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Stanford Health Care

Diagnosis

How We Can Help You

Cushing's syndrome is a rare problem that happens when you have too much of the hormone cortisol in your body. Cortisol is especially important in controlling blood pressure and metabolism. But it affects almost every area of your body. Normally, your body keeps cortisol in in balance through a complex system that involves your hypothalamus, pituitary gland, and adrenal glands.

Stanford is a global referral center for the diagnosis and management of Cushing’s disease with novel medications and pioneering surgical approaches for the pituitary gland.

WHAT WE OFFER YOU FOR CUSHING’S SYNDROME (CUSHING’S DISEASE)

  • Globally-recognized expertise in the treatment of Cushing’s Disease.
  • Team-based treatment planning that brings together specialists from neuroendocrinology, neurosurgery, neuroradiology, neuropathology, and more.
  • Access to advanced imaging including neuro-navigation of the brain to help surgeons more clearly distinguish pituitary tumors.
  • An active clinical research program dedicated to broadening options for the diagnosis and treatment of Cushing’s disease.
  • Assistance from our International Medical Services team to plan your travel and accommodations.
HUMAN RIGHTS CAMPAIGN
We are proud to have earned recognition from the Human Rights Campaign Foundation "Healthcare Equality Index."

Treatment Options for Cushing’s Syndrome (Cushing’s Disease)

If long-term use of steroid medicine is the cause of Cushing's syndrome:

  • Your doctor will help you lower your dose or gradually stop taking it. It may take a while for the symptoms to go away.
  • Do not stop taking steroid medicine on your own. That can be very dangerous. Your doctor will help you change your medicine or lower the dose slowly.
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Endoscopic Endonasal Approach (EEA) to Skull Base
Play Video | 4:35
Endoscopic Endonasal Approach (EEA) to Skull Base
Endoscopic Endonasal Approach (EEA) to Skull Base

If a pituitary tumor is the cause:

  • Surgery to remove the tumor offers the best chance for recovery. This surgery requires great skill and should be done at a major medical center where doctors specialize in pituitary surgery.
  • If surgery to remove the tumor was previously unsuccessful, you may have other options to consider such as medicine, radiation, or surgery to remove the adrenal glands. You and your doctor can talk about the pros and cons of each option.

If an adrenal tumor is the cause:

  • Surgery to remove the tumor is usually done if the tumor is not cancer (benign). If the tumor is cancer, the whole gland is removed.
  • Medicine may be tried if surgery isn't an option.

If a tumor of the lungs or another organ is the cause, the tumor will be removed or treated with radiation or medicines.

Cushing's Disease and Negative MRI
Patients with Cushing’s disease often present with a “negative” MRI study, showing no evidence of tumor. A highly experienced pituitary surgeon is often able to detect the presence of a tumor during surgical exploration of the pituiatry gland.

Treatment for Ectopic Cushing’s Syndrome
If the evaluation suggests the presence of ectopic Cushing's syndrome, then the treatment is directed to the source. For example, if a carcinoid tumor in the lung is detected, then there are several options for therapy, including surgical excision.

Treatment for Adrenal Growth
If an adrenal growth is the underlying cause, then surgical removal of the abnormal adrenal gland is necessary.

Clinical Trials for Cushing’s Syndrome (Cushing’s Disease)

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Open Clinical Trials

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Clinical trials evaluate new approaches, devices, or medications in the treatment of Cushing’s Disease. Ask your doctor or clinical trials coordinator about available trials that may be additional options for your care.

To learn more about the clinical trials we offer, contact Maria Coburn at 650-736-9551.

Closed trials are not currently enrolling, but may open in the future.
View Closed Clinical Trials Clinical Trials for Cushing’s Syndrome (Cushing’s Disease)

What is Cushing’s Syndrome (Cushing’s Disease)?

Diagnosis of Cushing’s Syndrome (Cushing’s Disease)

Cushing's syndrome can be hard to diagnose because many different factors can cause an elevation in cortisol levels.

Our neuro-endocrinologists will begin by taking your detailed medical history to discover more about current or previous medications and your symptoms.

Imaging studies will be recommended to rule out the presence of tumors on your adrenal glands, pituitary gland, or another organ. Tests will be recommended to measure the level of cortisol and other hormones in your blood and urine.

Tests for Causes of Cushing’s Syndrome

  1. ACTH level: This test helps distinguish an adrenal source (ACTH independent) from an ACTH dependent cause. A very low ACTH level suggests the problem is coming from the adrenal glands, and not the pituitary gland.
  2. High dose Dexamethasone suppression test: This test helps to distinguish patients with excess production of ACTH due to pituitary adenomas from those with ectopic ACTH-producing tumors. Patients are given 2 mg dexamethasone by mouth every 6 hours for 2 days. A 24-hour urine collection for cortisol is performed on the second day of the test. Cortisol suppression suggests a pituitary tumor. A similar test is performed using a single dose of 8 mg at midnight, and a fasting blood draw for cortisol the next morning.
  3. Sampling of petrosal sinuses: This test may be required to separate pituitary from ectopic causes of ACTH-dependent Cushing's syndrome in patients with a normal pituitary gland on brain MRI scan. Catheters are placed through a vein in the upper thigh/groin region and are threaded through the blood vessels to the petrosal sinuses, which surround the pituitary gland. ACTH levels higher in the petrosal sinuses than in a forearm vein indicate the presence of a pituitary adenoma (Cushing's disease); similar levels suggest ectopic ACTH syndrome.

Our Clinics

Skull Base Surgery Program
Skull base surgery is a highly-specialized field that addresses tumors and other abnormalities on the underside of the brain or base of the skull.
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Make An Appointment

To schedule an appointment, please call: 650-497-7777