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Cushing Disease/Syndrome

Other Known Aliases – hypercortisolism,

Definition – constellation of signs and symptoms due to excessive cortisol. This can be caused by several different mechanism that affect the hypothalamus-pituitary-adrenal axis:

• CRH secretion by hypothalamus
• ACTH secretion by:
  • Anterior pituitary
  • Ectopic tumor
• Cortisol secretion adrenal glands by:
  • Adrenal hyperplasia
  • Adrenal tumor
• Exogenous administration of corticosteroids

Clinical Significance – This is one of the more common endocrinologic pathologies you will see in clinical practice. Classic presentation includes obesity, abdominal striae, “moon face”, “buffalo hump”, and hirsutism. Diagnosis is made by obtaining a 24-hour urine cortisol measurement

History – Named after Harvey Williams Cushing (1869-1939), who was an American surgeon and pioneering neurosurgeon of the early 20th century. He received his medical doctorate from Harvard Medical School in 1895. He completed his internship at Massachussets General Hospital and went on to do a surgical residency under William Halsted at John Hopkins Hospital. He trained under Kocher in England for several years before returning stateside and setting up practice in Baltimore. One of his greatest contributions to western medicine was his introduction of blood pressure management he learned from Scipione Riva-Rocci in Italy during his time in Europe.

At the age of 32, he achieved associate professor at Johns Hopkins Hospital and was placed in full charge of all surgery of the central nervous system. In 1912, he first described what would become his eponymous disease, but before he could publish it, he was called to serve during the first world war as the director for a field hospital in France for the British. It was during this appointment that he cared for a fatally wounded soldier by the name of Lt. Edward Revere Osler, son of William Osler. He formally published his findings on his eponymous disease in 1932 in an article entitled “The Basophil Adenoma of the Pituitary Body and Their Clinical Manifestations: Pituitary Basophilism”.

During his career, he was regarded as the world’s leading teacher of neurosurgeons for in the first decades of the 20th century and held professorships at Johns Hopkins Hospital, Brigham Hospital in Boston, Harvard Medical School, Yale School of Medicine, as well as honorary Fellowship in the Royal College of Surgeons. He also was awarded the 1926 Pulitzer Prize for Biography for his biography on the life of William Osler and was nominated for the Nobel Prize in Physiology or Medicine 28 times.

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References

1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
5. Up To Date. www.uptodate.com
6. http://doc1.med.yale.edu/historical/cushing/hopkins.html
7. Hansson N, Schlich T. “Highly qualified loser”? Harvey Cushing and the Nobel Prize. Journal of neurosurgery. 2015; 122(4):976-9. [pubmed]
8. Cushing H. The basophil adenomas of the pituitary body. Annals of the Royal College of Surgeons of England. 1969; 44(4):180-1. [pubmed]
9. Starling PH. The case of Edward Revere Osler. Journal of the Royal Army Medical Corps. 2003; 149(1):27-9. [pubmed]
10. Ellis H. Harvey Cushing: Cushing’s disease. Journal of perioperative practice. 2012; 22(9):298-9. [pubmed]