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Cushing’s syndrome is a group of symptoms that result from an excess of steroid hormones. It can appear at any age. In addition to disfiguring obesity and stretch marks, it leads to serious complications, such as hypertension and diabetes. It also happens that Cushing’s syndrome may be the first symptom of a malignant tumor.
The causes of Cushing’s syndrome
The disease is caused, among others, by excessive amounts of glucocorticoids, i.e. steroid hormones produced naturally in the adrenal glands and endocrine glands. However, the main cause of Cushing’s syndrome is an excess of cortisol, a hormone produced in the adrenal cortex.
Cortisol, commonly known as the stress hormone, is produced by the adrenal glands when we experience stressful situations. Thanks to it, the body is mobilized to fight, although at the same time it is burdened with it. Although Cortisol contributes to the development of Cushing’s syndrome, it is also involved in metabolic processes (regulates the metabolism of glucose, fats and proteins.
The adrenal gland controls the pituitary gland, which produces the corticotropic hormone. As a result, they are stimulated to produce various hormones, including cortisol. Cushing’s syndrome was first described by Harvey Cushing, a famous neurosurgeon who once worked at Johns Hopkins Hospital – he is the one who owes its name to the disease.
What are the symptoms of Cushing’s syndrome?
Contrary to appearances, the excess of cortisol in the blood does not have particularly visible symptoms. To determine that we are dealing with Cushing’s syndrome, specialized laboratory tests should be carried out to confirm the presence of hormonal disorders. However, a certain constellation of symptoms should also be present for the diagnosis of Cushing’s syndrome.
Typically, people with Cushing’s syndrome gain weight significantly. Fat tissue is then deposited on the abdomen, torso, neck and face – the cheeks become chubby, the so-called bullish neck, face becomes rounded. However, limbs remain disproportionately thin. Blue-red stretch marks appear on the skin and it becomes flaccid.
Stretch marks appear slightly different on the skin of a person suffering from Cushing’s syndrome than those that sometimes remain after the pubertal spike. They are visible on the abdomen, thighs, breasts, hips and around the armpits and knee pits. Moreover, you may have problems bruising easily.
Patients also become more susceptible to infections. Then they lose their muscle strength and feel less willing to have sex. Women often complain of a menstrual disorder. The development of osteoporosis can lead to both bone pain and serious fractures, e.g. in the spine.
The consequences of the disease are the development of diabetes and hypertension. Consequently, all potentially life-threatening cardiovascular complications also develop. Patients with Cushing’s syndrome have elevated cholesterol levels, resulting from lipid metabolism disorders.
Find out more about Hormonal Disorders
When discussing the causes of the disease, one should pay attention to the mere fact of the presence of increased levels of hormones – this alone is a separate problem. The causes of Cushing’s syndrome are internal (excess production of hormones by the adrenal glands). However, many times the disease develops as a result of administering steroid hormones from outside.
Glucocorticosteroids are a group of anti-inflammatory drugs (including immunosuppressants) widely used in medicine. They are used in the treatment of neoplasms, many inflammatory diseases and diseases from the circle of autoimmunity. Doctors, aware of the side effects caused by drugs, recommend using them in small doses.
A common cause of Cushing’s syndrome is the so-called Cushing’s disease. It is manifested by excessive activity of the adrenal glands resulting from pathological stimulation of these glands by ACTH produced by a pituitary tumor (adenoma). It is worth adding that in 10-15% of cases, the production of the stimulating hormone takes place in tumors located in other parts of the body.
The patient must undergo screening tests to confirm excess cortisol in the blood. However, the diagnosis of Cushing’s syndrome is more advanced. Additional laboratory tests are needed to determine whether the source of the disorder is in the adrenal glands or in the pituitary gland.
The diagnosis of Cushing’s syndrome also includes imaging tests. Their purpose is to check for tumors in the adrenal glands, pituitary and other parts of the body that can also cause hormonal disorders. In addition, tests to assess the occurrence of disease complications and assess bone density should also be performed to quickly recognize osteoporosis.
Check what is the underactive and overactive adrenal cortex
Diagnosis of Cushing’s syndrome
The basic screening tests performed when diagnosing Cushing’s syndrome include:
- inhibition test with 1 mg DXM (dexamethasone) – before going to bed, around midnight, the patient receives a tablet (1 mg DMX). A fasting blood sample is then taken to see if cortisol is present. The study is performed on an outpatient basis.
