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Cushing Syndrome II: Pathophysiology

Cushing Syndrome II: Pathophysiology

Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...

Cushing Syndrome I: Introduction

Cushing Syndrome I: Introduction

Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the syndrome.Exogenous...

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Related Experiment Video

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Contrast Ultrasound Targeted Treatment of Gliomas in Mice via Drug-Bearing Nanoparticle Delivery and Microvascular Ablation

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Published on: December 15, 2010

Ultrasound-assisted microsurgery for Cushing's disease.

U J Knappe¹, M Engelbach, K Konz

¹Department of Neurosurgery, Johannes Wesling Klinikum, Minden, Germany. ulrich.knappe@klinikum-minden.de

Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [And] German Diabetes Association

|December 17, 2009

Summary

Intraoperative high-frequency ultrasound can identify pituitary microadenomas in Cushing's disease, even when MRI is negative. This technique aids in accurate tumor localization, improving surgical outcomes and preventing unnecessary gland exploration.

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Area of Science:

Neurosurgery
Endocrinology
Medical Imaging

Background:

Cushing's disease diagnosis can be challenging due to pituitary microadenomas often being undetectable by sellar MRI in up to 45% of cases.
Intraoperative ultrasound offers a potential solution by identifying microadenomas as hyperechoic structures during surgery.

Purpose of the Study:

To evaluate the efficacy of a new high-frequency ultrasound device for intraoperative localization of pituitary microadenomas in Cushing's disease patients.
To assess the diagnostic accuracy of intraoperative ultrasound compared to preoperative MRI, particularly in cases with negative MRI findings.

Main Methods:

Eighteen consecutive patients with Cushing's disease underwent transsphenoidal microsurgery.
A new direct contact high-frequency ultrasound probe (7.5-13 MHz) was used to scan the pituitary gland after opening the sellar floor.
Preoperative MRI findings were compared with intraoperative ultrasound results.

Main Results:

High-frequency ultrasound identified microadenomas as hyperechoic masses in 13 out of 17 cases (77%), including 3 of 4 cases with negative preoperative MRI.
Ultrasound correctly localized tumors in 2 cases where MRI findings were false positives.
Remission of hypercortisolism was achieved in 100% of patients, with preserved pituitary function in 94%.

Conclusions:

Intraoperative high-frequency ultrasound is effective in visualizing intrapituitary anatomy and pathologies, including in MRI-negative cases of Cushing's disease.
This technology can improve tumor localization accuracy, potentially reducing extensive gland exploration and the risk of hypopituitarism.