Cushing's disease is a rare
chronic disease caused by a
pituitary adenoma, which leads to excess secretion of
adrenocorticotropic hormone (
ACTH). The over-production of
ACTH leads to hyperstimulation of the adrenal glands and a chronic excess of
cortisol, resulting in the signs and symptoms of a severe clinical state (
Cushing's syndrome) that leads to significant morbidity, negative impacts on the patient's quality of life, and, if untreated, increased mortality. The management of patients with
Cushing's disease is complicated by the heterogeneity of the condition, with signs and symptoms that overlap with those of other diseases, and high subclinical incidence rates. Controversies surrounding the tests used for screening and identifying patients with
Cushing's disease add to the challenge of patient management. Surgical intervention to remove the
adenoma is the first-line treatment for patients with
Cushing's disease, but medical
therapies are useful in patients who relapse or are unsuitable for surgery. The recent introduction of
pasireotide, the first pituitary-directed medical
therapy, expands the number of treatment options available for patients with
Cushing's disease. This state-of-the-art review aims to provide an overview of the most recent scientific research and clinical information regarding
Cushing's disease. Continuing research into improving the diagnosis and treatment of
Cushing's disease will help to optimize patient management.