ACTH Adenoma (Cushing Syndrome)

A benign tumor of the pituitary gland that leads to excess cortisol (stress hormone) production in the body.

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Skull Base and Pituitary Surgery

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1Overview

Quick and clear information for patients

What is this Condition?

Cushing disease results from a benign tumor of the pituitary gland at the base of the brain that secretes excessive ACTH hormone, which continuously stimulates the adrenal glands. This stimulation causes overproduction of cortisol, a stress hormone in the body. Persistently elevated cortisol gradually produces distinctive changes: facial rounding, weight gain in the torso, purple stretch marks on skin, easy bruising, elevated blood pressure and blood sugar. Because symptoms develop gradually, recognition may be delayed. The tumor is usually small. Early diagnosis is important because untreated disease can have serious effects on the heart, blood vessels, and immune system.

Symptoms

Facial rounding (moon facies) and weight gain in torso and abdomen

Wide purple-red stretch marks on skin; easy bruising and slow-healing wounds

Muscle weakness in arms and legs (difficulty rising from chair, climbing stairs)

High blood pressure and elevated blood sugar

Bone weakening (osteoporosis), bone pain

Psychological changes: depression, anxiety, sleep and memory problems; menstrual irregularities in women

Diagnosis Methods

Diagnosis is made in two stages. First, the presence of cortisol excess is investigated using 24-hour urine cortisol measurement, late-night salivary cortisol sample, and low-dose suppression testing. In the second stage, whether this excess originates from the pituitary is determined; blood ACTH hormone is measured and MRI of the pituitary gland is obtained. If the tumor is very small, special blood sampling may be needed to determine its location.

Treatment Methods

The first-line treatment in Cushing disease is typically surgery; the tumor is removed via endoscopic transsphenoidal approach, and cortisol levels normalize in many patients. When surgery is insufficient or inappropriate, oral medications that reduce cortisol production are used. When these are inadequate, radiation therapy or adrenalectomy may be considered. The goal is to eliminate cortisol excess and reduce risks to the heart, blood vessels, and other organs.

Tumor removal via endoscopic transsphenoidal surgery (first-line treatment)

Oral pharmacological therapies that reduce cortisol production

Radiation therapy (radiotherapy) when other options are insufficient

Adrenalectomy via endoscopic approach when necessary, at physician's discretion

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Transsfenoidal hipofizektomi, endoskopik

Transsfenoidal hipofizektomi, endoskopik procedure

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Transsfenoidal hipofizektomi (adenomektomi)

Transsfenoidal hipofizektomi (adenomektomi) procedure

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CSF Fistula Surgery (Transsphenoidal Route)

CSF Fistula Surgery (Transsphenoidal Route) procedure

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Skull Base Dural Repair

Skull Base Dural Repair procedure

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References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.
Melmed S, ed. The Pituitary. 4th ed. London: Academic Press/Elsevier; 2017.
Honegger J, Reincke M, Petersenn S, eds. Pituitary Tumors: A Comprehensive and Interdisciplinary Approach. London: Academic Press/Elsevier; 2021.
Nieman LK, Biller BMK, Findling JW, et al. Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015:2807-2831.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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ACTH Adenoma (Cushing Syndrome)

Skull Base and Pituitary Surgery

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Transsfenoidal hipofizektomi, endoskopik

Transsfenoidal hipofizektomi (adenomektomi)

CSF Fistula Surgery (Transsphenoidal Route)

Skull Base Dural Repair

References

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Transsfenoidal hipofizektomi, endoskopik

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Skull Base Dural Repair

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