BACK TOTOP Browse A-ZSearchBrowse A-ZABCDEFGHIJKLMNOPQRSTUVWXYZ0-9 E-mail FormEmail ResultsName:Email address:Recipients Name:Recipients address:Message: Print-FriendlyBookmarksbookmarks-menuCushing diseasePituitary Cushing disease; ACTH-secreting adenomaCushing disease is a condition in which the pituitary gland releases too much adrenocorticotropic hormone (ACTH). The pituitary gland is an organ of the endocrine system.Endocrine systemEndocrine glands release (secrete) hormones into the bloodstream. The endocrine glands include:AdrenalHypothalamusIslets of Langerhans in the pancrea...ImageRead Article Now Book Mark Article Cushing disease is a form of Cushing syndrome. Other forms of Cushing syndrome include exogenous Cushing syndrome, Cushing syndrome caused by adrenal tumor, and ectopic Cushing syndrome.Cushing syndromeCushing syndrome is a disorder that occurs when your body has a high level of the hormone cortisol.ImageRead Article Now Book Mark Article Exogenous Cushing syndromeExogenous Cushing syndrome is a form of Cushing syndrome that occurs in people taking glucocorticoid (also called corticosteroid, or steroid) hormone...ImageRead Article Now Book Mark Article Cushing syndrome caused by adrenal tumoCushing syndrome due to adrenal tumor is a form of Cushing syndrome. It occurs when a tumor of the adrenal gland releases excess amounts of the horm...ImageRead Article Now Book Mark Article Ectopic Cushing syndromeEctopic Cushing syndrome is a form of Cushing syndrome in which a tumor outside the pituitary gland produces a hormone called adrenocorticotropic hor...ImageRead Article Now Book Mark Article Causes Cushing disease is caused by a tumor or excess growth (hyperplasia) of the pituitary gland. The pituitary gland is located just below the base of the brain. A type of pituitary tumor called an adenoma is the most common cause. An adenoma is a benign tumor (not a cancer).TumorA tumor is an abnormal growth of body tissue. Tumors can be cancerous (malignant) or noncancerous (benign).Read Article Now Book Mark Article HyperplasiaHyperplasia is increased cell production in a normal tissue or organ. Hyperplasia may be a sign of abnormal or precancerous changes. This is called...ImageRead Article Now Book Mark Article With Cushing disease, the pituitary gland releases too much ACTH. ACTH stimulates production and release of cortisol, a stress hormone. Too much ACTH causes the adrenal glands to make too much cortisol.Cortisol is normally released during stressful situations. It also has many other functions, including:Controlling the body's use of carbohydrates, fats, and proteins Reducing the immune system's response to swelling (inflammation) Regulating blood pressure and the body's water balance Symptoms Symptoms of Cushing disease include:Upper body obesity (above the waist) and thin arms and legs Round, red, full face (moon face) Moon faceFacial swelling is the buildup of fluid in the tissues of the face. Swelling may also affect the neck and upper arms.ImageRead Article Now Book Mark Article Slow growth rate in children Skin changes that are often seen include: Acne or skin infections Purple stretch marks (1/2 inch or 1 centimeter or more wide), called striae, on the skin of the abdomen, thighs, upper arms, and breasts StriaeStretch marks are irregular areas of skin that look like bands, stripes, or lines. Stretch marks are seen when a person grows or gains weight rapidl...ImageRead Article Now Book Mark Article Thin skin with easy bruising, most commonly on the arms and hands Muscle and bone changes include:Backache, which occurs with routine activities Bone pain or tenderness Bone pain or tendernessBone pain or tenderness is aching or other discomfort in one or more bones.ImageRead Article Now Book Mark Article Collection of fat between the shoulders (buffalo hump) Buffalo humpA hump on the upper back between the shoulder blades is an area of fat accumulation on the back of the neck. The medical name of this condition is d...Read Article Now Book Mark Article Weakening of the bones, which leads to rib and spine fractures Weak muscles causing exercise intoleranceWomen may have:Excess hair growth on the face, neck, chest, abdomen, and thighs Menstrual cycle that becomes irregular or stops Men may have:Decreased or no desire for sex (low libido) Erection problemsErection problemsAn erection problem occurs when a man cannot get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at ...ImageRead Article Now Book Mark Article Other symptoms or problems may include:Mental changes, such as depression, anxiety, or changes in behavior Mental changesConfusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...ImageRead Article Now Book Mark Article Fatigue FatigueFatigue is a feeling of weariness, tiredness, or lack of energy.Read Article Now Book Mark Article Frequent infections Headache Increased thirst and urination High blood pressure Diabetes (high blood sugar) Exams and Tests The health care provider will perform a physical examination and ask about your symptoms.Tests are done first to confirm there is too much cortisol in the body, and then to determine the cause.These tests confirm too much cortisol:24-hour urine free cortisol Urine free cortisolThe cortisol urine test measures the level of cortisol in the urine. Cortisol is a glucocorticoid (steroid) hormone produced by the adrenal gland. C...ImageRead Article Now Book Mark Article Dexamethasone suppression test (low dose) Dexamethasone suppression testDexamethasone suppression test measures whether adrenocorticotrophic hormone (ACTH) secretion by the pituitary can be suppressed.Read Article Now Book Mark Article Salivary cortisol levels (late at night and sometimes also early morning)These tests determine the cause of the high cortisol once it is confirmed:Blood ACTH level Blood ACTH levelThe ACTH test measures the level of adrenocorticotropic hormone (ACTH) in the