Title
Subscribe to the Magazine for free
Subscribe for free to keep reading! If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.

What Kind of Doctor Should I See for Cushing's Disease?

Why This Was Updated?

Our specialists regularly review advancements in health and wellness, ensuring our articles are updated with the newest information as it becomes accessible.
Medically Reviewed by

Cushing’s Disease is a rare hormonal disorder caused by a benign pituitary tumor that leads to the overproduction of adrenocorticotropic hormone (ACTH), resulting in excessive cortisol levels in the body. 

This condition disrupts normal cortisol rhythms and can cause serious health complications if not properly treated, including metabolic and cardiovascular disease.

Because it’s relatively rare and can present like diabetes or heart disease, it can be easy to miss. However, proper diagnosis and treatment of Cushing’s Disease are necessary to preserve long-term health.  

Specialists such as endocrinologists, neurosurgeons, and radiation oncologists typically diagnose and manage the disease, although the patient may need long-term medical care if chronic complications persist.

This article guides readers on the types of doctors they should consult if they suspect or have been diagnosed with Cushing’s Disease. This process begins with an open and honest conversation with the primary care doctor, who can direct the patient to further care if necessary. 

[signup]

What is Cushing’s Disease?

Cushing's disease is a specific form of Cushing’s syndrome caused by a benign pituitary tumor that overproduces adrenocorticotropic hormone (ACTH), leading to excessive cortisol production by the adrenal glands. This condition disrupts normal cortisol rhythms and can cause serious complications if left untreated. 

While Cushing’s syndrome broadly refers to any cause of prolonged high cortisol levels, Cushing's disease specifically refers to excessive cortisol driven by a pituitary adenoma, making up 80% of endogenous Cushing’s syndrome cases. 

Managing Cushing's disease involves a combination of surgery, medication, and ongoing monitoring. 

Cortisol’s Effects on the Body

Cortisol is a glucocorticoid hormone that regulates metabolism, modulates the immune response, directs the stress response, and is necessary for healthy fetal development

However, excessive cortisol disrupts these functions, leading to muscle weakness, osteoporosis, hyperglycemia, weight gain, hypertension, and increased risk of cardiovascular disease because of the widespread locations and effects of glucocorticoid hormone receptors throughout the body.

Prolonged high cortisol levels also affect brain health and can contribute to neuropsychiatric issues, including emotional instability, depression, anxiety, and cognitive deficits

Symptoms of Cushing’s Disease

Common symptoms of Cushing’s disease include central obesity, with fat accumulation in the abdomen, face ("moon face"), and upper back ("buffalo hump"). 

Due to disrupted collagen production, skin changes, such as thinning, slow wound healing, and purple stretch marks, are also prevalent. Patients may experience acne and altered hair growth, particularly in women and prepubertal children

Muscle weakness, especially in the limbs, creates a contrast between a large abdomen and thin extremities. 

Elevated cortisol can also lead to mood disturbances, including depression, anxiety, and cognitive impairment, as well as high blood pressure due to fluid retention. 

Metabolic issues like insulin resistance, hyperglycemia, and hyperlipidemia are common, along with bone health problems such as osteoporosis, resulting in fragile bones and back pain

Reproductive health may also be affected, with women facing menstrual irregularities and men experiencing decreased libido or erectile dysfunction

Other symptoms include increased thirst and urination, headaches, visual disturbances, and decreased immunity, which can mimic conditions like diabetes or cardiovascular disease.

Why Early Diagnosis is Crucial

The earlier Cushing’s disease is identified, the sooner the patient can begin treatment to normalize cortisol levels. Chronically elevated cortisol levels cause whole-body health complications, many of which persist after treatment for Cushing’s disease.

Cushing’s disease is associated with cardiovascular, metabolic, respiratory, psychiatric, and skeletal complications, many of which will continue to need long-term treatment, even after surgical removal of the pituitary tumor. Early identification and treatment of Cushing’s disease can reduce the severity of these important complications.

Cushing’s syndrome is rare outside of excessive or chronic glucocorticoid use. However, symptom recognition and the diagnostic process can take years, so discussing concerns with your primary care provider is important. 

This timeline is often due to the variability and subtlety of symptoms, which can make diagnosis challenging. However, since symptoms often mimic cardiometabolic conditions like diabetes or heart disease, Cushing’s disease should be considered in patients with unusual or progressive symptoms for their age.

Consulting the Appropriate Medical Provider

Often, patients first discuss their concerns with a primary care provider, who can initiate the referral process to other medical experts for the appropriate testing.

Primary Care Physician (PCP)

For those with undiagnosed chronic conditions like Cushing’s disease, PCPs are essential to initiate diagnosis and care. Their role is to listen, identify underlying causes of symptoms, initiate diagnostic tests, and refer to specialists if needed.

If you're experiencing unexplained symptoms, discuss them with your doctor. Expect a thorough review of your symptoms and medical history, focusing on weight changes, muscle weakness, skin changes, bone density loss, infections, hyperglycemia, hyperlipidemia, hypertension, and mood and cognitive shifts.

The doctor will review medication use, including chronic glucocorticoids or drugs like megestrol acetate, and inquire about herbals like licorice or topical glucocorticoids. Family and medical history will also be considered, particularly regarding endocrine issues.

A physical exam will check for key signs such as:

  • Easy bruising
  • Facial redness
  • Muscle weakness
  • Reddish-purple striae (stretch marks) over 1 cm wide
  • In children, weight gain with slowed growth can be an important sign of Cushing’s syndrome. 

