What is Cushing’s Syndrome Cortisol?

Cushing’s Syndrome & Cortisol: What You Need to Know

The stress hormone cortisol is necessary to maintain metabolism, blood pressure, the immune system, and the body's response to stress. However, when cortisol levels are persistently high, the delicately balanced systems of the body start to fail.

Cortisol plays a vital role in our lives. Still, when it is constantly elevated, it may cause a range of health problems, collectively known as Cushing syndrome, that involve several organ systems and quality of life.

What is Cushing’s Syndrome?

Prolonged elevation of cortisol, a vital stress and metabolism hormone, may cause Cushing syndrome, a hormone imbalance condition with multi-system involvement. Despite being essential in low doses, high concentrations over a prolonged period may severely affect day-to-day life and health.

What are the Effects of Cortisol on the Body?

Cortisol supports many normal functions, including:

• Regulating blood pressure and blood sugar levels
• Reducing inflammation and modulating immune responses
• Regulation of metabolism and energy generation
• Effects on memory, mood and stress
• Aids in the regulation of sleep patterns
• Weight gain is associated with high levels of cortisol.
   

Chronic cortisol excess, however, strips these benefits and redirects them towards harmful effects throughout the body.

What are the Causes of High Cortisol in Cushing’s Syndrome?

Cushing syndrome results when the body retains cortisol for an extended duration. It may be caused by internal (endogenous) or external (exogenous) factors.

1. Endogenous Causes (Produced by the Body)

• Pituitary Tumours: A benign tumour in the pituitary gland can also cause overproduction of ACTH (adrenocorticotropic hormone), prompting the release of cortisol.
• Adrenal Tumours: Adrenal gland tumours may directly overproduce cortisol.
• Ectopic ACTH Syndrome: Certain cancers, such as lung cancer, can produce ACTH, raising cortisol.
   

2. Exogenous Causes (External Factors)

• Long-term Use of Corticosteroids: Certain medicines, such as prednisone, which treat diseases such as asthma or arthritis, can imitate cortisol and cause Cushing syndrome.
   

What are the Common Symptoms of Cushing Syndrome?

Persistent high cortisol leads to:

• Weight gain in the trunk, face (“moon face”), and upper back (“buffalo hump”)
• Thin arms and legs, muscle weakness
• Skin changes: fragile skin, easy bruising, purple stretch marks, acne
• Excessive hair growth(hirsutism) in women and irregular menstrual cycles.
• Bone loss leading to osteoporosis and fractures 
• High blood pressure, high blood sugar or diabetes
• Mood and cognitive issues: depression, anxiety, insomnia, memory difficulties
• Sleep problems, such as insomnia.
• Reproductive changes: Irregular menstruation, reduced fertility, hirsutism, erectile dysfunction

What is the diagnosis of Cushing syndrome?

Cushing's syndrome can be diagnosed using the following methods:

1. Screening Tests:
   
   
   
   • 24‑hour urinary free cortisol
   • Late-night salivary cortisol
   • Low-dose dexamethasone suppression test
     
      
2. Confirmatory Assessment:
   
   
   
   • Early-morning ACTH levels to differentiate ACTH-dependent from independent causes
   • High-dose dexamethasone or CRH stimulation tests
     
      
3. Imaging Studies:
   
   
   
   • MRI of the pituitary gland or CT/MRI of the adrenal glands
   • Chest CT when ectopic ACTH secretion is suspected.
     
      
4. Inferior Petrosal Sinus Sampling: A specialised test to determine if the excess cortisol originates from the pituitary gland or another source.

What is the treatment for Cushing's syndrome?

Treating Cushing syndrome depends on its cause, but the goal is always to lower cortisol levels to a healthy range. Here are the main approaches:

Reduce Steroid Use: Gradual tapering under medical supervision for exogenous cases.
 

Surgery:
 

• Transsphenoidal surgery to remove pituitary tumours (Cushing’s disease).
• Adrenalectomy for cortisol-producing adrenal tumours.
• Resection of ACTH-secreting ectopic tumours
   

Radiation Therapy: An alternative when surgery is not feasible.

Medications:

• Osilodrostat, a once-daily treatment, has been shown to restore cortisol rhythms and improve sleep quality.
• Other drugs like ketoconazole, metyrapone, and mitotane help reduce cortisol production.
   

Replacement Therapy: Post-surgery cortisol replacement until adrenal recovery
 

What is the prevention & care of Cushing's syndrome?

While Cushing syndrome often results from medical conditions or prolonged corticosteroid use, confident lifestyle choices can help manage symptoms and support recovery.

• Monitor prescribed steroid use: For chronic conditions such as asthma, lupus, or arthritis.
• Regular health check-ups: To track blood pressure, glucose, bone density, and mental health
• Balanced Diet: Focus on nutrient-rich foods to support bone health and muscle strength, as Cushing's syndrome can lead to osteoporosis and muscle weakness.
• Regular Exercise: Engage in low-impact activities like swimming or walking to maintain mobility without excessive strain.
• Mental Health Support: Depression and anxiety can persist even after treatment, so stress management techniques and professional support may be beneficial.
• Skin & Wound Care: Since skin thinning and slow healing occur daily, gentle skincare and avoiding injuries can help.
   

What are the risks and complications of Cushing's syndrome?`

Untreated or poorly managed cases can result in:

• Cardiovascular issues: Hypertension, increased risk of heart attack or stroke
• Metabolic disorders: Diabetes, dyslipidaemia
• Bone disease: Osteoporosis and fractures
• Infections: A weakened immune system increases vulnerability.
• Psychiatric effects: Persistent depression, anxiety, cognitive impairment
• Blood clots: Increase the risk of deep vein thrombosis or pulmonary embolism.
• Fertility problems: Include irregular menstrual cycles in women and reduced libido in men.

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