blood. ACTH is a hormone released from the pituitary gland in the brai...ImageRead Article Now Book Mark Article Brain MRI Brain MRIA head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...ImageRead Article Now Book Mark Article Corticotropin-releasing hormone test, which acts on the pituitary gland to cause the release of ACTH Dexamethasone suppression test (high dose) Inferior petrosal sinus sampling (IPSS) -- measures ACTH levels in the veins that drain the pituitary gland compared to the veins in the chest Other tests that may be done include any of the following:Fasting blood glucose and A1C to test for diabetes Fasting blood glucoseA blood sugar test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of the...ImageRead Article Now Book Mark Article A1CA1C is a lab test that shows the average level of blood sugar (glucose) over the previous 3 months. It shows how well you are controlling your blood...ImageRead Article Now Book Mark Article Lipid and cholesterol testing Lipid and cholesterol testingThe triglyceride level is a blood test to measure the amount of triglycerides in your blood. Triglycerides are a type of fat. Your body makes some t...ImageRead Article Now Book Mark Article Bone mineral density scan to check for osteoporosis Bone mineral density scanA bone mineral density (BMD) test measures how much calcium and other types of minerals are in an area of your bone. This test helps your health care...ImageRead Article Now Book Mark Article More than one screening test may be needed to diagnose Cushing disease. Your provider may ask you to see a doctor who specializes in pituitary diseases. Treatment Treatment involves surgery to remove the pituitary tumor, if possible. After surgery, the pituitary gland may slowly start to work again and return to normal.During the recovery process from surgery, you may need cortisol replacement treatments because the pituitary needs time to start making ACTH again.Radiation treatment of the pituitary gland may also be used if the tumor is not completely removed.If the tumor does not respond to surgery or radiation, you may need medicines to stop your body from making cortisol.If these treatments are not successful, the adrenal glands may need to be removed to stop the high levels of cortisol from being produced. Removal of the adrenal glands can cause the pituitary tumor to get much bigger (Nelson syndrome). Outlook (Prognosis) Untreated, Cushing disease can cause severe illness, even death. Removal of the tumor may lead to full recovery, but the tumor can grow back. Possible Complications Health problems that may result from Cushing disease include:Blood clots in veins (deep vein thrombosis) Compression fractures in the spine Compression fracturesCompression fractures of the back are broken vertebrae. Vertebrae are the bones of the spine.ImageRead Article Now Book Mark Article Diabetes High blood pressure Infections Kidney stones Kidney stonesA kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time.ImageRead Article Now Book Mark Article Mood or other psychiatric problems Weight gain When to Contact a Medical Professional Call your provider if you develop symptoms of Cushing disease.If you have had a pituitary tumor removed, call your provider if you have signs of complications, including signs that the tumor has returned.Open ReferencesReferencesJuszczak A, Morris DG, Grossman AB, Nieman LK. Cushing's syndrome. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 13.Newell-Price JDC, Auchus RJ. The adrenal cortex. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 15.Weiss RE. Anterior pituitary. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 211.AllVideoImagesTogEndocrine glands - illustration Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).Endocrine glandsillustrationStriae in the popliteal fossa - illustration Striae in the popliteal fossa. Striae or stretch marks result from stretching of the skin, or other influences such as Cushing syndrome. Most pregnant women experience striae at some point during their pregnancy. This picture shows striae in the popliteal fossa (the area on the back side of the leg at the knee joint). When the striae first appear they have a violaceous (red-purple) color, but over time they take-on a dull white appearance.Striae in the popliteal fossaillustrationStriae on the leg - illustration Stretch marks (striae) result from rapid stretching of the skin which may occur with obesity, pubertal growth spurts, pregnancy, or from other influences such as Cushing syndrome.Striae on the legillustrationEndocrine glands - illustration Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).Endocrine glandsillustrationStriae in the popliteal fossa - illustration Striae in the popliteal fossa. Striae or stretch marks result from stretching of the skin, or other influences such as Cushing syndrome. Most pregnant women experience striae at some point during their pregnancy. This picture shows striae in the popliteal fossa (the area on the back side of the leg at the knee joint). When the striae first appear they have a violaceous (red-purple) color, but over time they take-on a dull white appearance.Striae in the popliteal fossaillustrationStriae on the leg - illustration Stretch marks (striae) result from rapid stretching of the skin which may occur with obesity, pubertal growth spurts, pregnancy, or from other influences such as Cushing syndrome.Striae on the legillustrationRelated Information Cushing syndrome(Condition)Tumor(Condition)Hyperplasia(Medical Test)Carbohydrates(Nutrition)Protein in diet(Nutrition)Diabetes(Condition)Broken bone(Injury)Kidney stones(Condition)Psychosis(Condition)High blood pressure(In-Depth)Diabetes - type 1(In-Depth)Kidney stones(In-Depth) Review Date: 5/13/2021 Reviewed By: Brent Wisse, MD, Board Certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. 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