Other, less specific signs include: 

  • A dorsocervical fat pad (a fat buildup between the shoulders and neck)
  • Facial fullness
  • Obesity
  • Thin skin
  • Peripheral edema (fluid rentention
  • Acne
  • Hirsutism (excessive coarse hair growth in women in areas like the face and chest)
  • Poor skin healing
  • Early-onset hypertension (high blood pressure)

Recent labs may show hypokalemia (low potassium), impaired glucose tolerance (high blood sugar, insulin resistance, or possibly diabetes), and dyslipidemia (high cholesterol).

Expect your primary care provider to share their insights and discuss whether a specialist referral is needed. If there's any uncertainty about the root cause of your condition, a referral is usually made for further evaluation.

Endocrinologist

Most commonly, a PCP will refer a patient to an endocrinologist if there is any concern for Cushing’s disease. 

What is an Endocrinologist?

An endocrinologist is a medical doctor who specializes in diagnosing and treating disorders of the endocrine or hormone, systems.  Endocrinologists commonly treat conditions such as diabetes, thyroid disorders, osteoporosis, adrenal disorders, and hormone imbalances, as well as less common conditions like Cushing’s disease.

Because of their highly specialized training, an endocrinologist is the best medical professional to diagnose and manage a complex condition like Cushing’s disease. They have the expertise to know which tests to order and how to interpret them to arrive at the correct diagnosis accurately. 

An endocrinologist will tailor an individual’s treatment plan based on the underlying cause; this may include referrals to additional specialists if needed.

How Will an Endocrinologist Diagnose Cushing’s Disease?

To begin the diagnostic process for Cushing’s disease, an endocrinologist will order screening tests like the 24-hour urinary free cortisol to detect elevated cortisol levels, the late-night salivary cortisol to assess loss of the normal circadian rhythm, or the dexamethasone suppression test to evaluate the body’s cortisol response. 

If initial tests suggest high cortisol, confirmatory tests follow. These may include a midnight serum cortisol test, a plasma ACTH test, the low-dose dexamethasone test with CRH stimulation, or the desmopressin test to confirm Cushing’s.

Initial workup indicating hypercortisolemia may be followed by imaging to assess for a hormone-producing tumor.

MRI is recommended for detecting small pituitary tumors in suspected ACTH-dependent Cushing's disease. If no tumor is found, further testing is needed. 

Adrenal CT scans are suggested for ACTH-independent Cushing's to identify adrenal tumors or hyperplasia and can also locate small ACTH-producing tumors. PET scans are used when ectopic ACTH production is suspected but not detected by CT or MRI, particularly for small neuroendocrine tumors. 

Bilateral Inferior Petrosal Sinus Sampling (BIPSS) differentiates between pituitary and ectopic ACTH sources when imaging is inconclusive. Higher ACTH levels in blood from the petrosal sinuses point to a pituitary source.

What Treatments Will an Endocrinologist Recommend for Cushing’s Disease?

Treatment for Cushing’s disease typically involves surgical intervention, a transsphenoidal adenomectomy to remove the pituitary tumor.

Radiation therapy is an option for patients unresponsive to surgery or with recurrent disease. 

Medications are also considered and can include:

  • Steroidogenesis inhibitors (ketoconazole, metyrapone, mitotane) for those unable to undergo surgery or awaiting radiation
  • Pituitary-directed drugs (cabergoline, pasireotide) 
  • Glucocorticoid antagonists (mifepristone) for persistent disease
  • Combination therapy may be necessary in severe cases

Even after hypercortisolism is controlled, ongoing monitoring is essential for persistent issues like hypertension, diabetes, and cardiovascular problems. Depending on the chronic conditions caused by Cushing’s disease, the patient may again be referred to the appropriate specialists for long-term management.

Neurosurgeon

A neurosurgeon specializes in performing surgeries on the nervous system, including the brain and spinal cord. In Cushing's Disease, they perform the transsphenoidal adenomectomy to remove the pituitary tumor (adenoma) causing excess cortisol production.

Removing the tumor is often the best option to normalize cortisol levels and reduce associated symptoms. Surgery is typically the first-line treatment when the tumor is accessible and the patient's condition is stable.

Typically, in transsphenoidal surgery, the tumor is removed through the nasal cavity. This approach is minimally invasive and has a high success rate in experienced hands. 

Radiation Oncologist

A radiation oncologist specializes in using radiation therapy to treat cancer and other conditions. In Cushing's Disease, they are essential when surgery isn't fully effective or possible, using targeted radiation to destroy residual tumor cells and reduce cortisol production.

Radiation therapy options include stereotactic radiosurgery, which delivers precise, high-dose radiation to the tumor with minimal impact on surrounding tissues, and conventional radiation therapy, which uses lower doses over several sessions to treat residual tumor cells.

Endocrine Surgeon

An endocrine surgeon specializes in surgeries on endocrine glands, such as the adrenal glands. For Cushing’s syndrome caused by adrenal gland issues, they may perform an adrenalectomy to remove one or both adrenal glands to control cortisol production.

Adrenal surgery, or adrenalectomy, is necessary when an adrenal tumor causes Cushing's syndrome or when other treatments have failed to control cortisol production. It's also considered in cases of severe disease where rapid reduction of cortisol levels is critical.

Patients typically require lifelong hormone replacement therapy to compensate for the loss of adrenal gland function, ensuring they maintain proper hormonal balance and avoid complications.

