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Cushing’s disease

  • Alternative Names

    Pituitary Cushing's disease


    Symptoms

    Symptoms usually include:

    • Upper body obesity (above the waist) and thin arms and legs
    • Round, red, full face (moon face)
    • Slow growth rate in children

    Skin changes that are often seen:

    • Acne or skin infections
    • Purple marks (1/2 inch or more wide), called striae, on the skin of the abdomen, thighs, and breasts
    • Thin skin with easy bruising

    Muscle and bone changes include:

    • Backache, which occurs with routine activities
    • Bone pain or tenderness
    • Collection of fat between the shoulders (buffalo hump)
    • Thinning of the bones, which leads to rib and spine fractures
    • Weak muscles

    Women often have:

    • Excess hair growth on the face, neck, chest, abdomen, and thighs
    • Menstrual cycle becomes irregular or stops

    Men may have:

    • Decreased fertility
    • Decreased or no desire for sex
    • Impotence

    Other symptoms that may occur include:

    • Mental changes, such as depression, anxiety, or changes in behavior
    • Fatigue
    • Headache
    • High blood pressure
    • Increased thirst and urination

    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