Cushing's disease Health Article

Signs and tests

Tests are done to confirm there is too much cortisol in the body, then to determine the cause.

These tests confirm too much cortisol:

• 24-hour urine cortisol
• Dexamethasone suppression test (low dose)

These tests determine cause:

• Blood ACTH level
• Brain MRI
• Corticotropin-releasing hormone test, which acts on the pituitary gland to cause the release of ACTH
• Dexamethasone suppression test (high dose)
• Petrosal sinus sampling - measures ACTH levels in the veins that drain the pituitary gland

Treatment

Treatment involves surgery to remove the pituitary tumor, if possible. After surgery, the pituitary 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 does not respond to surgery or radiation, you may get medications 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.

Expectations (prognosis)

Untreated, Cushing's disease can cause severe illness, even death. Removal of the tumor may lead to full recovery, but the tumor can grow back.

Complications

• Compression fractures
• Diabetes
• High blood pressure
• Infections
• Kidney stones
• Psychosis

Calling your health care provider

Call your health care provider if you develop symptoms of pituitary Cushing's.

If you have had a pituitary tumor removed, call if you have signs of complications, including signs that the tumor has returned.

References

Stewart PM. The adrenal cortex. In: Kronenberg H, Melmed S, Polonsky K, Larsen PR, eds. Williams Textbook of Endocrinology. Philadelphia, Pa: Saunders Elsevier; 2008:chap 14.