Other Specialists You May Need

Patients in long-term recovery from Cushing’s disease may need additional medical support. The following specialists often become part of the patient’s long-term medical team:

Cardiologist: Cushing’s disease can create long-term cardiovascular complications that persist beyond surgical, radiation, or medical treatment. A cardiologist manages cardiovascular complications such as hypertension and heart disease, which are common in patients with Cushing's disease due to prolonged exposure to high cortisol levels.

Dermatologist: a dermatologist treats skin-related symptoms, including thinning skin, acne, and easy bruising, which are direct effects of excess cortisol.

Psychiatrist or Psychologist: many patients with Cushing's disease experience psychological effects like depression and anxiety that may persist after cortisol levels normalize. A psychiatrist or psychologist can provide necessary interventions to improve mental well-being.

Nutritionist: a nutritionist develops a tailored diet plan to help manage weight, blood sugar levels, and overall health during and after treatment, which can be challenging due to the metabolic disturbances caused by Cushing's disease.

Importance of a Multidisciplinary Approach to Cushing’s Disease

Collaborative Care: a team of specialists working together ensures comprehensive care for Cushing’s Disease by addressing the wide range of symptoms and complications associated with chronically high cortisol. 

Each specialist contributes their expertise to create a holistic and effective treatment plan, from hormonal balance to cardiovascular health and mental well-being.

Coordinating Between Specialists: in a patient’s overall treatment plan for Cushing’s Disease, each specialist plays a distinct role—whether it’s managing hormone levels, cardiovascular health, skin conditions, or psychological support. 

Effective communication among healthcare providers ensures that all treatments are aligned and that the patient receives cohesive and integrated care.

[signup]

Key Takeaways

Key Specialists in Treating Cushing’s Disease include:

  • Endocrinologist: specializes in diagnosing and managing hormone-related disorders, often leading the treatment plan for Cushing’s Disease.
  • Neurosurgeon: performs transsphenoidal adenomectomy to remove the pituitary tumor, a primary treatment for Cushing’s Disease.
  • Radiation Oncologist: provides targeted radiation therapy when surgery isn't fully effective or possible.
  • Endocrine Surgeon: handles adrenalectomy when Cushing’s syndrome is caused by adrenal tumors.

Consulting the right specialists early is necessary for timely and effective treatment of Cushing’s Disease. Often, it is a visit with the primary care provider that initiates the required diagnosis and treatment through appropriate referrals. 

Then, an endocrinologist is essential for accurate diagnosis, while a neurosurgeon, radiation oncologist, and/or endocrine surgeon provide targeted treatments.

After Cushing’s disease is treated and cortisol levels normalize, additional specialists may join an individual’s healthcare team to manage chronic complications. 

With the right medical team, Cushing’s Disease can be managed effectively. Each specialist plays a part in diagnosis, treatment, and long-term care. Patients should feel reassured that a multidisciplinary approach offers the best chance for successful management and recovery from this complex condition.

Cushing’s Disease is a rare hormonal disorder caused by a benign pituitary tumor that leads to the overproduction of adrenocorticotropic hormone (ACTH), resulting in excessive cortisol levels in the body. 

This condition disrupts normal cortisol rhythms and can contribute to serious health complications if not properly managed, including metabolic and cardiovascular issues.

Because it’s relatively rare and can present like diabetes or heart disease, it can be easy to miss. However, proper diagnosis and management of Cushing’s Disease are necessary to support long-term health.  

Specialists such as endocrinologists, neurosurgeons, and radiation oncologists typically diagnose and manage the disease, although the patient may need long-term medical care if chronic complications persist.

This article guides readers on the types of doctors they may consider consulting if they suspect or have been diagnosed with Cushing’s Disease. This process begins with an open and honest conversation with the primary care doctor, who can direct the patient to further care if necessary. 

[signup]

What is Cushing’s Disease?

Cushing's disease is a specific form of Cushing’s syndrome caused by a benign pituitary tumor that overproduces adrenocorticotropic hormone (ACTH), leading to excessive cortisol production by the adrenal glands. This condition disrupts normal cortisol rhythms and can contribute to serious complications if left unmanaged. 

While Cushing’s syndrome broadly refers to any cause of prolonged high cortisol levels, Cushing's disease specifically refers to excessive cortisol driven by a pituitary adenoma, making up 80% of endogenous Cushing’s syndrome cases. 

Managing Cushing's disease involves a combination of surgery, medication, and ongoing monitoring. 

Cortisol’s Effects on the Body

Cortisol is a glucocorticoid hormone that regulates metabolism, modulates the immune response, directs the stress response, and is necessary for healthy fetal development

However, excessive cortisol can disrupt these functions, leading to muscle weakness, osteoporosis, hyperglycemia, weight gain, hypertension, and increased risk of cardiovascular issues because of the widespread locations and effects of glucocorticoid hormone receptors throughout the body.

Prolonged high cortisol levels also affect brain health and may contribute to neuropsychiatric issues, including emotional instability, depression, anxiety, and cognitive deficits

Symptoms of Cushing’s Disease

Common symptoms of Cushing’s disease include central obesity, with fat accumulation in the abdomen, face ("moon face"), and upper back ("buffalo hump"). 

Due to disrupted collagen production, skin changes, such as thinning, slow wound healing, and purple stretch marks, are also prevalent. Patients may experience acne and altered hair growth, particularly in women and prepubertal children

Muscle weakness, especially in the limbs, creates a contrast between a large abdomen and thin extremities. 

Elevated cortisol can also lead to mood disturbances, including depression, anxiety, and cognitive impairment, as well as high blood pressure due to fluid retention. 

