Cushing’s syndrome


What is Cushing’s syndrome ?

Cushing’s syndrome is a hormonal disorder caused due to chronic exposure of the body’s tissues to extreme levels of the cortisol hormone.

It is often referred to as ‘hypercortisolism’. The condition is very rare and affects mostly those who are in the age group of 20 to 50. The number of people affected in a year are estimated to be 10 to 15 per million.

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Symptoms of Cushing’s syndrome

Some of the symptoms of Cushing’s syndrome are as follows:

  • Progressive obesity and changes in skin such as:
    • Gaining weight and deposits of fatty tissues.
    • Fragile thin skin that bruises on touch
    • Acne
    • Pink or purple stretch marks on skin.
    • Slow healing of wounds, infections and insect bites
    • Women with Cushing’s syndrome may have visibly bulk body, hair in face and irregular periods.
    • Men with Cushing’s syndrome may have decreased libido and fertility, and erectile dysfunction

Other non common symptoms are as follows:

  • Fatigue
  • Anxiety, irritability and depression
  • Weakness of muscles
  • Loosing emotional control
  • Chronic diabetes
  • Blood pressure
  • Cognitive difficulties
  • Bone loss and fragility
  • Headache

Causes of Cushing’s syndrome

Excess levels of cortisol in body cause the Cushing’s syndrome. Hormones such as cortisol which regulate the processes throughout the body are produced by the glands of endocrine system. The endocrine system consists of glands such as pituitary glands, adrenal glands, parathyroid glands, thyroid glands, ovaries in women, testicles in men, and the pancreas.

A number of hormones, including cortisol, are produced by adrenal glands which perform a number of functions in body regulation. As a matter of fact, cortisol regulates the working of cardiovascular system and blood pressure, and helps to control the conversion of protein, carbohydrates and fats into usable energy. Additionally, it helps the body to respond to the stress and strain. However Cushing’s syndrome develops whenever the control of cortisol crosses the limit.

Taking high doses of corticosteroids over an extended period may cause the exogenous Cushing’s syndrome and may have the same effects of cortisol produced by the body.

The corticosteroid medications are given to treat inflammatory diseases and to prevent the body from rejecting a transplanted organ. Treating these conditions need excess doses, which is more than the limits of cortisol that the body can accept causing Cushing’s syndrome.

Corticosteroid injections to treat bursitis, joint pain and back pain; inhaled steroids for asthma, and steroid creams for skin disorders can also cause Cushing’s syndrome if they are in excess to the required limits.

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A condition that leads to excess production of cortisol by the adrenal glands or over production of the adrenocorticotropic hormone, which normally regulates the cortisol production can cause Cushing’s syndrome.  For example:

  • Pituitary gland tumor: It is a noncancerous tumor of the pituitary gland, located at the base of the brain that secretes excess amount of ACTH, which in turn stimulates the adrenal glands to produce more cortisol causing Cushing’s disease.
  • Primary adrenal gland disease: It is a disorder of the adrenal glands, resulting in noncancerous tumor of the adrenal cortex, called as an adrenal adenoma. It is rarely cancerous. Their excess production of cortisol causes Cushing’s syndrome.
  • An ectopic ACTH-secreting tumor: In rare cases, a tumor that develops on an organ which does not produce ACTH, will begin to secrete this hormone in excess, causing Cushing’s syndrome. These tumors may be cancerous or may be noncancerous, and normally occur in pancreas, the lungs, thymus or thyroid gland.
  • Familial Cushing’s syndrome: It is an inherited condition that develops tumors on one or more of the endocrine glands, disturbing the cortisol levels.

Treatment of Cushing’s syndrome

The main aim of the treatment is to reduce the levels of cortisol in body. The types of treatments are:

  • If Cushing’s syndrome is due to a tumor, the doctor may recommend for surgical removal by adopting the standard procedures. One may need to go for cortisol replacement medications after the operation, for production of the required level of cortisol.
  • If the cause for Cushing’s syndrome is due to long term use of corticosteroids, then the syndrome can be controlled by reducing its intake. The treatment for the underlying diseases can be well balanced by the doctor by the prescription of non-corticosteroid drugs. Follow the instructions of the doctor for reducing or for stopping the medicines. Otherwise it may create complications.
  • For patients of Cushing’s syndrome, medications such as ketoconazole, mitotane and metyrapone are given to avoid the surgical risks. In some cases hormone replacement medications may be given, if there is cortisol deficiency. If the medications do not help in controlling the excess cortisol, surgery is recommended.
  • If a total removal of tumor is not possible by surgery, then radiation therapy is used in conjunction with operation. Radiation is used on those who are unfit for surgery. Radiation therapy may be conducted over several sessions or in one single session with the help of a procedure called gamma-knife radiation technique. In this method a large dose of radiation is delivered on the tumor.
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