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A 43-year-old male is seen at the clinic with reports of weight gain and fatigue. He is noted to have a wide "moon" face with a ruddy complexion. The patient is diagnosed with Cushing's disease, most likely caused by a(n)

Explanation

• Increased adrenocorticotropic hormone (ACTH) caused by problems in the pituitary hypothalamus is a common cause of Cushing's disease (also known as Secondary Cushing's syndrome).

• Cushing's syndrome and Cushing's disease are often used interchangeably, but they are not the same. Cushing's disease refers to cases of pituitary-dependent causes of Cushing's syndrome, such as a pituitary adenoma.

• Symptoms of Cushing's disease include hirsutism (facial hair), a red/ruddy complexion, hyperglycemia, a buffalo hump, a round "moon" face, high blood pressure, osteoporosis, hypokalemia, decreased eosinphils, and decreased lymphocytes.

• Management must address the hyperplasia of pituitary tissue, usually requiring surgery. Patients are put on a low-sodium diet with administration of a potassium-sparing diuretic such as aldactone (Spironalactone). Fluids and electolytes are monitored. Regular capillary glucose checks are usually ordered, along with sliding scale insulin or an oral antidiabetic medication.

• Tumors of the adrenal cortex are common causes of Primary Cushing's syndrome.

• The most common cause of iatrogenic Cushing's syndrome is the long-term administration of glucocorticoids such as prednisone, which cause elevated levels of cortisol.

• Adrenal tumors and adrenal hyperplasia are common causes of Primary Cushing's syndrome, not Cushing's disease.

• Autoimmune disorders are not associated with Cushing's syndrome or disease.

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