Cushing’s disease

PubMed, the Internet portal of biomedical and life sciences literature, indexed an interesting article, entitled “Cushing’s disease” (Pituitary. 2006 Oct 30). Authors are De Martin M, Giraldi FP and Cavagnini F, from the Chair of Endocrinology, University of Milan, Ospedale San Luca, Istituto Auxologico Italiano, Milan, Italy. Cushing’s disease, i.e., pituitary ACTH-secreting adenoma causing excess glucocorticoid secretion, is a rare disease with significant mortality and morbidity. Timely diagnosis and appropriate treatment can alter the course of the disease and are therefore mandatory. First step of the diagnostic is the endogenous glucocorticoid excess by measurement of urinary free cortisol, cortisol circadian rhythmicity or suppression by low doses of dexamethasone. In patients with equivocal results, second line tests, such as the dexamethasone-suppressed CRH test and desmopressin stimulation, usually enable the diagnosis to be confirmed. The last step in the diagnostic algorhythm is often the most fraught with problems as the distinction between Cushing’s disease and ectopic ACTH secretion. Patients cured of Cushing’s disease require long-term monitoring given the risk of relapse and clinical burden of associated ailments. To access the full abstract of the article, click here.