Cushing's Disease

Cushing's disease: symptoms, etiology and treatment

Cushing's disease is an endocrine disease characterized by increased production of corticosteroid hormones due to hypersecretion of ACTH (adrenocorticotropic hormone) of pituitary origin. It is more common in middle-aged women. It is important to distinguish it from Itsenko-Cushing syndrome, which is caused by the presence of a tumor (benign or malignant) or bilateral micronodular hyperplasia of the adrenal cortex.

The reasons for the development of Cushing's disease are not entirely clear. In most patients it is associated with pituitary tumors (microadenomas or macroadenomas). In women, the disease often develops after childbirth, and can also occur in childhood and old age.

The pathogenesis of Cushing's disease is associated with a disruption of the “feedback mechanism” in the body. This occurs due to a decrease in the sensitivity of the hypothalamic-pituitary system to cortisol, which is the main hormone of the adrenal cortex. This defect results in uncontrolled secretion of ACTH and other adrenal hormones such as cortisol, corticosterone, aldosterone and androgens. The exact mechanisms of this phenomenon are not fully known, but the dopaminergic system is believed to play an important role in the development of the disease. An increase in ACTH secretion is in some cases accompanied by an increase in the release of prolactin, and the production of other tropic hormones, such as somatotropic, luteinizing and follicle-stimulating hormones, decreases due to the hypersecretion of cortisol and its effect on the function of the hypothalamus.

Symptoms of Cushing's disease are varied and may include:

1. Excessive fat deposits in the face, neck and torso, giving the face a moon-shaped appearance.
2. Thin limbs.
3. Dry, thin skin, acquiring a purplish-cyanotic hue on the face and chest area.
4. Acrocyanosis (bluish discoloration of the extremities).
5. Pronounced venous pattern on the chest and limbs, as well as stretch marks on the skin of the abdomen, thighs and inner surfaces of the shoulders.
6. Hyperpigmentation of the skin, especially in the folds (knuckles, elbows, knees), nipples, genitals and scars.
7. Muscle weakness, muscle atrophy and susceptibility to fractures.
8. Hypertension and edema.
9. Menstrual cycle disorders in women.
10. Decreased libido and erectile dysfunction in men.
11. Increased vulnerability to infectious diseases.
12. Mental disorders such as depression, anxiety, irritability and psychosis.

The diagnosis of Cushing's disease involves clinical assessment of symptoms and physical examination, as well as laboratory tests. To confirm the diagnosis, tests are performed for the secretion of corticosteroids and ACTH, as well as the formation of cortisol when the hypothalamic-pituitary system is suppressed.

Treatment for Cushing's disease can be conservative or surgical, depending on the cause and severity of the disease. Conservative treatment includes taking medications that reduce cortisol levels, such as mitotane and ketoconazole. However, these drugs can have serious side effects and require careful monitoring. Surgical treatment involves removal of the pituitary tumor responsible for hypersecretion of ACTH. In some cases, removal of both adrenal glands is required.

After treatment, it is important to carry out regular medical monitoring and optimize corticosteroid replacement therapy to prevent cortisol deficiency. Left untreated or inadequately treated, Cushing's disease can lead to serious complications, including diabetes mellitus, hypertension, osteoporosis, infectious diseases and mental disorders.

It is important to see your doctor if you suspect Cushing's disease or experience symptoms. Only a qualified medical specialist can make a diagnosis and prescribe appropriate treatment.