Cushing’s disease is one of the hardest diagnosis to make, requires multiple blood, urine, and salivary tests to diagnose, dynamic hormone stimulatory and inhibitory tests, 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) scan produce detailed images of the brain and allow doctors to detect the presence of a tumor. At times a special MRI protocol is needed as some tumors that cause Cushing disease are very small and regular brain MRIs might not pick them up. The test is noninvasive but requires 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 ACTH production from the tumor, cortisol production from the adrenals or block its effects at the receptor level. At times pituitary radiation is recommended or even bilateral adrenalectomy. For each patient the treatment is highly individualized considering all available surgical, medical and radiation tools as well as clinical trials.
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, 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.
Our Care Team
- Vice Chair for Clinical Research
- David and Ursel Barnes Professor in Minimally Invasive Surgery
- Professor of Neurosurgery, Neurology, and Otolaryngology
- Director, Center for Epilepsy and Pituitary Surgery
- Co-Director, Surgical Neuro-oncology
- Assistant Professor of Neurological Surgery
- Leon Levy Research Fellow
- Feil Family Brain and Mind Research Institute
- Assistant Professor of Neuroendocrinology in Neurological Surgery, Weill Cornell Medicine
- Director, Neurosurgical Radiosurgery
- Professor of Clinical Neurological Surgery
- Robert G. Schwager, MD ’67 Education Scholar, Cornell University
- Chief of Neurological Surgery, NewYork-Presbyterian Queens
- Co-director, Weill Cornell Medicine CSF Leak Program
- Chief of Neurological Surgery, NewYork-Presbyterian Brooklyn Methodist
- Alvina and Willis Murphy Associate Professor, Neurological Surgery
- Director, Brain Metastases Program
- Co-director, William Rhodes and Louise Tilzer-Rhodes Center for Glioblastoma
Reviewed by: Georgiana Dobri, M.D.
Last reviewed/last updated: December 2020