What is Cushing's syndrome? The state in which the body produces too much cortisol is called Cushing's syndrome. Cortisol is also sometimes known as a hormone whose production increases in times of stress and is a natural steroid hormone that is like the "cortisone" in some medicines. Cushing's syndrome can be caused because the body produces too much cortisol or for taking too many drugs on the type of cortisone.

What causes Cushing's syndrome? The most common cause of Cushing's syndrome is the type of drugs taking cortisone orally (by mouth) every day for months or weeks. Prednisone is the most common medicine that is taken in this way.

Steroid medicines for asthma and inhaled steroid creams for eczema and other skin conditions do not cause Cushing's syndrome. Even oral medicines taken daily for short periods of time or every other day for longer periods do not often cause Cushing's syndrome.

The second most common cause of Cushing's syndrome is Cushing's disease. Tumors in the adrenal glands or elsewhere in the body can also cause Cushing's syndrome.

What is Cushing's disease? Cushing's disease is the name doctors use when Cushing's syndrome is caused by a pituitary gland tumor. The pituitary gland is located at the bottom of the brain that controls the body's production of cortisol. These small tumors can cause the adrenal glands, located near the kidneys, produce too much cortisol.

Tumors in the pituitary gland in Cushing's disease are usually not cancerous. However, if the tumors grow too much they can cause problems with your vision. What are the Cushing’s disease symptoms and the Cushing’s syndrome signs?

Cushing’s disease symptoms can form fatty deposits around your stomach and your upper back, but arms and legs stay thin and do not usually get fatter. Your skin gets thinner and is easily bruised. Cuts, scrapes and insect bites are slow to heal. You can form streaks of pink or purple skin. The face may become round and bloated. You may feel tired and have muscle weakness. You may feel depressed

Women usually have irregular menstrual periods and they may grow thick or body hair that is more visible than usual. High blood pressure, osteoporosis (weak and brittle bones) and the levels of blood sugar above normal may be signs of syndrome or Cushing's disease. Often you are given skin infections or other infections, and they take longer to heal.

How does my doctor know if I have Cushing syndrome or disease? Your doctor may start by asking some questions and a physical examination. If the cause is a medicine you are taking, no tests are needed. If your doctor thinks you have Cushing syndrome or disease, but does not include drugs that are causing this, you may need to have some blood tests and urine tests.

You may be asked to collect your urine for 24 hours. Your doctor will explain how to do this test. You may also be given a medicine called dexamethasone before collecting the blood or urine. This tests your response to steroids. At some point you may need a computed tomography (CAT or CT scan) or examination (magnetic resonance imaging or MRI). These tests show a "snapshot" of the inside of your body. Looking at these pictures, your doctor can determine whether there are tumors on the pituitary gland or other parts of your body.

Pituitary tumors are pathological processes occurring in the pituitary gland, a structure with endocrine activity, located in the brain. Although its dimensions are very small, the pituitary has a very important role in the secretion of hormones that affect various organs and systems and participate generally in the maturing of the body.



Pituitary tumors represent 10-25% of all intracranial tumors by location. Pituitary disease symptoms are usually found in close examination because they are not immediately apparent as clear-cut signs of disease. Pituitary tumors are classified into 3 groups: Benign adenomas - tumors that are not cancer - They have a very slow growth rate and are not able to metastasize (to expand through the blood stream, the lymphatic system, in other parts of the body, at a distance from where the initial neoplasia took place).

Invasive pituitary adenomas - are tumors that are capable of expansion and invasion, especially in the cranial bones or sinuses located below the pituitary. Pituitary carcinomas - are malignancies (cancers). These are processes that extend into the central nervous system (brain and spinal cord) or outside it. Very few of pituitary tumors, however, are the result of neoplasia. This classification took into account the biological behavior of adenomas and their evolution, and is currently widely accepted by specialists in the field.

But most tumors are adenomas and only a small fraction of them are show pituitary disease symptoms. Invasive adenomas (35% of pituitary neoplasia cases) can invade the skull bones and the sphenoid sinus. Of all pituitary tumors, carcinomas represent 0.1-0.2%.

Pituitary adenomas can be classified according to:
The anatomy of the tumor – tumors are grouped according to size, which is determined from imagery measurements into: microadenomas (10 mm in diameter) and macroadenomas (over 1 cm diameter). Macroadenomas, in turn, can be split into encapsulated macroadenomas or invasive macroadenomas (localized or diffuse). Most tumors are microadenomas. This classification of adenomas according to size, extension and by exploring the invasineveness of the tumor using imagery is extremely detailed and complex.

Neurologic and radiologic scans include (among others):
- X ray of the skull (profile) to view the walls of the pituitary, to measure its diameters and then to classify adenomas.
- pneumoencephalography or PEG - is a more complicated method by which to view the amount of air that will deploy in the cerebrospinal fluid space above the sella turcica.
- carotid artery angiography - an investigation is carried out routinely in the laboratory analysis of pituitary tumors, but only if there are suspected vascular lesions.
- polytomography - special tomography is a method which makes detailed images (by consecutive sections) of the structures difficult to access, using a special device, able to perform complex movements.
- CT (computer tomography) - the modern method which can do sections at 3 mm distance. It has many advantages: viewing the structures surrounding the adenoma, capsule, integrity of bone walls and the invasive nature of the adenoma.

According to radio-anatomic classification, there are 4 stages of adenomas, as follows: Stage 1 - adenoma 1 cm in diameter, without extension to the sella; Stage 2 - macroadenoma (over 1 cm diameter) with possible extension to the sella; Stage 3 - macroadenoma with enlargement and invasion of the supersellar space; Stage 4 - macroadenoma that goes beyond the sella and walls.