Unexplained weight gain, especially in your belly and neck? Depression? Problems with memory or concentration? These common symptoms could have many causes. They could be a sign of Cushing’s disease.
Cushing's disease happens when you have too much adrenocorticotrophin hormone (ACTH). Too much ACTH causes your adrenal glands to make too much cortisol. Cortisol is your body's main stress hormone. Too much cortisol causes a number of symptoms.
Sometimes, Cushing's disease is caused by a kind of tumor of your pituitary gland. Called an ACTH-producing pituitary tumor, it's not cancer. But by putting your hormones out of balance, it does affect your whole body.
In other cases, Cushing's disease is caused by your medications. Changing your medications can improve your symptoms.
Cushing's Disease Treatment at UVA Health
Our UVA Health experts can pinpoint the source of your symptoms. They can get your hormone levels back to normal. And they can treat your tumor with surgery or radiation.
Medication can get your adrenal glands under control. It can stop them from making too much cortisol. We'll adjust your dose to get it just right.
This medication doesn't directly treat an ACTH-producing pituitary tumor.
If you have Cushing's disease because of a tumor, the best treatment is to remove it. Our neurosurgeons can remove the tumor through your nose.
We can use radiation to treat the tumor if surgery isn't right for you. We'll also use it along with surgery if we can't fully remove the tumor.
Gamma Knife radiosurgery is another option. This procedure can target the tumor directly. It also uses less radiation than conventional radiation treatment, which can last 5 weeks.
Symptoms of Cushing's Disease
Too much cortisol in your body causes:
- Weight gain, especially in the belly and neck
- Muscle loss
- Issues with sleep
- Difficulty concentrating
- Memory loss
- Infertility or other issues with sexual function
- Loss of menstrual periods
- Thin skin, easy bruising, and red marks, usually on the abdomen
- High blood pressure
- Diabetes mellitus
- Issues with your bones
- Cholesterol problems
- Heart disease
- Kidney stones
Diagnosing Cushing's Disease
Of all pituitary disorders, Cushing's disease is the most difficult to diagnose.
You'll need to go through 2 separate stages:
- The first stage establishes if you're producing cortisol
- The second stage pinpoints why you're producing too much cortisol
Screening for Cortisol Production
These three tests can check your cortisol:
- 24-hour urine-free cortisol levels
- Late-night salivary cortisol levels
- Overnight low-dose dexamethasone test
We also use these tests to confirm the diagnosis:
- Measurement of serum ACTH levels
- CRH stimulation test
- Inferior petrosal sinus sampling (done in the hospital by a specialist)
- CT or MRI scans