Cushing's Disease in Adults

Cushing's disease, one of several disorders more broadly categorized as Cushing's syndrome, develops in adults when their bodies produce too much of the hormone cortisol because of growths on the pituitary gland. Cortisol plays important roles in regulating the immune system, keeping the cardiovascular system operating and metabolizing foods. Excessive concentrations of cortisol in one's bloodstream can lead to serious problems. Untreated Cushing's disease can prove fatal, as can leaving underlying causes of Cushing's untreated.

Who Gets Cushing's Disease

• Cushing's disease usually develops in people between the ages of 25 and 50. Women who also suffer from poorly controlled type 2 diabetes, obesity and high blood pressure have the greatest risk for developing any form of Cushing's syndrome. In addition to Cushing's disease caused by pituitary-gland problems, Cushing's can result from overuse of corticosteroids, cancerous growths on adrenal glands and the growth of tumors that excrete cortisol anywhere in the body.

Causes

• According to the National Institute of Diabetes and Digestive and Kidney Disorders, Cushing's disease constitutes the second most common form of Cushing's syndrome. The overwhelming majority of Cushing's disease cases develop when an adenoma or a cancerous tumor forms on a patient's pituitary gland. Adenomas, which are benign growths, occur more frequently than cancerous tumors. A small number of patients who develop pituitary tumors may have a genetic abnormality that predisposes them to a form of cancer known as multiple endocrine neoplasia type 1 that causes tumors to form on the pituitary glands and other hormone-secreting glands.

Symptoms

• A long list of Cushing's syndrome symptoms featured in a fact sheet prepared for Medline Plus includes a distended belly, thin arms and legs, acne, skin infections, irregular fat deposition, impotence, cessation of menstruation, moon face (swelling of the face), easy bruising and red or purple splotches on the skin, weakness, bone pain, unintentional weight gain, loss of muscle mass and high blood pressure.

Treatments

• Doctors can prescribe ketoconazole (e.g., Nizoral from Ortho McNeil Janssen), mitotane (Lysodren from Bristol-Myers Squibb) or metyrapone (Metopirone from Novartis) alone or in combination to lower a patient's cortisol concentration. Adenomas or cancerous tumors that cause Cushing's disease require surgical removal and, sometimes, radiation treatments. Surgeries may have to be performed more than once to completely remove growths, and patients may also need to receive courses of chemotherapy drugs. Paradoxically, following pituitary surgery, patients may need to receive injections of hydrocortisone to ensure proper metabolic, immune and cardiovascular function.

Prognosis

• People with untreated Cushing's disease or uncontrolled cortisol concentrations can develop new or worsened diabetes, bone fractures, kidney stones and high blood pressure. Cancerous growths that give rise to Cushing's disease can often kill patients within five years if not removed and irradiated. However, Cushing's disease is the most curable form of Cushing's syndrome in adults. It has an 80 percent cure rate when the pituitary surgery to remove an adenoma or a cancerous tumor is performed by a highly experienced specialist.

Support

• Patients and their family can find information and resources through the Cushing's Support & Research Foundation. A website recommended by the National Institute of Diabetes and Digestive and Kidney Diseases as a place to start looking for information on Cushing's disease-related treatments is the site maintained by Pituitary Network Associates.