Which two patients have hormone levels characteristic of Cushings syndrome
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. Show
Cushing disease is a form of Cushing syndrome. Other forms of Cushing syndrome include exogenous Cushing syndrome, Cushing syndrome caused by adrenal tumor, and ectopic Cushing syndrome. CausesCushing disease is caused by a tumor or excess growth (hyperplasia) of the pituitary gland. The pituitary gland is located just below the base of the brain. A type of pituitary tumor called an adenoma is the most common cause. An adenoma is a benign tumor (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 also has many other functions, including:
SymptomsSymptoms of Cushing disease include:
Skin changes that are often seen include:
Muscle and bone changes include:
Women may have:
Men may have:
Other symptoms or problems may include:
Exams and TestsThe health care provider will perform a physical examination and ask about your symptoms. Tests are done first to confirm there is too much cortisol in the body, and then to determine the cause. These tests confirm too much cortisol:
These tests determine the cause of the high cortisol once it is confirmed:
Other tests that may be done include any of the following:
More than one screening test may be needed to diagnose Cushing disease. Your provider may ask you to see a doctor who specializes in pituitary diseases. TreatmentTreatment 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 from surgery, you may need cortisol replacement treatments because the pituitary needs time to start making ACTH again. 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. Removal of the adrenal glands can cause the pituitary tumor to get much bigger (Nelson syndrome). Outlook (Prognosis)Untreated, Cushing disease can cause severe illness, even death. Removal of the tumor may lead to full recovery, but the tumor can grow back. Possible ComplicationsHealth problems that may result from Cushing disease include:
When to Contact a Medical ProfessionalCall your provider if you develop symptoms of Cushing disease. If you have had a pituitary tumor removed, call your provider if you have signs of complications, including signs that the tumor has returned. Alternative NamesPituitary Cushing disease; ACTH-secreting adenoma Images
ReferencesJuszczak A, Morris DG, Grossman AB, Nieman LK. Cushing's syndrome. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 13. Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 15. Weiss RE. Anterior pituitary. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 211. Review Date 5/13/2021Updated by: Brent Wisse, MD, Board Certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Which patient is most likely to have Cushing's disease?Who is more likely to have Cushing's syndrome? Cushing's syndrome most often affects adults, usually aged 30 to 50,1 but can also occur in children. Cushing's syndrome affects about three times as many women as men.
What hormone is affected by Cushing's syndrome?Cortisol levels are sensed by the pituitary gland. Too much of the hormone cortisol in your body causes Cushing syndrome. Cortisol, which is produced in the adrenal glands, plays a variety of roles in your body.
Which of the following hormone levels are elevated in Cushing syndrome?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.
Who is most likely to have Cushing's disease Why?Cushing syndrome caused by either an adrenal or pituitary tumor affects women five times more frequently than men. Symptoms commonly begin between 25 to 40 years of age. Men are affected 3 times more often than women by ectopic ACTH production that is caused by lung cancer, which occurs later in life.
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