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Cushing Syndrome

Introduction

Cushing's syndrome is a hormonal disorder that results from high cortisol levels in the blood and is associated with various changes in the body, including the development of obesity, hypertension, diabetes, and osteoporosis. In addition, the prolonged use or abuse (especially by women for cosmetic reasons) of oral or topical corticosteroids such as prednisolone, dexamethasone, hydrocortisone, or cortisone, or preparations containing any of these drugs, is also a cause.

Etiology

Cortisol comes from your adrenal glands, located above the kidneys, and helps your body in:

  • Maintaining blood pressure
  • Converting the food you eat into energy
  • Regulating blood sugar
  • Lowering inflammation
  • Too much cortisol in blood could be due to:
  • Overuse of corticosteroids
  • Adrenal gland abnormality or tumor
  • Tumors of the pituitary gland
  • Family history of Cushing's syndrome
  • Ectopic adrenocorticotropic hormone (ACTH)-releasing Tumors in the lungs, pancreas, or thyroid gland
    An increase in cortisol levels can also be seen in other conditions such as:
  • Increased stress due to illness, surgery, pregnancy, or injury
  • Athletic training
  • Malnutrition
  • Alcohol abuse
  • High levels of emotional stress such as depression and panic disorders

Types

There are two types of Cushing’s syndrome:

  • Exogenous Cushing’s syndrome
    Exogenous Cushing’s syndrome is when the cause comes from something outside the body’s function. It often results from long-term usage of high-dose corticosteroid drugs, also known as glucocorticoids, similar to cortisol. Examples include prednisone, dexamethasone, and methylprednisolone. People with lupus, rheumatoid arthritis, asthma, and organ transplant recipients may need high doses of these drugs. Injectable corticosteroids to treat joint pain, back pain, and bursitis can also lead to Cushing’s syndrome.
  • Endogenous Cushing’s syndrome
    Endogenous Cushing's syndrome occurs when the source of the problem is internal, such as when the adrenal glands create too much cortisol. Cushing's disease is a good example. Adrenal gland tumors and benign or malignant tumors in the pancreas, thyroid, thymus gland, or lung can cause similar symptoms.

Signs And Symptoms

The following signs and symptoms characterize Cushing’s syndrome:
Weight gain

  • Excess body hair and acne (pimples)
  • Easy bruising of the skin
  • Stretch marks (reddish or purplish)
  • Menstrual irregularities
  • Weakness of the thigh muscles
  • Rounded or ‘moon’ face
  • Prominent supraclavicular fat pads (fatty tissue deposits)
  • Truncal obesity
  • Excess facial and body hair
  • Acne
  • Striae (reddish or purplish stretch marks) on the skin of the abdomen, thighs, breasts, and arms
  • Thin, fragile skin
  • Hypertension
  • Inability to rise from the squatting position
  • Slow healing of wounds
  • Depression, anxiety, and irritability

Risk Factors

Risk factors for Cushing's syndrome are

  • Adrenal or pituitary tumors
  • long-term therapy with corticosteroids
  • being female.

Diagnosis

Your healthcare provider will usually perform a physical examination to look for signs of Cushing's syndrome. Other tests include:

  • Urine and blood cortisol tests. These tests measure hormone levels and show whether your body produces excessive cortisol. You may be asked to collect your urine during a 24-hour period for the urine test. Urine and blood samples will be submitted to be tested in a laboratory.
  • Saliva test. Cortisol levels rise and normally fall throughout the day. Cortisol levels drop significantly in patients without Cushing syndrome by the evening. Doctors can determine whether cortisol levels are excessively high by testing cortisol levels in a small sample of saliva collected late at night.
  • Imaging tests. CT or MRI scans can reveal images of your pituitary and adrenal glands, detecting abnormalities like tumors.
  • Petrosal sinus sampling. This test can help determine whether Cushing syndrome is caused by the pituitary gland or something else. The blood sample is taken from the veins that drain the pituitary gland (petrosal sinuses) for the test.

Differential Diagnosis

  • Pseudo Cushing’s syndrome
  • metabolic syndrome x
  • polycystic ovary syndrome
  • 11-β hydroxylase deficiency

Complications

Complications can include:

  • Hypertension
  • blood clots
  • Stroke
  • Heart attack
  • kidney stones
  • loss of muscle mass and strength
  •  mental function abnormalities
  • Unhealthy cholesterol levels
  • insulin resistance and types 2 diabetes
  • increased thirst
  • frequent urination
  • profuse sweating
  • a higher risk of life-threatening blood infections
  • osteoporosis
  • Cushing’s syndrome can result in obesity and a slow growth rate in children.

Treatment

Your doctor will first determine why you have too much cortisol in your system. This will lead to a treatment plan for your disease. Suppose you're producing too much cortisol as a result of steroid medications. In that case, your doctor will check if you can gradually reduce your dosage while still managing your asthma, arthritis, or other diseases. You may require surgery to remove a tumor, and if a tumor can't be removed entirely, you may require radiotherapy and surgery. In some situations, radiotherapy can even be utilized instead of surgery.
When surgery and radiation don't work, cortisol-controlling medications may be an alternative. These drugs have the potential to cause significant side effects. In people with Cushing's syndrome who are very sick, a doctor may prescribe medications before surgery. Other hormones generated by the pituitary or adrenal gland may be affected by the tumor or its treatment, and you may need hormone replacement medication.

Lifestyle Modification

  • Gradually increase your activity level. Work your way up to a comfortable exercise or activity level without overdoing it. You'll slowly progress, and your persistence will be rewarded.
  • Eat in moderation. Nutritious foods give a good energy source for your recovering body and help in the loss of weight accumulated as a result of Cushing syndrome. Make sure you have adequate calcium and vitamin D in your diet. They work together to help your body absorb calcium, which can help strengthen your bones and prevent bone loss associated with Cushing syndrome.
  • Stay updated on your mental health. Depression is a common side effect of Cushing syndrome, and it can last or worsen following treatment. Please don't ignore or wait for your depression to pass. If you're sad, overwhelmed, or having trouble coping during your recovery, seek support from your doctor or a therapist as soon as possible.
  • Soothe aches and pains gently. Hot baths, massages, and low-impact exercises like water aerobics and tai chi can help relieve some of the muscular and joint discomfort associated with Cushing's syndrome recovery.

Prognosis

Tumor removal may lead to full recovery, but there is a chance of recurrence. Survival for people with ectopic tumors depends upon the overall outcome of the particular tumor type. Untreated, Cushing's syndrome can be life-threatening.