Description

Cushing's syndrome occurs when the body has too much of the hormone cortisol for a long time. This can be as a result of which the body is making too much cortisol, or take medicines called glucocorticoids, which affect the body the same way as cortisol.

Too much cortisol can cause some of the main symptoms of Cushing syndrome — a fatty hump between the shoulders, a rounded face, and pink or purple stretch marks on the skin. Cushing's syndrome can also cause high blood pressure or bone loss. Sometimes, it can cause type 2 diabetes.

Treatments for Cushing's syndrome is lower than that of the body, cortisol levels and improve symptoms. The sooner treatment begins, the better the chances of recovery.

Symptoms

The symptoms of Cushing's syndrome may vary depending on the level of cortisol of more.

The common symptoms of Cushing's syndrome

  • The weight gain in the trunk, with thin arms and legs.
  • The weight gain in the face. This is sometimes called moon face.
  • A fatty lump between the shoulders. This may be referred to as a buffalo hump.
  • Pink or purple stretch marks on the stomach, hips, thighs, breasts and armpits.
  • Thin, frail skin that bruises easily.
  • Slow healing of wounds.
  • Acne.

The symptoms of women with Cushing's syndrome may experience

  • Thick, dark hair on the face and body. This condition is called hirsutism.
  • Irregular periods or stop.

The symptoms of men with Cushing's syndrome may experience

  • Decreased sexual desire.
  • The reduction of fertility.
  • Problems getting an erection.

Other possible symptoms of Cushing's syndrome

  • Extreme tiredness.
  • The muscle weakness.
  • Depression, anxiety and irritability.
  • The emotions that are difficult to control.
  • Difficulty concentrating or remembering.
  • The lack of sleep.
  • The high blood pressure.
  • The pain of a headache.
  • Infections.
  • The darkening of the skin.
  • The loss of bone, which may lead to fractures of the bones.
  • The growth retardation in children.

When to see a doctor

Call your health care provider if you have symptoms of Cushing's syndrome, especially if you are taking medication with glucocorticoids for the treatment of a health problem like asthma, arthritis, or inflammatory bowel disease.

Causes

Cushing's syndrome is caused by the amount of cortisol in the body. Cortisol is a hormone that is produced in the adrenal glands. Helps the body respond to stress and has many other important functions, including:

  • Control of blood pressure.
  • The reduction of the inflammation.
  • Help the heart and blood vessels function properly.
  • The control of sugar in the blood.
  • Helping the body use food for energy.

The role of glucocorticoid medications (exogenous Cushing syndrome)

Cushing's syndrome can occur from taking glucocorticoid medications. These are often used to treat inflammatory diseases such as rheumatoid arthritis, lupus and asthma. Pain or injury in the back or joints, and many eruptions on the skin can be treated with glucocorticoids. It can also be used to stop the body from rejecting the new organ after a transplant.

Glucocorticoids can be taken by mouth, given by injection, rubbed into the skin or inhaled into the lungs through an inhaler. Any form of glucocorticoid, if taken in large amounts for a long time, can cause Cushing's syndrome.

When the body produces too much cortisol (Cushing's syndrome endogenous)

A hormone produced in the pituitary gland controls the amount of cortisol in the body makes. This is called adrenocorticotropic hormone (ACTH). Some tumors do ACTH, which creates more cortisol and can cause Cushing's syndrome. Problems with the adrenal gland can also affect the cortisol and cause Cushing's syndrome.

When Cushing's syndrome occurs in this way, it can be caused by:

  • ACTH-producing pituitary adenoma. Pituitary adenomas are tumors that grow in the pituitary gland. They are found at the base of the brain and are usually not cancer. These tumors sometimes make too much ACTH. This causes the adrenal glands to produce more cortisol. When Cushing's syndrome occurs in this way, it is called Cushing's disease. This happens more often in women and is the most common type of Cushing's syndrome endogenous.
  • Ectopic ACTH-producing tumor. In rare cases, a tumor that produces excess ACTH grows in a body that does not usually make the ACTH. This is the call of the production of ectopic ACTH. This causes the body to produce too much cortisol. These tumors can be cancerous, but not always. They are usually found in the lungs, the pancreas, the thyroid or thymus gland.
  • Tumors of the adrenal gland or disease.Problems with the adrenal glands, which can cause them to make too much cortisol. The most common is that of a tumor in the outer part of the adrenal gland called adrenal adenoma. These tumors are not cancerous, and only some of them do too much cortisol. Cancerous tumors in the outer part of the adrenal glands, known as adrenocortical carcinoma, are rare. But it can be done cortisol and cause Cushing's syndrome. Sometimes, various items that they make that cortisol can grow in the adrenal glands and cause Cushing's syndrome. This is called adrenal nodular hyperplasia.
  • Family of Cushing's syndrome. Rarely, people inherit a tendency to get tumors in one or more of your endocrine glands, which are glands that produce hormones. If these tumors do ACTH or cortisol, Cushing's syndrome can happen.

