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Cushing's Disease (Pituitary)

Cushing's syndrome caused by an ACTH-secreting pituitary adenoma.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Cushing's Disease (Pituitary)?

Cushing's disease (pituitary Cushing's syndrome) is a rare endocrine disorder caused by an ACTH-secreting pituitary adenoma. ACTH-driven adrenal cortisol hypersecretion causes systemic hypercortisolism. It is more common in women (3:1) and most often develops between 30-50 years of age.

Most adenomas are microadenomas (<10 mm) and may be difficult to demonstrate on MRI; in macroadenomas, mass effects (visual disturbance, headache) are added to the clinical picture. Diagnosis is established with three steps: (1) demonstration of hypercortisolism (24-hour urinary free cortisol, 1-mg dexamethasone suppression test, late-night salivary cortisol); (2) ACTH-dependent identification (ACTH measurement); (3) source localisation (high-dose dexamethasone, CRH stimulation, pituitary MRI, bilateral inferior petrosal sinus sampling).

Treatment is transsphenoidal selective adenomectomy (success 65-90%); if unsuccessful, radiotherapy, medical treatment (ketoconazole, metyrapone, mifepristone, pasireotide, osilodrostat) and bilateral adrenalectomy options exist. Untreated mortality is 4-5 times higher than the general population; cardiovascular events, infection and venous thromboembolism are leading causes of death.

Symptoms

Central obesity (face, abdomen, supraclavicular)
Moon face
Buffalo hump (dorsocervical fat pad)
Wide purple striae (>1 cm)
Easy bruising
Proximal muscle weakness
Hirsutism (women)
Acne, oily skin
Menstrual irregularity, infertility
Hypertension, diabetes
Osteoporosis, vertebral fracture
Depression, mood changes

Risk Factors

Pituitary adenoma (corticotroph)
MEN1 syndrome
Carney complex
Familial isolated pituitary adenoma
X-LAG syndrome (paediatric)
Female gender
30-50 age group

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Rapid weight gain (especially central)
  • Significant change in facial appearance
  • Wide purple striae
  • Newly developed hypertension and diabetes
  • Increased fragility, easy bruising
  • Muscle weakness
  • Menstrual irregularity, infertility
  • Severe depression, mood changes
  • Recurrent infections

Treatment Methods

01
24-hour urinary free cortisol (screening)
02
1-mg overnight dexamethasone suppression test
03
Late-night salivary cortisol
04
Plasma ACTH measurement
05
High-dose dexamethasone suppression test
06
Pituitary MRI
07
Inferior petrosal sinus sampling (BIPSS)
08
Transsphenoidal selective adenomectomy
09
Stereotactic radiotherapy (resistant cases)
10
Medical therapy (ketoconazole, metyrapone, pasireotide, osilodrostat)
11
Bilateral adrenalectomy (last option)
12
Lifelong follow-up (recurrence risk 10-20%)

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.