Cushing’s disease is a rare pathology characterized by excess production of adrenocorticotropic hormone (ACTH) secondary to a pituitary adenoma which stimulates adrenal cortisol secretion. The main consequences are the metabolic and cardiovascular complications, as well as osteoporosis and infection predisposition, which increase mortality in untreated patients. The first case presentation is about a patient with Cushing’s disease, surgically treated and cured, without any need for substitution or signs of pituitary-adrenal axis failure. The second case is a patient diagnosed with Cushing’s disease, with multiple complications, with clinical and hormonal relapse after selective adenomectomy and resistant to medical therapy, who is scheduled for reintervention. The third presentation is about a patient known with osteoporosis, diagnosed with Cushing’s disease based on the clinical appearance with bilateral adrenal adenomas, with left suprarenalectomy and pituitary gamma knife radiotherapy. We aim to introduce a pictorial assay consisting of a series of three cases, different from detection, management and outcome.
Key words: Cushing’s disease, pituitary adenoma, osteoporosis.
Cushing’s disease is determined by a hypotalamo- pituitary-adrenal (HPA) axis disruption, resulting in excess cortisol secretion and loss of circadian rhytm, and it is associated with a very high risk of complications, morbidity and mortality, affecting almost every system due to the hypercortisolism: cardiovascular, respiratory, metabolic, psychiatric and hormonal disorders1-3. Early diagnosis is essential for the further management.