Tumors of the adrenal gland or disease. Problems with the adrenal glands, which can cause them to make too much cortisol. The most common is that of a tumor in the outer part of the adrenal gland called adrenal adenoma. These tumors are not cancerous, and only some of them do too much cortisol.

Cancerous tumors in the outer part of the adrenal glands, known as adrenocortical carcinoma, are rare. But it can be done cortisol and cause Cushing's syndrome. Sometimes, various items that they make that cortisol can grow in the adrenal glands and cause Cushing's syndrome. This is called adrenal nodular hyperplasia.

Complications

Without treatment, Cushing's syndrome can cause complications, such as:

  • The loss of bone, also called osteoporosis, which can lead to fractures of the bones.
  • High blood pressure, also called hypertension.
  • Type 2 diabetes.
  • Severe or multiple infections.
  • The loss of muscle mass and strength.

Diagnosis

Take medications glucocorticoids is the most common way to get to Cushing's syndrome. Your health care provider can look to all your medicines (pills, injections, creams and inhalers to see if you are taking medicines that can cause the syndrome. If you are, you do not need other tests.

When Cushing's syndrome is caused by the body making too much cortisol, which can be difficult to diagnose. That is due to other illnesses that have similar symptoms. The diagnosis of Cushing's syndrome can be a long and complex process. You need to see a doctor who specializes in hormonal diseases, called an endocrinologist.

The endocrinologist will likely do a physical exam and look for signs of Cushing's syndrome, such as a round face, a hump on the back of the neck, and thin, with bruises on the skin with stretch marks.

If you have not been using a glucocorticoid medication, these tests can help identify the cause of Cushing's syndrome:

  • Blood and urine samples.These tests measure hormone levels and show whether the body is making too much cortisol. For the urine test, you may be asked to collect urine during a 24-hour period. Cortisol, ACTH and other hormones are measured in samples of urine and blood. Your doctor may also recommend other tests. These tests measure the levels of cortisol before and after using hormonal drugs to activate or block the cortisol.
  • Saliva test. Cortisol levels tend to rise and fall during the day. In people without Cushing's syndrome, cortisol drops in the evening. Looking at the levels of cortisol from a small sample of saliva collected in the evening, the health care team can see if the cortisol levels are too high.
  • Imaging tests. Computed tomography or magnetic resonance imaging you can take photos of the pituitary gland and the adrenal glands to see if something is shown, such as tumors.
  • Petrosal Inferior sinus sampling.This test can help you decide if the Cushing's syndrome is caused by an ACTH-producing pituitary adenoma, or ACTH-producing tumor in another organ. For the test, blood samples are taken from the veins that drain the pituitary gland, called the petrosal bottom of the sinuses. During the test, you will be given medicine through a vein to help you stay calm and comfortable. A thin tube that is placed in the groin or the neck, and is screwed to the petrosal bottom of the sinuses to collect a sample of blood. Another blood sample is taken of your forearm. Then, you are given a medication that causes the tumor in order to make the most of ACTH, and blood samples are taken again from the same areas. ACTH levels are then compared between the two sample areas. If the level of ACTH is increased in the breast of the sample, the problem comes from the pituitary gland. If ACTH levels are similar between the breasts and to the forearm, the problem is outside of the pituitary gland.

Blood and urine samples. These tests measure hormone levels and show whether the body is making too much cortisol. For the urine test, you may be asked to collect urine during a 24-hour period. Cortisol, ACTH and other hormones are measured in samples of urine and blood.

Your doctor may also recommend other tests. These tests measure the levels of cortisol before and after using hormonal drugs to activate or block the cortisol.

