Background Cushing's disease is a rare and little-known disease, and the individualization of drug treatment varies greatly. Studies have shown that the gene expression profile of Cushing's disease is related to its clinical characteristics. Therefore, the study aims to identify key differential genes between the age and size of tumors through bioinformatics technology, thus providing a theoretical basis for personalized targeted therapy of Cushing's disease. Methods Downloading the gene expression microarray (GSE93825) data from the Gene Expression Omnibus (GEO) database and obtaining differentially expressed genes (DEGs) of different tumor sizes and ages through GEO2R. The DAVID database, Cytoscape and String platforms were utilized for functional enrichment analysis and protein-protein interaction (PPI) network analysis on selected differential genes. Results First, 96 DEGs were identified between macroadenoma (MAC) and microadenoma (MIC), which initially proved the different gene expression characteristics between them. Second, a total of 2128 DEGs were identified in MAC age group. The top five hub genes of the PPI network were GNGT2, LPAR3, PDYN, GRM3, and HTR1D. A total of 16 DEGs were identified in MIC age group. In addition, 88 DEGs were identified in younger MAC and MIC groups. The top five hub genes included LEP, PTGS2, STAT6, CXCL12, and ITPKB. 299 DEGs were identified in senior MAC and MIC groups. The first five hub genes were CCR7, LPAR2, CXCR5, ADCY3, and TAS2R14. By virtue of DAVID and Cytoscape software, the function enrichment analysis and core module analysis were performed successfully. Conclusions In summary, our research shows through bioinformatics analysis that different gene expression profiles of Cushing's disease are related to the size and age of the tumor, which may provide new insights into the molecular pathogenesis of Cushing's disease. These hub genes may be used for accurate diagnosis and treatment of Cushing's disease.