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Cushing’s disease: the burden of illness

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Abstract

Cushing’s syndrome is caused by prolonged exposure to elevated cortisol levels. The most common form of endogenous Cushing’s syndrome is Cushing’s disease, which results from an adrenocorticotropic hormone-secreting pituitary tumour. Cushing’s disease is associated with increased mortality, mostly attributable to cardiovascular complications, and a host of comorbidities such as metabolic and skeletal disorders, infections and neuropsychiatric disturbances. As a consequence, Cushing’s disease substantially impairs health-related quality of life. It is crucial that the condition is diagnosed as early as possible, and that rapid and effective treatment is initiated in order to limit long-term morbidity and mortality. The initial treatment of choice for Cushing’s disease is selective transsphenoidal pituitary surgery; however, the risk of recurrence after initial surgery is high and remains so for many decades after surgery. A particular concern is the growing body of evidence indicating that the negative physical and psychosocial sequelae of chronic hypercortisolism may persist in patients with Cushing’s disease even after long-term surgical ‘cure’. Current treatment options for post-surgical patients with persistent or recurrent Cushing’s disease include second surgery, radiotherapy, bilateral adrenalectomy and medical therapy; however, each approach has its limitations and there is an unmet need for more efficacious treatments. The current review provides an overview of the burden of illness of Cushing’s disease, underscoring the need for prompt diagnosis and effective treatment, as well as highlighting the need for better therapies.

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Figure adapted from Johnson et al. [49]

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Acknowledgments

Financial support for medical editorial assistance was provided by Novartis Pharmaceuticals Corporation. We thank Richard Ogilvy-Stewart, PhD, Mudskipper Business Ltd, for medical editorial assistance with this manuscript.

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  1. Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini, 5, 80131, Naples, Italy

    Rosario Pivonello, Maria Cristina De Martino, Monica De Leo, Chiara Simeoli & Annamaria Colao

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  1. Rosario Pivonello
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Correspondence to Rosario Pivonello.

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RP and AC have received speaker and consultancy fees from Novartis. MCDM, MDL and CS have no conflicts of interest to declare.

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Pivonello, R., De Martino, M.C., De Leo, M. et al. Cushing’s disease: the burden of illness. Endocrine 56, 10–18 (2017). https://doi.org/10.1007/s12020-016-0984-8

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