Petrosal Inferior sinus sampling. This test can help you decide if the Cushing's syndrome is caused by an ACTH-producing pituitary adenoma, or ACTH-producing tumor in another organ. For the test, blood samples are taken from the veins that drain the pituitary gland, called the petrosal bottom of the sinuses.

During the test, you will be given medicine through a vein to help you stay calm and comfortable. A thin tube that is placed in the groin or the neck, and is screwed to the petrosal bottom of the sinuses to collect a sample of blood. Another blood sample is taken of your forearm. Then, you are given a medication that causes the tumor in order to make the most of ACTH, and blood samples are taken again from the same areas. ACTH levels are then compared between the two sample areas.

If the level of ACTH is increased in the breast of the sample, the problem comes from the pituitary gland. If ACTH levels are similar between the breasts and to the forearm, the problem is outside of the pituitary gland.

These tests can help your doctor diagnose Cushing's syndrome. They can also help rule out other health conditions, such as polycystic ovary syndrome — a hormone problem in people with enlarged ovaries. Depression, eating disorders, and alcoholism may also have symptoms similar to Cushing's syndrome.

Treatment

Treatments for Cushing's syndrome are designed to reduce the amount of cortisol in the body. The best treatment for you depends on the cause of down syndrome. The options include:

Reduce the use of glucocorticoids

If Cushing's syndrome is caused by taking a medication with glucocorticoids for a long time, your doctor may be able to control their symptoms by reducing the amount of medication you take. This is done with care over time, while still managing the disease for which you are taking. Do not reduce the dose of glucocorticoid drugs, or stop taking it on your own. Do this only with the help of your health care provider.

Stop taking this medicine too fast can cause you to have too little cortisol in your body. Slowly decreasing the medicine allows your body to make a good amount of cortisol.

Surgery

If Cushing's syndrome is caused by a tumor, the doctor may recommend removal of the tumor with surgery. Pituitary tumors are often removed by a neurosurgeon, who can do the operation through his nose. ACTH-producing tumors in other parts of the body can be removed with regular surgery or less invasive approaches with smaller incisions.

If an ACTH-producing tumor is not found, or if one cannot be completely eliminated, and the Cushing's syndrome continues, your health care provider may recommend the removal of the adrenal glands. This is called an adrenalectomy bilateral. This procedure is immediately stops the body from making too much cortisol. After both adrenal glands are removed, you may need to take medication to replace the cortisol and other adrenal hormone called aldosterone for the rest of your life.

Tumors of the adrenal gland can be removed through an incision in the abdomen or back. Often, tumors of the adrenal gland that are not cancerous can be removed with a minimally invasive approach.

After Cushing's syndrome of the surgery, the body does not make enough ACTH. You will have to take a cortisol replacement medicine to give your body the right amount of cortisol. Most of the times, the body begins to produce enough cortisol again, and your health care provider can reduce the replacement of the medicine. Your endocrinologist may use blood tests to help decide if you need the cortisol of the medicine and when it can be stopped.

This process can take from six months to a year or more. Sometimes, people with Cushing's syndrome need ongoing replacement of the medicine.

Radiation therapy

If the surgeon is not able to completely remove a pituitary tumor, radiation therapy may be necessary in conjunction with surgery. The radiation can also be used for people who cannot undergo surgery.

The radiation may be administered in small doses over six weeks, or with a single high dose of radiation. In both cases, your health care provider can plan your procedure in a way that reduces the radiation exposure to other tissues.

Drugs

Medications can be used to control the levels of cortisol when surgery and radiation therapy do not work or are not an option. Medications can also be used before surgery in people who are very sick with Cushing's syndrome. This can improve the symptoms of the disease and reduce the risks of the surgery. Medical therapy for Cushing's syndrome is not a cure and may not completely improve all of the symptoms of excess cortisol.

Medications for the control of the production of cortisol by the adrenal gland include ketoconazole, osilodrostat (Isturisa), mitotane (Lysodren), levoketoconazole (Recorlev), and metyrapone (Metopirone).

Mifepristone (Korlym, Mifeprex) is approved for people with Cushing's syndrome who have type 2 diabetes or high blood sugar. Mifepristone does not reduce the amount of cortisol in the body makes, but blocks the effect of cortisol on the tissues.

