From the Guidelines
Cushing's disease is a specific form of Cushing's syndrome caused by a pituitary adenoma secreting excess adrenocorticotropin (ACTH), whereas Cushing's syndrome is a broader condition characterized by excessive cortisol in the body, which can result from various causes, including exogenous steroid use, adrenal tumors, or ectopic ACTH production. The distinction between these two conditions is crucial for proper diagnostic workup and treatment planning, as addressing the specific cause is essential for successful management 1.
Key Differences
- Cushing's disease is caused by a pituitary adenoma, whereas Cushing's syndrome can result from various causes, including exogenous steroid use, adrenal tumors, or ectopic ACTH production 1.
- Both conditions share similar symptoms, including moon face, buffalo hump, central obesity, purple striae, hypertension, hyperglycemia, and muscle weakness 1.
- Diagnosis involves measuring cortisol levels through 24-hour urinary free cortisol, late-night salivary cortisol, or dexamethasone suppression tests, and determining the cause helps distinguish Cushing's disease from other forms of Cushing's syndrome 1.
Treatment
- For Cushing's disease, transsphenoidal surgery to remove the pituitary adenoma is the first-line treatment 1.
- Other forms of Cushing's syndrome may require adrenalectomy, tumor removal, or discontinuation of exogenous steroids 1.
- Understanding the distinction between Cushing's disease and Cushing's syndrome is essential for proper treatment planning and management, as highlighted in the consensus guidelines updated in 2021 1.
Clinical Implications
- Accurate diagnosis and treatment of Cushing's disease and Cushing's syndrome are critical to optimize patient outcomes and reduce morbidity and mortality 1.
- The Pituitary Society's consensus workshop and guideline update provide recommendations for screening, diagnosis, and management of Cushing's disease, emphasizing the importance of personalized care and consideration of patient- and disease-specific factors 1.
From the Research
Definition and Causes
- Cushing's disease is a specific type of Cushing's syndrome, caused by an adrenocorticotropin (ACTH) secreting pituitary adenoma, leading to excessive secretion of cortisol from the adrenal glands 2, 3, 4, 5.
- Cushing's syndrome, on the other hand, is a broader term that refers to a condition caused by excess cortisol in the body, which can be due to various reasons, including pituitary tumors, adrenal tumors, or other causes 3, 5.
Key Differences
- The primary difference between Cushing's disease and Cushing's syndrome is the underlying cause of the excess cortisol production. Cushing's disease is specifically caused by a pituitary adenoma, while Cushing's syndrome can be caused by a variety of factors 2, 3, 4, 5.
- Cushing's disease is the most common cause of endogenous Cushing's syndrome, accounting for approximately 80% of all cases 2.
Treatment Options
- Treatment options for Cushing's disease include transsphenoidal surgery, radiation therapy, medical therapy, and bilateral adrenalectomy 2, 3, 4, 5, 6.
- The treatment of choice for Cushing's disease is neurosurgical tumor removal of the pituitary adenoma, which can be repeated if unsuccessful 2, 3, 4, 6.
- Medical therapy is often used as a second-line treatment option, or to control hypercortisolism before surgery, and can include medications that inhibit adrenal steroidogenesis or decrease ACTH production 2, 3, 4, 5.