Cushing Syndrome: Everything You Need to Know

Cushing Syndrome is a hormonal disorder, in which there is an abnormally high level of the hormone Cortisol.

Moreover, it is a rare problem,  can is due to adrenal glands making too much cortisol.

It can be either due to tumors or mass found in the pituitary gland, however, it can also be due to tumors in adrenal glands.

People with this syndrome might observe their face getting round like a moon, gaining weight in unusual ways, bruising occurs often and easily or may feel weak.

Moreover, women might have issues of fertility and other problems. CS, crushing syndrome is most often found in adults ranging from the age of 20 to 50.

Normal Functions of Adrenal Glands

The Adrenal Glands are present above each of your kidneys and are triangle shaped.

Moreover, they measure about half an inch in height and about 3 inches in length.

Each adrenal gland has 2 layers.

The adrenal medulla is the inner part and makes epinephrine or adrenaline

The adrenal cortex, which is the outer part and makes steroid hormone or cortisone and aldosterone.

These glands control different processes of your body and their job is to keep the body in balance.

Therefore, by making different hormones, which are important for maintaining good health, are produced by them.

For instance, these hormones help to regulate fluid and salt levels in your body that in turn affects blood volume and blood pressure.

Moreover, they help your body to react to stress and change, cause a faster heart rate, and boost other systems that help you to react quickly.

However, if there is a problem with the cortex or medulla, it can result in high blood pressure.

Pituitary glands control the cortisol levels and are present at the base of your brain.

Moreover, the hypothalamus makes corticotropin-releasing hormone, CHR, which tells the pituitary gland how much cortisol the glands make.

In case, your pituitary gland detects high levels of cortisol, it sends a signal and stops producing it. This feedback system is like a thermostat to balance the cortisol levels in your body.

Cushing Syndrome Signs and Symptoms

The most common signs and symptoms of this syndrome are weight gain, fat deposits especially in the mid of your body, face, and between shoulders, and upper back.

Thinning of your skin, stretch marks, skin injuries that slowly heal, acne, fatigue, and muscle weakness.

In addition to the above common signs and symptoms, there are other symptoms, observable in people with Cushing Syndrome. These are:

• high blood pressure
• increase in thirst
• frequent urination
• osteoporosis
• high blood sugar
• headaches and mood swings
• anxiety, depression
• increase in the incidence of infections.

Cushing’s Syndrome in Children

Cushing’s Syndrome is also present in childer, although its development is less frequent than that in adults.

According to a study in 2019, about 10% of the cases of this syndrome occur in children.

In addition to the above symptoms, children may also show the following symptoms:

• Obesity,
• a slower rate of growth
• hypertension, or high blood pressure

Cushing’s Syndrom in Women

This syndrome occurs more in women than in men.

According to the National Institutes of Health, NIH, 3 times as many women develop this syndrome than men.

They also can develop excess facial and body hair.

This occurs on the face, neck, chest, thighs, and abdomen. Moreover, women may also experience irregular menstruation cycles.

However, in some cases, menstruation is may be absent altogether. If they do not get treatment in time it can cause difficulties to conceive.

Cushing’s Syndrome in Men

As children and women show certain additional symptoms, men might also face additional signs and symptoms as women do.

These are erectile dysfunction. decrease in fertility etc.

Causes of Cushing Syndrome

Excess levels of Cortisol in your body cause Cushing syndrome.

Cortisol is a hormone that your adrenal glands produce and plays different roles in your body.

For instance, it regulates blood pressure, reduces inflammations, and keeps your heart and blood vessels functioning properly.

Moreover, cortisol helps your body to respond to stress and regulates the conversation of proteins, carbohydrates, and fats into energy.

The causes can either be Exogenous Cushing syndrome or Endogenous Cushing Syndrome.

Let us discuss them separately.

Exogenous Cushing Syndrome

This syndrome can be due to taking oral corticosteroid medications like prednisone, in high dosage over time.

