Cushing syndrome

What Is Cushing Syndrome?

Cushing syndrome, also known as hypercortisolism, is a condition caused by prolonged exposure to high levels of the hormone cortisol. Cortisol is a steroid hormone produced by the adrenal glands and plays an important role in regulating metabolism, immune function, blood pressure, and other essential functions.

In Cushing syndrome, the body is exposed to excessive levels of cortisol over a long period of time. This can happen for a variety of reasons including tumors of the pituitary gland or adrenal glands, or high doses of glucocorticoid medications. Whatever the cause, the excess cortisol wreaks havoc on many vital processes in the body.

Cushing syndrome is a serious condition that requires treatment to reduce cortisol levels. Left untreated, it can lead to various disabling and potentially fatal complications.

Symptoms of Cushing Syndrome

Some of the common signs and symptoms of Cushing syndrome include:

• Weight gain – Fat deposits predominantly in the face, upper back and abdomen give a rounded, ‘moon face’ appearance.
• Skin changes – The skin becomes thinner and bruises easily. Red or purple stretch marks may appear on the abdomen, thighs, breasts and arms. Excess hair growth (hirsutism) may occur on the face, chest and abdomen in women.
• Muscle weakness – Loss of muscle mass leads to weakness, especially in the hips and shoulders.
• Bone loss – Osteoporosis can develop due to high cortisol interfering with bone formation. Fractures may occur with minor stresses.
• High blood pressure – Cortisol influences blood pressure regulation, frequently leading to hypertension.
• High blood sugar – The increased cortisol can trigger insulin resistance and diabetes symptoms.
• Fatigue, headaches, anxiety, irritability – The hormonal imbalances caused by high cortisol affect mood, energy levels and overall wellbeing.
• Other signs – These include acne, thin skin that bruises easily, slowed growth rate in children, excess thirst, frequent urination, and in women – menstrual irregularities, excess facial and body hair.

Causes of Cushing Syndrome

Cushing syndrome has a few potential causes:

• Pituitary adenomas – Benign tumors of the pituitary gland are the most common cause. The tumor secretes adrenocorticotropic hormone (ACTH) which stimulates the adrenal glands to produce excess cortisol.
• Adrenal gland tumors – Tumors in the adrenal glands can also directly trigger excess cortisol secretion. Adrenal adenomas are a common cause.
• Ectopic ACTH syndrome – Some tumors outside the pituitary, like lung tumors, secrete ACTH leading to cortisol overproduction.
• Medications – High doses of glucocorticoid drugs like prednisone taken for conditions like asthma, arthritis can trigger Cushing syndrome. Topical creams can also cause it in some cases.
• Other less common causes – these include excess production of CRH (the hormone that triggers ACTH release) and genetic mutations causing adrenal hyperplasia.

Risk Factors

Factors that increase the risk of developing Cushing syndrome include:

• Age – Most common in adults ages 20-50.
• Sex – Slightly more common in women than men.
• Family history – Cushing’s is more likely if close relatives have had the disorder.
• Tumors – People with cancers are more likely to have tumors that trigger excess cortisol.
• Medications – Long term oral, inhaled or topical steroid use elevates risk.
• Other conditions – Diabetes, hypertension, osteoporosis may increase susceptibility to the disorder.

Complications of Cushing Syndrome

When left untreated, Cushing syndrome can lead to various potentially serious complications such as:

• Bone loss – Osteoporosis and higher fracture risk
• Diabetes – Chronically high blood sugar levels
• High blood pressure – Increased risk of heart attack, stroke, kidney damage
• Infections – Increased risk due to weakened immune system
• Blood clots – Can cause pulmonary embolism, stroke and heart attack
• Neurocognitive issues – Memory and concentration problems
• Mental health issues – Depression, anxiety, psychosis
• Fatty liver disease – Can progress to cirrhosis
• Kidney stones – Calcium build up from bone loss
• Death – Cardiovascular disease and infections are leading causes

Early diagnosis and treatment are crucial to prevent permanent damage from Cushing’s.

Diagnosing Cushing Syndrome

Since the signs and symptoms can be quite nonspecific, diagnosing Cushing syndrome can often be challenging. Doctors use a combination of approaches:

• Medical history – Important clues are medications, family history, associated conditions.
• Physical exam – Characteristic Cushingoid features like central weight gain, moon face and buffalo hump.
• Blood and urine tests – Elevated midnight cortisol, low ACTH, high creatinine and glucose offer clues.
• Dexamethasone suppression test – Failure to suppress cortisol after this steroid medication helps diagnosis.
• Imaging – CT, MRI and PET scans help find tumors in pituitary, adrenal glands or elsewhere.
• Biopsies – May be needed to evaluate adrenal tumor type.

Once the underlying cause is found through above tests, appropriate treatment can be initiated.

Treating Cushing Syndrome

Treatment focuses on reducing excessive cortisol levels in the body. This is done either by removing the source of excess cortisol (tumor) or inhibiting cortisol production medically.

• Tumor removal – Pituitary or adrenal tumors may be removed surgically. Other ectopic ACTH tumors can also be excised.
• Medications – Drugs like ketoconazole, mitotane, mifepristone can reduce cortisol levels.
• Radiation therapy – Pituitary irradiation helps destroy ACTH producing tumors.
• Bilateral adrenalectomy – Surgical removal of both adrenal glands as a last resort if other measures fail. Needs lifelong replacement hormones.

Lifestyle measures like stress reduction, regular exercise, healthy diet and adequate sleep also help manage the condition. Any underlying medical conditions like diabetes and hypertension must be well controlled too.

Preventing Cushing Syndrome

Since most cases are due to tumor growths, there are no definitive ways to prevent the condition. However, the following measures can help reduce the risk to some degree:

• Limit steroid medication – Avoid prolonged use of oral, inhaled or topical steroids unless absolutely necessary.
• Treat predisposing conditions – Manage diabetes, hypertension, osteoporosis, obesity through diet and exercise.
• Get regular health screenings – Early diagnosis of any tumors increases treatment success.
• Manage stress – Chronic stress contributes to cortisol overproduction.
• Active lifestyle – Regular exercise helps maintain healthy hormone levels.
• Balanced nutritious diet – Essential to maintain optimal health and body weight.

Conclusion

Cushing syndrome is a complex hormonal disorder caused by high exposure to cortisol. The diverse symptoms like central weight gain, moon face and abdominal striae along with secondary hypertension, diabetes can significantly impact quality of life. While challenging to diagnose, treatments like tumor removal, cortisol-inhibiting medications and radiation therapy can help resolve the disorder in many cases. Lifestyle measures also assist with managing the condition. Increased awareness and prompt treatment of Cushing syndrome is key to preventing long term complications.