What is Cushing’s disease?

Cushing’s disease and Cushing’s syndrome are closely related. Cushing’s syndrome occurs when your body is exposed to too much cortisol, a stress hormone produced in the adrenal glands. There are many possible causes, including:

  • A benign tumor in the pituitary gland
  • A typically benign tumor in one of the adrenal glands
  • Cancers that make cortisol (rare)
  • Excessive steroid medication, such as prednisone or hydrocortisone

When Cushing’s syndrome occurs because of a benign tumor in the pituitary, it is called Cushing’s disease.

What are the Symptoms?

Symptoms are widespread and often progress over a period of months to a few years. They can differ from patient to patient. In adults, any symptom present since childhood or adolescence is not likely Cushing’s syndrome.

Many Cushing’s symptoms are nonspecific, meaning they are common in the general population and with other medical conditions. This can make Cushing’s difficult to diagnose. These nonspecific symptoms include:

  • Anxiety
  • Depressed mood
  • Fatigue
  • Loss of libido
  • Weight gain in the middle of the body

In addition, females may also have:

  • Acne
  • Changes in their menstrual cycle
  • Extra hair growth

Symptoms which may be more specific to Cushing’s syndrome include:

  • Easy bruising and dark stretch marks
  • Fat accumulation in the face, neck or abdomen
  • Rounding of the face

Weakness in the upper leg and upper arm muscles (which may make it more difficult to stand from a seated position or climb stairs).

Cushing’s syndrome can also cause or make other conditions worse, including high blood pressure, diabetes, osteoporosis, kidney stones, sleep apnea and heart disease. Since cortisol suppresses immune function, people with Cushing’s syndrome also have an increased risk for infections.

How is Cushing’s diagnosed?

Confirming a diagnosis of Cushing’s requires tests involving urine, saliva and the suppression of cortisol (a stress hormone). Often, tests may be repeated later to see how results change over time.

If Cushing’s syndrome is confirmed, additional labs and imaging tests are performed to determine the cause. The most common cause is the pituitary gland, leading to a Cushing’s disease diagnosis.

How is Cushing’s disease treated?

If a tumor is found, surgical removal is the most effective treatment. It’s the only treatment that may lead to a full cure. Surgery is best performed by a team of specialists, including a neurosurgeon and an ear, nose and throat physician. After surgery, an endocrinologist is also involved to monitor hormone levels.

Surgical success rates and complications directly correlate with the experience of the surgeon, so choosing a team with extensive experience is vital. Patients typically stay in the hospital several days for recovery and to monitor hormonal changes.

For some patients, Cushing’s is treated with medical therapy. This is an option if no tumor can be found, a tumor cannot be fully removed, or the patient cannot have surgery. Fortunately, there are many medications that can effectively lower cortisol to normal levels. These medications are typically managed by an endocrinologist who has experience treating Cushing’s syndrome.

If a patient has surgery but a tumor cannot be fully removed, doctors may also consider radiation therapy. This treatment often works well, although it takes several years to have its full effect. Often, medical therapy is used as a bridge to manage symptoms during this time.

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