Metabolic issues like insulin resistance, hyperglycemia, and hyperlipidemia are common, along with bone health problems such as osteoporosis, resulting in fragile bones and back pain

Reproductive health may also be affected, with women facing menstrual irregularities and men experiencing decreased libido or erectile dysfunction

Other symptoms include increased thirst and urination, headaches, visual disturbances, and decreased immunity, which can mimic conditions like diabetes or cardiovascular disease.

Why Early Diagnosis is Crucial

The earlier Cushing’s disease is identified, the sooner the patient can begin management to support normal cortisol levels. Chronically elevated cortisol levels can contribute to whole-body health complications, many of which persist after management for Cushing’s disease.

Cushing’s disease is associated with cardiovascular, metabolic, respiratory, psychiatric, and skeletal complications, many of which will continue to need long-term management, even after surgical removal of the pituitary tumor. Early identification and management of Cushing’s disease can reduce the severity of these important complications.

Cushing’s syndrome is rare outside of excessive or chronic glucocorticoid use. However, symptom recognition and the diagnostic process can take years, so discussing concerns with your primary care provider is important. 

This timeline is often due to the variability and subtlety of symptoms, which can make diagnosis challenging. However, since symptoms often mimic cardiometabolic conditions like diabetes or heart disease, Cushing’s disease should be considered in patients with unusual or progressive symptoms for their age.

Consulting the Appropriate Medical Provider

Often, patients first discuss their concerns with a primary care provider, who can initiate the referral process to other medical experts for the appropriate testing.

Primary Care Physician (PCP)

For those with undiagnosed chronic conditions like Cushing’s disease, PCPs are essential to initiate diagnosis and care. Their role is to listen, identify underlying causes of symptoms, initiate diagnostic tests, and refer to specialists if needed.

If you're experiencing unexplained symptoms, discuss them with your doctor. Expect a thorough review of your symptoms and medical history, focusing on weight changes, muscle weakness, skin changes, bone density loss, infections, hyperglycemia, hyperlipidemia, hypertension, and mood and cognitive shifts.

The doctor will review medication use, including chronic glucocorticoids or drugs like megestrol acetate, and inquire about herbals like licorice or topical glucocorticoids. Family and medical history will also be considered, particularly regarding endocrine issues.

A physical exam will check for key signs such as:

  • Easy bruising
  • Facial redness
  • Muscle weakness
  • Reddish-purple striae (stretch marks) over 1 cm wide
  • In children, weight gain with slowed growth can be an important sign of Cushing’s syndrome. 

Other, less specific signs include: 

  • A dorsocervical fat pad (a fat buildup between the shoulders and neck)
  • Facial fullness
  • Obesity
  • Thin skin
  • Peripheral edema (fluid retention)
  • Acne
  • Hirsutism (excessive coarse hair growth in women in areas like the face and chest)
  • Poor skin healing
  • Early-onset hypertension (high blood pressure)

Recent labs may show hypokalemia (low potassium), impaired glucose tolerance (high blood sugar, insulin resistance, or possibly diabetes), and dyslipidemia (high cholesterol).

Expect your primary care provider to share their insights and discuss whether a specialist referral is needed. If there's any uncertainty about the root cause of your condition, a referral is usually made for further evaluation.

Endocrinologist

Most commonly, a PCP will refer a patient to an endocrinologist if there is any concern for Cushing’s disease. 

What is an Endocrinologist?

An endocrinologist is a medical doctor who specializes in diagnosing and treating disorders of the endocrine or hormone, systems.  Endocrinologists commonly treat conditions such as diabetes, thyroid disorders, osteoporosis, adrenal disorders, and hormone imbalances, as well as less common conditions like Cushing’s disease.

Because of their highly specialized training, an endocrinologist is the best medical professional to diagnose and manage a complex condition like Cushing’s disease. They have the expertise to know which tests to order and how to interpret them to arrive at the correct diagnosis accurately. 

An endocrinologist will tailor an individual’s treatment plan based on the underlying cause; this may include referrals to additional specialists if needed.

How Will an Endocrinologist Diagnose Cushing’s Disease?

To begin the diagnostic process for Cushing’s disease, an endocrinologist will order screening tests like the 24-hour urinary free cortisol to detect elevated cortisol levels, the late-night salivary cortisol to assess loss of the normal circadian rhythm, or the dexamethasone suppression test to evaluate the body’s cortisol response. 

If initial tests suggest high cortisol, confirmatory tests follow. These may include a midnight serum cortisol test, a plasma ACTH test, the low-dose dexamethasone test with CRH stimulation, or the desmopressin test to confirm Cushing’s.

Initial workup indicating hypercortisolemia may be followed by imaging to assess for a hormone-producing tumor.

MRI is recommended for detecting small pituitary tumors in suspected ACTH-dependent Cushing's disease. If no tumor is found, further testing is needed. 

Adrenal CT scans are suggested for ACTH-independent Cushing's to identify adrenal tumors or hyperplasia and can also locate small ACTH-producing tumors. PET scans are used when ectopic ACTH production is suspected but not detected by CT or MRI, particularly for small neuroendocrine tumors. 

Bilateral Inferior Petrosal Sinus Sampling (BIPSS) differentiates between pituitary and ectopic ACTH sources when imaging is inconclusive. Higher ACTH levels in blood from the petrosal sinuses point to a pituitary source.

What Treatments Will an Endocrinologist Recommend for Cushing’s Disease?

