Cushing's disease


at Cushing's disease In the body too much cortisol is produced. This is often caused by a tumor in the pituitary gland. More often, women are affected. Among other things, they suffer from overweight, loss of strength and increased susceptibility to infections. If the causative tumor can be removed, the chances of recovery are good. Read all about the causes, symptoms and treatment of Cushing's disease here.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. E24 Products OverviewMusic Cushing

  • description
  • symptoms
  • Causes and risk factors
  • Examinations and diagnosis
  • treatment
  • Disease course and prognosis

Cushing's disease: description

Cushing's disease was named after its author, neurosurgeon Harvey Cushing. Patients suffering from Cushing's disease have too much cortisol in their body (hypercortisolism). Cortisol is a hormone that is produced in the adrenal cortices. It is considered a stress hormone and mobilizes energy reserves in stressful situations.

For cortisol to be produced in the adrenal cortex, it must be stimulated by another hormone: corticotropin (ACTH). ACTH is formed in the pituitary gland (pituitary gland). In Cushing's disease, too much ACTH circulates in the bloodstream causing ACTH-dependent hypercortisolism.

In addition to Cushing's disease, there are other forms of hypercortisolism such as Cushing syndrome, which is not triggered by ACTH from the pituitary gland.

Cushing's disease: facts and figures

Cushing's disease is one of the so-called endogenous forms of hypercortisolism. This means that the body on its own (endogenous = from the inside) produces too much ACTH and therefore cortisol.

The endogenous hypercortisolism is very rare in contrast to the exogenous (externally caused). According to literature, one in every 100,000 people suffer from Cushing's disease each year. Especially women between the ages of 30 and 40 are affected. It is estimated that about three-quarters of them have a tumor in the pituitary gland that produces ACTH.

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Cushing's disease: symptoms

The following symptoms are typical for Cushing's disease:

  • Redistribution of fat deposits: Fat is stored primarily on the trunk and face. Therefore, patients have a full moon face and a so-called bull's neck, but comparatively thin arms and legs.
  • Loss of strength: The muscle mass decreases (myopathy) and the bones become brittle (osteoporosis).
  • Susceptibility to infection: Because the immune system of the body is partially suppressed by cortisol, pathogens can easily multiply. Wound healing is also disturbed.
  • high blood pressure
  • Increased blood sugar levels
  • Streaky reddish discoloration of the skin (Striae rubrae) especially on the upper arms and legs as well as on the flanks
  • Thin, parchment-paper-like skin on which more open areas (ulcers) can occur.

In addition, women with Cushing's disease may have symptoms such as the following due to an excess of male hormones:

  • menstrual disorders
  • Change in hair type: women increasingly grow hair on the face, on the chest and on the abdomen (hirsutism)
  • Humanization (virilization): Women get a deeper voice, male body proportions or their clitoris grows.

In addition, patients with Cushing's disease may be psychologically conspicuous, for example, due to depression. Children with Cushing's disease often suffer from growth arrest.

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Cushing's disease: causes and risk factors

The main cause of Cushing's disease is a pituitary microadenoma in 80 percent of cases. A microadenoma is a small, benign tumor in most cases. In the healthy body, there are control circuits that control the amounts of hormones produced. A microadenoma that produces hormones itself is not subject to this regulatory cycle. Therefore, the amount of hormones in the body increases beyond the required levels.

If Cushing's disease is present, more corticotropin (ACTH) is produced. ACTH stimulates the adrenal cortex to form cortisol. Therefore, one speaks of an ACTH-dependent hypercortisolism. Apart from the production of cortisol, ACTH also causes a production of male hormones (androgens) in the adrenal cortex. Therefore, women with Cushing's disease have symptoms that are attributable to increased androgen levels in the blood.

Not just a microadenoma can be the cause of Cushing's disease. In some cases there is a dysfunction of the hypothalamus. Corticoliberin (CRH) is produced in this brain area. This hormone stimulates the production of ACTH in the pituitary gland. If too much corticcoliberine is formed in the hypothalamus, increased cortisol in the adrenal cortex is accordingly produced by an increased formation of ACTH.

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Cushing's disease: examinations and diagnosis

If you suspect Cushing's disease, your GP will refer you to a specialist in endocrinology. First, he asks you in detail about your medical history (anamnesis). He will ask you the following questions:

  • Did you gain weight?
  • Have your body proportions changed?
  • Do you have bone pain?
  • Are you more likely to catch a cold?

Subsequently, your doctor will examine you physically. He also pays attention to your skin color and possible skin changes. He taps your spine and asks if you are in pain. Your doctor will ask you to squat up to test your muscle power. He also takes blood from you.