Cushing Syndrome, also known as hypercortisolism, is a disorder characterised by an excess of cortisol in the body.
Cortisol is a steroid hormone produced by the adrenal glands, which are located on top of each kidney. While cortisol plays a crucial role in regulating metabolism, immune response, and stress, excessive levels can lead to a myriad of health issues. Just some of the complications that can arise from untreated Cushing Syndrome include osteoporosis, high blood pressure and type 2 diabetes.
Cushing syndrome can develop from various causes, which can be broadly categorised into endogenous and exogenous factors. Endogenous Cushing Syndrome occurs due to factors within the body that lead to excessive cortisol production. This may result from: Pituitary Adenoma (Cushing’s Disease), a benign tumour in the pituitary gland; tumours in the adrenal glands, and, rarely, tumours outside the pituitary or adrenal glands that produce ACTH and trigger excessive cortisol secretion. Exogenous Cushing Syndrome results from prolonged exposure to high doses of glucocorticoid medications that may be used in the treatment of various diseases.
Cushing Syndrome is rare, affecting around 10-15 people per million. It typically is found in people aged 20-50, and often goes undiagnosed.
Symptoms
The symptoms of Cushing Syndrome can vary widely and may develop gradually. Some common signs and symptoms include:
- Weight gain: Particularly in the abdomen, face, and neck, often resulting in a rounded “moon” face and a hump on the upper back.
- Muscle weakness: Thinning of the muscles and proximal muscle weakness.
- Skin changes: Thin, fragile skin with purple or pink stretch marks (striae), easy bruising, and slow wound healing.
- High blood pressure: Hypertension is common due to cortisol’s effect on blood vessel constriction and fluid retention.
- Glucose intolerance: Increased blood sugar levels can lead to diabetes mellitus.
- Osteoporosis: Reduced bone density and increased risk of fractures due to cortisol’s interference with bone formation and calcium absorption.
- Emotional disturbances: Mood swings, irritability, anxiety, and depression may occur.
- Menstrual irregularities: Menstrual cycles may become irregular or stop altogether.
- Decreased libido: Loss of interest in sex or erectile dysfunction in men.
Diagnosis
Diagnosing Cushing Syndrome involves a comprehensive evaluation of medical history, physical examination, and various tests, including urine and saliva tests to measure cortisol levels, blood tests to measure cortisol and ACTH levels, and imaging tests such as MRI or CT scans to see if there are abnormalities in the adrenal glands or pituitary gland.
Treatment
Treatment depends on the cause. Surgery is used to remove tumours causing excess cortisol production; medications can be prescribed to inhibit cortisol production when surgery is not possible or likely to be effective; radiation therapy can be used to shrink or destroy pituitary or ectopic tumours, and lifestyle changes are used to help manage symptoms, such as weight management, blood pressure controls and blood sugar level monitoring. Adrenal gland surgery may be recommended if the ACTH-producing tumour cannot be found or fully removed; following this surgery, cortisol medicine and hormone replacement treatment will be needed.
If Cushing Syndrome is caused by taking glucocorticoid medicine for a long time, tapering off the medicine with professional advice and support may be advised.
Summary
Cushing Syndrome is a complex disorder characterised by excessive cortisol levels, leading to a range of physical and psychological symptoms. Early diagnosis and appropriate management are essential to prevent complications and improve quality of life for individuals affected by this condition.
