Cushing's Disease

Cushing’s disease is an endocrine disease that occurs when too much cortisol is in the blood due to excessive ACTH, adrenocorticotrophich hormone. The pituitary is responsible for this anomaly. ACTH stimulates the adrenal glands to secrete cortisol. This disease is most common in those aged 20-70 and is most likely to be women.
Cushing’s disease is not the same as Cushing Syndrome. Cushing’s disease is a direct cause of a pituitary tumor, most likely a pituitary adenoma. Cushing's syndrome mostly means that there is an increased cortisol level, however a pituitary tumor is not the cause. There are many reasons that the body can secrete too much cortisol. Common symptoms of Cushing's disease include skin changes/bruising, weight gain including added fat on the back of the neck, decreased fertility and sex drive, high blood pressure, diabetes, and mood or behavior disorders.
Early signs of Cushing’s disease often go unnoticed because they come on slowly. The first thing most physicians do to determine Cushing’s disease is to do a blood test to determine elevated cortisol in the blood stream. Once Cushing’s Disease is suspected, an MRI is performed. MRI is about 70% accurate in diagnosing this disease.
The only cure for this disorder is transsphenoidal surgery to remove the tumor. If the tumor has not spread to other structures, the cure rate is about 80-85%. Medication is an alternative to surgery. They can be used to help inhibit ACTH production.

Langerhans Cell Histiocytosis

Langerhans Cell Histiocytosis is a rare disease that occurs when there are too many of a certain white blood cell. These cells function normally within the body and their job is to help fight infections. LCH occurs when too many of these cells accumulate in an area of the body. Scientists are still unsure as to why this occurs to some people. The most common place to see this is in the head and neck, sternum, ribs, long bones, and vertebrae. This disorder most often affects children 10 and under.

Common symptoms include skin rash, tenderness/pain around the area involved, loose or lost teeth, swollen gums, vision problems and weakness to name a few. To diagnose this disease a CBC is drawn, CT or MRI done and even a biopsy can be necessary.

Treatments vary widely from simply taking medication and surgery to radiation therapy and chemotherapy. Chemotherapy is the most serious treatment that is considered as this mode of therapy can’t differentiate between cancerous cells and healthy cells. Remember that the majority of those diagnosed with this disease are children.

The long-term outlook for a child with this condition is good. Survival rate is high, but many have long-term chronic ailments.

The image above is taken from the textbook, Maxillofacial Imaging and demonstrates this disease in a one year child. The image shows a soft tissue mass that has eroded the mastoid cortex and complete opacification/destruction of the mastoid air cells.

Susan Brumley

Multiple Sclerosis

Multiple Sclerosis, or MS, is a disease that hits close to home for me. My cousin Kaye was diagnosed with this about 6 years ago.

MS is a chronic disease with no cure at this time. Symptoms range from visual and gait disturbances early on to tremors, bladder problems, and muscle weakness. Generally the patient will deteriorate to the point that walking aides and/or a wheelchair is necessary. The ability to think and reason is affected as well. Dependence on others oftentimes leads to depression in this disease. Many times the symptoms are very random and no two MS sufferers may present identically.

I've added two MRI images that depict MS lesions that are typical with this disease. MRI is 95% accurate in diagnosing this disease.