An overview of Cushing's Syndrome

Cushing’s syndrome or hypercortisolism is a disorder that occurs when your body makes too much of the hormone cortisol over a long period of time. Cortisol is sometimes called the “stress hormone” because it helps your body respond to stress.

Cushing syndrome is caused by an excess of the hormone cortisol. Your adrenal glands produce cortisol.

Cortisol helps with a number of your body’s functions, including:

~ regulating blood pressure and the cardiovascular system

~ reducing the immune system’s inflammatory response

~ converting carbohydrates, fats, and proteins into energy

~ balancing the effects of insulin

~ responding to stress

Your body may produce high levels of cortisol for a variety of reasons, including:

~ high stress levels, including stress related to an acute illness, surgery, injury, or pregnancy, especially in the final trimester

~ athletic training

~ malnutrition

~ alcoholism

~ depression, panic disorders, or high levels of emotional stress

Corticosteroids

The most common cause of Cushing syndrome is the use of corticosteroid medications, such as prednisone, in high doses for a long period. Healthcare professionals can prescribe these to treat inflammatory diseases, such as lupus, or to prevent rejection of a transplanted organ.

The most common cause of Cushing syndrome is the use of corticosteroid medications, such as prednisone, in high doses for a long period. Healthcare professionals can prescribe these to treat inflammatory diseases, such as lupus, or to prevent rejection of a transplanted organ.

Tumors

Several kinds of tumors can also lead to a higher production of cortisol.

Some of these include:

1. Pituitary gland tumors. The pituitary gland releases too much adrenocorticotropic hormone (ACTH), which stimulates cortisol production in the adrenal glands. This is called Cushing disease.

2. Ectopic tumors. These are tumors outside of the pituitary that produce ACTH. They usually occur in the lung, pancreas, thyroid, or thymus gland.

3. Adrenal gland abnormality or tumor. An adrenal abnormality or tumor can lead to irregular patterns of cortisol production, which can cause Cushing syndrome.

4. Familial Cushing syndrome. Although Cushing syndrome isn’t typically inherited, it’s possible to have an inherited tendency to develop tumors of the endocrine glands.

The signs and symptoms of Cushing’s syndrome can vary depending on the levels of excess cortisol.

Common signs and symptoms of Cushing’s syndrome

~ Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), and between the shoulders (buffalo hump)

~ Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms

~ Thinning, fragile skin that bruises easily

~ Slow healing of cuts, insect bites and infections

~ Acne

~ Depression, anxiety and irritability

~ Muscle weakness

~New or worsened high blood pressure

~ Bone loss, leading to fractures over time

~ In children, impaired growth

Signs and symptoms women with Cushing’s syndrome may experience

~ Thicker or more visible body and facial hair (hirsutism)

~ Irregular or absent menstrual periodsIrregular or absent menstrual periods

~ Women with Cushing syndrome may develop extra facial and body hair.

~ Untreated Cushing syndrome in women can lead to difficulties becoming pregnant.

Signs and symptoms men with Cushing’s syndrome may experience

~ Decreased sex drive

~ Decreased fertility

~ Erectile dysfunction

Cushing’s syndrome can be particularly difficult to diagnose. This is because many of the symptoms, like weight gain or fatigue, can have other causes. Additionally, Cushing syndrome itself can have many different causes.

A healthcare professional will review your medical history. They’ll ask questions about symptoms, any health conditions you may have, and any medications you’re taking.

They’ll also perform a physical exam where they’ll look for signs like a bump between your shoulders, stretch marks, and bruises.

Next, they may order lab tests, including:

24-hour urinary free cortisol test: For this test, you’ll be asked to collect your urine over a 24-hour period. The levels of cortisol will then be tested.

Salivary cortisol measurement: In people without Cushing syndrome, cortisol levels drop in the evening. This test measures the level of cortisol in a saliva sample that’s been collected late at night to see if cortisol levels are too high.

Low-dose dexamethasone suppression test: For this test, you’ll be given a dose of dexamethasone late in the evening. Your blood will be tested for cortisol levels in the morning. Normally, dexamethasone causes cortisol levels to drop. If you have Cushing syndrome, this won’t occur.

