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Surgery for Cushing's Disease

Cushing's disease makes up roughly 70% of the diagnosed cases of Cushing's syndrome. Women are five times more likely than men to develop Cushing's disease. Fortunately, surgical treatment is successful in most cases.

  1. The Facts

    • Cushing's disease is the term used to describe Cushing's syndrome when it is caused by one or more tumors located on the pituitary gland referred to as pituitary andenomas. These tumors are usually not cancerous but they can cause the adrenal glands to produce too much cortisol. Long term exposure of high cortisol levels is what causes Cushing's syndrome.

    History

    • According the National Adrenal Diseases Foundation, Cushing's disease was first diagnosed by Dr. Harvey Cushing in 1932. Dr. Cushing had first noted the signs and symptoms of this disorder in a female patient in 1912 and was subsequently able to determine that these symptoms stemmed from an overproduction of cortisol caused by abnormalities in the pituitary gland. In the past, Cushing's disease was surgically treated by removing the adrenal glands entirely to halt cortisol production, but this method would cause adrenal insufficiency and sometimes cause large tumors known as Nelson's syndrome to develop.

    Identification

    • Symptoms of Cushing's disease include thin arms and legs with a bloated abdomen, acne, depression, diabetes, headache, impotence, weight gain, and excessive facial hair in females, among other symptoms. Tests will first need to be done to determine if there is too much cortisol in the body. These include 24-hour urine tests, midnight plasma tests, and late-night salivary tests. Once Cushing's syndrome has been diagnosed, additional tests such as CT scans or an MRI will determine if pituitary andenomas are the cause, leading to a diagnosis of Cushing's disease.

    Treatment

    • Pituitary surgery is the recommended treatment when the cause of too much cortisol in the body has been determined to be pituitary andenomas. This surgery has a success rate of 80% and if the surgery fails, it can usually be repeated with an equally optimistic success rate. The surgeon uses fine instruments and a special microscope to access the pituitary gland through the nostril.

    Outlook

    • Cushing's disease can cause severe illness or even death if left untreated. In some cases, tumors removed during surgery may grow back and require additional surgery or radiation treatments. Doctors may prescribe drugs such as ketoconazole, mitotane, aminoglutethimide and metyrapone to help control cortisol levels and avoid additional tissue damage.

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