but might take longer for complex cases. Patients generally experience shorter hospital stays, less blood loss and shorter recovery times than with standard surgery techniques.

The best candidates for laparoscopic adrenalectomy:

  • Have benign tumors
  • Are diagnosed with pheochromocytoma, Cushing's Syndrome or adrenal adenomas
  • Have hormone overproduction in both adrenal glands (Cushing's disease)

Other candidates for laparoscopy include patients with isolated metastases to the adrenal gland from other sites (lung, breast, and melanoma).

 
Other Treatments
Patients with suspected adrenocortical carcinoma are best treated with a standard, open surgical procedure to remove the tumor and other affected tissue. For patients with advanced adrenocortical carcinoma, chemotherapy with mitotane may be used to relieve symptoms from progressing disease. This type of cancer is not sensitive to radiation therapy.