CUSHING’S DISEASE: MODERN STRATEGIES FOR DIAGNOSIS AND CLINICAL MANAGEMENT

Abstract

Cushing’s disease is an uncommon endocrine disorder characterized by excessive secretion of adrenocorticotropic hormone (ACTH) from a pituitary adenoma, leading to chronic overstimulation of the adrenal glands and sustained endogenous hypercortisolism. Although rare, the disease carries considerable clinical importance because of its association with significant morbidity and mortality. It occurs predominantly in women, and ACTH-producing adenomas represent a relatively small proportion of all pituitary tumors. In many patients, the underlying lesion is a pituitary microadenoma that may be difficult to visualize using standard radiological techniques, contributing to diagnostic challenges. The clinical manifestations of Cushing’s disease are diverse and result from the systemic effects of prolonged cortisol excess. Typical features include progressive central weight gain, characteristic facial rounding, dorsocervical fat accumulation, supraclavicular fullness, skin fragility with easy bruising, violaceous striae, proximal muscle weakness, hypertension, glucose intolerance or diabetes mellitus, and reduced bone mineral density with an increased risk of fragility fractures. Reproductive dysfunction, hirsutism, and a range of psychological and cognitive disturbances are also frequently observed. Because these manifestations often overlap with common conditions such as obesity, metabolic syndrome, and pseudo-Cushing states, diagnosis may be delayed. As a result, many patients already exhibit substantial cardiovascular, metabolic, and skeletal complications by the time the disease is recognized, emphasizing the importance of early detection and timely intervention.