Cushing's Disease: Symptoms, Treatment and Causes

Julie Seel 

Introduction

Cushing's disease is relatively rare and is commonly in adults. Cushing's is a hormonal disorder that the body's tissues care exposed to increased levels of the hormone cortisol. (NIH)

The cortisol hormone is released when there is stress and with exercise in some people. The main thing's that the cortisol does are: throttling or suppressing the immune system, metabolizing fats and carbohydrates, and increases blood sugar. (healthline) The Cushing's disease is more commonly observed in women, and about 90% of those cases are due to pituitary microadenoma or corticotroph hyperlplasia. (virtual library)

Signs and Symptoms

Signs and symptoms vary, but most cases have upper body obesity, round face (moon face), increased fat around the neck and shoulder area (buffalo hump), osteoporosis, high blood pressure, increased blood sugars. Also women can have increased hair on face and chest, abdomen and thighs. Men may get a decrease in fertility and absence of sexual desire and possibly erectile dysfunction. (Nih)(Lab) the ICD-10 code for the Cushing's disease is E24.9. In some rare cases people have had inherited the gene for Cushing's disease, such as multiple endocrine neoplasia type 1 or Men-1. This can increase risk for tumors developing throughout the endocrine system and sometimes include the pituitary and adrenal glands. People who are obese and have diabetes are at a high risk for this disease (Lab).

Diagnostic Testing

There are a number of tests the doctor can give for the Cushing's disease diagnosis. A 24-hour urine cortisol, dexamethasone suppression test (low dose), salivary cortisol levels are taken in early morning and late at night. These three tests will confirm too much cortisol in the body. Also, the tests can determine the cause of the disease are: blood ACTH level, brain MRI, corticotropin-releasing hormone test, dexamethasone suppression test (high dose), and inferior petrosal sinus sampling (IPSS). Other tests that can be done but isn't necessary are: fast blood glucose and A1c for diabetes, lipid and cholesterol testing, bone mineral density can too check for osteoporosis. (Medline Plus)

Treatment Options

At the follow-up appointment the doctor will go over all the test results, and the next plan of action will be. The treatment would be surgery to remove the pituitary tumor and the pituitary gland may return to normal and start to work slowly again. During the recovery process, cortisol replacement therapy, so the pituitary needs to be able to have time to make ACTH again. Also, if the doctor could not remove the whole tumor completely radiation might be done to the pituitary gland. If surgery and radiation doesn't work on the tumor, medication may be needed to stop making the coritsol in the body. The last resort if none of these treatments work, the adrenal glands will be removed, and it will stop the increased levels of the cortisol. Also, if the adrenal glands are removed the tumor on the pituitary gland will get much, much bigger. (medline)

Prognosis/ Summary

If Cushing's disease is left untreated, it can lead to severe complications. People can have excessive fatigue, obesity, nausea and vomiting, diabetes, hypertension and can lead to premature death. (Skull) Removal of the tumor can be a full recovery, but lifelong replacement medication to keep your hormones in balance. Two medications that have been approved by the FDA are: mifepristone and pasireotide, for the treatment of Cushing's disease. (Medline Plus)

Very rare the tumor can grow back, and the patients will need to go back to the doctor and see what can be done the treatment options are.

REFERENCES

Cuevas-Ramos, D. (n.d.). Update on medical treatment for Cushing's Disease. [online] Available at: http://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-016-0033-9.

Ilias I, N. (2012). National institute of diabetes and digestive and kidney diseases. [online] Available at: https://www.niddk.nih.gov/health-information/endocrine-diseases/cushings-syndrome [Accessed 5 Mar. 2017].

Krause, L. (2005). Pituitary-dependent Cushing's disease. [online] Available at: http://www.healthline.com/health/cushings-disease [Accessed 28 Jan. 2016].

Labtestonline.org. (2016). Labtestonline.org. [online] Available at: http://www.labtestonline.org/conditions/cushing [Accessed 10 Mar. 2017].

Mayoclinic.org. (2016). Overview - Cushing syndrome - Mayo Clinic. [online] Available at: http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/home/ovc-20197169 - 47k [Accessed 10 Mar. 2017].

Medlineplus.gov. (2016). Cushing Syndrome | Hypercortisolism | MedlinePlus. [online] Available at: https://medlineplus.gov/cushingssyndrome.html [Accessed 10 Mar. 2017].

Skullbaseinstitute.com. (n.d.). Cushing's Disease: Surgery, Treatment & Symptoms | Skull Base Institute. [online] Available at: http://www.skullbaseinstitute.com/pituitary-gland-tumor-surgery/cushings-disease-endoscopic-surgery.htm [Accessed 10 Mar. 2017].