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Endocrinology

Treatment and forecast - Syndrome of Kushinga

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Syndrome of Kushinga
Treatment and forecast

Treatment of a syndrome of Kushinga

Steroidogenesis inhibitors (hloditan, aminoglutethimide) after statement of the diagnosis appoint to most of patients with an endogenous hypercorticoidism. Patients to whom the protonoterapiya is appointed to area of a hypophysis are forced to receive drugs is long, about one year and more waiting for development of effect of a protonoterapiya.
Trenssfenoidalny removal of a kortitropinoma of a hypophysis is a choice method at a syndrome of Kushinga in a situation when at MRT it is possible to visualize adenoma accurately. Remission develops at 90% of the operated patients. Predictively after an adenomectomy development of a tranzitorny hypocorticoidism which can remain from several months to one year is favorable.

Protonoterapiya on area of a hypophysis is shown to patients with a syndrome of Kushinga at whom hypophysis adenoma is not visualized. Development of permanent remission of a syndrome of Kushinga can be expected approximately in a year after carrying out a protonoterapiya.

The adrenalectomy is the main method of treatment of a kortikosteroma of an adrenal gland. In some cases at a heavy current of a syndrome of Kushinga when carrying out a protonoterapiya is shown to the patient, the unilateral adrenalectomy which allows to reduce expressiveness of a hypercorticoidism several is made. The bilateral adrenalectomy for treatment of a syndrome of Kushinga is practically not used the last several decades. Nevertheless in some cases at extremely severe disease it is necessary to resort to it. After a bilateral adrenalectomy at a syndrome of Kushinga there can be a significant growth in adenoma of a hypophysis (a syndrome of Nelson).

At a malrelated AKTG-syndrome treatment will depend on localization and prevalence of tumoral process. In most cases radical treatment because of widespread innidiation is impossible. Symptomatic carrying out a bilateral adrenalectomy is in some cases shown.
Symptomatic therapy at a hypercorticoidism includes purpose of hypotensive drugs, potassium, glucose-lowering drugs, and also drugs of treatment of osteoporosis. In more detail diagnosis and treatment of a syndrome of Kushinga are stated in the special managements.

Forecast

In the absence of adequate treatment mortality at an illness of Kushinga in the first 5 years from the beginning of a disease reaches 30 — 50% of patients. The forecast is optimum at an illness of Kushinga caused high-quality kortikosteromy though recovery of function of the second adrenal gland happens not at all patients (80%). At a syndrome of Kushinga the forecast is favorable at early diagnosis and timely begun treatment. After achievement of an eukortitsizm most of patients demands prolonged treatment of the developed complications, first of all, of osteoporosis. The forecast at a malrelated AKTG-syndrome is most adverse and at widespread innidiation of a malignant kortikosteroma. At a malignant kortikosteroma the 5-year survival makes up to 20-25%; average life expectancy of the patient — 14 months.