Treatment for Cushing’s disease typically involves surgical intervention, a transsphenoidal adenomectomy to remove the pituitary tumor.

Radiation therapy is an option for patients unresponsive to surgery or with recurrent disease. 

Medications are also considered and can include:

  • Steroidogenesis inhibitors (ketoconazole, metyrapone, mitotane) for those unable to undergo surgery or awaiting radiation
  • Pituitary-directed drugs (cabergoline, pasireotide) 
  • Glucocorticoid antagonists (mifepristone) for persistent disease
  • Combination therapy may be necessary in severe cases

Even after hypercortisolism is managed, ongoing monitoring is essential for persistent issues like hypertension, diabetes, and cardiovascular problems. Depending on the chronic conditions caused by Cushing’s disease, the patient may again be referred to the appropriate specialists for long-term management.

Neurosurgeon

A neurosurgeon specializes in performing surgeries on the nervous system, including the brain and spinal cord. In Cushing's Disease, they perform the transsphenoidal adenomectomy to remove the pituitary tumor (adenoma) causing excess cortisol production.

Removing the tumor is often the best option to support normal cortisol levels and reduce associated symptoms. Surgery is typically the first-line treatment when the tumor is accessible and the patient's condition is stable.

Typically, in transsphenoidal surgery, the tumor is removed through the nasal cavity. This approach is minimally invasive and has a high success rate in experienced hands. 

Radiation Oncologist

A radiation oncologist specializes in using radiation therapy to treat cancer and other conditions. In Cushing's Disease, they are essential when surgery isn't fully effective or possible, using targeted radiation to address residual tumor cells and support cortisol production management.

Radiation therapy options include stereotactic radiosurgery, which delivers precise, high-dose radiation to the tumor with minimal impact on surrounding tissues, and conventional radiation therapy, which uses lower doses over several sessions to address residual tumor cells.

Endocrine Surgeon

An endocrine surgeon specializes in surgeries on endocrine glands, such as the adrenal glands. For Cushing’s syndrome caused by adrenal gland issues, they may perform an adrenalectomy to remove one or both adrenal glands to support cortisol production management.

Adrenal surgery, or adrenalectomy, is necessary when an adrenal tumor causes Cushing's syndrome or when other treatments have failed to manage cortisol production. It's also considered in cases of severe disease where rapid reduction of cortisol levels is critical.

Patients typically require lifelong hormone replacement therapy to compensate for the loss of adrenal gland function, ensuring they maintain proper hormonal balance and avoid complications.

Other Specialists You May Need

Patients in long-term recovery from Cushing’s disease may need additional medical support. The following specialists often become part of the patient’s long-term medical team:

Cardiologist: Cushing’s disease can create long-term cardiovascular complications that persist beyond surgical, radiation, or medical treatment. A cardiologist manages cardiovascular complications such as hypertension and heart disease, which are common in patients with Cushing's disease due to prolonged exposure to high cortisol levels.

Dermatologist: a dermatologist treats skin-related symptoms, including thinning skin, acne, and easy bruising, which are direct effects of excess cortisol.

Psychiatrist or Psychologist: many patients with Cushing's disease experience psychological effects like depression and anxiety that may persist after cortisol levels normalize. A psychiatrist or psychologist can provide necessary interventions to improve mental well-being.

Nutritionist: a nutritionist develops a tailored diet plan to help manage weight, blood sugar levels, and overall health during and after treatment, which can be challenging due to the metabolic disturbances caused by Cushing's disease.

Importance of a Multidisciplinary Approach to Cushing’s Disease

Collaborative Care: a team of specialists working together ensures comprehensive care for Cushing’s Disease by addressing the wide range of symptoms and complications associated with chronically high cortisol. 

Each specialist contributes their expertise to create a holistic and effective treatment plan, from hormonal balance to cardiovascular health and mental well-being.

Coordinating Between Specialists: in a patient’s overall treatment plan for Cushing’s Disease, each specialist plays a distinct role—whether it’s managing hormone levels, cardiovascular health, skin conditions, or psychological support. 

Effective communication among healthcare providers ensures that all treatments are aligned and that the patient receives cohesive and integrated care.

[signup]

Key Takeaways

Key Specialists in Treating Cushing’s Disease include:

  • Endocrinologist: specializes in diagnosing and managing hormone-related disorders, often leading the treatment plan for Cushing’s Disease.
  • Neurosurgeon: performs transsphenoidal adenomectomy to remove the pituitary tumor, a primary treatment for Cushing’s Disease.
  • Radiation Oncologist: provides targeted radiation therapy when surgery isn't fully effective or possible.
  • Endocrine Surgeon: handles adrenalectomy when Cushing’s syndrome is caused by adrenal tumors.

Consulting the right specialists early is necessary for timely and effective management of Cushing’s Disease. Often, it is a visit with the primary care provider that initiates the required diagnosis and management through appropriate referrals. 

Then, an endocrinologist is essential for accurate diagnosis, while a neurosurgeon, radiation oncologist, and/or endocrine surgeon provide targeted treatments.

After Cushing’s disease is managed and cortisol levels normalize, additional specialists may join an individual’s healthcare team to manage chronic complications. 

With the right medical team, Cushing’s Disease can be managed effectively. Each specialist plays a part in diagnosis, treatment, and long-term care. Patients should feel reassured that a multidisciplinary approach offers the best chance for successful management and recovery from this complex condition.

The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.
Learn More
No items found.

Lab Tests in This Article

No lab tests!

