Cushing’s disease develops when the pituitary gland releases too much adrenocorticotropic hormone (ACTH), usually the fault of a tumor on that gland. High ACTH levels cause the adrenal glands — situated above both kidneys — to produce too much cortisol, a condition called hypercortisolism.
Among other things, cortisol regulates blood pressure, controls the immune response, controls the body’s use of macronutrients by limiting the effects of insulin, and helps the body respond to stress.
Cushing’s disease is most frequently diagnosed in patients 30 to 40 years old, and it is more common among women, although it’s unclear why. No environmental or hereditary causes have been identified.
How are Cushing’s disease and Cushing’s syndrome different?
Cushing’s disease and Cushing’s syndrome are both named after Harvey Cushing, who first identified the symptoms and causes of the condition in 1912.
Cushing’s disease is categorized under the general condition of Cushing’s syndrome and refers exclusively to excess cortisol arising from a pituitary tumor secreting ACTH. Cushing’s syndrome refers to any collection of symptoms caused by hypercortisolism. Several factors cause this, although Cushing’s disease comprises about 70 percent of all cases. Specific causes include the long-term, regular use of corticosteroids to treat a different condition, or a tumor on the pituitary gland, adrenal gland or another part of the body
How does Cushing’s disease affect the body?
Cushing’s disease is difficult to diagnose because its symptoms develop slowly and are extremely varied. In fact, many researchers believe that more people live with the disease than the number of people who have been diagnosed. Its symptoms include:
- Excessive weight gain around the torso
- Muscle weakness, especially in the legs
- Red and/or full, round face and appearance of acne
- High blood pressure
- Development of diabetes mellitus and excessive thirst
- Increased tendency to bruise easily
- Reduced sex drive
- Mood swings
- Back pain and bone tenderness
- Irregular menstrual cycle in women
- Excessive hair growth on unusual parts of the body, specifically on the face in women
- Reduced fertility in men
Because Cushing’s disease can progress very slowly, symptoms may go unrecognized for a long time. Unidentified accumulation of these symptoms may cause many people to become depressed. Diagnosis requires numerous tests to first, identify hypercortisolism, and then narrow the cause to a malfunctioning pituitary gland.
How is Cushing’s disease treated?
Treatment for Cushing’s disease typically involves surgically removing the tumor. The operation requires a small cut behind the upper lip or inside the nose. This may temporarily affect the patient’s sense of smell. Success rates for this procedure top 80 percent for tumors smaller than 10 mm, and about 50 percent for larger tumors.
Following surgery, patients may be prescribed cortisol replacement medications until the body can maintain healthy cortisol levels naturally. Additional testing may be performed to ensure the surgery was successful.
New experimental treatments are also being developed for Cushing’s disease. These are particularly valuable for people for whom surgery is not feasible, or has failed.
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