- Daily excretion of cortisol in the urine – To perform this test, a patient suspected of having Cushing’s syndrome must collect it in a container XNUMX hours a day after passing the morning urine, along with the first urine released the next morning. The determination of cortisol is performed on a minimum of two daily urine collections.
- cortisol levels in the blood or saliva – people with Cushing’s syndrome have high levels of cortisol in the evening hours. Therefore, this examination is carried out around 23.00-24.00. The patient must then be in hospital.
ACTH measurement and a CRH stimulation test are also performed when diagnosing Cushing’s syndrome. When tests show an excess of cortisol in the body, there is a stage of dynamic laboratory tests, which include:
- computed tomography or magnetic resonance imaging of the adrenal glands (most often when hormonal tests indicate an adrenal tumor);
- magnetic resonance imaging of the pituitary gland;
- Thyroid ultrasound;
- CT of the chest and abdominal cavity;
- radioisotope research.
Pituitary and adrenal tumors are surgically removed. It is very likely that the symptoms of the disease will improve if the procedure is performed radically.
However, sufferers who lack adrenal glands will need to replace their adrenal hormones for life. People with Cushing’s syndrome may also use medications to suppress the adrenal production of steroid hormones.
Treatment of Cushing’s syndrome is case-by-case. If a person also has persistent diabetes and high blood pressure, then treatment is also necessary. It is also required by patients suffering from diseases such as osteoporosis and lipid disorders.
Find out more about pituitary adenomas
It depends on the causes of the disease. Patients with pituitary or adrenal tumors removed as a result of surgery have the best prognosis. Unfortunately, the situation is worse when the cause of Cushing syndrome is a malignant tumor.
Once treatment is complete, the patient should be under the constant observation of an endocrinologist and have regular check-ups. Ways to prevent the disease are still unknown.
Cushing’s syndrome and diet
People with Cushing’s syndrome often have a problem with diabetes or poor glucose tolerance. Therefore, the basis of the diet should be, inter alia, whole grains, pasta, rice and groats. It is worth limiting the consumption of simple carbohydrates, i.e. sweets, fruit, dried fruit and honey. You can replace them, for example, with nuts and fresh fruit – no more than two servings a day.
It is recommended to eat 3 to 4 meals no more than every 4 hours. This will avoid constant stimulation of the pancreas. A diet devoid of large amounts of carbohydrates (less than 150 g per day) is very popular among people suffering from Cushing’s syndrome. It is advisable to limit the consumption of fatty meats, cold cuts, frying fats and full-fat dairy products.
Glucocorticoids, commonly used in the treatment of Cushing’s syndrome, increase the excretion of calcium, zinc and potassium. To supplement the deficiency of these ingredients, it is worth including in your diet: sunflower seeds, spinach, hazelnuts, fish and poppy seeds.
Cushing’s syndrome and pregnancy
Diagnosing the disease during pregnancy can be problematic. Pregnant women have higher levels of total cortisol and ACTH than non-pregnant women. The symptom of the disease in pregnant women is the increase in body weight, disproportionate to the stage of pregnancy. Other symptoms of Cushing’s syndrome include high blood pressure and easy bruising. Often these changes are considered normal in this condition, which delays the diagnosis of the disease.
Children suffering from this disease begin to grow slower and gain weight faster. The symptoms of Cushing’s syndrome, as in adults, are due to the catabolic action of cortisol. In order to recognize when a child develops Cushing’s symptoms, it is necessary to establish a period when the child suddenly stopped growing and began to gain weight. As such, it’s a good idea to measure and weigh your baby regularly – percentile grids to measure weight and height will be useful.
The development of the disease does not accelerate overnight. Interestingly, Cushing’s disease in dogs follows a similar course to that in children, with both symptoms developing slowly. Much depends, among others on age and on whether the stress hormone is secreted continuously or cyclically. Cushing’s syndrome in children also manifests itself in a characteristic bull’s-neck (also called a buffalo or widow’s neck).
The face of a child with Cushing’s syndrome becomes rounded. However, fatigue, high blood pressure and stretch marks do not appear in all patients, and only treats half of the children. If it is suspected that a child has Cushing’s syndrome, appropriate tests will be performed to see if the child’s adrenal glands are producing excess cortisol.
Read also: Stress – Former Friend, Present Killer
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