Barbot, M., Ceccato, F., & Scaroni, C. (2019). The Pathophysiology and Treatment of Hypertension in Patients With Cushing's Syndrome. Frontiers in endocrinology, 10, 321. https://doi.org/10.3389/fendo.2019.00321

Bryant, A. Thyroid Disorders: Types, Causes, and Treatments. (2024, May 23). Rupa Health. https://www.rupahealth.com/post/thyroid-disorders-types-causes-treatments‌

Buliman, A., Tataranu, L. G., Paun, D. L., Mirica, A., & Dumitrache, C. (2016). Cushing's disease: a multidisciplinary overview of the clinical features, diagnosis, and treatment. Journal of medicine and life, 9(1), 12–18.

Castinetti, F., Morange, I., Conte-Devolx, B., & Brue, T. (2012). Cushing’s disease. Orphanet Journal of Rare Diseases, 7(1), 41. https://doi.org/10.1186/1750-1172-7-41

Chaudhry HS, Singh G. Cushing Syndrome. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470218/

Chen, Y., Li, Y., Chen, X., & Sun, Q. (2013). Neuropsychiatric disorders and cognitive dysfunction in patients with Cushing’s disease. Chinese Medical Journal, 126(16), 3156–3160. https://doi.org/10.3760/cma.j.issn.0366-6999.20130944

Cloyd, J. A Functional Medicine Approach to Cystic Acne. (2023, March 30). Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-cystic-acne

Cloyd, J. A Root Cause Medicine Protocol For Patients With Osteoporosis: Testing, Therapeutic Diet, and Supportive Supplements. (2023, September 6). Rupa Health. https://www.rupahealth.com/post/a-root-cause-medicine-protocol-for-patients-with-osteoporosis-testing-therapeutic-diet-and-supportive-supplements

Cloyd, J. (2023, May 18). Complementary and Integrative Medicine Approaches to Managing High Blood Pressure: Specialty Testing, Lifestyle Modifications, and Natural Remedies. Rupa Health. https://www.rupahealth.com/post/complementary-and-integrative-medicine-approaches-to-managing-high-blood-pressure-testing-lifestyle-modifications-and-natural-remedies

Cloyd, J. Cortisol and Anxiety: Understanding the Connection. (2024, June 7). Rupa Health. https://www.rupahealth.com/post/cortisol-and-anxiety

Cloyd, J. Cortisol and Weight Gain: Understanding the Connection. (2024, April 15). Rupa Health. https://www.rupahealth.com/post/cortisol-and-weight-gain-understanding-the-connection

Cloyd, J. (2023, December 1). A Functional Medicine Protocol For Balancing Blood Sugar. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-protocol-for-balancing-blood-sugar

‌Cloyd, J. Utilizing Functional Medicine Labs In Practice To Help Individualize Nutrition Options for Type 2 Diabetics. (2023, June 27). Rupa Health. https://www.rupahealth.com/post/3-functional-medicine-labs-that-can-help-individualize-nutrition-options-for-type-2-diabetics

Diorio, B. (2023, January 27). Functional medicine labs that are important for longevity and cognition. Rupa Health. https://www.rupahealth.com/post/functional-medicine-labs-that-are-important-to-longevity-and-cognition

Ferraù, F., & Korbonits, M. (2015). Metabolic comorbidities in Cushing’s syndrome. European Journal of Endocrinology, 173(4), M133–M157. https://doi.org/10.1530/eje-15-0354

Fleseriu, M., Auchus, R., Bancos, I., Ben-Shlomo, A., Bertherat, J., Biermasz, N. R., Boguszewski, C. L., Bronstein, M. D., Buchfelder, M., Carmichael, J. D., Casanueva, F. F., Castinetti, F., Chanson, P., Findling, J., Gadelha, M., Geer, E. B., Giustina, A., Grossman, A., Gurnell, M., Ho, K., … Biller, B. M. K. (2021). Consensus on diagnosis and management of Cushing's disease: a guideline update. The lancet. Diabetes & endocrinology, 9(12), 847–875. https://doi.org/10.1016/S2213-8587(21)00235-7

Halimova, Z., & Irgasheva, O. B. (2021). Turakulov Republican Specialized Scientific and Practical Medical Center of Endocrinology of the Ministry of Health of the Republic of Uzbekistan, Tashkent, Republic of Uzbekistan. INTERNATIONAL JOURNAL of ENDOCRINOLOGY (Ukraine), 16(4), 310–315. https://doi.org/10.22141/2224-0721.16.4.2020.208483

Hasenmajer, V., Sbardella, E., Sciarra, F., Minnetti, M., Isidori, A. M., & Venneri, M. A. (2020). The Immune System in Cushing’s Syndrome. Trends in Endocrinology & Metabolism, 31(9), 655–669. https://doi.org/10.1016/j.tem.2020.04.004

Henry, E. (2022, January 4). How To Reverse Weight Gain And Slowed Metabolism. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-slow-metabolism-middle-age

Hodgens A, Sharman T. Corticosteroids. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554612/

‌Irvine, E., Yap, Y. W., Purewal, T., & Irvine, E. (2017). A case of acute confusion: Cushing's syndrome presenting with primary hyperparathyroidism. BMJ case reports, 2017, bcr2016218694. https://doi.org/10.1136/bcr-2016-218694

Kairys N, Anastasopoulou C, Schwell A. Cushing Disease. [Updated 2023 Feb 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448184/

Kelly D. F. (2007). Transsphenoidal surgery for Cushing's disease: a review of success rates, remission predictors, management of failed surgery, and Nelson's Syndrome. Neurosurgical focus, 23(3), E5. https://doi.org/10.3171/foc.2007.23.3.7

