Treatment for Cushing's syndrome depends on the cause.

For Cushing's syndrome caused by long-term corticosteroid medicine use

Never stop taking corticosteroid medicine on your own because it might lead to a life-threatening adrenal crisis. When you take steroids, your adrenal glands stop making cortisol. If you suddenly stop taking your medicine, your adrenal glands may not be able to start making cortisol quickly enough. This can lead to an adrenal crisis and a severe drop in blood pressure. To avoid this, your doctor will want to gradually reduce and then stop your medicine.

Your doctor may change your corticosteroid medicine from a longer-acting steroid (such as prednisone) to a shorter-acting one (such as hydrocortisone). Sometimes corticosteroid medicines can be taken every other day. Either way, the body's normal production of cortisol returns gradually.

If you must continue taking corticosteroid medicine to control another condition, the dosage can sometimes be lowered to reduce symptoms and the risk of complications.

If your doctor and you are trying to reduce the dosage of your medicine and you become ill, contact your doctor immediately.

If reducing the dosage does not make Cushing's syndrome go away, your doctor will perform more tests to look for another cause of your condition.

For Cushing's syndrome caused by pituitary tumors (Cushing's disease)

If you are well enough to have surgery, surgical removal of the pituitary tumor offers the best chance for recovery. The surgery ( transsphenoidal adenomectomy) requires great skill and should be performed at a major medical center where teams of doctors specialize in pituitary surgery.

Transsphenoidal adenomectomy is successful: ¹

• About 85% of the time if the tumor is less than 1cm in diameter.
• About 25% of the time if the tumor is 1cm in diameter or larger.

Cushing's disease returns in about 2% of adults and up to 40% of children who have the operation. ² Surgery can be repeated, often with good results.

Gamma knife radiosurgery has recently been introduced in the United States. In this technique, many small beams of radiation are focused on the tumor to shrink and destroy it. It does not involve a surgical incision (there is no "knife" involved), and there is minimal damage to surrounding tissue. It can be done as an outpatient and with local anesthesia. Few centers in the United States have gamma knife facilities.

Medicine therapies may be tried if surgery is not possible or has failed.

For Cushing's syndrome caused by adrenal tumors

Doctors almost always recommend surgery to remove benign adrenal tumors that are producing hormones. If a tumor is cancerous, the affected adrenal gland is removed. Although chemotherapy is usually advised, there is no proven long-term treatment for adrenal cancer. On rare occasions, both adrenal glands must be removed. In this case, you would take daily long-term hormone replacement.