What is Cushing’s syndrome?
Cushing’s syndrome is a rare, progressive disease that occurs due to chronic and excessive production of the hormone cortisol. Cortisol is naturally synthesised (produced) in the human body by the adrenal glands and helps with regulating blood pressure, converting food into energy, controlling the immune system’s inflammatory response and handling stress. If left untreated, Cushing’s syndrome can cause problems.
How are cortisol levels normally controlled?
The hypothalamus, pituitary, and adrenal glands regulate the production of cortisol.The hypothalamus releases corticotrophin-releasing hormone (CRH) into the blood when cortisol levels are low. This causes the pituitary gland to release adrenocorticotrophic hormone (ACTH), another hormone. After being released, ACTH is transported to the adrenal glands, where it causes the glands to produce cortisol.
When the body’s cortisol levels reach their maximum level for optimal bodily function, the release of CRH and ACTH is inhibited. Usually, this peak happens early in the morning. Following this, a drop in ACTH will result in a drop in cortisol levels.
Throughout the day, cortisol levels will fluctuate, but the hypothalamus, pituitary, and adrenal glands’ normal functions will maintain cortisol levels within a specific range that is never too high or too low.
What are the symptoms of Cushing’s syndrome?
The disease presents either over time or suddenly. The most important change is weight gain and increased body fatty tissue, caused by a redistribution and accumulated deposition of fat. This may appear as:
- A swollen and puffy face
- A fatty ‘hump’ between the shoulders at the base of the neck, in the upper back
- Fat on the chest and the stomach
Other symptoms of Cushing’s syndrome include:
- Purple or pink stretch marks on the thighs, abdomen, breasts and arms
- Skin that is thin and fragile, easily bruised
- Fatigue
- Acne
- Muscle weakness
- High blood pressure
- Cuts and infections that heal slowly
- Bone loss (osteoporosis), as elevated levels of cortisol directly inhibit bone formation and affect the hormone of growth
- Type 2 diabetes, as blood glucose levels rise
- Low libido
- Erectile dysfunction
- Changes in mood, anxiety or depression
- Issues with fertility such as absent or irregular menstrual periods
- Hirsutism (in women), due to the overproduction of androgen hormones in the blood
How is Cushing’s syndrome diagnosed?
Cushing’s syndrome can be challenging to diagnose, especially if you haven’t been taking steroids. This is due to the fact that Cushing’s syndrome symptoms can mimic those of other illnesses, including eating disorders, depression, and polycystic ovary syndrome. This may cause a diagnosis to be delayed by years.
Following a physical examination, if Cushing’s syndrome is suspected, a blood, urine, and saliva test, an inferior petrosal sinus sampling (a diagnostic procedure that samples the petrosal sinus veins to test for ACTH), and imaging tests like an MRI or CT scan will be used to measure the cortisol level in your body.
What are the causes of Cushing’s syndrome?
The main cause of Cushing’s syndrome is an overproduction of the hormone cortisol. This commonly results from the use of corticosteroid medications over a long period of time (they contain an artificial version of cortisol in them), but it can also result from:
- High levels of stress
- Malnutrition
- Alcoholism
- Depression and panic disorders
- Intensive athletic training
- Tumours (pituitary gland, adrenal gland)
Cushing’s syndrome usually develops in adults aged 20 to 50, with women being three times more likely to be affected.
Is Cushing’s syndrome genetic?
Rarely, an inherited tendency to develop small tumors on the adrenal glands can cause Cushing’s syndrome by affecting cortisol levels.
Can Cushing’s syndrome be prevented?
The only way to prevent Cushing’s syndrome caused by corticosteroid medication is to avoid taking this type of medication, if possible.
Treatments for Cushing’s syndrome
The goal of Cushing’s syndrome treatment is to regulate and restore normal cortisol levels in the patient’s body.This can be accomplished by reducing the dosage of some drugs, but if the cause is a tumor, for instance, treatment will require medication, surgery, chemotherapy, or radiation therapy.
A surgeon’s goal when performing surgery is to remove the tumor entirely. Most patients will experience adrenal insufficiency following surgery, which will temporarily impair their ability to produce cortisol. To give your body the right amount of cortisol, you will then need to take cortisol replacement drugs. Your body will eventually resume producing enough cortisol hormones through the adrenal glands. But the entire procedure could take up to year or longer.
For patients who are unable to have surgery or whose tumor was not entirely removed during surgery, radiotherapy is advised. To eradicate the tumor, radiation can be given in small doses over the course of six weeks or in a single, high dose of radiation known as stereotactic radiotherapy. If a tumor is malignant or has spread to other parts of the body, chemotherapy may be recommended.
If surgery, radiotherapy, and chemotherapy are unsuccessful, medications may be used to reduce and control the body’s cortisol levels. They can also be used before surgery to reduce surgical risk and treat severe symptoms of Cushing’s syndrome. However, not all of the symptoms of excess cortisol may be alleviated by medication.
Your doctor might suggest having your adrenal glands surgically removed (a procedure known as a bilateral adrenalectomy) if none of these treatments are successful. This last procedure will address the excess cortisol production, but it will necessitate lifelong replacement medication.
What is the prognosis of Cushing’s syndrome?
If treatment targets the disease’s underlying cause, the majority of symptoms will typically go away or noticeably improve within a year. In 25% of cases, however, Cushing’s syndrome will recur (for instance, if a tumor recurs). In these situations, additional care will be required.
Which specialist treats Cushing’s syndrome?
Cushing’s syndrome is usually treated by endocrinologists.
What can I eat and drink with Cushing’s syndrome?
If you have Cushing’s syndrome, small lifestyle changes can help you to manage and prevent the progression of symptoms, including:
- Increasing your intake of calcium and vitamin D
- Stopping smoking
- Decreasing or eliminating alcohol
- Exercising regularly, for example, swimming or cycling – but avoiding high impact activities such as running or weight lifting which place stress on the body. This is to reduce the risk of falls and possible bone fracture.
- Reducing your sodium intake
- Controlling your blood sugar levels
- Eating protein-rich food
What is the difference between Cushing’s syndrome and Cushing disease?
Both conditions are brought on by high cortisol levels in the body, but Cushing’s disease is a type of Cushing’s syndrome that happens when the pituitary gland produces too much ACTH due to a pituitary adenoma, which is a benign tumor. The adrenal glands are then stimulated to produce too much cortisol when the body has too much ACTH.
The only cause of Cushing disease is a tumor or growth in the pituitary gland, as opposed to Cushing’s syndrome, which can occur for a number of reasons.