Khakham, C. Exploring Integrative Medicine Strategies for Optimal Heart Health: The Role of Specialty Lab Testing and Stress Reduction Techniques. (2023, May 11). Rupa Health. https://www.rupahealth.com/post/exploring-integrative-medicine-strategies-for-optimal-heart-health-the-role-of-specialty-lab-testing-and-stress-reduction-techniques

Khakham, C. Top Labs To Run Bi-Annually On Your Depression Patients. (2023, July 28). Rupa Health. https://www.rupahealth.com/post/top-labs-to-run-bi-annually-on-your-depression-patients

Khakham, C. Top Labs To Run Bi-Annually On Your High Cholesterol Patients. Rupa Health. Published August 3, 2023. https://www.rupahealth.com/post/top-labs-to-run-bi-annually-on-your-high-cholesterol-patients

Kreitschmann-Andermahr, I., Psaras, T., Tsiogka, M., Starz, D., Kleist, B., Siegel, S., Milian, M., Kohlmann, J., Menzel, C., Führer-Sakel, D., Honegger, J., Sure, U., Müller, O., & Buchfelder, M. (2015). From first symptoms to final diagnosis of Cushing's disease: experiences of 176 patients. European journal of endocrinology, 172(3), 285–289. https://doi.org/10.1530/EJE-14-0766

Kresge, K. (2023, February 21). An Integrative Medicine Approach to Depression. Rupa Health. https://www.rupahealth.com/post/an-integrative-medicine-approach-to-depression

Lamos, E. M., & Munir, K. M. (2014). Cushing disease: highlighting the importance of early diagnosis for both de novo and recurrent disease in light of evolving treatment patterns. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 20(9), 945–955. https://doi.org/10.4158/EP14068.RA

Maholy, N. (2023, May 26). Integrative Nutrition Approaches to Managing Blood Sugar Levels. Rupa Health. https://www.rupahealth.com/post/integrative-nutrition-approaches-to-managing-blood-sugar-levels

Mann, M., Koller, E., Murgo, A., Malozowski, S., Bacsanyi, J., & Leinung, M. (1997). Glucocorticoidlike activity of megestrol. A summary of Food and Drug Administration experience and a review of the literature. Archives of internal medicine, 157(15), 1651–1656. https://doi.org/10.1001/archinte.157.15.1651

McLaughlin, N., Kassam, A. B., Prevedello, D. M., & Kelly, D. F. (2011). Management of Cushing’s Disease After Failed Surgery - A Review. Canadian Journal of Neurological Sciences / Journal Canadien Des Sciences Neurologiques, 38(1), 12–21. https://doi.org/10.1017/s031716710012075x

Menconi, M., Fareed, M., O'Neal, P., Poylin, V., Wei, W., & Hasselgren, P. O. (2007). Role of glucocorticoids in the molecular regulation of muscle wasting. Critical care medicine, 35(9 Suppl), S602–S608. https://doi.org/10.1097/01.CCM.0000279194.11328.77

Nath, A., Murthy, G.V.S., Babu, G.R. et al. Effect of prenatal exposure to maternal cortisol and psychological distress on infant development in Bengaluru, southern India: a prospective cohort study. BMC Psychiatry 17, 255 (2017). https://doi.org/10.1186/s12888-017-1424-x

Nieman L. K. (2018). Recent Updates on the Diagnosis and Management of Cushing's Syndrome. Endocrinology and metabolism (Seoul, Korea), 33(2), 139–146. https://doi.org/10.3803/EnM.2018.33.2.139

Nieman, L. K., Biller, B. M., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., & Montori, V. M. (2008). The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism, 93(5), 1526–1540. https://doi.org/10.1210/jc.2008-0125

Nieman, L. K., Biller, B. M., Findling, J. W., Murad, M. H., Newell-Price, J., Savage, M. O., Tabarin, A., & Endocrine Society (2015). Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism, 100(8), 2807–2831. https://doi.org/10.1210/jc.2015-1818

Pappachan, J. M., Hariman, C., Edavalath, M., Waldron, J., & Hanna, F. W. (2017). Cushing’s syndrome: a practical approach to diagnosis and differential diagnoses. Journal of Clinical Pathology, 70(4), 350–359. https://doi.org/10.1136/jclinpath-2016-203933

Ramírez-Villaescusa, J., Ruiz-Picazo, D., Oliveira, C. L., & Morillas-Ariño, C. (2020). Secondary thoracolumbar deformity and sagittal imbalance due to osteoporosis in a young man with Cushing's disease: A case report. International journal of surgery case reports, 76, 134–138. https://doi.org/10.1016/j.ijscr.2020.09.182

Rubinstein, G., Osswald, A., Hoster, E., Losa, M., Elenkova, A., Zacharieva, S., Machado, M. C., Hanzu, F. A., Zopp, S., Ritzel, K., Riester, A., Braun, L. T., Kreitschmann-Andermahr, I., Storr, H. L., Bansal, P., Barahona, M.-J., Cosaro, E., Dogansen, S. C., Johnston, P. C., & Santos de Oliveira, R. (2019). Time to Diagnosis in Cushing’s Syndrome: A Meta-Analysis Based on 5367 Patients. The Journal of Clinical Endocrinology & Metabolism, 105(3), e12–e22. https://doi.org/10.1210/clinem/dgz136

