Cushing’s disease and Cushing’s syndrome
In this second post about adrenal disorders we are looking at Cushing’s disease and Cushing’s syndrome where patients are found to have had high blood levels of cortisol over a long period of time.
It is most common in women aged 25 to 45; there are 2 per million reported new cases of Cushing’s syndrome a year. It is by a benign pituitary tumour in 90% of cases or occasionally tumours on the adrenal glands. Very rarely it can be caused by other tumours such as lung tumours which produce ACTH (called ectopic ACTH).
Cushing’s syndrome can also be the result of long-term high dose excess glucocorticoid therapy. For example:
- In immune disorders such as rheumatoid arthritis
- for allergic disorders such as asthma and
- to prevent transplant rejection
In the long-term the outcome may then be adrenal failure as normal adrenal gland function remains suppressed when the steroid therapy stops.
Discovered in 1912, Cushing’s disease is named after Harvey Cushing an American neurosurgeon. Cushing’s patients typically have round faces and gain weight around their neck, trunk and abdomen whilst having slender arms and legs. Other features may include:
- Fat pads at both sides of the neck above the collarbone
- A tendency to bruise easily
- Red/purple stretch marks (striae) on the abdomen (similar to those from pregnancy)
- Thinning skin
- Weakness in the muscles closest to the trunk of the body
- Susceptibility to infection
- High blood sugar levels
- Blood pressure
- Weak bones
- In children there may be stunted growth
- In men there may be reduced fertility and libido
- In women there may be abnormal hair growth on the face, neck and chest and irregular periods alongside thinning scalp hair and acne
- Anxiety or depression occurs in about 50% of patients
Diagnosis and Treatment
If high levels of cortisol are detected, the cause must be determined before embarking on treatment to bring cortisol secretion back to normal levels. Endoscopic surgery performed through the nose is used to remove any tumours from the pituitary gland with a cure rate of 70% to 80% among expert pituitary surgeons (the permanent cure rate is reduced to 60% to 70% due to later recurrences).
Where surgery is not possible treatment will involve, medical therapy, radiotherapy or removal of both adrenal glands.
If the source of the excess cortisol is the adrenal gland itself then a laparascopic adrenalectomy is indicated.
For more information on Cushing’s syndrome please download this booklet
As GP’s may only see one or two pituitary disease patients during his career the Pituitary Foundation has produced this Pituitary disease fact file
I hope this has helped. My other post on adrenal disorders is about Addison's Disease and can be found here
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As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link.