Case Study 187 | Cushing’s Disease | Explained By Dr. Betsy Grunch

Case Study 187: Cushing’s Disease Cushing’s disease is a specific form of Cushing’s syndrome caused by a pituitary adenoma that secretes excess adrenocorticotropic hormone (ACTH) — driving the adrenal glands to produce excess cortisol. 📊 Facts & Figures: • Cushing’s disease accounts for 60–70% of endogenous Cushing’s syndrome cases. • It is 3–5 times more common in women, especially between the ages of 20–40. • Average tumor size is 5 mm, often invisible on MRI — making diagnosis challenging. • Median diagnostic delay is 2–5 years due to subtle, overlapping symptoms. 🩺 Symptoms include: • Central weight gain, moon face, dorsocervical fat pad (“buffalo hump”) • Hypertension, glucose intolerance/diabetes, hirsutism, muscle weakness • Menstrual irregularities, mood swings, osteoporosis, and skin fragility (purple striae, bruising) 🧪 Diagnosis involves: • 1 mg low-dose dexamethasone suppression test • 24-hour urinary free cortisol • Late-night salivary cortisol • If ACTH is elevated, pituitary MRI and Inferior Petrosal Sinus Sampling (IPSS) help localize the source. 🔪 Treatment: First-line is transsphenoidal surgery to remove the adenoma. • Long-term remission rates: 65–85% after initial surgery • Recurrence rate: up to 20–25% over time • For persistent disease: radiation, medical therapy (e.g., ketoconazole, mifepristone), or bilateral adrenalectomy 💡 Why it matters: Left untreated, chronic cortisol elevation increases cardiovascular mortality, worsens mental health, and severely impacts quality of life. But early diagnosis and expert surgical care can lead to remission and recovery. #CushingsDisease #Endocrinology #PituitaryTumor #LadySpineDoc #SundayCaseStudy