Salvio, G., Martino, M., Giancola, G., Arnaldi, G., & Balercia, G. (2021). Hypothalamic–Pituitary Diseases and Erectile Dysfunction. Journal of Clinical Medicine, 10(12), 2551. https://doi.org/10.3390/jcm10122551

Starke, R. M., Williams, B. J., Vance, M. L., & Sheehan, J. P. (2010). Radiation therapy and stereotactic radiosurgery for the treatment of Cushing's disease: an evidence-based review. Current opinion in endocrinology, diabetes, and obesity, 17(4), 356–364. https://doi.org/10.1097/MED.0b013e32833ab069

Steffensen, C., Bak, A. M., Rubeck, K. Z., & Jørgensen, J. O. (2010). Epidemiology of Cushing's syndrome. Neuroendocrinology, 92 Suppl 1, 1–5. https://doi.org/10.1159/000314297

Stratakis C. A. (2016). Skin manifestations of Cushing's syndrome. Reviews in endocrine & metabolic disorders, 17(3), 283–286. https://doi.org/10.1007/s11154-016-9399-3

Sweetnich, J. (2023, June 12). Integrative Treatment Options for Adrenal Disorders: Specialty Testing, Nutrition, Supplements. Rupa Health. https://www.rupahealth.com/post/integrative-treatment-options-for-adrenal-disorders-specialty-testing-nutrition-supplements

Sweetnich, J. (2023, April 4). What is Potassium’s Role in The Body? Rupa Health. https://www.rupahealth.com/post/potassium-101

Teeter, L. A. (2023, April 13). Using functional nutrition to address hormone imbalances. Rupa Health. https://www.rupahealth.com/post/using-functional-nutrition-to-address-hormone-imbalances

Tomita A. (1998). Nihon rinsho. Japanese journal of clinical medicine, 56(6), 1574–1578.

Weinberg, J. 34 Million Americans Have This Symptomless Bone Condition - Here’s How You Can Prevent It. (2022, August 16). Rupa Health. https://www.rupahealth.com/post/osteopenia-prevention

Weinberg, J. ACTH Hormone: Roles, Regulation, and Health Implications. (2024, April 5). Rupa Health. https://www.rupahealth.com/post/acth-hormone-roles-regulation-and-health-implications

Yoshimura, H. Implementing Bioidentical Hormone Therapy in Practice With Specialty Lab Testing. (2023, July 5). Rupa Health. https://www.rupahealth.com/post/biodentical-hormone-therapy-protocol-and-testing

Subscribe to the Magazine for free to keep reading!
Subscribe for free to keep reading, If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
See All Magazine Articles
Trusted Source
The Journal of Pediatrics
Peer Reviewed Journal
Visit Source
CDC
Government Authority
Visit Source
Office of Dietary Supplements
Government Authority
Visit Source
National Heart Lung and Blood Institute
Government Authority
Visit Source
National Institutes of Health
Government Authority
Visit Source
Clinical Infectious Diseases
Peer Reviewed Journal
Visit Source
Brain
Peer Reviewed Journal
Visit Source
The Journal of Rheumatology
Peer Reviewed Journal
Visit Source
Journal of the National Cancer Institute (JNCI)
Peer Reviewed Journal
Visit Source
Journal of Cardiovascular Magnetic Resonance
Peer Reviewed Journal
Visit Source
Hepatology
Peer Reviewed Journal
Visit Source
The American Journal of Clinical Nutrition
Peer Reviewed Journal
Visit Source
The Journal of Bone and Joint Surgery
Peer Reviewed Journal
Visit Source
Kidney International
Peer Reviewed Journal
Visit Source
The Journal of Allergy and Clinical Immunology
Peer Reviewed Journal
Visit Source
Annals of Surgery
Peer Reviewed Journal
Visit Source
The Journal of Neurology, Neurosurgery & Psychiatry
Peer Reviewed Journal
Visit Source
Chest
Peer Reviewed Journal
Visit Source
Blood
Peer Reviewed Journal
Visit Source
Gastroenterology
Peer Reviewed Journal
Visit Source
The American Journal of Respiratory and Critical Care Medicine
Peer Reviewed Journal
Visit Source
The American Journal of Psychiatry
Peer Reviewed Journal
Visit Source
Diabetes Care
Peer Reviewed Journal
Visit Source
The Journal of the American College of Cardiology (JACC)
Peer Reviewed Journal
Visit Source
The Journal of Clinical Oncology (JCO)
Peer Reviewed Journal
Visit Source
Journal of Clinical Investigation (JCI)
Peer Reviewed Journal
Visit Source
Circulation
Peer Reviewed Journal
Visit Source
JAMA Internal Medicine
Peer Reviewed Journal
Visit Source
PLOS Medicine
Peer Reviewed Journal
Visit Source
Annals of Internal Medicine
Peer Reviewed Journal
Visit Source
Nature Medicine
Peer Reviewed Journal
Visit Source
The BMJ (British Medical Journal)
Peer Reviewed Journal
Visit Source
The Lancet
Peer Reviewed Journal
Visit Source
Journal of the American Medical Association (JAMA)
Peer Reviewed Journal
Visit Source
Pubmed
Comprehensive biomedical database
Visit Source
Harvard
Educational/Medical Institution
Visit Source
Cleveland Clinic
Educational/Medical Institution
Visit Source
Mayo Clinic
Educational/Medical Institution
Visit Source
The New England Journal of Medicine (NEJM)
Peer Reviewed Journal
Visit Source
Johns Hopkins
Educational/Medical Institution
Visit Source