Cushing's Syndrome

Cushing's syndrome is a disorder caused when the body's tissues are exposed to too much cortisol for a long time. Cortisol is created by the adrenal glands found just above the kidneys. Normally, cortisol is released into the body after the hypothalamus (a part of the brain) sets off a precisely tuned chain of the events. The hypothalamus send a message to the pituitary gland, which in turn sends a hormone (adrenocorticotropin -- ACTH) to trigger the adrenal glands.

Cortisol is important for:

  • Maintaining blood pressure and the working of the heart
  • Reducing the immune system's inflammatory response
  • Helping the body respond to stress
  • Balancing the effects of insulin in breaking down sugar for energy
  • Regulating the body's use of proteins, carbohydrates and fats
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Symptoms

There are many signs of Cushing's syndrome including:

  • A fatty (buffalo) hump between your shoulders
  • Bruising that happens easily
  • Development of a mild form of diabetes
  • Flushing of the face
  • Impotence among men
  • Increased hair growth on the face and body
  • Irregular or absent monthly periods among women
  • Loss of fertility
  • Loss of sex drive
  • Mood swings, depression and anxiety
  • Muscle weakness and difficulty rising from a seated position without using the arms
  • Rising blood pressure
  • Rounding of the face (moon face)
  • Slow healing of cuts, insect bites and infections
  • Stretch marks on the skin of the stomach area, thighs, breasts and arms
  • Weight gain around the trunk of the body

 

Causes and Risk Factors

A person can have too much cortisol in the body for two reasons:

  • He or she is taking corticosteroids such as prednisone for asthma, rheumatoid arthritis, lupus or other inflammatory disease.
  • He or she has a tumor that has upset the signals that control cortisol production. Most cases of Cushing's syndrome are caused by pituitary adenoma . (This form is known as Cushing's disease.) Sometimes tumors outside the pituitary gland (such as lung tumors) produce ACTH that stimulates the adrenal glands. Adrenal tumors or cancer may also release too much cortisol into the body.

In rare cases, a person may inherit the tendency to develop tumors in one or more glands such as the adrenal glands or the pituitary gland.

Cushing's can affect a person of any age, but most often affects people who are middle aged.

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Diagnosis

Cushing's syndrome shares symptoms with many other conditions, so it can be difficult to diagnose. Because it tends to develop slowly, it can go unrecognized for a long time.

If you have been taking a corticosteroid medication for a long time, your doctor may suspect that you have developed Cushing's. In some cases, the symptoms point to the possibility of Cushing's.

If there is a question about whether you have Cushing's syndrome, your doctor may order tests such as:

  • Blood tests to measure the level of cortisol in your body
  • Urine tests to measure cortisol levels. You may be asked to collect a sample of your urine over a full 24-hours. Sometimes a urine test is done in association with drugs to increase or reduce cortisol production
  • Saliva test. Normally, the level of cortisol in the body drops significantly overnight. This test measures the cortisol in a salvia sample taken between 11 p.m. and midnight.
  • Magnetic resonance imaging (MRI) to check for tumors in the pituitary or adrenal glands
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Treatments

If Cushing's syndrome isn't treated, you can suffer bone loss (osteoporosis), high blood pressure, kidney stones, diabetes or infections. Ultimately, Cushing's syndrome can lead to death.

The treatment your doctor prescribes will depend on the specific cause of the excess cortisol.

If you have been using corticosteroids for a long time, your medication may need to be reduced to control the Cushing's while the other condition is being treated.

If the cause of the condition is a tumor, you may need surgery. A pituitary tumor can be removed by a neurosurgeon through your nose using minimally invasive surgical techniques. Radiation therapy may be given after surgery. After surgery, it may be necessary to have cortisol replacement therapy. In some cases, cortisol production will return to normal; in other cases, replacement hormones will be needed for the rest of your life.

If surgery and radiation are not possible, some drugs can be prescribed to control excess cortisol production.