Cushing’s Syndrome
Cushing’s Syndrome is a hormone disorder caused by the body tissues being exposed to high levels of the hormone cortisol for a long period of time. The disease is commonly caused by taking corticosteroid medicine in high doses over an extended period of time. The condition can also be caused by the body’s excess production of cortisol due to an overactive adrenal gland. It is a rare disease that mostly affects adults between the ages of 20 to 50. Females are more likely to get the disease than males due to an adrenal or pituitary tumor. Cushing’s Syndrome signs and symptoms include progressive obesity and skin changes.
There is rapid gain in the upper body fat deposit along the collar bone and the back of the neck which is often called “buffalo humps” and a rounded face which is referred to as “moon face”. The skin stretches causing pink or purple stretch marks along the stomach, thighs, breasts, and arms. A woman with the syndrome could experience excess body hair growth on their face, neck, chest, stomach, and thighs. It could cause their menstrual cycle to become irregular or stop. A man with the syndrome could experience decreased fertility and erectile dysfunction.
Other signs and symptoms include excess sweating, fatigue, muscle weakness, headaches, high blood pressure, thinning and fragility of the skin causing it to bruise easily and heal poorly. Other symptoms also include dryness of the skin, acne, weakened bones, cognitive difficulties, and high blood sugar which may lead to diabetes. Cushing’s Syndrome can also cause loss of emotional control which could lead to depression, anxiety, and irritability. The adrenal gland of the endocrine system produces a number of hormones, including cortisol.
Cortisol plays a number of roles throughout the body. It helps with regulating the body’s blood pressure, which keeps the cardiovascular system functioning normal. It helps to react to stress by converting proteins, carbohydrates, and fats into usable energy. The condition can be caused by medication such as prednisone that has the same effects as the cortisol that is produced in the body. A doctor may prescribe this type medicine to patients with inflammatory disease such as asthma, lupus, rheumatoid arthritis, or to prevent the body from rejecting a transplanted organ.
The treatment of these conditions often requires higher amounts of cortisol than the body normally needs in a day. The condition can be caused by your own body producing excess cortisol. This could occur from the excess production of one or both of the adrenal glands of the adrenocorticotropic hormone (ACTH) which regulates production of cortisol. A benign tumor of the pituitary gland can cause secretion of an excess amount of ACTH, which will, in return, stimulate the adrenal gland to make more cortisol than the body needs.
As mentioned previously, the condition occurs more often in women. Urine and blood lab tests are performed to measure the hormone levels in the urine and blood. These tests will show if the body is producing an excessive amount of cortisol. Saliva tests are also used by analyzing cortisol levels in salvia collected at night. Normally, cortisol levels rise and fall throughout the day, but levels in people without Cushing’s Syndrome will drop considerably in the evening. Imaging tests such as CT or MRI scans can detect abnormalities such as tumors in the pituitary and/or adrenal glands.
All of these tests can help a doctor diagnose Cushing’s Syndrome and rule out other medical conditions. The treatment for Cushing’s Syndrome depends on what caused the cortisol to be high in the body. The treatment should be designed to lower the high level of cortisol in the body. If the disease was caused by long term exposure to corticosteroids, then the treatment would be reducing the use of corticosteroid. For patients with asthma, arthritis, or other conditions that require medication to manage their illness, doctors can prescribe noncorticosteroid drugs.
Surgery is recommended if the disease is caused by a tumor that is present in the pituitary gland, adrenal glands, lungs, or pancreas. If surgery does not remove the tumor completely, radiation therapy is used in conjunction with the operation. Medications such as Nizoral, Lysodren, and Metopirone are prescribed to control production of cortisol when the surgery or radiation therapy doesn’t work. The length of recovery depends on the severity and cause of the Cushing’s Syndrome. Patients should be advised to increase their daily activities slowly due to weakened muscles.
They need to be sure that they are eating sensibly and getting enough calcium and Vitamin D to help strengthen their bones. They need to monitor their mental health because depression can develop due to being overwhelmed or having difficulty coping with recovery. For aches and pains; the patient can take hot baths and do low impact exercises such as water aerobics. For patient recovery from cognitive difficulties, they can do crossword puzzles or math problems to exercise their brain and help to improve their brain function.
