Cushing's disease: pathobiology, diagnosis, and management.
Cushing's disease (CD) is the result of excess secretion of adrenocorticotropic hormone (ACTH) by a benign monoclonal pituitary adenoma. The excessive secretion of ACTH stimulates secretion of cortisol by the adrenal glands, resulting in supraphysiological levels of circulating cortisol. The pathophysiological levels of cortisol are associated with hypertension, diabetes, obesity, and early death. Successful resection of the CD-associated ACTH-secreting pituitary adenoma is the treatment of choice and results in immediate biochemical remission with preservation of pituitary function. Accurate and early identification of CD is critical for effective surgical management and optimal prognosis. The authors review the current pathophysiological principles, diagnostic methods, and management of CD.
Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Russell R
RR
Lonser
Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; and.
Lynnette
L
Nieman
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
Edward H
EH
Oldfield
D006801:Humans; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy
ATCH = adrenocorticotropic hormone; CD = Cushing's disease; CRH = corticotropin-releasing hormone; CRH-R1 = CRH receptor-1; CS = Cushing's syndrome; Cushing's disease; IPSS = inferior petrosal sinus sampling; SPGR = spoiled gradient recalled; SRS = stereotactic radiosurgery; diagnosis; oncology; surgery; treatment