Cushing's disease - a disease with hyperfunction of the pituitary gland

Cushing's or Itenko-Cushing's disease is a disease that is caused by a violation of the functions of the hypothalamus, pituitary gland and adrenal glands with the development of a complex of pathological changes. The disease was first described by N. Itenko in 1924, and in 1932 Cushing linked his development with the pituitary adenoma.

Causes of development of the Itenko-Cushing's disease is a basophilic adenoma of the anterior lobe of the pituitary gland or an increase in the number of basophilic cells of the pituitary gland. These changes can arise as a result of craniocerebral and psychic traumas, encephalitis, endocrine disorders.

At the heart of the development of the disease is hyperproduction by the pituitary gland of adrenocorticotropic hormone, which causes an increase in the synthesis of adrenal cortisol.

Cushing's disease - clinical picture

The disease develops gradually. Patients complain of the appearance of general weakness, drowsiness, apathy, progressive obesity. Obesity concerns mainly the upper half of the trunk. As a result, the patients form a moon-shaped face, full shoulders, hips, with disproportionately thin, atrophic forearms and legs. There is dryness and peeling of the skin, male-type haemorrhage in women, with simultaneous hair loss on the head, feminization of men. On the skin of the abdomen, shoulders, chest glands appear wide dystrophic bands of reddish purple. Over time, muscle atrophy develops in the limbs, their strength decreases. Arterial hypertension develops with kidney damage, brain complications and the development of atherosclerosis.

Itenko-Cushing's disease leads to a disruption of the mineral metabolism, the result of which is the development of osteoporosis. Owing to osteoporosis, the nerve roots are displaced and squashed, an intense pain in the limbs, a spine, the curvature of the thoracic spine develops with the formation of kyphosis, pathological fractures. The blood raises the content of calcium and cholesterol. The absorption of glucose is inhibited, as a result of which diabetes mellitus develops. Increased propensity to develop bleeding, poorly heal wounds. Patients complain of a violation of sexual function, decreased libido and potency, there are disorders of the menstrual cycle. Possible neurosis, depression, hypochondria, psychosis.

From the heart develops left ventricular hypertrophy, tachycardia, malignant symptomatic arterial hypertension. In the study of the kidneys, proteinuria, a decrease in glomerular filtration and a rate of renal blood flow are revealed. Possible development of nephrosclerosis with a deficiency in the function of these organs. In some patients, stones are detected in the kidneys.

Diagnosis of the disease

Cushing's disease is diagnosed by radiographing the skull with a targeted study of the Turkish saddle, computed tomography of the skull and adrenal glands, and angiography. Laboratory tests determine the level of the hormone cortisol in the blood and the amount of corticosteroids in the urine.

Cushing's disease - treatment

The choice of the necessary method of treatment mainly depends on the cause of the development of the disease and the severity of the clinical manifestations of the disease.

In the early stages of prescribing medications that reduce the secretion of adrenocorticotropic hormone and corticosteroids. They also use antihypertensive drugs, symptomatic therapy. The course of drug treatment lasts up to eight months. In the absence of effect, severe forms of the disease, a combination treatment consisting of radiation therapy and surgical intervention (removal of the pituitary gland or adrenalectomy) is prescribed.