These oral medications are prescribed to treat inflammatory diseases like Rheumatoid Arthritis, lupus, and asthma.

They are also used to prevent your body from rejecting an organ through a transplant.

It is possible to develop this syndrome from injectable corticosteroids.

For instance, frequent injections for joint pain, pain in the back, and bursitis.

However, inhaling them for the treatment of asthma is likely to cause this syndrome or skin creams for skin disorders like eczema.

But in some people, these medications can cause this syndrome, especially if they take them in high dosage.

Endogenous Cushing Syndrome

This condition is due to either your body producing excess cortisol or too much adrenocorticotropic hormone, ACTH, which regulates cortisol production.

It can be related to:

Pituitary Adenoma: A tumor that is benign or no-cancerous in the pituitary gland, and produces an excess amount of ACTH.

As a result, it sends signals to the adrenal glands to produce more cortisol. When this happens it is Cushing’s disease.

It is common in women and is also one of the most common forms of the endogenous syndrome.

An ACTH-secreting Tumor: A tumor might develop in an organ that does not produce ACTH normally and begins to secret it in high levels.

These tumors can be benign or cancerous and are found in the lungs, pancreas, thyroid, or thymus gland.

Primary Adrenal Gland Disease: It is a disorder of the adrenal gland that produces too much cortisol

The most common one is a non-cancerous tumor of the adrenal cortex or Adrenal Adenoma.

However, only a small fraction of adenomas produce too much cortisol.

Cancerous tumors of the Adrenal cortex are, however, rare and can cause this syndrome.

Familial Cushing Syndrome: People might inherit a tendency to develop a tumor in one or more of the endocrine glands, therefore affecting the levels of cortisol.

Diagnosing CS

The diagnosis of CS is often hard and is often masked by other health conditions.

Moreover, you will need to see your doctor or health care provider find out if you have this syndrome or not.

Diagnosis depends on your medical history, physical examination, and lab tests for cortisol levels.

Your doctor will most likely review all your medications including pills, injections, creams, and inhalers.

It is done to determine whether these medications are causing the problem or not. If it is so, further tests are not required.

However, in the case of Endogenous Cortisol production, diagnosis is often difficult.

Its diagnosis can be long and extensive and you will likely have to visit an Endocrinologist.

This will look at the signs and symptoms of this syndrome, medical history, or other diagnosing tests.

Urine and Blood Tests

These tests measure the hormone levels in your body, whether it is making high levels of cortisol or not.

For the urine test, you can be asked to collect your urine over a 24-hour period.

An extensive analysis is done in the laboratory to see the levels of cortisol.

Your doctor may also recommend other tests that involve specifically measuring the cortisol levels and after using hormone medications to stimulate or suppress cortisol.

Saliva Test

The levels of cortisol normally rise and fall throughout the day, and this is normal.

However, in people with CS, levels of cortisol drop significantly in the evening.

Therefore, analysis of cortisol levels from the sample of your salvia at late night can help in the diagnosis.

Further Tests

After confirmation of CS, images and other tests can help to find the cause.

Blood tests and image testing can help to identify the presence of a tumor. In these tests they will look for:

1. Very low levels of corticotropic, which indicate the presence of Adrenal Tumor. CT scan or MRI can confirm the diagnosis.
2. Slightly high levels of corticotropin indicate the presence of the pituitary tumor. MRI of the brain can confirm the diagnosis. However, more tests may be required it does not shoe in the MRI.
3. Excess levels of ACTH indicate Ectopic ACTC. More tests are needed to confirm this.

Petrosal Sinus Sampling.

This test can help determine whether the cause of Cushing syndrome is in the pituitary or somewhere else.

For the test, your doctor will take blood samples from the veins that drain the pituitary gland or petrosal sinuses.

A thin tube is inserted into your upper thigh or groin area while you’re sedated and is threaded to the petrosal sinuses.

Petrosal Sinuses help to measure the levels of ACTH while blood samples from the forearm are taken.

If the ACTH level is higher in the sinus sample, the problem stems from the pituitary.

