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CUSHING’S SYNDROME

Men's Health, Women's Health / By

CUSHING’S SYNDROME

Cushing’s syndrome is a rare condition that occurs when the body is exposed to high levels of the hormone cortisol over a long period of time.

  • Cortisol which is produced in the adrenal glands, two small glands on top of the kidney, plays a variety of role in the body. It is sometimes called the stress hormone because it helps the body respond to stress
  • It also helps the body maintain blood pressure, reduce inflammation, keep the heart and blood vessel functioning, and regulate the way the body converts proteins, carbohydrates, and fats into usable energy
  • About two to three million people are affected each year, with women three times more often than men
  • It most commonly affects people who are 20 to 50 years of age
  • if left untreated, Cushing’s syndrome can lead to complications, including high blood pressure, type 2 diabetes, loss of muscle mass and strength, bone loss, or frequent infections

CAUSES

The cause can be exogenous (developing from a cause outside the body) or endogenous (developing from internal processes)

EXOGENOUS

The most common cause of Cushing’s syndrome is prolonged use of prescribed cortisol-like glucocorticoids (also called steroids) to treat medical disorders, including asthma, rheumatoid arthritis, and also for immunosuppression after organ transplants. They are also injected into a joint to treat pain.

ENDOGENOUS

The most common cause of endogenous Cushing’s syndrome is a pituitary gland tumor (pituitary adenoma), a benign tumor of the pituitary gland. Normally, ACTH (adrenocorticotropic hormone) is released from the pituitary gland (located at the base of the brain) when necessary to stimulate the release of cortisol from the adrenal gland. A pituitary gland tumor results in the production of an excess amount of ACTH, which in turn stimulates the adrenal gland to make more cortisol. This is also known as Cushing’s disease and it is responsible for 70% of endogenous Cushing’s syndrome.

A noncancerous tumor of the adrenal cortex called adrenal adenoma can cause the condition. Occasionally, benign, nodular enlargements of both adrenal glands can cause Cushing’s syndrome

Tumors that develop outside the normal pituitary-adrenal system, in organs that normally do not produce ACTH. These tumors can be benign or cancerous and can be found in the lungs, thyroid, or pancreas.

SYMPTOMS

Common signs and symptoms include:

  • Acne
  • Thinning of the skin, causing dryness and easy bruising
  • Weight gain and fatty tissue deposits, particularly of the face (moon face), on the back of the neck (buffalo hump)
  • Red or purple striae (stretch marks) on the skin of the abdomen, thighs, breasts, and arms

Other symptoms include:

  • Excess sweating
  • Severe fatigue
  • Loss of emotional control
  • Headache
  • Cognitive difficulties, including memory and attention dysfunction
  • Insomnia
  • Persistent high blood pressure
  • Increased urination
  • Depression, irritability, or moodiness
  • Immune suppression
  • Sleep disturbances
  • In children, impaired growth

Symptoms specific to women include:

  • Irregular or absent menstrual period
  • Facial hair
  • Thicker or more visible body
  • Infertility

Symptoms specific to men include:

  • Baldness
  • Decreased libido
  • Erectile dysfunction
  • Impotence

DIAGNOSIS AND TREATMENT

To make a diagnosis, the doctor will carry out a physical exam, looking for symptoms associated with the condition.

Your doctor may suspect Cushing’s syndrome if you have been using corticosteroid medications over a long period of time

If you have not been using the medications, diagnostic tests that may help pinpoint the cause includes:

  • Urine and blood tests
  • Saliva test
  • Imaging tests including CT scan, or MRI
  • Petrosal sinus sampling
TREATMENT

The aim of the treatment option is to lower the high level of cortisol in the body. Treatment options may include:

Reducing the use of corticosteroid – The doctor may be able to keep your symptoms under control by reducing the dosage, while still managing your arthritis, asthma or other condition. Do not stop taking the dosage on your own without a doctor’s supervision.  In exogenous Cushing’s, hormone production is suppressed by the glucocorticoid medication. An abrupt stoppage can, therefore, lead to an acute and potentially-life threatening adrenal insufficiency. It is always advised that the dose be slowly and carefully tapered off to allow internal cortisol production to pick up.

In some cases where sufficient levels of internal production may never be recovered, affected individuals must continue taking glucocorticoids at physiological dosage for life.

Surgery – if cases are related to a tumor, complete surgical removal may be recommended

Radiation Therapy – if surgery cannot totally remove a tumor, radiation therapy in conjunction with surgery may be recommended.

Radiation may also be used for people who are not suitable for surgery.

Medications can be used where surgery and radiation therapy fails. Medications can be used to reduce the overproduction of cortisol hormone at the adrenal gland or decrease ACTH production from a pituitary tumor.

Surgical removal of the adrenal gland may be recommended if all other treatment option fails.