News Items about Treatments
- In adrenal crisis, an intravenous or intramuscular injection of hydrocortisone (an injectable corticosteroid) must be given immediately. If your doctor gave you a prescription for injectable hydrocortisone, use that immediately and have someone get you to the hospital.
During an Adrenal Crisis, low blood pressure, low blood glucose, and high levels of potassium can be life threatening. Standard therapy involves intravenous injections of hydrocortisone, saline (salt water), and dextrose (sugar). This treatment usually brings rapid improvement. When the patient can take fluids and medications by mouth, the amount of hydrocortisone is decreased until a maintenance dose is achieved. If aldosterone is deficient, maintenance therapy also includes oral doses of fludrocortisone acetate.
Treatment of Addison's disease involves replacing, or substituting, the hormones that the adrenal glands are not making. Cortisol is replaced orally with hydrocortisone tablets, a synthetic glucocorticoid, taken once or twice a day. If aldosterone is also deficient, it is replaced with oral doses of a mineralocorticoid called fludrocortisone acetate (Florinef), which is taken once a day. Patients receiving aldosterone replacement therapy are usually advised by a doctor to increase their salt intake. Because patients with secondary adrenal insufficiency normally maintain aldosterone production, they do not require aldosterone replacement therapy. The doses of each of these medications are adjusted to meet the needs of individual patients.
Adrenal Glands are small organs located on top of each kidney. Tumors of the adrenal glands are often hormonally active, and may result in high blood pressure, rapid heart rate, headache, sweating, easy bruising, fatigue, fluid retention, low potassium levels, and many additional problems. some adrenal tumors are malignant. Permitting rapid recovery and significantly less discomfort than surgery performed in the traditional “open” manner.
Almost all adrenal operations can be performed using a minimally invasive approach through 3-4 tiny incisions. Minimally invasive adrenalectomy using both laparoscopic and retroperitoneoscopic approaches. Almost all patients are discharged home 24-48 hours after surgery.
When a person has both adrenal glands out, it is called a bilateral adrenalectomy, which is often called a BLA on the message boards.
About Adrenal Post-Op
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Currently, there is only one medical therapy specifically indicated for Cushing's disease in the U.S. Surgery is the main therapeutic option, followed by radiation, and a handful of medications are used off-label.
Korlym, previously known as Corlux, gained FDA approval on February 17, 2012 to treat Cushing's disease in patients for whom surgery failed or is not an option. Corcept's first-generation compound, Korlym, also known as mifepristone, directly blocks the cortisol (GR-II) receptor and the progesterone (PR) receptor.
Signifor (pasireotide), a somatostatin analogue, has gained approval by the European Medicines Agency committee to treat Cushing's disease in patients for whom surgery failed or is not an option.
Your doctor will prescribe medication based on your tumor and the specific hormone imbalances it is causing. Medications may be oral or injected.
- Corlux (now called Korlym)
- Cortendo (Ketoconozole)
- Growth Hormone
- Plenadren® (hydrocortisone, modified release tablet), an orphan drug for treatment of adrenal insufficiency in adults
- rosiglitazone maleate
Researchers, led by Shlomo Melmed, at Cedars-Sinai Medical Center, Los Angeles, have now identified a potential new therapeutic target -- the protein EGFR, which is the target of a drug used to treat some patients with non–small cell lung cancer (gefitinib). As discussed by Melmed and colleagues in their paper, as well as Frederic Wondisford, at Johns Hopkins University School of Medicine, Baltimore, in an accompanying commentary, the data generated in human, canine, and mouse models provide strong support to investigate the clinical effects of gefitinib in patients with Cushing disease.
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When medication is ineffective, the pituitary tumor may need to be surgically removed. A neurosurgeon will perform this surgery.
Pituitary tumor surgery (transsphenoidal, transnasal and endocsopic are the most common approaches) is performed under general anesthesia. It takes about 3 hours for the surgical removal of tumor although it could take longer as the surgeon checks other areas from the tumor location.
You will be required to stay in the hospital for a few days and you will be kept under medical observation.
After gaining consciousness, you may feel dizzy, confused and disoriented. You may also have a headache. MaryO'Note - I had the worst headache of my life but IV morphine helped!
You may also feel nauseous and may vomit if blood from surgery has leaked from the back of throat and entered the stomach. This feeling subsides within a few hours post surgery.
You also may have a CSF (cerebrospinal fluid) leak. When this fluid leaks out, the pressure around the brain and spinal cord drops. This may require a second surgery.
Symptoms of infection (fever, chills, change in mental status) that occur after pituitary surgery are a medical emergency and need to be treated with antibiotics.
During your stay at the hospital, nurses will monitor your urine output, as well as nasal drainage.
You will likely have nasal packing and you should avoid blowing your nose until that is removed.
During your stay at the hospital, your doctor will mostly prescribe you with medications such as Tylenol with codeine, morphine or Vicodin to manage pain and discomfort. You will also be prescribed steroids such as Cortef along with directions on how to wean off it.
After your surgery, be sure to follow up with your endocrinologist.
About Pituitary Post-Op
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When a pituitary tumor cannot be completely removed, radiation may be used to help shrink the remaining portion. This treatment focuses the radiation only on the tumor, so there is less exposure to the rest of the brain.
- Proton Radiation Therapy
- Stereotactic. A newer option for treating pituitary adenomas, radiosurgery focuses radiation on the tumor only, minimizing exposure to other tissues. Emerging data indicates radiosurgery may be more effective than conventional radiation in lowering abnormal hormone production and does so over a shorter time period.
Most radiosurgery techniques are one-time treatments, which increases the risk of some side effects, including vision loss. The risk of radiation injury is greater for patients when the tumor is close to or involves nearby optic tissues or part of the brain known as the hypothalamus. For higher-risk patients, staged, or fractionated, treatments may reduce the risk of injuring other tissues.
- CyberKnife. Treating pituitary adenomas with the CyberKnife combines the advantages of conventional radiation and radiosurgery. Since CyberKnife performs radiosurgery, radiation exposure is limited to the adenoma. CyberKnife treatment can be fractionated, however, like conventional radiation therapy.
This approach lessens the radiation risk to sensitive structures around the tumor, like optic tissues and part of the brain known as the hypothalamus. CyberKnife fractionated stereotactic radiosurgery is also well suited for treating adenomas that invade the cavernous sinus, which contains nerves that control eye movement and facial sensation.
After surgery, you may be prescribed a form of cortisol. Your doctor will tell you when and how to wean off this. Do not stop on your own. Adrenal crisis may be the result. Acute adrenal crisis is an emergency caused by decreased cortisol. The crisis may occur in a person with Addison's disease, or as the first sign of adrenal insufficiency. More uncommonly, it may be caused by a pituitary gland disorder. It may also be caused by sudden withdrawal of corticosteroids, removal or injury of the adrenal glands, or destruction of the pituitary gland. Risk factors are stress, trauma, surgery, or infection in a person with Addison's disease, or injury or trauma to the adrenal glands or the pituitary gland. The incidence is 4 out of 100,000 people.
Contact your doctor if you have these symptoms
* headache * profound weakness * fatigue * slow, sluggish, lethargic movement * nausea * vomiting * low blood pressure * dehydration * high fever * chills shaking * confusion or coma * darkening of the skin * rapid heart rate * joint pain * abdominal pain * unintentional weight loss * rapid respiratory rate * unusual and excessive sweating on face and/or palms * skin rash or lesion may be present * flank pain * appetite, loss
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