Cushing disease

Cushing disease refers to Cushing syndrome caused by an adrenocorticotrophic hormone (ACTH)-secreting pituitary adenoma. Transsphenoidal removal of the adenoma is the optimal treatment for Cushing disease. Following successful surgery, the patient will be transiently glucocorticoid deficient. Use glucocorticoid replacement as for hypopituitarism until the pituitary–adrenal axis recovers (typically several months, and up to a year), then gradually withdraw the glucocorticoid. Remission rates vary between 65 and 90% for microadenomas and up to 65% for macroadenomas; up to 25% of patients who have initial remission will experience recurrence within 10 years.

Radiotherapy can also be used to treat Cushing disease, but it can take several months to years to achieve biochemical normalisation. Drug therapy to block cortisol production is used in the interim.

See also Cushing syndrome.