Cushing’s disease: what is it?

Cushing’s disease is one form of syndrome by Cushing. It is due to a adenoma of the’pituitary which induces an excessive production ofhormones corticosteroids by adrenal glands. It’s a very rare disease which affects about one to three people in a million per year. In children, Cushing’s disease affects boys more, but in adults (around 40), it affects women more.

Causes of Cushing’s disease

The secretion cortisol is normally controlled by another hormone, L’ACTH (Adreno Cortico-Tropic Hormone or corticotropic hormone), produced by the pituitary gland, a Endocrine gland located at the base of the brain. When an adenoma (tumor benign) develops in the pituitary gland, secreting cells multiply which leads to overproduction of ACTH, which in turn stimulates the production of cortisol by the adrenal glands. Cushing’s disease has no identified cause, nor genetic nor environmental.

Note that there are other causes endogenous with Cushing’s syndrome, but which are not strictly speaking Cushing’s disease:

• tumor in organs outside the pituitary gland which start to secrete ACTH;
• tumor of the adrenal gland that secretes excess cortisol.

Cushing’s syndrome can also have causes exogenous, by prolonged administration of high doses of corticosteroids of synthesis.

Symptoms of Cushing’s disease

The most characteristic signs of Cushing’s disease are weight gain and changes in appearance physical, due to prolonged exposure to corticosteroid hormones. Patients present with excess fat on the upper part of the body, sometimes with a lump in the upper part of the body. back (buffalo hump), a puffy, rounded face, thin arms and legs. The other evocative signs:

• muscle wasting resulting in lack of tone;
• thinning of the skin, with the appearance of bruises and difficulty in healing;
• purplish streaks similar to stretch marks on theabdomen and the thorax.

The long-term consequences:

• arterial hypertension;
• osteoporosis with risk of fatigue fracture;
• decrease in resistance infections;
• phlebitis;
• increased risk of diabetes ;
• increased risk of kidney stones ;
• mental disorders (depression, irritability, sleep disorders or even hallucinations).

Children with Cushing’s syndrome are stunted and stay short. In some people, the adrenal glands also produce a large amount of male sex hormones, which leads to excessive hairiness on the face and body, as well as a baldness in women.

Treatment of Cushing’s disease

Cushing’s disease can be cured byablation of the pituitary adenoma responsible for the hypersecretion of ACTH. It is a delicate operation but not very traumatic, which consists in introducing a endoscope in the nostril up to the pituitary gland. When the adenoma is well identified, the surgery pituitary gland allows remission total in 70 to 80% of cases. The patient then returns to a normal appearance within a few months. The result is less good when the adenoma is too small to be spotted or it is too large. In case of recidivism, reoperation or radiotherapy can be considered.

After the operation, medical follow-up is necessary because the removal of the pituitary gland sometimes results in an abnormally low level of cortisol, thyroid and sex hormones, andADH (antidiuretic hormone). The latter induces a diabetes insipidus, characterized by constant thirst and profuse urine.