Cushing's disease

Last edited 04/2021 and last reviewed 08/2021

Cushing's disease is considered a rare condition characterized by the hypersecretion of the adrenocorticotropic hormone (ACTH)

• due to a pituitary adenoma that ultimately causes endogenous hypercortisolism by stimulating the adrenal glands
  
  
• prevalence of Cushing's disease is of 40:1,000,000 people and more often occurs in women (sex ratio of 9:1 in favor of women)
  
  
• on presentation, over 50% of the patients with Cushing's disease have pituitary microadenoma with a diameter smaller than 5 mm, which are difficult to see through imaging investigation (Computer Tomography and Magnetic Resonance)
  • of these, only 10% are large enough to produce a mass effect on the cerebral tissue or to affect the structure of the sellar region (ballooned or increased in size or contour of the sella turcica) (1)

It is conveniently remembered by recalling that its discoverer, Harvey Cushing, was a brain surgeon

Notes (2):

• subclinical Cushing's disease is defined by ACTH-induced mild hypercortisolism without typical features of Cushing's disease

Reference:

• Buliman A et al. Cushing’s disease: a multidisciplinary overview of the clinical features, diagnosis, and treatment.J Med Life. 2016 Jan-Mar; 9(1): 12-18.
• Kageyama K et al. Pathophysiology and treatment of subclinical Cushing's disease and pituitary silent corticotroph adenomas. Endocrin Journ. 2014;61(10):941-8. doi: 10.1507/endocrj.ej14-0120. Epub 2014 Jun 29.