Long Term Remission Rates after Pituitary Surgery for Cushing's Disease

Cushing’s syndrome is a rare endocrine disorder that occurs when your body is exposed to an overabundance of the hormone cortisol.3 Cortisol is known as the stress hormone. The interruption of cortisol secretion can cause weight gain and can ultimately determine where you put the weight on.8 There are many underlying causes such as Pituitary Adenomas, Ectopic ACTH Syndrome, Adrenal Tumors, and Familial Cushing’s Syndrome.2 The majority of these people affected by this hormonal disorder experience weak muscles, increase fat, high blood pressure, etc.1 Although thousands are affected in various ways, there are currently several channels of treatment administered by medical professionals. Through the use of improving technology, medical professionals are better understanding the disorder, allowing them to develop better treatment practices.

Clinical Manifestations: (What are the textbook signs & symptoms of the disease? *Highlight the s/s your patient has.)

This case study presents a clinical situation related to the endocrine system. The questions at the each segment of the case will test your understanding of the endocrine system.

Cushing 's syndrome (CS) is characterized by pathologically elevated free glucocorticoid levels. Endogenous hypercortisolism is usually due to ACTH-secreting pituitary corticotropic adenomas and less often due to ectopic ACTH-secreting neuroendocrine neoplasms or ACTH-independent adrenal cortisol hypersecretion (Yaneva, 2010). Cushing 's disease occurs infrequently in an inherited setting in both of these conditions (Yaneva, 2010).

What parts of the body does it affect? How common is it? Are there multiple forms/causes for developing the condition? How long can an individual survive?

O B J E C T I V E S 1. To define the following terms: metabolism, hormone replacement therapy, type 1 diabetes, type 2 diabetes, and glucose standard curve. 2. To explain the role of thyroxine in maintaining an animal’s metabolic rate. 3. To explain the effects of thyroid-stimulating hormone on an animal’s metabolic rate. 4. To understand how estrogen affects bone density. 5. To explain how hormone replacement therapy works. 6. To explain how fasting plasma glucose is used to diagnose diabetes. 7. To understand how levels of cortisol and ACTH can be used to diagnose endocrine diseases.

1. Cushing's disease is a hormonal disorder which is caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. It is sometimes referred to as hypercortisolism, it is fairly rare and it most commonly affects adults between the ages of 20 to 50. There is an estimated 10 to 15 of every million people who are affected every year.

It is important to distinguish between Cushing disease and Cushing syndrome. While both are based on high levels of cortisol circulating in the body, Cushing disease is specifically caused by a generally benign tumor of the pituitary gland which secretes excess levels of adrenocorticotropic hormone (ACTH), leading to overproduction of cortisol in the adrenal glands. Cushing syndrome, on the other hand, refers to the symptoms caused by elevated levels of cortisol in the body due to any cause, and is also called hypercortisolism or hyperadrenocorticism. In addition to the Cushing disease promoting pituitary tumor, a number of additional circumstances may lead to the development of Cushing Syndrome. Elevated levels of cortisol often are a result of a prolonged use of corticosteroids, which may be prescribed for the treatment of allergies, asthma, or autoimmune diseases. However, elevated cortisol levels may also occur with cancerous or benign tumors of the ACTH-producing lungs, pancreas, or thyroid stimulating an excess production of cortisol. Cushing syndrome is fairly rare, affecting 10 -15

Heather et al showed a stimulation test referred to as the metyrapone test. This test not only measures the potential increase in a cortisol level of the patient, but also causes the shunting of endocrine products to make more cortisol due to inhibiting the further progression of precursors to other hormones such as sex hormones. This type of stimulation test was not found in other articles that were reviewed for this paper. It would be helpful to see how often and how beneficial a test such as the metyrapone test is over a possible standard ACTH stimulation test (high or low dose).

The basic cause for Equine Cushing's Disease is the lack of dopaminergic control within the intermediate lobe. As a result peptide hormones are overly secreted into the body. Melanotrophs of the intermediate lobe release pro-opiomelanocortin (POMC) into the body. This is then split to form three hormones: α-melanocyte–stimulating hormone (α-MSH), β-endorphin (β-END)–related peptides and corticotropin-like intermediate peptide (CLIP). Normally, dopamine binds to 2 inhibitory receptors on the melanotrophs, stoping the production of hormones. This function is lacking in individuals with Equine Cushing's Disease. Consequentially hypertrophy, hyperplasia, and over production of POMC peptides occur in the intermediate lobe of the pituitary gland.

Choice "E" is the best answer. Cushing syndrome is a clinical syndrome associated with an excess of glucocorticoids(GCs), due either to elevated levels of endogenous cortisol or exogenous use of glucocorticoid medications such as prednisone, prednisolone, hydrocortisone, and betamethasone. Common signs and symptoms include altered fat deposition (including “moon facies” and “buffalo hump”, referring to fat deposition in the face and the upper back), weight gain, hypertension, striae, acne, hyperglycemia, and central muscle weakness. Treatment involves cessation of glucocorticoid therapy, though a taper is crucial, as abrupt withdrawal can lead to acute adrenal insufficiency and shock. In non-endocrine disorders, GCs are commonly given in pharmacologic (therapeutic) doses to suppress inflammation. In endocrine disorders, however, corticosteroid doses are often given at or close to physiologic doses (rather than in therapeutic ranges). GC-associated toxicity appears to be related to both the average dose and cumulative duration of GC use. However, for most GC-related adverse events, “threshold” dose or treatment duration has not been established.

A more recent and less invasive treatment for Cushing’s disease is photonic therapy treatment. This treatment is similar to acupuncture. The difference between this treatment and acupuncture is that a special red light is used to stimulate acupuncture points instead of using needles. It was pioneered by a leading veterinary surgeon twenty years ago.

The presence of a medical conditions such as hormonal or genetic disorders can predispose a child to obesity. Hypothyroidism is a hormonal condition where the thyroid gland produces an insufficient amount of thyroid hormone. The deficiency of the thyroid hormone slows the metabolism causing the child to add on unnecessary weight. Another hormonal condition is Cushing’s Syndrome, which results when the adrenal glands produce an excess amount of a steroid hormone called cortisol. Cortisol can help control blood sugar levels and regulate metabolism. Excess amount of the steroid hormone leads to a buildup of fat in the face, abdomen, and upper back. Therefore, obesity can be a result of having a metabolic disorder.

Cushing’s Syndrome is a condition that results from chronic exposure to excessive amounts of glucocorticoids circulating in the blood stream for an extended period of time. The disease was first reported by Harvey Cushing over one hundred years ago, yet the condition still plagues endocrinologists today. Reasons for this difficulty include the vast amount of often vague symptoms that the syndrome presents, most of which are found in a plethora of other conditions as well, combined with the multiple forms that the condition can manifest itself. Symptoms of Cushings Syndrome include, but are not limited to, weight gain, hirutism, easy bruising, hypertension, acne, facial plethora, muscle weakness, striae, depression,

This is further backed up by a study(23) conducted in women who suffered from hypothalamic amenorrhoea. That means they have no periods because of insufficient GnRH production. The levels of leptin in these patients were discovered to be abnormally low. After being given recombinant leptin mean LH concentrations and LH pulse frequency was significantly