The video, which features Dr. Bruce and two other experts, helps doctors become more familiar with collaborating across specialties to diagnose and treat the disease.
Diagnosing and treating Cushing Disease is a specialist heavy endeavor. It can involve:
Dr. Bruce is the neurosurgeon at the multidisciplinary Pituitary Tumor Center at Columbia University Medical Center/New York Presbyterian Hospital. Here, many of the specialists mentioned above are gathered in one place. They see many patients with Cushing Disease and are experts in the intricacies of its diagnosis and treatment. Dr. Bruce enjoys sharing this expertise with other physicians.
When someone has Cushing Syndrome, his or her body has too much of the hormone cortisol. This can cause the bones, skin and muscles to become weak. The abdomen may enlarge, and the upper back or chest may accumulate fat. Blood pressure may rise. Excess hair can grow in, or hair may fall out.
These and many other nonspecific symptoms can be (but are not always) signs of elevated cortisol–which causes Cushing Syndrome.
Cushing Syndrome is the name for the collection of symptoms due to elevated cortisol, but it does not specify the cause of cortisol elevation. Causes can include a malfunction of the adrenal gland, taking certain medications, or having a tumor on the pituitary gland.
The most common endogenous (non-medication) cause is a pituitary tumor. Cushing Disease is the official name for Cushing Syndrome that is caused by a pituitary tumor. But arriving at that diagnosis takes time.
Usually, when a patient has Cushing, the first stop is a family doctor. Symptoms may be subtle. If the symptoms lead the doctor to suspect Cushing, he will want to measure whether the cortisol levels are too high. Even this step is not straightforward, since everyone’s levels fluctuate naturally.
If the doctor determines that his patient does have too much cortisol, then the symptoms can be called Cushing Syndrome. Next, an endocrinologist may test to see if the problem is with the pituitary or another part of the body.
If the problem does come from the pituitary, then a patient might see a radiologist for an MRI of the pituitary gland. But the gland is small and the tumor might be tiny and hard to visualize.
That’s when an experienced pituitary surgeon like Dr. Bruce comes in. If there is a pituitary tumor, finding and removing it is the only hope of a cure. On a case-by-case basis, the team determines the best option with each patient: the type and extent of pituitary surgery, radiation therapy, or radiosurgery.
But the story isn’t over yet. “Ironically,” explains Dr. Bruce, “if the tumor is removed, [the patient] will feel worse” for a little while. They will experience “headaches, muscle pain, generalized body weakness, and fatigue. Those are all actually good signs that the tumor has been successfully removed.”
These symptoms arise because the patient’s body is in withdrawal from the abnormally high cortisol levels produced by the tumor. To help with these unpleasant effects, Dr. Bruce immediately puts patients on a low dose of a cortisol replacement. Patients stay on that replacement until their bodies can take over hormone regulation again. It can be a while—“up to one year,” says Dr. Bruce.
Even the experts have to handle Cushing on a case-by-case basis. So the video overview is an invaluable resource for doctors who don’t see the disease often. The video appears on the website Medscape. Interested physicians can earn Continuing Medical Education credit by studying the video, its transcript, and its slides, and then taking a test on Medscape.
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