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International Journal of Endocrinology
Volume 2013 (2013), Article ID 893781, 7 pages
http://dx.doi.org/10.1155/2013/893781
Review Article

Diagnosis and Multimodality Management of Cushing’s Disease: A Practical Review

Department of Neurosurgery, Keck School of Medicine of USC, 1200 North State Street, Suite 3300, Los Angeles, CA 90089, USA

Received 11 August 2012; Accepted 12 December 2012

Academic Editor: Lewis S. Blevins

Copyright © 2013 Gabriel Zada. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cushing’s Disease is caused by oversecretion of ACTH from a pituitary adenoma and results in subsequent elevations of systemic cortisol, ultimately contributing to reduced patient survival. The diagnosis of Cushing’s Disease frequently involves a stepwise approach including clinical, laboratory, neuroimaging, and sometimes interventional radiology techniques, often mandating multidisciplinary collaboration from numerous specialty practitioners. Pituitary microadenomas that do not appear on designated pituitary MRI or dynamic contrast protocols may pose a particularly challenging subset of this disease. The treatment of Cushing’s Disease typically involves transsphenoidal surgical resection of the pituitary adenoma as a first-line option, yet may require the addition of adjunctive measures such as stereotactic radiosurgery or medical management to achieve normalization of serum cortisol levels. Vigilant long-term serial endocrine monitoring of patients is imperative in order to detect any recurrence that may occur, even years following initial remission. In this paper, a stepwise approach to the diagnosis, and various management strategies and associated outcomes in patients with Cushing’s Disease are discussed.