CUSHING'S DISEASE


Cushing's disease is a rare condition  when the pituitary gland, which is an endocrine gland secretes more  Adrenocorticotropic hormone. This inturn causes the adrenal gland to release the hormone cortisol excessively that causes certain signs and symptoms.

Causes

Cushing’s disease is mostly caused by a tumour or excess growth(hyperplasia) of the pituitary gland. This tumor is mostly a pituitary adenoma which is a benign tumor.This tumor secretes more ACTH which causes the adrenal glands to release more cortisol, which is a stress hormone that is released in stressful conditions. It also helps in controlling the body’s usage of carbohydrate,protein and fat.

Cushing’s disease may also be a part of another condition called MEN type 1.This type maybe inherited. Otherwise Cushing’s disease is not inherited.

 Signs and symptoms

  • Weight gain of the upper portion of the body(above waist).
  • Round, puffy and moon shaped face.
  • Slow growth rate of children and delayed onset of puberty.
  • Purple coloured stretch marks over abdomen,thighs,breasts.
  • Thinning of skin with easy bruising.
  • Muscle weakness, bone pains and bone thinning which may lead to osteoporosis or fractures.
  • High blood pressure and high blood sugar.
  • Menstrual irregularity and increased hair growth in women.
  • Reduction in sex drive for men.

Diagnosis

  • 24 hour urine tests to detect cortisol level
  • Dexamethasone suppression test
  • Salivary Cortisol tests at 12 midnight and early morning
  • Brain MRI to identify any pituitary tumor
  • Inferior petrosal sinus sampling
     Other tests may include
  • Fasting blood sugar and HbA1C to detect diabetes
  • Lipid profile
  • Bone marrow density scan to detect Osteoporosis

Treatment

There are a number of different treatments for Cushing’s disease:

  1. Surgery to remove the pituitary tumour causing Cushing’s disease. Replacement with cortisol is needed till the pituitary gland starts functioning again.
  2. Radiotherapy to the pituitary gland when patient cannot undergo surgery or part of the tumor is remaining after surgery.
  3. Tablets to decrease the cortisol levels if the tumor is not responding to surgery or radiation.
  4. Surgery to remove the adrenal glands to stop high levels of  cortisol production.

 Side-effects of the treatment

  • The main side-effects of surgery is the same as that of any other surgery like excessive bleeding, infections and pain.
  • Hydrocortisone tablets are given to the patients for few months to retain the cortisol levels in the body till the pituitary and adrenal functions return. 
  • Due to surgery of the pituitary gland, other hormones secreted by the pituitary have to be replaced as tablets or injections.
  • Reduction in cortisol levels may affect the liver. So intermittent blood tests are mandatory to check the proper functioning of the liver.

Long term implication

The bodily changes such as appearance ,muscle and bone weakness etc due to excessive cortisol will come back to normal in a few weeks once the disease has been treated.

 Postmenopausal women however have to be treated to prevent osteoporosis.

Fluctuations in blood pressure and blood sugar have to be monitored and treated if necessary.

Hydrocortisone tablets have to be taken for life and the doses should be increased in stressful conditions as injury,illness or surgery to help the body withstand the stress.

Those who had cushing’s disease for a long time and have been treated may have thin bones and weak muscles or may already have osteoporosis. So they need proper strengthening exercise to improve bone and muscle strength.

Your Endocrinologist at Idea Clinics will be able to assess and guide you periodically even if you have been treated.