Cushing syndrome – Symptoms, Diagnosis, and Treatments

What is Cushing syndrome?

Cushing syndrome, or hypercortisolism, occurs thanks to abnormally high hormone cortisol levels. This will happen for various reasons.

In most cases, getting treatment can facilitate the cortisol levels. Cushing syndrome occurs when your body has an excessive amount of the hormone cortisol over time. This will result from taking oral corticosteroid medication. Or your body might produce an excessive amount of cortisol.

Too much cortisol can cause some trademark signs of Cushing syndrome. This syndrome causes a fatty hump between the shoulders, a rounded face, and purple stretch marks on your skin. Cushing syndrome also can result in high blood pressure, bone loss and, once in a while, diabetes.

Treatments for Cushing syndrome can lower the body’s cortisol levels to normal and manage the symptoms. The sooner treatment begins, the higher your chances for recovery.

Symptoms of Cushing syndrome

The commonly exhibited signs and symptoms of Cushing syndrome can vary, counting on excess cortisol.

The most common symptoms are as follows

• Weight gain
• Fatty deposits, especially within the midsection, the face (causing a round, moon-shaped face), and between the shoulders and the upper back 
• Purple stretch marks on the breasts, arms, abdomen and thighs
• Thinning skin that bruises easily
• Skin injuries that are slow to heal
• Acne
• Fatigue
• Muscle weakness

In addition to the typical symptoms above, other symptoms will sometimes be observed in people with Cushing syndrome.

These can include

• High blood glucose
• Increased thirst
• Increased urination
• The high blood pressure (hypertension)
• Headache
• Mood swings
• Anxiety
• Irritability
• Depression
• Increased number of infections
• Irregular menstrual periods

Cushing syndrome among children

Children can have Cushing syndrome, although they develop it less frequently than adults.

In addition to the symptoms, children with Cushing syndrome can also have the following.

• Obesity
• Slow growth rate
• The high vital signs 

Cushing syndrome among women

Cushing syndrome is more common in women than in men. Women are prone to Cushing syndrome three times more compared to their counterparts. Women with Cushing syndrome can develop facial hair.

 This most frequently occurs on the

• Face and neck
• Chest
• Abdomen
• Thighs

Additionally, women with Cushing syndrome can also experience irregular menstruation. In some cases, menstruation is absent altogether. Untreated Cushing syndrome in women can cause difficulties in becoming pregnant.

Cushing syndrome in men

Just like women and children, men with Cushing syndrome also can experience additional symptoms. Men with Cushing syndrome may have the following.

• Erectile dysfunction
• Loss of sexual interest
• Decreased fertility

Other signs and symptoms of Cushing syndrome include the following.

• Severe fatigue
• Muscle weakness
• Depression, anxiety and irritability
• Loss of emotional control
• Cognitive difficulties
• New or worsened high vital sign
• Headache
• Infections
• Skin darkening
• Bone loss, resulting in fractures over time
• In children, impaired growth

Cushing syndrome– Causes

Cushing syndrome is caused by more than the hormone cortisol. Your adrenal glands produce cortisol.

Cortisol helps with a variety of your body’s functions, including.

• Regulating vital signs and the cardiovascular system
• Reducing the immune system’s inflammatory response
• Converting carbohydrates, fats and proteins into energy
• Balancing the consequences of insulin
• Response to anxious situations.

Our body produces high levels of cortisol for a number of reasons, including.

High-stress levels, including the stress associated with an acute illness, surgery, injury, or pregnancy, especially within the last trimester. Other symptoms include

• Training
• malnutrition
• Excessive alcohol consumption
• depression, panic disorder, high levels of stress and
• Corticosteroids

One of the common causes of Cushing syndrome is corticosteroid medications, like prednisone, in high doses for an extended period. Doctors and healthcare professionals can prescribe such medications to treat inflammatory diseases like lupus.

High doses of injectable steroids given to treat back pain can cause Cushing syndrome. However, a lower dose of the same in the form of inhalants, like those used for asthma, or creams, like those prescribed for eczema, usually are not strong enough to cause this health condition. This prolonged use has been linked to developing Cushing syndrome.

Tumours

Several sorts of tumours can also lead to a higher production of cortisol.

Some of these include

Pituitary gland tumours. The pituitary releases too much adrenocorticotropic hormone (ACTH), which stimulates cortisol production within the adrenal glands. This is often called Cushing disease.

Ectopic tumours.

These are tumours outside of the pituitary that produces ACTH. They typically occur in the lung, pancreas, thyroid or thymus.

Adrenal gland abnormality or tumour. An adrenal abnormality or tumour can cause irregular patterns of cortisol production, which may pave the way for Cushing syndrome.

Familial Cushing syndrome.

 Although Cushing syndrome isn’t inherited, there are chances to possess an inherited tendency to develop tumours in the endocrine glands.

Cushing syndrome vs Cushing disease

Cushing syndrome is caused by the pituitary overproducing ACTH, which in turn becomes cortisol, it’s called Cushing disease.

As with Cushing syndrome, Cushing’s disease affects a majority of women more than men.

What are the risk factors of Cushing syndrome?

The major risk factor for developing Cushing syndrome is high-dose corticosteroids over a period of time. If a doctor prescribes corticosteroids to treat a health condition, ask them about the dosage and how long you’ll take them.

Other risk factors can include

• Female
• The age
• Living with pituitary or adrenal tumours

Some cases of Cushing syndrome are due to tumour formation. Although there is often a genetic predisposition to develop endocrine tumours (familial Cushing syndrome). 

