Cushing’s disease

General Illness Information


Common Name:

Cushing’s Disease, Cushing’s syndrome.

Medical Term: Cushing’s Disease, Cushing’s syndrome

Description: Clinical abnormalities associated with chronic exposure to excessive amounts of cortisol.

Causes: The most frequent cause is prolonged use of  steroid medications (Cortisone, or ACTH).

Other causes:

  • ACTH-secreting pituitary tumor;
  • Ectopic ACTH production (e.g., small-cell carcinoma of lung, bronchial carcinoid);
  • Endogenous ACTH-independent hypercortisolism: Adrenal adenoma, Adrenal carcinoma, Macro/micro nodular hyperplasia of the adrenal gland.

Prevention:

Avoid excessive corticosteroid treatment when possible.

Signs & Symptoms

  • Moon face, Increased fat tissue in neck and trunk;
  • Central weight gain;
  • Emotional ups and downs;
  • Hypertension;
  • Osteoporosis;
  • Purple striae on the skin;
  • Diabetes;
  • Muscle weakness due to loss of muscle mass from increased catabolism;
  • Skeletal growth retardation in children;
  • Easy bruising;
  • Hirsutism

Risk Factors

  • Any medical problem requiring prolonged use of corticosteroids;
  • Pituitary tumor;
  • Adrenal mass

Diagnosis & Treatment

Blood tests will reveal abnormalities in: 24 hour urinary cortisol, Plasma cortisol (am and pm), Plasma ACTH concentration, Blood sugar levels, electrolytes, lipids. Imaging: Chest films X-rays of the lumbar spine – osteoporosis is common. If pituitary tumor suspected – pituitary MRI scan. If adrenal disease suspected – abdominal CT scan. If ectopic ACTH-secretion suspected – chest CT scan.

General Measures:

Treatment depends on cause. Surgery is the treatment of choice; persistent disease may require – radiation, drug therapy, or surgery

Medications:

Anti-adrenal drugs have not been successful, but are used by skilled physicians when all other treatments have failed.

Activity:

As tolerated, in accordance with symptoms and treatment.

Diet:

  • Potassium supplements;
  • High protein diet

Possible Complications :

  • Osteoporosis;
  • Increased susceptibility to infections;
  • Hirsutism;
  • Metastases of malignant tumors

Prognosis

Guardedly favorable prognosis with surgery