Cushing's Syndrome Epidemiology Forecast

Key Highlights:

• Endogenous Cushing’s syndrome is classified as Adrenocorticotropic Hormone (ACTH)-dependent or ACTH-independent. ACTH-dependent Cushing’s syndrome accounts for 80%–85% of cases. Of these, 75%–80% are due to ACTH production from a pituitary adenoma (Cushing’s disease).
• There were nearly 37,100 diagnosed prevalent cases of Cushing’s disease in 7MM in 2024. Among these, the US accounted for the highest number of diagnosed prevalent cases of Cushing’s disease.
• The diagnosed prevalent patient population for Cushing’s disease in EU4 and the UK was approximately 12,400 patients in 2024.
• The diagnosed prevalent cases of Cushing’s disease in the 7MM varied according to gender, with diagnosed prevalent cases higher in females than in males.

DelveInsight’s “Cushing’s Disease – Epidemiology Forecast – 2034” report delivers an in-depth understanding of Cushing’s disease, historical and forecasted epidemiology in the United States, EU4 (Germany, France, Italy, and Spain) and the United Kingdom, and Japan.

Geography Covered

• The United States
• EU4 (Germany, France, Italy, and Spain) and the United Kingdom
• Japan

Study Period: 2021-2034

Cushing’s Disease Understanding

Cushing’s Disease Overview

Cushing’s disease is an endocrine disorder characterized by increased ACTH production from the anterior pituitary, leading to excess cortisol release from the adrenal glands. A pituitary adenoma often causes this, or it results from excess Corticotropin-releasing Hormone (CRH) from the hypothalamus. It is mainly sporadic and is rarely seen in the context of endocrine tumor syndromes. In the last few years, the advancement of next-generation sequencing technologies has brought a renaissance in the understanding of the genetic events underlying the pathogenesis of Cushing’s disease. Patients with Cushing’s disease almost always have a pituitary adenoma, often not evident by imaging. However, rare cases may result from diffuse corticotroph cell hyperplasia, even without ectopic secretion of CRH. The tumors are usually microadenomas (<10 mm in size); only about 5–10% are macroadenomas. Macroadenomas are more likely to produce abnormally high ACTH concentrations than microadenomas (83% vs. 45%).

Several genetic mutations are responsible for these adenomas. The most common mutation is USP8 (ubiquitin-specific peptidase 8). These mutations lead to abnormal expression of growth factors, which act with ACTH to increase cortisol levels.

Cushing’s Disease Diagnosis

Diagnosis of Cushing’s disease is often delayed for years, partly because of a lack of awareness of the insidious, progressive disease process and testing complexity. Screening and diagnostic tests for Cushing’s disease assess cortisol secretory status: abnormal circadian rhythm with Late-night Salivary Cortisol (LNSC), impaired glucocorticoid feedback with overnight 1 mg Dexamethasone Suppression Test (DST) or Low-dose 2-day Dexamethasone Test (LDDT), and increased bioavailable cortisol with 24-h Urinary Free Cortisol (UFC) In this setting, the sensitivity of all tests is higher than 90%; the highest sensitivity rates are obtained with DST and LNSC and the lowest with UFC. Specificity is somewhat lower than sensitivity, with LNSC being the most specific and DST and UFC being the least specific. Magnetic Resonance Imaging (MRI) is the imaging method of choice for detecting ACTH-secreting pituitary adenomas. However, in part because most lesions are very small, with the use of standard 1.5T MRI, only approximately 50% of microadenomas are depicted.

A noninvasive approach using a combination of three or four tests, specifically CRH and desmopressin stimulation plus MRI, followed by whole-body CT if the diagnosis is equivocal, correctly diagnosed Cushing’s disease in approximately half of patients in one series.

Further details related to diagnosis will be provided in the report…

Cushing’s Disease Epidemiology

The Cushing’s disease epidemiology chapter in the report provides historical as well as forecasted epidemiology segmented by total diagnosed prevalent cases of Cushing’s disease, total gender-specific diagnosed prevalent cases of Cushing’s disease, and age-specific diagnosed prevalent cases of Cushing’s disease in the 7MM covering the US, EU4 (Germany, France, Italy, Spain) and the UK, and Japan from 2021 to 2034.

• In 2024, the total diagnosed prevalent cases of Cushing’s disease in the United States were approximately 19,950 cases, projected to increase during the forecast period (2025–2034).
• In 2024, gender-specific diagnosed prevalent cases accounted for approximately 4,450 and 15,500 cases for males and females, respectively, in the US.
• The total diagnosed prevalent cases of Cushing’s disease in EU4 and the UK were approximately 12,400 in 2024. Males accounted for approximately 2,650 cases, and females had approximately 9,750 cases.
• Among the total age-specific diagnosed prevalent cases of Cushing’s disease in the US, adults were observed to have higher cases, i.e., ~17,950, and children were observed to have the lower number of cases, i.e., ~2,000 in 2024. The cases are anticipated to increase during the forecast period (2025–2034).

Cushing’s Disease Report Insights

• Patient population
• Country-wise epidemiology distribution

Cushing’s Disease Report Key Strengths

• Ten years forecast
• 7MM coverage 
• Cushing’s disease epidemiology segmentation

FAQs

• What are the disease risks, burdens, and unmet needs of Cushing’s disease? What will be the growth opportunities across the 7MM concerning the patient population with Cushing’s disease?
• What is the historical and forecasted Cushing’s disease patient pool in the US, EU4 (Germany, France, Italy, and Spain), the UK, and Japan?

Reasons to Buy

• Insights on patient burden/disease prevalence, evolution in diagnosis, and factors contributing to the change in the epidemiology of the disease during the forecast years.
• To understand key opinion leaders’ perspectives around the diagnostic challenges to overcome barriers in the future.
• Detailed insights on various factors hampering disease diagnosis and other existing diagnostic challenges.