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You know what kind of brain tumor story is behind Cushing's disease?
Cushing's disease, the name behind it, hides a series of stories related to brain tumors, which affects many patients suffering from this disease. Unlike Cushing's syndrome, which is caused by exogenous corticosteroids, Cushing's disease is mainly caused by tumors in the pituitary gland, which over-secret adrenocorticotropic hormone (ACTH), ultimately leading to excessive secretion of cortisol in the body. According to statistics, pituitary adenoma is one of the main causes of endogenous Cushing's syndrome, accounting for up to 80%. However, the medical challenges behind this and the impact on patients' lives cannot be underestimated.
The first step in diagnosing Cushing's disease is confirming hypercortisolemia, which often requires a variety of miscellaneous tests to confirm the diagnosis.
Signs and symptoms of Cushing's disease
People with Cushing's disease often present with a variety of signs related to excess cortisol. These symptoms sometimes resemble those of other conditions, making diagnosis difficult. Common symptoms include purple stretch marks, muscle wasting, osteoporosis and kidney stones. In children, the two main symptoms are obesity and stunted growth.
Diagnosis process
In diagnosing Cushing's disease, scientists generally first confirm whether the patient has hypercortisolemia. This usually includes saliva, serum cortisol tests, 24-hour urine free cortisol tests, and dexamethasone suppression tests. However, since a single test cannot ensure accuracy, cross-comparison of the results of multiple tests is usually required.
Whether it is an ACTH blood test, a urine free cortisol test, or an evening saliva cortisol test, they are all essential tools in the diagnostic process.
Brain imaging examination
Brain imaging tests, such as CT or MRI, are often helpful in finding ACTH-secreting tumors of the pituitary gland. However, according to research, 40% of Cushing's disease patients cannot rely on MRI to detect tumors, making the diagnostic process even more uncertain. If imaging is inconclusive, more invasive low-dose sampling (BIPSS) may be required to confirm the diagnosis.
Treatment strategies
Currently, the preferred treatment for Cushing's disease is surgical removal of ACTH-secreting adenomas. This type of surgery mainly has two entry methods: nasal cavity and upper lip. It is necessary to choose the appropriate method according to the size and location of the tumor. For some patients whose tumors cannot be identified during the initial surgery, reexploration may be required during subsequent surgeries.
The surgical success rate can reach 65% to 90% in patients with microadenomas, while it does not exceed 65% in patients with macroadenomas.
Epidemiology
According to statistics, the incidence of Cushing's disease is low, with a study in Spain showing that the annual incidence rate is approximately 2.4 cases per million people. The condition is more common in women, with a female to male ratio of 3 to 6:1, and most patients are women between 50 and 60 years old. Without timely treatment, the fatality rate of the disease is as high as 10 to 11%.
Historical background
Cushing's disease is named after American neurosurgeon Harvey Cushing. As early as 1912, he first described this disease and believed that it was related to pituitary gland dysfunction. Since then, many patient cases have proven his views at that time, and with the development of science and technology, the understanding of Cushing's disease has become increasingly profound.
Despite increasing medical awareness of Cushing's disease, it remains a challenging disease. Not only because its symptoms are similar to other diseases, but also because its diagnosis and treatment require multi-faceted professional knowledge and technology. When we face such a complex health problem, we can’t help but wonder: Are there more unrevealed disease stories hidden in the depths of medicine?
