Definition:

The term “Cushing’s syndrome” is used to describe a condition resulting from long-term exposure to excessive cortisol (glucocorticoids). The term “Cushing’s disease” is reserved for Cushing’s syndrome that is caused by excessive secretion of adrenocorticotropic hormone (ACTH) by a pituitary tumor, usually an adenoma, which refers to a benign tumor of glandular tissue.

• Cushing’s disease is responsible for roughly two-thirds of the cases of endogenous Cushing’s syndrome. The remainder of the endogenous cases are caused by ectopic ACTH-secreting tumors and primary adrenal neoplasms.
• Cushing’s disease occurs most frequently in women of reproductive age, but it can affect males and females of any age.
• The pituitary tumors in Cushing’s disease are usually microadenomas, which, by definition, are 10 mm or less in diameter. Micro-adenomas generally do not cause symptoms by local mass effect. These tumors are most often discovered when clinical manifestations of hypercortisolism resulting from hypersecretion of ACTH prompt an appropriate diagnostic work-up. Occasionally, microadenomas are found incidentally during imaging performed for other reasons.
• Depression, obesity, alcoholism, medications, eating disorders, and other conditions can cause mild clinical and laboratory findings, similar to those in Cushing’s syndrome, termed “pseudo-Cushing’s syndrome.”

Signs and Symptoms:

• Sudden weight gain
• Central obesity
• Hypertension
• Proximal muscle weakness
• Glucose intolerance or diabetes mellitus
• Hyperlipidemia
• Decreased libido or impotence
• Menstrual disorders
• Depression or psychosis
• Facial plethora/reddish complexion
• Easy bruising
• Violaceous striae wider than 1 cm
• Acne
• Hirsutism
• Recurrent opportunistic or bacterial/fungal infections
• Osteopenia or osteoporosis
• In children, impaired growth

Causes:

• ACTH dependent such as Cushing’s disease, Ectopic ACTH syndrome
• ACTH independent such as: Iatrogenic, Adrenal adenoma

Tests/Labs:

• Cortisol, Urinary lab test

Treatment

• Transsphenoidal removal of the tumor is the treatment of choice for Cushing’s disease.
• Most patients are rendered hypoadrenal for months to years after the procedure. During this period, they require glucocorticoid replacement therapy.

Other Treatments

Specific medications and supplements, tailored to each patient, can help in the treatment of this condition.

Please contact us for an appointment to discuss appropriate evaluation and treatment.