Cushing’s syndrome is a rare disorder that mostly affects adults of age group 20 to 50 years. This article discusses the syndrome in detail.
Cushing’s Syndrome (also known as hypercorticism or hyperadrenocorticism), named after the American doctor Dr. Harvey Cushing, is an endocrine/hormonal disorder caused by high level of cortisol in blood. It mainly refers to a medical condition (abnormality) in which the pituitary gland starts producing large amount of Adrenocorticotropic Hormone (ACTH) in blood, which in turn increases cortisol level in blood (ACTH hormones are necessary to stimulate secretion of cortisol by adrenal glands).
It is not only limited to human beings, as it can occur in domestic animals such as dogs and horses as well.
Causes
- The most common cause of increase in cortisol level in the blood is due to exogenous administration of glucocorticoids (steroid hormones). Generally, glucocorticoids are given to a patient for treatment of other diseases.
- Other steroids used for treatment of various diseases such as rheumatoid arthritis, asthma, etc., and after operations such as organ transplant are also responsible. In such scenarios, the patient also may be given synthetic ACTH hormones, which may lead to increased level of cortisol in the blood.
- Other than external causes, problems (malfunctioning of) related to pituitary gland that secrete ACTH hormones can be a cause. Normally, the secretion of ACTH hormone by pituitary gland is kept under check/control, and only necessary amount is released to help secrete cortisol in blood by adrenal glands. Malfunctioning of this system can lead to this syndrome.
- Pituitary Cushing’s disease is related to the problem with pituitary glands, and it leads to increased secretion of ACTH hormone, which in turn stimulates secretion of cortisol by adrenal glands.
- Adrenal Cushing’s disease is related to adrenal glands in which adrenal glands develop tumors, which lead to excessive secretion of cortisol in blood.
- Tumors outside the pituitary-adrenal system can also cause excess secretion of ACTH hormones leading to ectopic or paraneoplastic Cushing’s (which occurs commonly in conjunction with other diseases such as small cell lung cancer).
- According to some doctors, this disorder may be inherited as well. If your parents or any of your ancestors have had this disorder, there is a possibility that you may develop it too.
Symptoms
The intensity of signs and symptoms may vary from patient to patient. They may include:
- Obesity in the upper part of the body, such as area around the neck, face etc. (arms and legs remain slender)
- Fragile and thin frame
- Tendency to get bruised easily
- Development of pink or purple stretch marks on skin
- Weakened bones and muscles
- Severe fatigue
- High blood pressure and increased blood sugar level
- Increase in urination and thirst
- Increase in depression, irritability, etc.
- Excessive hair growth on the entire body (especially women)
- Irregularity in the menstrual cycle (for women)
- Problem with sexual desire, erectile dysfunction etc (for men)
Diagnosis
Your doctor may suggest you to go for some tests before confirming the disorder. These tests include:
- Urine Test for Cortisol Level: In this test, urine samples are collected from the patient within 24 hours. The patient may be asked to urinate every hour or 2 hours to collect urine for test.
- LDDS Test (Low Dose Dexamethasone Suppression): In this test, the patient is given a low dose of synthetic glucocorticoid at some interval, and cortisol level is administered to come to any conclusion.
- Midnight Plasma Cortisol and Late-night Salivary Cortisol Measurements: If a person is suffering from this condition, the cortisol production in his/her body does not get suppressed as in normal person during night. Patient’s saliva sample is taken to measure the cortisol level in blood, and then come to a conclusion.
- Dexamethasone-CRH Test (Dexamethasone-Corticotropin-Releasing Hormone Test): This test is used to distinguish between cases of pseudo-Cushing’s and mild Cushing’s. It is a combination of LDDS Test and CRH-stimulation.
Some other tests include:
- Petrosal Sinus Sampling
- Radiologic Imaging (visualization of endoctrine glands)
- HDDS (High Dose Dexamethasone Suppression) Test
- CRH Stimulation Test
Treatment
There are several options used to treat this syndrome based on the patient’s condition and necessity.
- Surgical Removal of Tumors: This is one of the most commonly used treatment options because of its high success rates, and the fact that surgery can be repeated in case the previous surgery fails. In this, the tumors are removed surgically (also known as Transsphenoidal Adenomectomy) with the help of a special microscope.
- Medication: In case surgery is not recommended, the doctor may choose to go for the treatment of medication. If medication fails to cure the condition, surgery is used to remove the tumors, and sometimes removal of adrenal glands (also known as bilateral adrenalectomy) can be suggested.
- Radiation, Chemotherapy or Drugs: This option is used when the syndrome is developed in conjunction with other diseases such as cancer.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for expert medical advice.
