<unk>  is an  endocrine disorder caused by high levels of cortisol in the blood from a variety of causes, including primary pituitary adenoma (known as<unk> 's disease), primary adrenal hyperplasia or neoplasia, ectopic ACTH production (e.g., from a small cell lung cancer), and iatrogenic (steroid use).<unk>  was first identified by Dr. Harvey<unk>  (an American physician, surgeon, and endocrinologist) in 1932 as a polyglandular disorder. It was later named as<unk> . Normally, cortisol is released from the adrenal gland in response to ACTH being released from the pituitary gland. Both<unk>  and<unk> 's disease are characterized by elevated levels of cortisol in the blood, but the cause of elevated cortisol differs between the two.<unk> 's disease specifically refers to a tumor in the pituitary gland that stimulates the excessive release of cortisol from the adrenal gland by releasing large amounts of ACTH. In<unk> 's disease, ACTH levels do not respond to negative feedback from the high levels of cortisol.<unk> 's disease is particularly common in females. Annually, there are around 2–5 new cases per million people worldwide. Common risk factors in the development of<unk> 's disease are female gender and genetic factors. Symptoms of<unk>  include  rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity), a round face often referred to as a "moon face", excessive sweating, insomnia, reduced libido, impotence, amenorrhea, infertility and psychological disturbances, ranging from euphoria to psychosis. Depression and anxiety.<unk>  may progress to develop amenorrhoea, infertility, and psychological disturbances. If left untreated, patients with<unk>  may progress to develop diabetes, cardiovascular and psychiatric complications. The prognosis depends on the severity of the disease. When<unk> 's is suspected, either a dexamethasone suppression test (administration of dexamethasone and frequent determination of cortisol and ACTH level) or a 24-hour urinary measurement for cortisol offer equal detection rates. Dexamethasone is a glucocorticoid and simulates the effects of cortisol, including negative feedback on the pituitary gland. When dexamethasone is administered and a blood sample is tested, high cortisol would be indicative of<unk> . A novel approach, recently cleared by the US FDA, is sampling cortisol in saliva over 24 hours, which may be equally sensitive, as late night levels of salivary cortisol are high in<unk> oid patients. Other pituitary hormone levels may need to be ascertained. CT scan of the adrenal gland is performed to detect the presence of the adrenal adenoma and the cause of ectopic ACTH. CT scan is preferred over MRI in these cases. MRI of the pituitary gland is performed to detect the presence of the pituitary adenoma. The medications usually used for the treatment of<unk>  are Pasireotide, Cabergoline, Ketoconazole, and Metyrapone. The choice of medical therapy should be individualized. It is guided by drug efficacy, side effects, individual patient factors, and cost. If an adrenal adenoma is identified it may be removed by either laparoscopic or open adrenalectomy. An ACTH-secreting corticotrophic pituitary adenoma should be removed after diagnosis. Regardless of the adenoma's location, most patients will require steroid replacement postoperatively at least in the interim as long-term suppression of pituitary ACTH and normal adrenal tissue does not recover immediately. Clearly, if both adrenals are removed, replacement with hydrocortisone or prednisolone is imperative.
Cushing's syndrome
Addison's disease
Tietze's syndrome
Sheehan's syndrome
Adie syndrome
Nelson's syndrome
Dressler's syndrome
Addison-gull syndrome