Cushing’s syndrome is a condition that occurs due to excess production or accumulation of cortisol in the body. This article will discuss information related to Cushing’s syndrome.
What is Cushing’s Syndrome?
Abnormal levels of hormone cortisol is called as Cushing’s syndrome or hypercortisolism. It occurs mostly due to overuse of the oral corticosteroid medication. In some, the body produces too much of hormone cortisol. It is relatively rare condition and can occur in people between the age group 20 to 50 years.
In normal conditions, the adrenal glands produce hormone cortisol. These glands are located above kidneys. The adrenal glands comprise of the medulla (inner part) and the cortex (outer part). The cortex produces cortisol, after it is stimulated the hormone adrenocorticotrophic hormone (ACTH). The ACTH is produced by the pituitary gland. The pituitary gland in turn is controlled by the hypothalamus. The hypothalamus produces corticotophin releasing hormone (CRH) that controls the pituitary gland. If any of the above develop problems, it could affect the adrenal gland and its cortisol production.
The signs and symptoms of Cushing’s syndrome varies from person to person. The most common symptoms include upper body obesity and changes in the skin. The signs of hypercortisolism include:
- Excessive and sudden weight gain in the upper body, between the shoulders (buffalo hump) and in the face (moon face)
- Pink or purple stretch marks on the thighs, shoulders, stomach, breasts and arms
- Thinning of skin that makes it easy to get bruished easily as well as fragile
- Healing of simple cuts, insect bites and infections becomes slow
- Increase in occurance of acne
- Muscle weakness and fatigue
- Glucose intolerance leading to diabetes
- High blood pressure
- Women develop thicker and visible facial hair as well as suffer from irregular periods
- Men suffer from erectile dysfunction, decreased fertility as well as libido
There can be many different causes of Cushing’s syndrome. The most common cause is the long term use of high doses corticosteroid medications. These medications are used by people with severe asthma, rheumatoid arthritis, eczema, etc. In such cases, one has to accept the certain degrees of Cushing’s syndrome.
This condition can also result du to the body’s overproduction of cortisol hormone. It could be related to a tumor of the pituitary gland, ectopic ACTH tumor or develop adrenal gland disease.
The doctor will first check if the patient is not on some steroid medication. Then, he may conduct a physical examination for the classic signs of Cushing’s syndrome. For this the doctor may ask for a 24-hour urinary free cortisol test, late-night salivary cortisol measurements as well as midnight plasma cortisol levels.
Once Cushing has been diagnosed the doctor will check for cause excessive cortisol production by conducting further tests.
Treatment depends on the management of the underlying cause. This means if the patient is on steroid treatment, then the dosage levels need to be reviewed. In case of a pituatry tumor, surgical removal of the tumor will help in curing the condition in about 80% patients.
Tumors of the adrenal gland, ACTCH producing tumors, etc. can be treated with surgery or chemotherapy.In other cases, where surgery is not possible or not required, medications such as metyrapose, ketoconazole can be used to reduce the cortisol production.
Untreated Cushing’s can lead to the following complications:
- High blood pressure
- Kidney stones
- Muscle loss and weakness
- Bone loss leading to fractures
- Enlargement of pituitary tumors
The outcome of the disease is better is the treatment is started sooner. It is therefore, important to visit the doctor as soon as possible. However, the symptoms won’t go away overnight. One needs to eat light and right, keep a tab on their depression, try simple exercises that helps alleviate muscle and joint pain. Speak to your doctor regarding what’s best for you and win the long war against Cushing’s disease.
Written by: Saptakee sengupta
Date last updated: March 29, 2015