Cushing's Disease

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Diagnosing and Treating Cushing's Disease

Cushing’s disease requires multiple blood, urine, and salivary tests to diagnose, and at times even blood sampling from near the pituitary (inferior petrosal sinus sampling, or IPSS) to determine that a pituitary tumor is the culprit. When the syndrome is suspected or diagnosed, a patient will need a workup to determine what’s causing the hormonal excess. It is recommended that the work-up and interpretation be done at a medical center with expertise in neuroendocrine tumors, as accurate diagnosis is fundamental and often hard to derive. 

Magnetic resonance imaging (MRI) and computerized tomography (CT) scans produce detailed images of the brain and allow doctors to detect the presence of a tumor. Both of these tests are noninvasive, but they do require time in a scanner to produce tiny slices of images that are then combined into three-dimensional pictures. Sometimes the patient will need a special contrast agent in advance to increase the visibility of any abnormality found.

Treatment Options
Cushing’s disease may be able to be treated surgically, by removing the pituitary tumor causing the overproduction of cortisol. (See Surgery for a Pituitary Tumor.) In cases where surgery is not recommended, pituitary tumors may be treated with medication to suppress cortisol production to suppress or block its effects at the receptor level, or at times with radiation.

Pituitary tumors are complex lesions that should be treated at major medical centers, by a team experienced in the diagnosis and treatment of tumors affecting the hormones. Weill Cornell Brain and Spine Center is fortunate to be home to an internationally recognized surgical team with advanced skills in minimally invasive procedures to remove pituitary tumors. Neurosurgeon Theodore Schwartz, MD, and otolaryngological (ENT) surgeon Vijay Anand, MD, routinely use endonasal (through the nose) approaches to removing pituitary tumors, with no head or facial scarring. (See video of endonasal surgery technique.) The team has operated successfully on tumors that other surgeons have deemed impossible to remove. (See video of patient who had a giant tumor removed endonasally.) Dr. Dobri is well versed in all available medications for Cushing's disease, and has taken care of many patients with complex disease that requires combination medical therapy.

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Reviewed by: Georgiana Dobri, M.D.
Last reviewed/last updated: June 2018