Cushing's Disease

Cushing's disease occurs when a benign tumor in the pituitary gland (pituitary adenoma) over-secretes the adrenal gland-stimulating hormone (ACTH).

It is more common in women between the ages of 20-50. It can also be seen in men and children. Cushing's disease should be suspected when there is increased hair growth, typical weight gain, acne on the skin, easy bruising, and especially purple-colored cracks.

What are the Symptoms of Cushing's Disease?

  • Weight gain, inability to lose weight, especially from the trunk
  • Facial swelling, rounding, redness
  • Oily skin, acne
  • easy bruising on the skin
  • hair growth
  • Subcutaneous swellings on the back of the neck, on the sides of the neck
  • Hair thinning, shedding
  • purple cracks
  • Bodily obesity and purple
  • Hair growth in a female patient

Other symptoms that may be seen in some patients:

  • muscle weakness,
  • Muscle pains
  • osteoporosis
  • Depression
  • Hypertension
  • diabetes
  • Heart disease

What to do if you have symptoms of Cushing's disease?

Endocrinologists should be consulted. Examination and necessary blood tests will be done. With the help of blood tests, he can make the differential diagnosis between diseases that may give similar symptoms such as simple obesity, polycystic ovarian disease, false Cushing's table. The diagnosis process is difficult and the blood and urine tests performed by an experienced endocrinologist sometimes need to be repeated several times and can take time.

It can also be caused by a tumor

All symptoms of Cushing's disease occur due to excessive secretion of the hormone cortisol. Cortisol hormone is secreted from the adrenal glands. It is the pituitary gland that stimulates this secretion. Excess cortisol may result from pituitary overstimulation, from a tumor of the adrenal gland itself, or, rarely, from another tumor focus. In order to differentiate this, pituitary and abdominal MRI examinations are performed, as well as a series of tests.

How is Cushing's Disease Treated?

When the diagnosis of Cushing's disease is confirmed, the treatment to be applied is the removal of the adenoma in the pituitary gland by the neurosurgeon. These tumors, which are usually smaller than 1 centimeter, are treated with transsphenoidal surgery. Cushing's disease is one of the most experienced surgeries in pituitary surgery. ACTH-secreting pituitary adenomas are usually smaller than 1 centimeter. In 25 percent of patients, the tumor is too small to be seen even on the best MRI. A normal MRI does not reject the disease if the tests point to the pituitary. If an adenoma is not seen, venous blood sampling of the pituitary gland should be performed by interventional neuroradiologists with a catheter from the groin to confirm the diagnosis and determine the location of the tumor in the pituitary gland. If the treatment of the disease cannot be achieved with surgery, removal of the adrenal glands, drug therapy or radiosurgery may be considered.

What happens if it is not treated?

Untreated patients may experience osteoporosis, hypertension, diabetes, heart disease, and vascular occlusion. Their quality of life is severely impaired and there is a risk of death from stroke or heart attack.

All these complications can be prevented in patients who are well-treated and followed up regularly. When patients go into remission, they lose weight rapidly, skin symptoms regress, and blood pressure and blood sugar levels can decrease to normal limits. Even recovered patients should be seen by an endocrinologist once a year for life.

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