Cushing's Disease
Table of Contents
What Is Cushing’s Disease?
Cushing’s disease is an endocrine disorder that occurs when the body produces an excessive amount of the hormone cortisol. Cortisol is a hormone produced by the adrenal glands and plays a role in the body’s stress response, metabolic balance, blood pressure regulation, and immune system function. However, the long-term presence of this hormone at high levels leads to serious health problems.
Prof. Dr. Ömür Günaldı explains that Cushing’s disease is mostly caused by a tumor (adenoma) that develops in the pituitary gland. This tumor secretes excessive adrenocorticotropic hormone (ACTH), which increases cortisol production.
Although this disease is rare, its diagnosis and treatment require special expertise. If not diagnosed in time, it can lead to permanent problems such as heart disease, diabetes, hypertension, and osteoporosis.
Difference Between Cushing’s Disease and Cushing’s Syndrome
Cushing’s syndrome includes all conditions that lead to elevated cortisol levels in the body.
Cushing’s disease, on the other hand, is the form that originates specifically from the pituitary gland. In other words, every Cushing’s disease is a Cushing’s syndrome, but not every Cushing’s syndrome is Cushing’s disease.
Prof. Dr. Ömür Günaldı emphasizes that this distinction is crucial in terms of treatment approach, as surgical planning changes depending on the source of the disease.
Causes of Cushing’s Disease
The primary cause of Cushing’s disease is a small, benign tumor in the pituitary gland. This tumor produces excessive ACTH. ACTH stimulates the adrenal glands to secrete excessive cortisol.
Main Causes
- Pituitary adenoma (most common cause)
- Long-term use of corticosteroid medications (secondary cause)
- Tumors producing ectopic ACTH (lung, pancreas, etc.)
- Rarely, tumors of the adrenal gland
Prof. Dr. Ömür Günaldı states that in the majority of patients, surgery is the primary treatment for pituitary-origin tumors and that early intervention is important for restoring cortisol balance.
Symptoms of Cushing’s Disease
Excess cortisol affects almost all systems of the body. Since symptoms develop slowly, patients often live with the condition for a long time without noticing it.
Physical Symptoms
- Rounding of the face (moon face)
- Fat accumulation on the back of the neck (buffalo hump)
- Weight gain around the abdomen while arms and legs remain thin
- Thinning of the skin, purple stretch marks
- Acne and facial hair growth
Metabolic Symptoms
- High blood sugar (hyperglycemia, development of diabetes)
- High blood pressure
- Muscle wasting and weakness
Psychological Symptoms
- Anxiety, depression, irritability
- Sleep disturbances
Symptoms in Women
- Menstrual irregularities
- Excess hair growth on the face and body (hirsutism)
- Difficulty becoming pregnant
Symptoms in Men
- Reduced sexual desire
- Low testosterone levels
Prof. Dr. Ömür Günaldı notes that changes in body shape and muscle weakness are among the most important clues in Cushing’s disease and that early diagnosis is possible when these symptoms are taken seriously.
How Is Cushing’s Disease Diagnosed?
The diagnostic process is quite detailed because cortisol imbalances may arise from different underlying causes.
Hormone Tests
- 24-Hour Urine Cortisol Test: Measures the average cortisol level.
- Low-Dose Dexamethasone Test: Evaluates cortisol suppression response.
- Plasma ACTH Test: Determines whether the disease is pituitary-origin.
Imaging Tests
- Brain MRI: Detects the presence of an adenoma in the pituitary gland.
- Adrenal MRI or CT: Used to assess whether there is a tumor in the adrenal glands.
Prof. Dr. Ömür Günaldı emphasizes that diagnosis is based not only on hormone levels but also on the combined evaluation of clinical symptoms and MRI findings.
Treatment of Cushing’s Disease
Treatment is planned according to the source of the disease. The goal is to stop excessive cortisol production and restore hormonal balance.
Pituitary Surgery
This is the primary treatment method. Removal of the tumor aims to normalize ACTH production.
Surgery is usually performed through the nose using the endoscopic transsphenoidal approach.
Prof. Dr. Ömür Günaldı states that pituitary surgery can be performed using minimally invasive techniques.
Medication
Used in patients who are not suitable for surgery or when the tumor cannot be completely removed. These medications suppress cortisol production.
Radiotherapy
Applied when tumor residue remains after surgery. However, its effect appears slowly; therefore, it is often supported with temporary medication.
Adrenal Surgery
In rare cases, the adrenal glands may be removed completely. In this situation, the patient must take lifelong hormone replacement.
