Cushing's Disease

In a normal and healthy individual, their pituitary gland knows exactly when to release the hormone that kicks starts cortisol production. The hormone is called adrenocorticotropic hormone (ACTH) and when it is released, the cortisol is produced and then sent out into the body. For people who suffer from Cushing's disease, their body isn't properly able to regulate how much cortisol is made, and it ends up making too much.

Why It Happens

People of all ages can develop Cushing's but it is most often seen in people who are 20 to 50 years of age, it's also more predominant in women. With that said it is a rare disease with only 10 to 15 people out of one million being diagnosed with it each year.

Pituitary gland is found at the base of a person's brain. As mentioned, in a person who has Cushing's disease, there is too much ACTH being release by his/her pituitary gland. It is a chain reaction because then the adrenal glands start to product excess cortisol. Cortisol plays a key role in helping your body deal with welling, how it uses proteins, fats, and carbohydrates.

In most cases the cause of Cushing's disease is a pituitary tumor called an Adenoma. Usually this Adenoma is benign and relatively small in size. Because these tumors are so small they can be difficult to detect and therefor diagnose with Cushing's disease is often delayed.

Cushing's Disease vs. Cushing's Syndrome – Are They the Same Thing?

Maybe you've heard of the two terms Cushing's syndrome and Cushing's disease and just assumed they are one in the same. This is actually false, they are two separate medical conditions often grouped together by people.

Cushing's syndrome: A person who has Cushing's syndrome actually had Cushing's disease, which is the medical cause for the syndrome. Cushing's syndrome refers to a condition in which the body is over-producing cortisol. Corticosteroid medication can cause this, along with other reasons.

Cushing's disease refers to the condition where the pituitary gland creates excess ACTH due to a tumor. This excess ACTH affects the adrenal glands, which then go into overdrive and the cortisol levels increase.

Although these are two different conditions, the symptoms can be the same. Shared symptoms include weight gain in the face and abdominal regions and red lines that form on the abdomen.

Symptoms of Cushing's Disease

Cushing's disease has a number of symptoms associated with it, and the person may only exhibit one or two of them, or many on the list. It's also important to note that some symptoms are specific to males, whereas others are specific to females.

General Symptoms

  • Weakness of the muscles
  • Fatigue
  • Difficulties with a person's cognitive ability
  • Irritability, anxiety, and/or depression
  • Headaches
  • Problems controlling emotions
  • High blood pressure, or worsening blood pressure
  • Bone density loss, meaning it's easier to get fractures
  • An intolerance to glucose, this can end up causing diabetes
  • Weight gain in the face, midsection, between the shoulders, and the upper back
  • Cuts and infections heal very slowly
  • Skin bruises easily and is thin
  • Stretch marks that are purple or pink and develop on the arms, breasts, thighs, and abdomen
  • Acne

Common Symptoms in Males

  • Erectile dysfunction
  • A decrease in fertility levels
  • A decrease in the libido

Common Symptoms in Females

  • Menstrual periods that is either irregular or skipped over all together
  • An increase in facial and body hair

Diagnosis of Cushing's Disease

Diagnosing Cushing's disease is an important step to take so the person can get the proper treatment needed for the illness. What makes this disease a bit tricky to diagnosis is the fact the symptoms aren't fast-moving, in fact they take quite a while to develop. Another tricky part in the diagnosis is that the symptoms can appear in cycles, so depending on when you are tested it may not show up.

Testing for Cushing's disease is done with an endocrinologist. They will take blood samples and will specifically look at your cortisol levels making sure they aren't elevated.Sometimes an MRI is also needed if they are trying to find a tumor. Keep in mind that you may need to perform multiple blood tests.

Treatments for Cushing's Disease

Once the disease has been diagnosed, doctors can then form the appropriate treatment plan for each individual. There are actually several options when it comes to treatments, here's a look at them:

1. Radiotherapy

This is performed on the person's pituitary gland and is often a good option if the patient has already had surgery that wasn't successful or they are unable to have the necessary surgery. There is no need to stay in the hospital during this therapy and it takes place over four to five weeks on a daily basis.The way it works is that the patient wears a customized mask so that they are properly aligned on the radiotherapy machine.

2. Removal of the Adrenal Glands

This surgical option is obviously done in the hospital. Patients can opt to have the procedure done by laparoscopically. This is usually the option for those who cannot have their tumor on their pituitary gland removed, or the surgery was attempted but was unsuccessful.

3. Removal of the Pituitary Gland

This option is a surgical procedure that removes the source of the problem right at the pituitary gland. It has a high success rate of 80% and is performed by a neurosurgical specialist. There is no scarring to worry about with this surgery as the surgeon goes in through the nose.

4. Tablets

Another option for patients is to take tablets that work to control production of cortisol. It targets the adrenals by working to slow down their production levels. This is usually given to a patient who is on the wait-list for surgery so it is meant as a short-term treatment plan. Medications can include ketoconazole and metyrapone.

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