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Hypothalamic-Pituitary Axis01:37

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The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.
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Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
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Stress triggers a coordinated physiological response involving the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. This dual activation ensures that the body is prepared for both immediate and prolonged stress management. The process begins with the perception of a stressor. This initial phase activates the SNS, leading to the rapid release of adrenaline (epinephrine) from the adrenal glands.
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Updated: Mar 20, 2026

Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids
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Update on Hypercortisolism Therapy.

Giorgio Arnaldi, Laura Trementino

    Frontiers of Hormone Research
    |May 24, 2016
    PubMed
    Summary

    Cushing's syndrome treatment requires personalized approaches. Surgery is the primary option for tumors, while radiation and medications serve as secondary or preparatory therapies with variable success and potential side effects.

    Area of Science:

    • Endocrinology
    • Oncology
    • Surgical Treatment

    Background:

    • Cushing's syndrome presents significant treatment challenges.
    • Management must be individualized based on tumor type and patient factors.
    • Current therapeutic options include surgery, radiotherapy, and pharmacotherapy.

    Purpose of the Study:

    • To review the current treatment landscape for Cushing's syndrome.
    • To outline the roles of surgery, radiotherapy, and medical management.
    • To discuss the efficacy and limitations of each therapeutic modality.

    Main Methods:

    • Review of existing literature on Cushing's syndrome treatment.
    • Analysis of surgical outcomes for pituitary, ectopic, and adrenal tumors.
    • Evaluation of radiotherapy as a second-line treatment.

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  • Assessment of pharmacotherapy efficacy and side effects.

    • Main Results:

    • Surgery is the gold standard, particularly for adrenal tumors, with high success rates in specialized centers.
    • Pituitary radiotherapy offers a second-line option but has variable long-term cure rates and risks secondary hypopituitarism.
    • Medical therapy is versatile, used as first-line for surgical candidates or those unsuitable for surgery, and as second-line post-surgery or pre-radiotherapy/adrenalectomy.
    • The success of medical therapy varies with hypercortisolism severity and etiology, often accompanied by significant side effects.

    Conclusions:

    • Treatment selection for Cushing's syndrome necessitates a tailored approach.
    • Surgery provides the best chance of cure for many Cushing's syndrome cases.
    • Radiotherapy and medical treatments are crucial adjuncts or alternatives, each with distinct indications, efficacy, and risk profiles.