Cushing's Disease (Pituitary ACTH Excess) | Medical Encyclopedia

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Key Facts

Cushing's disease is a specific form of Cushing's syndrome caused by a pituitary tumor (adenoma) that secretes excess Adrenocorticotropic Hormone (ACTH), which stimulates the adrenal glands to produce too much cortisol.

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Pathophysiology

A pituitary adenoma hypersecretes ACTH, overriding the normal negative feedback loop. This leads to bilateral adrenal hyperplasia and chronic hypercortisolism, affecting metabolism, immune function, and cardiovascular health.

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Symptoms & Clinical Features

Weight gain, particularly around the midsection and upper back (buffalo hump).

Rounding of the face (moon face).

Purple stretch marks (striae) on the abdomen, thighs, and breasts.

Thin, fragile skin that bruises easily.

Muscle weakness and bone loss (osteoporosis).

High blood pressure and Type 2 diabetes.

Fig 1.1: Clinical visualization of endocrine pathways related to cushing's disease (pituitary acth excess).

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Diagnosis

Screening involves 24-hour urinary free cortisol, late-night salivary cortisol, or a Low-Dose Dexamethasone Suppression Test (LDDST). A High-Dose Dexamethasone test and Pituitary MRI are used to differentiate it from other causes of Cushing's syndrome.

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Diagnostic Pathway

Initial Screening

Symptom review and baseline hormonal blood tests.

Confirmatory Testing

Advanced diagnostic protocols (e.g., OGTT, MRI, Suppression tests).

Personalized Plan

Tailored treatment strategy based on clinical results.

Fig 2.1: Specialized clinical decision matrix for cushing's disease (pituitary acth excess).

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Treatment & Management

The gold standard treatment is Transsphenoidal surgery to remove the pituitary adenoma. If surgery is unsuccessful, options include pituitary radiation, bilateral adrenalectomy, or medications like Ketoconazole, Metyrapone, or Pasireotide.

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