What is hypercortisolism? What is the best treatment?

There are some methods for treating some diseases. Different diseases have certain symptoms and different causes. Therefore, when you find that you have a disease, you must first understand the disease so that you will know how to treat it. What kind of disease is hypercortisolism? For such diseases, you must have some understanding before treatment so that you can choose a treatment method that suits you, and you also need to actively cooperate during treatment.

Many people don’t know much about hypercortisolism. What kind of disease is it and how to best treat it? Therefore, when we find that we have this disease, we must choose a good treatment method.

Cushing's Syndrome (CS), also known as hypercortisolism or Cushing's syndrome, was first reported by American neurosurgeon Harvey Cushing in 1921. This syndrome is a group of syndromes caused by long-term excessive secretion of cortisol by the adrenal cortex due to various causes. The main manifestations are moon face, sanguineous appearance, centripetal obesity, acne, purple striae, hypertension, secondary diabetes and osteoporosis.

Since long-term use of exogenous glucocorticoids or drinking large amounts of alcoholic beverages can also cause clinical manifestations similar to Cushing's syndrome, and both manifest as hypercortisolemia, the syndrome caused by organic lesions is called endogenous Cushing's syndrome, and the syndrome caused by exogenous supplements or alcohol is called exogenous, drug-induced or Cushing's-like syndrome.

Disease treatment :

(I) Treatment of ACTH-dependent CS

1. Remission and cure criteria:

(1) Treatment goals:

Symptoms and signs improve, hormone levels and biochemical indicators return to normal or near normal, and long-term control prevents recurrence.

The causes of ACTH-dependent CS are diverse, and require the cooperation of multiple disciplines (endocrinology, neurosurgery, urology, thoracic surgery, radiotherapy, etc.) to develop an individualized treatment plan. The first-line treatment is resection of pituitary ACTH adenoma or ectopic ACTH tumor. Second-line treatment includes radical surgery, radiotherapy, drug therapy and bilateral adrenalectomy.

(2) Remission and cure criteria:

The preferred treatment for Cushing's disease is selective transsphenoidal or transcranial pituitary adenoma resection performed by an experienced neurosurgeon. Patients may experience hormone withdrawal symptoms after surgery and need to supplement with physiological doses of adrenal glucocorticoids until the hypothalamic-pituitary-adrenal (HPA) axis returns to normal. For patients with severe symptoms, short-term intravenous supraphysiological doses of adrenal glucocorticoids can be used for treatment. It is recommended to stop using glucocorticoids or use low-dose dexamethasone within the first week after surgery and measure the morning serum cortisol concentration to evaluate the surgical effect (Table 5). If hormones are discontinued, the patient must be closely observed for symptoms of adrenal insufficiency.

Through the detailed introduction above, we have a good understanding of hypercortisolism, especially the treatment of the disease, and we know how to proceed. However, when we find that we have such a disease, we must actively cooperate with the doctor's treatment method, which will help improve the disease.