Cushing's Syndrome

Cushing's syndrome is a debilitating endocrine disorder characterized by excessive cortisol levels in the blood which may be the result of a tumor of the pituitary gland, adrenal glands (located above the kidneys) or from tumors or cancer arising elsewhere in the body (ectopic ACTH producing tumors). Cushings disease refers specifically to excessive ACTH secretion by a pituitary tumor (also called pituitary adenoma). The cause of Cushings Syndrome is a pituitary adenoma in over 70% of adults and in approximately 60-70% of children and adolescents. Most pituitary ACTH-secreting adenomas are small in size (microadenomas). Overall, Cushings Disease is relatively rare, affecting 10 to 15 of every million people each year, and most commonly affects adults aged 20 to 50 years. Women account for over 70% of cases.

Symptoms and signs of Cushings syndrome and disease may include:

  • Change in body habitus: weight gain in face (moon face), above the collar bone (supraclavicular) and on back of neck (buffalo hump)
  • Skin changes with easy bruising, purplish stretch marks (stria) and red cheeks (plethora)
  • Excess hair growth (hirsutism) on face, neck, chest, abdomen, and thighs
  • Generalized weakness and fatigue
  • Loss of muscle
  • Menstrual disorders in women (amenorrhea)
  • Decreased fertility and/or sex drive (libido)
  • Hypertension
  • Diabetes mellitus
  • Depression with wide mood swings

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Patient Story: My Battle with Cushing's Disease

My name is Teri. I am one-year post-op/in recovery from endoscopic trans-sphenoidal resection of pituitary adenoma, which is brain surgery to remove a benign tumor on my pituitary gland that causes Cushing’s Disease.

Cushing's disease is a serious condition. The patient has an excess of the steroid hormone cortisol in the blood, caused by a pituitary tumor that is secreting adrenocorticotropic hormone (ACTH). ACTH is a hormone produced by the normal pituitary gland. ACTH stimulates the adrenal glands (located on top of the kidneys) to produce cortisol, commonly referred to as “the stress hormone”.

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PNA Medical Corner: Testing for Cushing’s

This month the PNA Medical Corner showcases an article co-written by four members of the PNA, Drs. Quinones-Hinojosa, Gallia, Wand and Salvatori, all of Johns Hopkins in Baltimore. The study looks at methods to diagnose Cushing’s Disease, and is entitled Venous Sampling for Cushing Disease: Comparison of Internal Jugular Vein and Inferior Petrosal Sinus Sampling. The authors conclude that IJVS should not be routinely used to determine if the pituitary is to blame for high ACTH levels. It was published online in the journal Endocrine Practice on May 23, 2016.

Dr. Alberto Quinones HinojosaDr. Gary GalliaDr. Gary WandDr. Roberto Salvatori

Drs. Alberto Quinones-Hinojosa, Gary Gallia, Gary Wand and Roberto Salvatori

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