The Endocrine Society has issued a Clinical Practice Guideline (CPG) on strategies for treating Cushing's syndrome, a condition caused by overexposure to the hormone cortisol.
The CPG, entitled "Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline," was published online and will appear in the August 2015 print issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of the Endocrine Society.
Cushing's syndrome occurs when a person has excess cortisol in the blood for an extended period, according to the Hormone Health Network. When it is present in normal amounts, cortisol is involved in the body's response to stress, maintains blood pressure and cardiovascular function, keeps the immune system in check, and converts fat, carbohydrates and proteins into energy. Chronis overexposure to the hormone can contribute to the development of cardiovascular disease, infections and blood clots in veins.
People who take cortisol-like medications such as prednisone to treat inflammatory conditions, including asthma and rheumatoid arthritis, can develop Cushing's syndrome. The high cortisol levels return to normal when they stop taking the medication. This is called exogenous Cushing's syndrome.
In other cases, tumors found on the adrenal or pituitary glands or elsewhere in the body cause the overproduction of cortisol and lead to the development of Cushing's syndrome. The Clinical Practice Guidelines focus on this form of the condition, known as endogenous Cushing's syndrome.
"People who have active Cushing's syndrome face a greater risk of death -- anywhere from nearly twice as high to nearly five times higher -- than the general population," said Lynnette K. Nieman, MD, of the National Institutes of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, MD, and chair of the task force that authored the guideline. "To reduce the risk of fatal cardiovascular disease, infections or blood clots, it is critical to identify the cause of the Cushing's syndrome and restore cortisol levels to the normal range."
In the CPG, the Endocrine Society recommends that the first-line treatment for endogenous Cushing's syndrome be the removal of the tumor unless surgery is not possible or unlikely to address the excess cortisol. Surgical removal of the tumor is optimal because it leaves intact the hypothalamic-pituitary-adrenal axis, which is integral to the body's central stress response.
Other recommendations from the CPG include:
o A tumor that secretes adrenocorticotropic hormone (ACTH) -- the hormone that signals the adrenal glands to produce cortisol -- has formed somewhere in the body other than the adrenal or pituitary gland.
o A tumor has formed on the pituitary gland itself.
Materials provided by The Endocrine Society. Note: Content may be edited for style and length.
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