A 15-Year-old girl from Bangladesh came to Dr Soumitra Ray at The Calcutta Medical Research Institute (CMRI), complaining of puffiness of the face, and an increase in the central body mass. She also showed hyper pigmented skin markings typical to the disease called stria – purple markings on her body. Her blood reports showed her cortisol levels to be high. MRI Scan revealed a tumour in the pituitary gland. It was a 5-mm. size tumour. Dr Roy read the symptoms and diagnosed it as Cushing’s Disease.
Cushing’s disease is an extremely rare condition seen only in 10-15 cases in a million. Sighted mostly in women, it is not so common in children. A type of pituitary tumour called adenoma grows in the pituitary gland located at the centre base of the brain. The tumour is usually benign (non-cancerous). With Cushing’s disease, the pituitary tumour secretes an excess hormone called ACTH. ACTH stimulates production and release of cortisol, a hormone released usually during stress. Too much ACTH causes the adrenal glands to make too much cortisol. It controls the use of carbohydrate, fat, and protein used by the body. It also helps reduce the immune system’s response to inflammation.
There can be surgical complications in Cushing’s disease. Since the pituitary gland controls several hormonal functions, one has to ensure that no other hormonal complications are caused. Therefore, during diagnosis and treatment a team of highly skilled medical specialists including surgeons, anaesthetists, endocrinologist must be present.
The treatment for Cushing’s disease involves surgical removal of the pituitary tumour. After removal, symptoms gradually disappear and the hormone levels stabilises within six months. Dr Roy decided to perform the surgery on the 15-year-old girl. The approach to the tumour was made through the nose to ensure the least damage to the brain was done, avoiding successive complications. The tumour was exposed and removed. The patient was discharged within 5 days.