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Cushing's Disease

Description

Cushing's disease occurs due to the overproduction of a hormone called cortisol. This overproduction occurs because of a benign tumor called pituitary adenoma in the pituitary gland that is found at the base of the brain. This tumor causes excessive secretion of adrenocorticotropic hormone (ACTH), which leads to hypercortisolism, a state where cortisol levels are abnormally high.

Causes
Causes of Cushing's disease include:
  • A benign tumor called a pituitary adenoma which causes the pituitary gland to produce excessive ACTH.
  • This ACTH stimulates the adrenal glands to release abnormally high quantity of cortisol.
  • There are other forms of Cushing's syndrome as well; caused by adrenal gland tumors or steroid medications.
Symptoms

Symptoms of Cushing's Disease can vary because the hormone cortisol affects various systems of the body, some common symptoms of Cushing's disease are:

  • Appearance: Individuals with Cushing's disease experience unusual weight gain, mainly in the face, upper back and abdomen area. They will also appear to have thin arms and legs because of muscle wasting and purple stretch marks on the abdomen, thighs or breasts.
  • Changes to the skin: The individual will experience easy bruising, acne and slow wound healing.
  • Other diseases: Individuals with cushing's disease can experience High blood pressure (hypertension) and High blood sugar (hyperglycemia) or diabetes.
  • Changes in Muscle and Bone: Muscle weakness in Cushing's disease is common, and so is osteoporosis which can lead to fractures.
  • Mood and Cognitive Changes: It's common for individuals to experience depression, anxiety, mood swings, and difficulty concentrating.
  • Women: Can expereience irregular menstrual periods or amenorrhea.
  • Men: Can experience erectile dysfunction or decreased libido.
Diagnosis

Diagnosis of Cushing's disease involves several tests to confirm hypercortisolism:

  • 24-hour urinary free cortisol test: This test measures cortisol levels in the urine by collecting and analysing all the urine produced by the patient over a period of 24 hours.
  • Late-night salivary cortisol test: This test measures cortisol levels at night by collecting saliva samples at 11:00 o'clock at night on two different nights.
  • Dexamethasone suppression test: This test involves giving dexamethasone and checking changes in cortisol levels.
  • ACTH levels: Checking ACTH levels helps differentiate between pituitary and adrenal causes.
  • Imaging tests: MRI is done to detect tumors of the oituitary gland and CT scans for evaluating adrenal gland.
Management
Treatment of Cushing's disease involves:
  • Surgery: The primary treatment for Cushing's disease is the removal of the pituitary adenoma (transsphenoidal surgery).
  • Medications: In cases where surgery is not an option drugs like ketoconazole, metyrapone, or pasireotide are used to reduce cortisol production. 
  • Radiation Therapy: Is another option when surgery isn't possible.
  • Adrenalectomy: Involves removal of the adrenal glands in severe cases.
  • Managing Complications:This involves taking mediciation for conditions like diabetes, osteoporosis, or hypertension caused by Cushing's disease.

Available Medicine for Cushing's Disease

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