Dexamethasone–CRH test. High cortisol levels can happen for a variety of reasons, from consuming too much alcohol to living with depression or anxiety. This test, which includes a shot of the hormone CRH and a dose of dexamethasone, can help a doctor note if high cortisol levels are due to Cushing syndrome, or another issue.

Diagnosing the cause of Cushing syndrome

After you receive the diagnosis of Cushing syndrome, your doctor must still determine the cause of the excess cortisol production.

Tests to help determine the cause may include:

Blood adrenocorticotropin hormone (ACTH) test: Levels of ACTH in the blood are measured. Low levels of ACTH and high levels of cortisol could indicate the presence of a tumor on the adrenal glands.

Corticotropin-releasing hormone (CRH) stimulation test: In this test, you’re given a shot of CRH. This will raise levels of ACTH and cortisol in people with pituitary tumors.

High-dose dexamethasone suppression test: This is the same as the low-dose test, except that a higher dose of dexamethasone is used. If cortisol levels drop, you may have a pituitary tumor. Higher levels or cortisol could point to an adrenal tumor or ectopic tumor.

Petrosal sinus sampling: Blood is drawn from a vein near the pituitary and from a vein far from the pituitary. A shot of CRH is given, and if ACTH rises in the blood near the pituitary, it can indicate a pituitary tumor. Similar levels from both samples indicate an ectopic tumor.

Imaging studies: These can include things like CT and MRI scans. They’re used to visualize the adrenal and pituitary glands to look for tumors.

The type of treatment depends on the underlying cause of the high cortisol levels. If you use glucocorticoids, your healthcare provider will likely lower the dosage or prescribe a non-glucocorticoid medication. If a tumor is causing Cushing’s syndrome, it might need to be killed with radiation or removed surgically. Another option is for your healthcare provider to prescribe a medication such as ketoconazole that will slow down the production of cortisol. You may work with several healthcare providers to treat the tumor and Cushing’s syndrome symptoms.

1. Chemotherapy: Chemotherapy is necessary if a tumor is cancerous and has spread to other parts of your body. Be sure to discuss all side effects with your healthcare provider.

2. Medications: Adding drugs that reduce cortisol or taking away drugs that can cause Cushing’s syndrome.

3. Radiation: Surgery on a pituitary tumor may not be possible. In those cases, you might have to go through a six-week period of radiation. Cortisol levels may take years to return to normal. Medicines that increase cortisol levels are available. Be sure to discuss all side effects with your healthcare provider.

4. Surgery: Surgically removing pituitary tumors, adrenal tumors and ectopic tumors is effective, but you’ll have to be prescribed cortisol medicine. You’ll be able to stop the medications after six to 18 months. Often, after laparoscopic surgery, you’ll be able to leave the hospital within one or two days and feel back to “normal” in about three to five weeks.

If Cushing’s syndrome is properly treated, the disease may go away after two to 18 months. Be sure to stay in contact with your healthcare provider during that period.

If you have Cushing syndrome, it’s important that it’s properly managed. If you don’t get treatment for it, Cushing syndrome can lead to a variety of potentially serious health complications. Which includes :

1. osteoporosis, which can increase your risk of bone fractures

2. muscle loss (atrophy) and weakness

3. high blood pressure (hypertension)

4. Type 2 diabetes

5. frequent infections

6. heart attack or stroke

7. depression or anxiety

8. cognitive difficulties like trouble concentrating or problems with memory

9. enlargement of an existing tumor

Cushing’s syndrome can be difficult to live with, but your quality of life doesn’t have to decrease. There are healthcare providers trained to help you and there are treatments available. With proper procedures and medicine, Cushing’s syndrome can be cured.

You may find yourself dealing with some emotional and social issues as a result of Cushing’s syndrome. Some people may feel embarrassed by the balding, excessive hair and/or the weight gain in the face and back of the neck. “Moon face” and “buffalo hump” may make you hesitate to participate in social situations. With time, those symptoms can be cured. Cushing’s syndrome can also cause depression and other mental illnesses. If need be, consult a therapist for counseling and a psychiatrist for medication to help yourself deal with the emotional impact of Cushing’s syndrome.