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Management of Hypercorticism and Hypocorticism
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Management of Hypercorticism and Hypocorticism
By: Mohammed Almushity
361110412
Introdction
Introdction
What are the treatments for adrenal and pituitary glands disorders?
Include:
- Surgery to remove tumors in the adrenal or pituitary glands.
- Minimally invasive surgery performed through the nostrils to remove tumors in the pituitary gland.
- Medication to stop the excess production of hormones.
- Hormone replacement.
Mangement of Hypercorticism
Treating of Cushing's syndrome
Mangement of Hypercorticism
''High levels of cortisol''
Treatment for Cushing's syndrome depends ...
Treatment for Cushing's syndrome depends on what's ''causing high levels of cortisol'' to accumulate in your body.
- If your Cushing's syndrome is caused by the long-term use of corticosteroids:
you'll need to gradually reduce your dosage to the lowest possible dose required to control the condition being treated.
- If your Cushing's syndrome is caused by a tumour (endogenous Cushing's syndrome)
the following treatment options are available:
- Cortisol-inhibiting medications
- Radiotherapy
- Surgery
1- Reducing corticosteroid use
It's usually not safe to suddenly stop taking corticosteroids.
So, gradual reduction is recommended.
2- Cortisol-inhibiting medications
2- Cortisol-inhibiting medications
They designed to block the adverse effects of cortisol.
- They tend to be used short term leading up to surgery, or after surgery or radiotherapy, to help make these treatments more effective.
- Occasionally, They are used on a long-term basis in people unwilling or unable to have surgery.
There are:
- Ketoconazole (Nizoral).
- Metyrapone (Metopirone).
- Mitotane (Lysodren).
3- Surgery
Pituitary gland removal
Pituitary gland removal
- Surgery to remove a tumour in the pituitary gland is known as transsphenoidal adenoectomy.
- Under general anaesthetic
The surgeon removes the pituitary tumour either:
- Through your nostril
- opening made in your upper lip.
Adrenal gland removal
Adrenal gland removal
- Laparoscopic (keyhole) surgery is usually used.
The surgeon makes a small incision in your abdomen and passes tiny instruments through it to remove your adrenal gland.
Complications of surgery
- Low cortisol level after surgery
- Loss of other pituitary hormonal function
- Nelson's syndrome;
(it is a tumour inside your pituitary gland that grows fairly rapidly over a period of month
after removing of both adrenal gland)
4- Radiotherapy
4- Radiotherapy
Radiotherapy may be recommended if pituitary gland surgery ''doesn't'' achieve a cure or if you're unable to have surgery.
It involves using:
- High-energy X-rays; to shrink the tumour and stop it producing adrenocorticotropin hormones (ACTH).
- Type of radiotherapy known as stereotactic radiosurgery (SRS);
It is increasingly being used to treat pituitary tumours.
This uses a series of movable frames to hold your head in a precise position. A computer is then used to send energy rays to the exact location of the pituitary tumour.
Mangement of Hypocorticism
Treatment of Addison's disease
Treatment of Addison's disease
Involves hormone correction of the levels of steroid hormones
Some options for treatment include:
Oral corticosteroids:
- Hydrocortisone (Cortef)
- Prednisone
- Cortisone acetate may be used to replace cortisol.
- Your doctor may prescribe Fludrocortisone to replace aldosterone.
Corticosteroid injections:
If you're ill with vomiting and can't retain oral medications, injections may be needed
In case of Addisonian crisis
It is a life-threatening situation that results in:
- low blood pressure
- low blood levels of sugar
- high blood levels of potassium.
In case of Addisonian crisis
Treatment typically includes intravenous injections of:
- Hydrocortisone
- Saline solution
- Sugar (dextrose)
Treatment of Cortisol deficiency ''generally''
(primary and secondary)
Treatment of Cortisol deficiency ''generally''
- Hydrocortisone (Cortef)
- Prednisone (Deltasone)
- Prednisolone (Delta-Cortef)
- Methylprednisolone (Medrol)
- Dexamethasone (Decadron)
References
References
- Nieman LK, Ilias I. Evaluation and treatment of Cushing’s syndrome. The Journal of American Medicine. 2005;118(12):1340–1346.
- Labeur M, Arzt E, Stalla GK, Páez-Pereda M. New perspectives in the treatment of Cushing's syndrome. Current Drug Targets-Immune, Endocrine & Metabolic Disorders. 2004;4:335–342.
- Addison disease. Merck Manual Professional Version.
- Hay WW, et al. Endocrine disorders. In: Current Diagnosis & Treatment: Pediatrics. 22nd ed. New York, N.Y.: McGraw-Hill Education; 2014.
- Eileen K. Corrigan (2007). "Adrenal Insufficiency (Secondary Addison's or Addison's Disease)". NIH Publication No. 90-3054.