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Neurosciences and Behavioral Health Center

Cushing's Disease

Cushing's disease, also called ACTH-producing pituitary tumor, is a pituitary tumor that secretes adrenocorticotrophin hormone (ACTH) and causes overproduction of cortisol by the adrenal glands.

Excessive cortisol production causes:

  • Weight gain, particularly in the abdomen and neck
  • Loss of muscle
  • Depression
  • Sleep disturbance
  • Memory loss
  • Difficulty concentrating
  • Loss of sexual function
  • Infertility
  • Loss of menstrual periods
  • Thin skin, easy bruising and red stretch marks, usually on the abdomen
  • High blood pressure
  • Diabetes mellitus
  • Osteoporosis and bone fractures
  • Abnormal lipids (cholesterol)
  • Heart disease
  • Kidney stones

Diagnosing Cushing's Disease

Cushing's disease is the most difficult diagnosis of all pituitary disorders.

The diagnosis requires two separate stages:

  • The first stage establishes if you're producing cortisol
  • The second stage determines the precise cause of this excess cortisol production

A multidisciplinary approach involving endocrinologists and neurosurgeons is essential for the correct diagnosis and appropriate management of patients with Cushing’s disease.

Screening for Excess Cortisol Production

There are three screening tests that detect excess and abnormal cortisol production:

  • 24-hour urine-free cortisol levels
  • Late-night salivary cortisol levels
  • Overnight low dose dexamethasone test

Since these tests aren't 100 percent accurate, several tests are often needed to confirm a diagnosis. These include:

  • Measurement of serum ACTH levels
  • CRH stimulation test
  • Inferior petrosal sinus sampling (requires hospitalization and a procedure by a specialist)
  • CT or MRI scans

Treatment for Cushing's Disease

Surgery is the best treatment is removal of the tumor. 

Medications

Medication is used to control adrenal gland cortisol overproduction, but does not treat the source of the problem, the pituitary tumor. Careful monitoring is necessary to establish the optimal dose and to determine if it's effective and has no unwanted effects on the liver.

Radiation Therapy

If surgery does not work, we can use irradiation to return cortisol production to normal and control tumor growth. This works in 50-60 percent of patients.

Gamma Knife radiosurgery is another option. It provides a precisely targeted, single dose of radiation, in comparison to conventional irradiation therapy, which takes five weeks of daily treatment.

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Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

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We offer something that isn't offered at most other hospitals: Next-day surgery without delays for some patients. 

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Advanced Treatment

Treatment of tumors at the base of the skull is highly complex. These tumors are hard to reach, and surgery is a delicate process that can affect many areas of the body.

At UVA’s Skull Base Center, we have a team of experts who provide comprehensive management of these challenging tumors.