From the Guidelines
The treatment for Cushing's hump (buffalo hump) should focus on addressing the underlying cause of Cushing's syndrome, with the primary approach involving normalizing cortisol levels through various interventions, as recommended by the most recent and highest quality study 1.
Treatment Approaches
- For exogenous causes (medication-induced), gradually tapering and discontinuing corticosteroid medications under medical supervision is recommended.
- For endogenous causes, treatment depends on the specific source:
- Pituitary adenomas may require transsphenoidal surgery, as selective adenomectomy is considered first-line treatment of choice for CYP with Cushing disease 1.
- Adrenal tumors often need surgical removal.
- Ectopic ACTH-producing tumors typically require tumor resection.
Medication Options
- Medication options include ketoconazole (400-1200 mg/day), metyrapone (500-6000 mg/day), or mifepristone (300-1200 mg/day) to block cortisol production or action, with ketoconazole and metyrapone being used to reduce cortisol burden in CYP with Cushing disease awaiting definitive surgery or the effect of pituitary radiotherapy 1.
Lifestyle Modifications
- Lifestyle modifications like regular exercise and a balanced diet can help manage weight and improve overall health during recovery.
- Patients should understand that the hump is a symptom of abnormal fat distribution caused by excess cortisol and addressing the underlying hormonal imbalance is essential for improvement.
Outcome
- Once cortisol levels normalize, the buffalo hump may gradually decrease in size over months to years, though complete resolution isn't guaranteed.
- Lifelong follow-up for children treated for Cushing disease is essential, as recurrence of Cushing disease in adults has been reported up to 15 years after apparent surgical cure 1.
From the Research
Treatment for Cushing's Hump
The treatment for Cushing's hump, a symptom of Cushing's syndrome, typically involves addressing the underlying cause of the condition.
- Surgery to remove the source of excess endogenous cortisol production is usually the first line of treatment 2, 3.
- Medications such as adrenal steroidogenesis inhibitors, pituitary-targeted drugs, or glucocorticoid receptor blockers may be used in addition to surgery or in cases where surgery is not possible 2, 4, 5.
- Adrenally directed medical therapies, including ketoconazole, metyrapone, osilodrostat, mitotane, and etomidate, can be used to inhibit adrenal steroidogenesis and reduce cortisol production 5, 6.
Medical Management
Medical management of Cushing's syndrome may involve:
- Ketoconazole, which can be used to suppress adrenal cortisol production, but may have side effects such as hepatotoxicity 4, 5, 6.
- Metyrapone, which can also suppress adrenal cortisol production, but may have side effects such as increased androgen and mineralocorticoid production 4, 5, 6.
- Etomidate, which can be used to rapidly reverse cortisol excess in patients with acute complications of hypercortisolism 4, 6.
Additional Therapies
In some cases, additional therapies such as radiation therapy or bilateral adrenalectomy may be necessary 2, 3, 6.