And, if the ACTH levels are similar between the sinuses and forearm, the root of the problem lies outside of the pituitary gland.

Treatment Options

The design of the treatment of CS is to lower the high levels of cortisol.

Moreover, the best treatment depends on the cause of the syndrome. Options are:

Reduce in Steroid Medications:

In case, the case of Cushing Syndrome, CS is long-term use of corticosteroids, your doctor may be able to reduce the signs and symptoms by reducing the dosage of drugs over a period of time.

However, do not do this yourself without consulting your doctor or health care provider.

Discontinuing abruptly can cause a deficiency in the levels of cortisol.

Therefore, reducing them gradually and slowly can allow your body to resume the normal production of cortisol in your body.

Surgery

If the cause of CS is a tumor, you might need complete surgical removal of the tumor.

Neurosurgeons typically remove the tumor of pituitary glands and will perform it through your nose.

If the tumor is in the adrenal glands, lungs, or pancreas, the surgeon will perform a  standard operation or by using invasive surgical techniques, with small incisions.

After the surgery, you will have to take cortisol replacement medications.

This helps to provide the right amount of cortisol.

You will gradually return to normal hormone production. Moreover, your endocrinologist can help to determine the course of treatment and when to stop through blood tests.

It is important to note that this step can take longer. However, in most cases, people return to normal adrenal function.

Radiation Therapy for Cushing Syndrome

If the surgeon is unable to remove a pituitary tumor, he or she will usually prescribe radiation therapy as well as surgery.

Additionally, radiation may be used for people who aren’t suitable candidates for surgery.

Radiation can be given in small doses over a six-week period, or with a technique, stereotactic radiosurgery.

In the latter procedure, a large, one-time dose of radiation is delivered to the tumor, and the radiation exposure to surrounding tissues is minimized.

Medications

In case surgery and radion do not work, medications are prescribed before surgery.

This helps to improve the signs and symptoms in extreme cases, however, these do not completely improve all signs and symptoms.

Certain medications to control excessive production of cortisol at the adrenal gland include

• ketoconazole,
• mitotane (Lysodren)
• metyrapone (Metopirone)

Mifepristone is for people who have Type 2 diabetes or glucose intolerance. This does not decrease the production of cortisol however, it blocks the effects of cortisol on your tissues of the body.

Side effects may include fatigue, nausea, vomiting, headaches, muscle aches, high blood pressure, low potassium, and swelling.

Some have more serious side effects, like neurological side effects and liver toxicity.

However, in certain cases, the tumor or its treatment will cause the pituitary or adrenal gland to produce not enough other hormones, and your doctor will recommend hormone replacement medications.

Complications of Cushing Syndrome

Certain complications can occur if you do not get timely treatment for crushing’s syndrome. These are Bone loss or osteoporosis, which can result in unusual fractures like rib fractures, and your feet.

High blood pressure and type 2 diabetes.

Frequent or unusual infections and loss of strength and muscle mass.

Diet For People with Cushing Syndrome

Though diet can cure this syndrome. however, it can help to keep your cortisol levels from raising more and to help prevent certain complications,

The dietary tips are as follows:

Keeping track of high-calorie intake and gaining weight is one of the causes of CS.

CS can lead to an increase in the levels of blood sugar levels, therefore avoid foods that can cause such a rise.

Focus on eating foods like vegetables, fruits, whole grains, and fish instead.

Limit your sodium intake as CS is also associated with high blood pressure.

Make sure to get Calcium and Vitamin D as, during CS, you are more prone to fractures.

The Outlook

Cushing Syndrome is a hormonal disorder, however, you can not diagnose it yourself. It is often masked by other diseases and health problems.

The sooner you get treatment, the better as it can cause complications like type 2 diabetes, high blood pressure, and high sugar levels.

It takes time for your signs and symptoms to improve, therefore, be sure to ask your doctor or health care provider about dietary guidelines. Moreover, keep follow-up appointments and increase your activity level slowly.