What Is Cushing's Disease?
Cushing’s Disease is a condition characterized by the overproduction of cortisol, one of the body’s most important hormones. However, the most fundamental and decisive feature of this disease is a benign tumor (adenoma) in the pituitary gland as the root cause of the problem. This small tumor begins to secrete a significantly larger amount of ACTH (adrenocorticotropic hormone) than normal. ACTH, in turn, stimulates the adrenal glands to produce an excessive amount of cortisol. Cushing’s Disease is thus a specific subtype of Cushing’s Syndrome, where the excess cortisol originates from the pituitary gland. As our doctor, Uzm. Dr. Burcu Meryem Atak Sançmış, emphasizes, an accurate diagnosis and differentiating tests are very important for the treatment of this disease.
What Are The Causes Of Cushing's Disease?
The sole and primary cause of Cushing’s Disease is, as already mentioned, a tumor (adenoma) that develops in the pituitary gland. These tumors are often very small (microadenomas), but they can still significantly influence hormone production. Rarely, larger tumors (macroadenomas) can also occur. The exact reason for the development of these tumors is unknown, but it’s assumed that they could be related to genetic predisposition or environmental factors. This isn’t an infection or a condition transmitted from outside; it’s an anomaly that develops within the person’s own body.
What Are The Symptoms Of Cushing's Disease?
The symptoms of Cushing’s Disease are very diverse and can vary from person to person, as they are caused by the effects of excessive cortisol on many organs and systems in the body. However, some common and striking symptoms include:
- Weight Gain: A significant weight gain, especially in the face (moon face), neck, and torso, accompanied by thinning arms and legs.
- Bruising And Skin Problems: Easy bruising, thin skin, stretch marks (striae, especially red-purple on the abdomen, chest, and thighs), and poorly healing wounds.
- Muscle Weakness: Significant loss of strength, especially in the arms and legs.
- Fatigue: A constant and excessive feeling of tiredness.
- High Blood Pressure: High blood pressure that is difficult to control.
- Diabetes (Sugar Disease): Elevated blood sugar or worsening of existing diabetes.
- Bone Loss (Osteoporosis): Decreased bone density and susceptibility to bone fractures.
- Menstrual Irregularities And Infertility: In women, irregular or absent periods, fertility problems.
- Sexual Dysfunction In Men: Loss of libido, impotence.
- Mood Swings: Depression, anxiety, irritability, and cognitive problems.
- Weakened Immune System: Frequent infections.
- Growth Retardation In Children: Stagnation or slowing of normal growth in children.
How Is Cushing's Disease Diagnosed?
The diagnosis of Cushing’s Disease requires a detailed evaluation and various tests. The process led by Uzm. Dr. Burcu Meryem Atak Sançmış usually includes the following steps:
- History And Physical Examination: Our doctor carefully listens to the patient’s symptoms, medical history, and family history. Typical Cushing’s symptoms are sought during the physical examination.
- Cortisol Level Measurements:
- 24-Hour Urine Free Cortisol Test: The cortisol level is measured in urine collected over 24 hours. High cortisol levels suggest Cushing’s Syndrome.
- Overnight Salivary Cortisol Test: It’s examined whether the cortisol level, which should increase at night, is suppressed.
- Low-Dose Dexamethasone Suppression Test: After administering a specific dose of dexamethasone (a synthetic cortisol), it’s checked whether the cortisol level in the blood is suppressed. Normally, cortisol levels should decrease; if they do not, the suspicion of Cushing’s Syndrome increases.
- ACTH Level Measurement: The ACTH level in the blood is measured to differentiate whether the cause of Cushing’s Syndrome originates from the pituitary gland (high ACTH) or from another site (low ACTH). In Cushing’s Disease, the ACTH level is normally high or close to normal.
- Pituitary Imaging (MRI): If the ACTH level is high, an MRI (Magnetic Resonance Imaging) of the brain is performed to identify the tumor in the pituitary gland. Since the tumors can be very small, they may sometimes not be visible on the MRI.
- Inferior Petrosal Sinus Sampling (IPSS): This is an advanced diagnostic method used in cases where pituitary MRI doesn’t show a tumor, but the suspicion of Cushing’s Disease is high. Samples are taken from the blood vessels (inferior petrosal sinuses) that carry blood from the pituitary gland, and ACTH levels are measured. This test helps to definitively determine whether the ACTH truly originates from the pituitary.
How Is Cushing's Disease Treated?
Treatment focuses on the removal of the tumor in the pituitary gland and has a high success rate. Treatment methods may include:
- Surgical Intervention (Transsphenoidal Adenomectomy): This is the most commonly preferred and effective treatment method. Neurosurgeons reach the pituitary gland through the nose and sinus cavities to remove the tumor. Since this method is minimally invasive, the healing process is generally fast. After successful surgery, most patients return to normal cortisol levels. Mrs. Sanıçamuş also emphasizes that this surgical approach is usually the first choice for her patients.
- Radiation Therapy (Radiotherapy): In cases where surgery isn’t suitable or the tumor couldn’t be completely removed after surgery, radiation therapy may be applied. This treatment aims to stop or reduce the growth of tumor cells. Its effect usually appears more slowly and can have some side effects.
- Medication Treatment: Medication treatment can be used before surgery, in cases of recurrence after surgery, or in situations where surgery isn’t possible. These medications help to directly reduce cortisol production or control ACTH secretion. However, they are generally used to control symptoms rather than as a permanent solution.
- Adrenalectomy (Removal Of Adrenal Glands): Very rarely, if other treatment methods fail or excessive cortisol levels cannot be controlled, the surgical removal of one or both adrenal glands may be considered. In this case, the patient must receive lifelong cortisol replacement therapy.
After treatment, it’s very important to regularly follow up with patients, monitor cortisol levels, and administer cortisol replacement therapy if necessary. Mrs. Meryem Sanıçamuş states that they meticulously carry out the postoperative follow-up of their patients and provide them with all possible support during their recovery process.
Frequently Asked Questions
What Happens If Cushing's Disease Is Left Untreated?
Is Cushing's Disease Contagious?
Do All Symptoms Disappear After Treatment?
Is Cushing's Disease Genetically Determined?
What Is The Difference Between Cushing's Syndrome And Cushing's Disease?
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