Cushing's syndrome is caused by prolonged exposure to high levels of glucocorticoids and can be due to exogenous glucocorticoid intake or endogenous overproduction. The endogenous causes are divided into ACTH-dependent or ACTH-independent. Treatment depends on the cause but may include medications like metyrapone or ketoconazole to reduce cortisol levels, trans-sphenoidal removal of pituitary tumors, pituitary irradiation for Cushing's disease, or bilateral adrenalectomy as a last resort if other measures fail to control the disease.

4. Androgens
Epinephrine,
norepinephrine
Glucocorticoids
Mineralocorticoids

6. Cushing’s syndrome
Cushing’s syndrome (CS) is composed of symptoms and signs associated
with prolonged exposure to inappropriately high levels of plasma
glucocorticoids.
- Exogenous glucocorticoid intake is the most common cause of CS.
- The endogenous causes are divided into ACTH-dependent and ACTHindependent CS.

23. Medical Treatment
Metyrapone, an 11β-hydroxylase blocker,
which is given in doses of 750 mg to 4 g
daily in 3–4 divided doses.
Ketoconazole (200 mg three times daily)
is also used and is synergistic with metyrapone.

24. Cushing’s disease - ACTH dependent (pituitary) Cushing Syndrome
- Trans-sphenoidal removal of the tumor

25. Cushing’s disease - ACTH dependent (pituitary) Cushing Syndrome
- External pituitary irradiation

26. Cushing’s disease - ACTH dependent (pituitary) Cushing Syndrome
- Medical therapy to reduce ACTH (e.g.
bromocriptine, cabergoline, cyproheptadine, somatostatin analogues such
as pasireotide) is rarely effective. There is some evidence that aggressive
corticotroph adenomas may respond to temozolomide chemotherapy.

27. Bilateral adrenalectomy is an effective last resort if other measures
fail to control the disease. This can be performed laparoscopically.