Prof. Dr. Ömür Günaldı emphasizes that the treatment process should be personalized and that surgery, medication, and radiotherapy may be combined when needed.
Pituitary Surgery Process
Pituitary surgery used in Cushing’s disease is performed through the inside of the nose. The surgeon reaches the pituitary gland with the help of an endoscope and carefully removes the tumor tissue.
Prof. Dr. Ömür Günaldı explains the advantages of this method:
- No direct intervention on brain tissue
- Aims to protect the eyes and nervous structures
- Performed through the nose without an external incision
- Recovery time varies from person to person
Most patients’ cortisol levels return to normal within a few days after surgery.
Complications of Cushing’s Disease
Untreated Cushing’s disease may lead to serious organ damage in the long term.
Cardiovascular System
Hypertension, heart enlargement, and arrhythmias may develop.
Skeletal System
Excess cortisol increases bone breakdown and leads to osteoporosis.
Metabolic Effects
Diabetes, obesity, and high cholesterol are common.
Infection Risk
Since cortisol suppresses the immune system, susceptibility to infections increases.
Prof. Dr. Ömür Günaldı notes that the greatest long-term risk of the disease is cardiovascular problems and emphasizes that early treatment may reduce these risks.
Recovery After Cushing’s Disease Surgery
Cortisol levels decrease rapidly after surgery. During this period, patients may experience fatigue and weakness as the body adjusts to lower cortisol levels.
- Hormone replacement may be required in the first weeks.
- Hormone levels gradually return to normal.
- Visual disturbances and headaches usually improve quickly.
Prof. Dr. Ömür Günaldı states that regular hormone tests after surgery are essential and that the success of treatment is evaluated through long-term follow-up.
Psychological Effects of Cushing’s Disease
High cortisol levels may cause depression, anxiety disorders, and mood changes.
These symptoms decrease as hormones return to normal after surgery.
Prof. Dr. Ömür Günaldı emphasizes that psychological support is also an important part of the recovery process.
Nutrition and Lifestyle in Cushing’s Disease
Healthy nutrition, exercise, and stress management are very important during treatment.
Diet Recommendations
- Reduce sugar and salt intake
- Drink plenty of water
- Consume foods rich in vitamin D and calcium
- Include fresh vegetables and fruits in your diet
Exercise
Regular walking and light exercise protect bone health and increase muscle strength.
Stress Management
Meditation, breathing exercises, and adequate sleep help regulate cortisol levels.
Prof. Dr. Ömür Günaldı notes that maintaining healthy lifestyle changes after treatment supports general health.
Cushing’s Disease and Pregnancy
Pregnancy is rare in women with Cushing’s disease because hormonal imbalance prevents ovulation.
If hormonal balance is restored after treatment, normal pregnancy becomes possible.
Prof. Dr. Ömür Günaldı recommends completing surgical treatment and stabilizing hormone levels before planning pregnancy.
Costs of Cushing’s Disease Treatment
Costs vary depending on diagnostic tests, surgical method, length of hospital stay, and additional treatment needs.
Prof. Dr. Ömür Günaldı creates a personalized plan according to the patient’s medical needs.
Follow-Up Process in Cushing’s Disease
After treatment, hormone levels are monitored through regular check-ups.
- Frequent tests are performed during the first 6 months.
- MRI scans are used to evaluate the pituitary region.
- As cortisol levels stabilize, medications are gradually reduced.
Prof. Dr. Ömür Günaldı emphasizes that regular follow-up is important for detecting recurrence early.
Success Rates in Cushing’s Disease Treatment
Early diagnosis is important for treatment.
Most patients regain hormonal balance within 3–6 months after surgery.
Prof. Dr. Ömür Günaldı states that treatment success depends not only on surgery but also on nutrition, stress management, and regular medical follow-up.
Can Cushing’s Disease Be Prevented?
It is not directly preventable, but complications can be avoided with early diagnosis.
- Hormone testing is recommended when symptoms such as long-term weight gain and facial rounding are noticed.
- Cortisone-containing medications should not be used without medical supervision.
Prof. Dr. Ömür Günaldı notes that as awareness increases, the disease can be detected at an earlier stage, preventing permanent damage.
Cushing’s disease is a serious endocrine disorder that disrupts cortisol balance in the body. Early diagnosis, proper treatment, and a multidisciplinary approach are important in its management.
Modern pituitary surgery techniques aim to improve patients’ quality of life.
Prof. Dr. Ömür Günaldı provides personalized treatment planning for Cushing’s disease.
When hormonal balance is achieved, physical and emotional symptoms may improve.
Recognizing Cushing’s disease early opens the door to a healthier life.