Cushing's syndrome is a debilitating endocrine disorder characterized by excessive cortisol levels in the blood which may be the result of a tumor of the pituitary gland, adrenal glands (located above the kidneys) or from tumors or cancer arising elsewhere in the body (ectopic ACTH producing tumors). Cushing's disease refers specifically to excessive ACTH secretion by a pituitary tumor (also called pituitary adenoma). The cause of Cushings Syndrome is a pituitary adenoma in over 70% of adults and in approximately 60-70% of children and adolescents. Most pituitary ACTH-secreting adenomas are small in size (microadenomas). Overall, Cushings Disease is relatively rare, affecting 10 to 15 of every million people each year, and most commonly affects adults aged 20 to 50 years. Women account for over 70% of cases.
The Management of Residual and Recurrent Cushing's Disease
Transsphenoidal surgery is the initial treatment of choice for most patients with proved or highly suspected Cushing's disease. Published reports demonstrate that at experienced centers, such as the California Center for Pituitary Disorders at UCSF, remission following surgery can be expected in 80 to 90% of patients with microadenomas and 50 to 60% of patients with macroadenomas. Recurrent hypercortisolism can be expected in approximately 10% of patients with microadenomas and 30% of patients with macroadenomas who enter remission after surgery. Thus, a number of patients will still require additional therapy after initial surgery.
When faced with patients who have persistent or recurrent hypercortisolism due to clearly documented ACTH-producing pituitary tumors, one must carefully consider the different treatment alternatives in the context of the affected patient. Ideal therapeutic strategies include those that are directed at resolution of the hypercortisolism and also control the offending tumor. In many cases, however, these objectives of treatment must be dealt with independently. Patients should be advised of the available treatments, the expected outcomes, risks, inconveniences, and costs so that they can make informed decisions on how best to proceed. Referral to a tertiary medical center should be seriously considered.
Patients may need help managing metabolic and endocrine disorders with healthy eating and lifestyle choices, and now there's a comprehensive set of clinical guidelines, issued jointly by the American Association of Clinical Endocrinologists, the American College of Endocrinology, and the Obesity Society, to assist them.
The new guidelines cover topics that include nutritional recommendations for weight management, cardiovascular health, chronic kidney disease, diabetes, bone health, pregnant women and mothers who are breastfeeding, and older patients, according to J. Michael Gonzalez-Campoy, MD, PhD, and colleagues on the joint Task Force on Healthy Eating Clinical Practice Guidelines.
By Bruce Jancin, Family Practice News Digital Network
ESTES PARK, COLO. – Diabetes mellitus, osteoporosis, and hypertension are conditions that should boost the index of suspicion that a patient with some cushingoid features may in fact have endogenous Cushing's syndrome, Dr. Michael T. McDermott said at a conference on internal medicine sponsored by the University of Colorado.
An estimated 1 in 20 patients with type 2 diabetes has endogenous Cushing's syndrome. The prevalence of this form of hypercortisolism is even greater – estimated at up to 11% – among individuals with osteoporosis. In hypertensive patients, the figure is 1%. And among patients with an incidentally detected adrenal mass, it's 6%-9%, according to Dr. McDermott, professor of medicine and director of endocrinology and diabetes at the University of Colorado.
By Sherry Boschert, Clinical Endocrinology News Digital Network
SAN FRANCISCO – Measurements of prolactin levels during inferior petrosal sinus sampling did not help localize pituitary adenomas in patients with Cushing's disease in a study of 28 patients, contradicting findings from a previous study of 28 patients.
The value of prolactin measurements in tumor localization using inferior petrosal sinus sampling (IPSS) remains unclear and needs further study in a larger, prospective study, Dr. Susmeeta T. Sharma said at the Endocrine Society's Annual Meeting. The current and previous studies were retrospective analyses.