Cushing’s Disease

Cushing’s disease is a rare but serious condition that stems from a benign tumor in the pituitary gland. This tumor produces an excess of adrenocorticotropic hormone (ACTH), which overstimulates the adrenal glands, leading to abnormally high levels of cortisol—a hormone essential for managing stress, metabolism, and immune responses. While cortisol is vital for health, too much of it wreaks havoc on the body, resulting in a specific form of Cushing’s syndrome, a broader term for high cortisol regardless of its cause.

How Common Is Cushing’s Disease?

Cushing’s disease is rare, affecting about 2 to 8 people per million each year. It most commonly strikes adults aged 20 to 50, and women are far more likely to develop it than men, with a 5:1 female-to-male ratio.

What Causes Cushing’s Disease?

The root cause is typically a small, benign pituitary tumor (adenoma) that churns out ACTH. This hormone overstimulates the adrenal glands, leading to an overflow of cortisol. This hormonal imbalance can disrupt multiple systems in the body, causing metabolic, cardiovascular, and immune complications.

Signs and Symptoms

Cushing’s disease doesn’t just manifest on the inside—it often leaves noticeable clues. Patients may develop:

  • Weight gain focused on the face (moon face), upper back (buffalo hump), and abdomen.

  • Purple stretch marks (striae) on the skin.

  • Easy bruising and delayed wound healing.

  • Muscle weakness, fatigue, and high blood pressure.

  • High blood sugar and, in some cases, full-blown diabetes.

  • Psychological changes, such as depression, anxiety, or memory difficulties.

These symptoms may develop gradually, making the condition difficult to recognize early.

Diagnosing Cushing’s Disease

Diagnosing Cushing’s disease is a meticulous process requiring several steps:

  1. Initial Screening: Tests like a 24-hour urinary free cortisol measurement or a late-night salivary cortisol test assess cortisol levels.

  2. ACTH Levels: Determining whether high cortisol is ACTH-dependent (from the pituitary) or independent.

  3. Imaging Studies: MRI scans of the pituitary gland help locate the adenoma. If imaging is inconclusive, advanced tests like inferior petrosal sinus sampling may be necessary.

Treatment Options

Managing Cushing’s disease often involves a combination of treatments tailored to the individual:

  • Surgery: Transsphenoidal surgery to remove the pituitary tumor is the most common and effective first-line treatment, offering remission for 70-90% of patients.

  • Medications: When surgery isn’t enough, drugs like ketoconazole or mifepristone can control cortisol production or block its effects.

  • Radiation Therapy: Used as a secondary treatment when surgery and medications fall short.

  • Bilateral Adrenalectomy: In extreme, refractory cases, removing both adrenal glands may be considered, though this requires lifelong hormone replacement.

Why Early Treatment Matters

If left untreated, Cushing’s disease can lead to severe complications, including heart disease, diabetes, osteoporosis, and frequent infections. Even with successful treatment, long-term follow-up is crucial to monitor for recurrence and manage residual effects.

How Dr. Hasan Can Help

At Chia Endocrinology & Wellness, Dr. Farhad Hasan specializes in diagnosing and treating Cushing’s disease and other disorders related to high cortisol. With years of expertise, he offers compassionate care tailored to each patient’s unique needs. From navigating complex diagnostic steps to guiding patients through advanced treatments, Dr. Hasan works closely with his patients to help them regain their health and vitality.

If you or someone you know is experiencing symptoms of high cortisol, hypercortisolism, or Cushing’s disease, schedule a consultation to start your journey toward effective care. At Chia Endocrinology & Wellness, you're in expert hands.

At Chia Endocrinology & Wellness, Dr. Farhad Hasan serves patients across Western Pennsylvania, including the city of Pittsburgh and surrounding areas in Allegheny County such as Ross Township, McCandless, Pine, Marshall, Mars, Richland, Gibsonia, Wexford, Sewickley, Franklin Park, Hampton, Shaler, Findlay, Upper St. Clair, Robinson, North Fayette, Monroeville, and Moon Township. We also serve Butler County, covering Cranberry Township, Seven Fields, Zelienople, Butler, Harmony, and Evans city, as well as patients in nearby Washington County and Beaver County.