Signs of Cushing disease (Excessive cortisol disease)

Description

Results from the increased presence of cortisol in the body. The disease is caused by a tumor or excess growth (hyperplasia) of the pituitary gland. This gland is located at the base of the brain. The gland produces too much ACTH resulting in excess cortisol. Cortisol controls the body's use of carbohydrates, fats, and proteins and also helps reduce the immune system's response to swelling (inflammation).

Symptoms

Abdomen that sticks out and thin arms and legs (central obesity), acne or skin infections, collection of fat on the back of the neck (buffalo hump), depression, diabetes, easy bruising, excessive facial hair growth in females, headache, impotence, increased urination, moon face (round, red, and full), bones become weak, stopping of menstruation, weakness, weight gain.

Tests

A history and physical exam will be performed. Tests to identify too much cortisol will be done including: a 24-hour urine cortisol, and/or a dexamethasone suppression test (low dose). The following tests to determine the cause of too much ACTH will be conducted: brain MRI, dexamethasone suppression test (high dose), serum ACTH levels, test that measures ACTH levels in the veins that drain the pituitary gland (petrosal sinus sampling).

Standard Workup

CBC
Chem 12
MRI

Treatment

The portion of the pituitary gland producing too much ACTH is removed surgically. Radiation therapy is sometimes also needed after surgery. Cortisol replacement after surgery is sometimes needed. If surgery and radiation is not effective then drugs to reduce ACTH production may be administered. If the cortisol levels are still too high than surgery to remove the adrenal glands is considered. For more information contact the National Endocrine and Metabolic Diseases Information Service at: http://www.endocrine.niddk.nih.gov or call (888)828-0904