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Cushing disease is a condition in which the pituitary gland releases too much adrenocorticotropic hormone (ACTH). The pituitary gland is an organ of the endocrine system.
Cushing disease is a form of Cushing syndrome.
Pituitary Cushing disease
Cushing disease is caused by a tumor or excess growth (hyperplasia) of the pituitary gland. The pituitary gland is located at the base of the brain. A type of pituitary tumor called an adenoma is the most common cause. An adenoma is almost always benign (not a cancer).
With Cushing disease, the pituitary gland releases too much ACTH. ACTH stimulates production and release of cortisol, a stress hormone. Too much ACTH causes the adrenal glands to make too much cortisol.
Cortisol is normally released during stressful situations. It controls the body's use of carbohydrates, fats, and proteins and also helps reduce the immune system's response to swelling (inflammation).
Symptoms of Cushing disease include:
Skin changes that are often seen include:
Muscle and bone changes include:
Women often have:
Men may have:
Other symptoms may include:
Tests are done to confirm there is too much cortisol in the body, then to determine the cause.
These tests confirm too much cortisol:
These tests determine cause:
Other tests that may be done include any of the following:
Treatment involves surgery to remove the pituitary tumor, if possible. After surgery, the pituitary gland may slowly start to work again and return to normal.
During the recovery process, you may need cortisol replacement treatments. Radiation treatment of the pituitary gland may also be used if the tumor is not completely removed.
If the tumor does not respond to surgery or radiation, you may need medicines to stop your body from making cortisol.
If these treatments are not successful, the adrenal glands may need to be removed to stop the high levels of cortisol from being produced.
Untreated, Cushing disease can cause severe illness, even death. Removal of the tumor may lead to full recovery, but the tumor can grow back.
Call your health care provider if you develop symptoms of Cushing disease.
If you have had a pituitary tumor removed, call if you have signs of complications, including signs that the tumor has returned.
McGee S. Cushing syndrome. In: Evidence-Based Physical Diagnosis. 3rd ed. Philadelphia, Pa: Elsevier Saunders. 2012:chap 13.
Molitch M. Anterior pituitary. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 231.
Stewart PM, Krone NP. The adrenal cortex. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Elsevier Saunders; 2011: chap 15.