Cushing's Disease
Cushing's disease is a specific form of Cushing's syndrome caused by an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma. The excess ACTH drives bilateral adrenal hyperplasia and chronic cortisol hypersecretion, producing a characteristic cluster of metabolic, musculoskeletal, cardiovascular, and psychiatric abnormalities.
Understanding Cushing's Disease
Cushing's disease accounts for approximately 70 per cent of all endogenous Cushing's syndrome cases. The underlying pituitary microadenoma — often smaller than 5 mm — is frequently invisible on standard MRI and requires dedicated pituitary protocol imaging or inferior petrosal sinus sampling for localisation. Chronic cortisol excess produces profound systemic effects: visceral obesity, insulin resistance and diabetes, hypertension, osteoporosis, proximal myopathy, skin fragility, and immune suppression. The metabolic syndrome induced by hypercortisolism carries a four-fold increase in cardiovascular mortality if left untreated.
Selective transsphenoidal adenomectomy offers the best chance of cure with preservation of normal pituitary function. In the hands of an experienced pituitary surgeon, remission rates for microadenomas exceed 85 per cent. For international patients, Istanbul provides rapid access to elite pituitary surgery at 60 per cent below Western private healthcare costs.
Treatment Options for Cushing's Disease
View All ProceduresPituitary Tumour Treatment in Turkey
The pituitary gland (a pea-sized organ at the base of the brain) is the body's master hormonal regulator, controlling thyroid function, growth, cortisol production, reproductive hormones, and more. Pituitary tumours (adenomas) are almost always benign, but they can cause significant problems through two mechanisms: hormonal overproduction (secreting excess growth hormone, cortisol, or prolactin) and mass effect (compressing the optic nerves, causing visual field loss, or pressing on the brain).
arrow_forwardCraniotomy (Brain Surgery) in Turkey
A craniotomy is the surgical opening of the skull to access the brain for the removal of tumours, clipping of aneurysms, resection of arteriovenous malformations (AVMs), or decompression of swollen brain tissue. A bone flap is temporarily removed, the intracranial procedure is performed under microscope guidance, and the bone is secured back in place at closure. It remains the definitive approach for lesions that cannot be treated with less invasive methods such as Gamma Knife radiosurgery.
arrow_forwardSymptoms of Cushing's Disease
The clinical features of Cushing's disease develop insidiously over months to years. Central obesity with rounded facies (moon face), supraclavicular and dorsocervical fat pads (buffalo hump), and thin atrophic skin that bruises easily are hallmark signs. Proximal myopathy makes climbing stairs or rising from a chair difficult. Violaceous striae wider than 1 cm on the abdomen, thighs, and breasts are characteristic. Osteoporosis with vertebral compression fractures occurs in 50 per cent of patients. Psychiatric manifestations include depression, anxiety, irritability, and cognitive impairment. Women experience menstrual irregularity and hirsutism; men develop decreased libido and erectile dysfunction.
Diagnostic Pathways
24-hour urinary free cortisol (UFC) measurement provides an integrated assessment of daily cortisol production. Late-night salivary cortisol testing detects loss of the normal circadian cortisol rhythm. Low-dose dexamethasone suppression test (LDDST) — failure to suppress serum cortisol after 1 mg dexamethasone — confirms the diagnosis of Cushing's syndrome. Plasma ACTH measurement differentiates ACTH-dependent (pituitary or ectopic) from ACTH-independent (adrenal) causes. Pituitary MRI with thin-section gadolinium-enhanced sequences identifies the microadenoma in 60 per cent of cases. Inferior petrosal sinus sampling (IPSS) with CRH stimulation is the gold standard for confirming pituitary ACTH secretion when MRI is negative.
Advanced Treatment Options at Vellum Select
Transsphenoidal Adenomectomy
Selective adenomectomy via transsphenoidal approach is the first-line treatment. Pituitary Tumour Treatment in Turkey at Vellum Select is performed by Prof. Dr. Türker Kılıç, who employs both microscopic and fully endoscopic techniques to maximise adenoma identification and resection while preserving normal pituitary tissue. Remission rates for microadenomas exceed 85 per cent. For larger or invasive adenomas where complete resection is not achieved, adjunctive therapies include repeat surgery, stereotactic radiosurgery, or medical therapy with steroidogenesis inhibitors.
Craniotomy
For large pituitary adenomas with significant suprasellar extension not amenable to transsphenoidal surgery, Craniotomy (Brain Surgery) in Turkey via a subfrontal approach provides the necessary exposure.
To discuss your Cushing's disease diagnosis with Prof. Dr. Türker Kılıç, view his profile or contact Vellum Select to arrange a consultation.