Cushing’s syndrome (CS), also referred to as hypercortisolism, is a disorder that occurs when the body has a high level of the the hormone cortisol.
Causes
There are many types of Cushing’s syndrome, with the most common being exogenous Cushing’s syndrome. Exogenous Cushing’s syndrome is caused by taking too much glucocorticosteroid medicine. Some of the most common glucocorticosteroid medications are prednisone, prednisolone and dexamethasone. The body recognizes and treats these drugs the same as the hormone cortisol, which is made by our adrenal gland. Glucocorticosteroid medications are used to treat a variety of conditions and diseases such as asthma, bowel disease, cancer, rheumatoid arthritis, joint pain and skin inflammation. This means that many patients may be at risk for this disease.
Another cause for Cushing’s syndrome is when the person’s body is producing too much of the hormone cortisol. Cortisol is produced in the adrenal glands. This overproduction of cortisol may be a result of many different factors. Causes of overproduction of cortisol are:
Pituitary tumor
Tumor of the adrenal gland
Ectopic Cushing’s syndrome
Benign carcinoid tumors of the lung
Islet cell tumors of the pancreas
Medullary carcinoma of the thyroid
Small cell tumors of the lung
Tumors of the thymus gland
Symptoms
Symptoms differ from person to person. Some are affected by debilitating fatigue, weight gain, and the red, round, and full face known as moon face. Others may have very few symptoms, which can make their disease easier to manage but more difficult to diagnose.
Other common symptoms include:
Skin infections
Striae on the abdomen, thighs and breasts
Thin skin that easily tears and bruises
Back pain with normal activity
Bone pain and/or tenderness
Mental changes, headaches and depression
Fat collection between shoulder blades
Rib and spine fractures
Amenorrhea
Decrease in male sex drive and difficulty getting or sustaining an erection
Exams and tests
Tests that may be used to identify Cushing’s syndrome include:
24-hour urine test to measure cortisol and creatinine
Blood test to measure adrenocorticotropic hormone (ACTH), cortisol and potassium levels
Saliva cortisol levels
Dexamethasone suppression test
MRI and/or CT scan
Treatment
Treatment of Cushing’s syndrome depends on the cause. The goal of treatment is to eradicate the cause of a patient’s hypercortisolism. If the cause is long term steroid use being taken to control another disorder, the physician may decrease the medication dose and/or frequency, or he or she may stop the medication all together if the patient’s situation allows him or her to do so.
Surgery is the number one most effective treatment for patients with ectopic Cushing’s syndrome. Removing the tumor removes the cause; however, tumors will often recur. If a patient’s tumor is benign, surgery is almost always used. If the patient’s tumor is malignant or has metastasized, surgery may not be an option. When the physician feels there may be benefit, he will order complimentary treatments in conjuction with surgery, such as chemotherapy and radiotherapy.
Prognosis
Davenport, Liam. (2016). Surgery Preferred Option in Cushing’s Disease for Best Survival. Retrieved from http://www.medscape.com/viewarticle/865073.
Harding, Anne. (2015). Metyrapone Appears Effective in Cushing’s Syndrome in Long Term. Retrieved from http://www.medscape.com/viewarticle/851888.
Recent Comments