Cushing syndrome diagnosis

Cushing’s syndrome is often complicated to diagnose. This is usually because many symptoms, like weight gain or fatigue, can produce other causes. Additionally, Cushing syndrome itself can have many various reasons.

A healthcare professional will review your medical record. They’ll ask questions about the symptoms, any health conditions a patient has, and the medications they are consuming.

They’ll also perform a physical examination where they’ll search for signs like a bump between the shoulders, stretch marks, and bruises.

Next, they’ll order lab tests, including

24-hour urinary-free cortisol test

You’ll be asked to gather your urine over 24 hours for this test. The amount of cortisol in the body will be tested.

Salivary cortisol measurement

For people without Cushing syndrome, cortisol levels drop by the evening. This test measures the extent of cortisol in a saliva sample collected late at night to check if cortisol levels are higher than usual.

Low-dose dexamethasone suppression test

For this test, a person would take a dose of dexamethasone late in the evening. Your blood is going to be tested for cortisol levels in the morning. Typically, dexamethasone causes cortisol levels to drop. If you’ve got Cushing syndrome, this won’t occur.

Dexamethasone–CRH test

High cortisol levels can happen for various reasons, from consuming excessive alcohol to living with depression or anxiety.

This test, which incorporates a small dose of the hormone CRH and a shot of dexamethasone, can help a doctor note if high cortisol levels are caused by Cushing syndrome or another issue.

Diagnosing Cushing syndrome

After a person undergoes a diagnosis of Cushing syndrome, a doctor must still determine the explanation for the excess cortisol production.

Tests to assist in determining the cause

Blood adrenocorticotropin hormone tests are prescribed. Levels of ACTH within the bloodstream are measured. A drop in the levels of ACTH and high levels of cortisol could indicate the presence of a tumour in the adrenal glands.

Corticotropin-releasing hormone stimulation test

 During this test, you’re given an attempt of CRH. This may raise levels of ACTH and cortisol in people with pituitary tumours.

High-dose dexamethasone suppression test is often the same as the low-dose test, except that a better dose of dexamethasone is used. If cortisol levels drop, you’ll have a pituitary tumour. Higher levels of cortisol could point to an adrenal tumour or ectopic tumour.

Petrosal sinus sampling.

A small sample of blood is drawn from a vein near the pituitary and a vein far away from the pituitary. An attempt of CRH is given, and if ACTH rises within the blood flowing near the pituitary, it can indicate a pituitary tumour.

Imaging studies

These studies can include things like CT and MRI scans. They visualize the adrenal and pituitary glands to look for tumours.

Treatment of Cushing syndrome 

The overall objective of Cushing syndrome treatment is to lower cortisol levels in your body. This will be done in various ways. 

The treatment that a person receives will rely on what’s causing their condition.

A doctor may prescribe medications to help manage cortisol levels. Some medications decrease cortisol production within the adrenal glands or reduce ACTH production in the pituitary gland. Other drugs contain the effect of cortisol on the tissues.

If you employ corticosteroids, a change in medication or dosage could also be necessary. Don’t try and change the dosage yourself. A person has to do this under close medical supervision.

Pituitary tumours

The most common type of treatment for pituitary tumours is surgery. The surgeon will insert a thin tube through a nostril or an opening below the upper lip to remove cancer.

After the surgery, your body won’t make enough ACTH initially, so you’ll likely be prescribed cortisol medication for months to years.

If surgery isn’t possible, radiotherapy may be an option.

Ectopic ACTH-producing tumours

Like pituitary tumours, surgery is usually the first option for ectopic tumours.

If surgery doesn’t work or isn’t an option, chemotherapy, radiation, and other cancer treatments could also be able to help shrink the tumour.

Medications to scale cortisol levels may also be part of your treatment plan.

One of the last treatment options is the removal of the adrenal glands.

Adrenal tumours

Surgery to eliminate the adrenal gland with the tumour is the first line of treatment for adrenal tumours.

In severe cases, both adrenal glands may be removed. During this instance, you’ll need to take medication for life to replace the hormones that adrenal glands produce, including cortisol.

Natural treatments for Cushing syndrome

Although specific lifestyle changes and diet won’t cure your condition, they will help to keep your cortisol levels from rising even more or help to prevent complications.

Lifestyle tips for those with Cushing syndrome include.

Lose weight if recommended

Since weight gain is one of the main symptoms of Cushing syndrome, if your doctor has recommended you reduce it, consider working with a nutritionist and increasing your physical activity to get your weight to an optimal level.

Try to avoid drinking alcohol

Because heavy alcohol use can cause signs and symptoms of Cushing, your doctor may recommend you stop drinking.

Manage your blood glucose

Cushing syndrome can cause high blood glucose, so attempt to limit foods that can cause a spike in blood sugar level. Samples of foods to focus on eating include vegetables, fruits, whole grains, and fish.

Cut back on sodium

Cushing syndrome is additionally associated with high blood pressure (hypertension). Due to this, your doctor may recommend you limit your sodium intake. This will entail not adding salt to food and carefully reading food labels to check the sodium content.

Make sure to get enough calcium and vitamin D. Cushing syndrome can weaken your bones, making you susceptible to fractures. Both calcium and vitamin D can help to strengthen your bones.

To sum up

Cushing syndrome, or hypercortisolism, occurs due to abnormally high hormone cortisol levels. In most cases, getting treatment can facilitate or manage the cortisol levels. This syndrome causes a fatty hump between the shoulders, rounded face, and purple stretch marks on your skin. Cushing syndrome also can result in high blood pressure, bone loss and, once in a while, diabetes.

Treatments for Cushing syndrome can return the body’s cortisol levels to normal and manage the symptoms. The sooner treatment begins, the higher your chances for recovery.

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