Cushing's+Disease

Name of Disease: Cushing’s Disease Root cause of Disease: An adenoma forms on the pituitary gland. This adenoma causes the pituitary gland to increase its production of the adrenocorticotropic hormone (ACTH) which accounts for the production of cortisol. With an increased amount of ACTH the adrenal gland starts producing unnecessary amounts of cortisol; the hormone responsible for maintaining blood pressure, cardiovascular functions, using insulin to breakdown sugar for energy, and the metabolism of proteins among other things. This disease is not to be confused with Cushing’s syndrome. Affected cell types/tissues/organs/systems: Cushing’s disease is especially harmful to the cardiovascular tissue and skin tissue. Cushing’s disease has been shown to induce metabolic conditions ranging from obesity to diabetes. Psychiatric complications can also arise from Cushing’s disease. Historical Background: Harvey Cushing first classified this disease in 1932. He was a brain surgeon and is considered the “father of modern neurosurgery.” Although Cushing’s disease is not a rare disease by any means, there are no reported cases of anyone “famous” to have it. The only people I have found to have hinted of Cushing’s disease were Elvis and King Henry VIII. Common Symptoms: Standard Treatments: One of the most common tests people undergo to determine if they have Cushing’s disease is a 24-hour urine cortisol test. This test measures the amount of cortisol in the urine to check if there is an increase or decrease in the amount of cortisol in the urine. The standard treatment for Cushing’s disease is to surgically remove the adenoma from the pituitary gland. This procedure’s success rate is about 65-90% effective, with the only problem being that adenomas recur in about 20% of the cases. One paper found determined an 84% increase in overall mortality for patients who have been diagnosed with Cushing’s disease compared to the general population (Graversen et al., 2012)
 * Rapid weight gain in the lower torso, chest, neck, and face (central obesity)
 * Depression
 * Easy bruising
 * Acne, skin lesions
 * Increased urination
 * Diabetes due to impaired glucose tolerance

Current Research: One drug that is being looked at more closely is the somatostatin analouge pasireotide. This drug acts to reduce the amount of ACTH secreted by the pituitary gland. Reznik et al., (2012) found that it positively affects the glucose homeostasis because of the “expression of somatostatin receptor subtypes on the membranes of pancreatic islet-cells.” The problem with using this drug is that there have been unfavorable side-effects. Radiotherapy and forms of chemotherapy have also been suggested. (Reznik et al., 2012) Liubinas et al., (2011) examined ways to prevent reoccurrence of Cushing’s disease after the initial removal of the tumor from the pituitary gland. The reoccurrence rate after successful surgery is 2-27%. They proposed treatments such as repeat surgery, medical therapy, radiotherapy, and bilateral adrenalectomy. They found that repeat surgery is the best choice to manage any reoccurrence of Cushing’s disease. (Liubinas et al., 2011)

References: Figure 1 received from [] Figure 2 received from [] Graversen, D., et al. Mortality in Cushing’s syndrome: A systematic review and meta-analysis. European Journal of Internal Medicine. (2012). **23**, 278-282. Liubinas, S.V., L.D., Porto, and A.H. Kaye. Management of recurrent Cushing’s Disease. Journal of Clinical Neuroscience. (2011) 18: 7-12. Reznik, Y., et al. Management of hyperglycaemia in Cushing’s disease: Experts’ proposals on the use of pasireaotide. Diabetes Metab. (2012). http://dx.doi.org/10.1016/i.diabet.2012.10.005