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WHAT IS CUSHING’S SYNDROME?
Cushing’s syndrome reflects the physical and mental changes that happen in the body from having too much cortisol in the blood for a long period of time.
Cortisol is a steroid hormone produced by the adrenal glands (which are above the kidneys).
In normal amounts, cortisol helps the body:
- respond to stress
- maintain blood pressure and cardiovascular function
- keep the immune system in check
- convert fat, carbohydrates and proteins into energy
WHAT CAUSES CUSHING’S SYNDROME?
There are two types of Cushing’s syndrome:
exogenous and endogenous. The symptoms for both are the same. The only difference is how they are caused.
- exogenous Cushing’s syndrome is the most common and is found in patients taking cortisol-like medications such as prednisone. These medications are used to treat inflammatory disorders such as asthma and rheumatoid arthritis, or to suppress the immune system after an organ transplant. This type of Cushing’s is temporary and goes away after the patient has finished taking the cortisol-like medications.
- Endogenous Cushing’s syndrome is unusual, it usually comes on slowly and can be difficult to diagnose. It is caused either by a problem with the adrenal glands or the pituitary (a gland located at the base of the brain). In the adrenal glands, the problem is caused by a tumor (usually non-cancerous) that produces too much cortisol.
When the problem is with the pituitary, it is caused by a tumor that produces too much ACTH (the hormone that tells the adrenal glands to make cortisol). When the tumors form in the pituitary the condition is often called Cushing’s disease.
The majority of tumors that produce ACTH originates in the pituitary but sometimes non-pituitary tumors (usually in the lungs) can also produce too much ACTH and cause Cushing’s syndrome.
SIGNS AND SYMPTOMS OF CUSHING’S SYNDROME:
- Weight gain, especially in the upper body.
- Rounded face and extra fat on the upper back and above the collarbones.
- High blood sugar (diabetes).
- High blood pressure (hypertension).
- Thin bones (osteoporosis).
- Muscle loss and weakness.
- Thin, fragile skin that bruises easily.
- Purple-red stretch marks (Usually over the abdomen and under the arms).
- Depression and difficulties thinking clearly.
- Too much facial hair in women.
- Irregular or absent menstrual periods and infertility.
- Reduced sex drive.
- Poor height growth and obesity in children.
HOW IS CUSHING’S SYNDROME DIAGNOSED?
The most sensitive and specific test to diagnose Cushing’s syndrome is to measure cortisol levels in the saliva between 11:00 P.M. and midnight. A sample of saliva is collected in a small plastic container and sent to the laboratory for analysis. In healthy people, cortisol levels are very low during this period of time. In contrast, patients with Cushing’s syndrome have high levels. Cortisol levels can also be measured in urine that has been collected over a 24-hour period.
Finally, another screening test for Cushing’s syndrome is for patients to have their cortisol levels measured in the morning, after they have been given a laboratory-made steroid (dexamethasone) the night before.
HOW IS CUSHING’S SYNDROME TREATED?
The treatment for Cushing’s syndrome depends on the cause. Exogenous Cushing’s syndrome goes away after patients finish taking the cortisol-like medications they were using to treat another condition. Your doctor will determine when it is appropriate for you to slowly decrease and eventually stop using the medication. For endogenous Cushing’s syndrome the first approach is usually surgery to remove the tumor. Although for most patients surgery is successful, some may also need radiation therapy or drugs to lower cortisol production, or to remove the adrenal glands.
The majority of patients with Cushing’s syndrome can be successfully treated with great results.
WHAT SHOULD YOU DO WITH THIS INFORMATION?
If you have symptoms of Cushing’s syndrome, see your doctor to determine the cause. An endocrinologist (an expert in hormone-related conditions) can work with you to diagnose and treat your condition.