Pasireotide (Signifor) is given as an injection twice a day. It works by reducing the amount of ACTH in the tumor, which decreases the levels of cortisol. Other medications that are being developed.

The side effects of these drugs may include tiredness, upset stomach, vomiting, headaches, muscle aches, high blood pressure, low potassium levels, and swelling. Some have more serious side effects, such as the brain and the nervous system side effects and liver damage.

Sometimes, the tumor or its treatment causes the pituitary gland or the adrenal glands to make too little of other hormones. If this happens, your doctor may recommend hormone replacement.

Lifestyle and home remedies

The recovery of Cushing's syndrome is usually a slow and gradual process. It may take time before you begin to feel better. These tips can help you on your journey back to health.

  • Increase activity gradually. Work up to a comfortable level of exercise or activity without overdoing it. Do not do activities that may cause harm, such as high-impact exercise. With patience and perseverance, you will be able to improve little by little over time.
  • Eat sensibly. The nutritious foods are a good source of fuel for the body during recovery. It can also help you lose the weight you gained from the Cushing's syndrome. Make sure you're getting enough calcium and vitamin D. Taken together, help your body absorb calcium, which can strengthen your bones. This can counteract the loss of bone density caused by Cushing's syndrome.
  • Keep an eye on your mental health. Depression can be a side effect of Cushing's syndrome, but can also continue or start after starting the treatment. Don't ignore depression or wait. Seek help quickly from your health care provider or a therapist if you're depressed, overwhelmed or are having problems to face during their recovery.
  • Gently soothe aches and pains. Hot baths, massages and a low-impact exercises such as water aerobics and tai chi can help reduce some of the muscle and joint pain that occurs in Cushing's syndrome recovery.

Coping and support

Support groups can be helpful to treat Cushing's syndrome and recovery. They bring you together with other people who have the same type of challenges, along with their families and friends. Support groups offer a place where you can share common problems with other people who understand.

Ask your doctor about support groups in your community. Your local health department, the public library and the internet can also be good sources to find a support group in your area.

Preparing for your appointment

It is likely that you see your primary care provider first. However, sometimes when you call to schedule an appointment, you may be referred immediately to a doctor who specializes in hormonal disorders, called an endocrinologist.

It is a good idea to prepare for your visit. This way, you can make the most of your time with your health care provider. Here's how you can prepare, and what to expect.

What you can do

  • Knowing what to do prior to your visit. When you make the appointment, ask if there is something that you need to do to prepare for the test.
  • Write down the symptoms you are experiencing, including any that seem unrelated to the appointment. For example, if you have had headaches more often, or if you've been feeling down, or more tired than usual, tell your health care provider. Also talk with your doctor about any change in their appearance, such as weight gain, acne new or more hair on the body.
  • Write down key personal information, including any change in your personal relationships or sex life. Tell your doctor if the people closest to you have noticed that you seem irritable or has more mood swings than in the past. This can help bring a photo of yourself that shows all the changes in his appearance since I started having symptoms.
  • Make a list of all the medicines, vitamins, creams, or supplements you are currently taking, or have used in the past. Write down the name, dose and timing of steroid drugs that has been made before, such as cortisone injections.
  • Have a family member or friend along, if possible. Sometimes it can be difficult to remember all information that is obtained during an appointment. Someone who comes with you may remember something that you missed or forgot.
  • Write questions to ask their health care provider.

Your time with your provider can be limited, so preparing a list of questions that can help you make the most of their time together. For Cushing's syndrome, some basic questions to ask include:

  • What is the cause of my symptoms?
  • What tests do I need? How are these tests done?
  • What are my treatment options? What do I recommend?
  • Will my symptoms improve with treatment? I'm going to see a change in the way that I see or how I feel?
  • Will the treatment help me to feel better emotionally?
  • What is the long-term effect of each treatment? Will affect this if I have children?
  • How do you know that the treatment is working?
  • I have other health conditions. How can I best manage these conditions?
  • Are there brochures or other printed material that I can take my house? What sites do you recommend?

In addition to the questions you have prepared, feel free to ask any other questions during your appointment.

What to expect from your doctor

Your doctor will probably ask a lot of questions. Be prepared to answer them you can save time so that you can talk about other concerns or questions. Your provider may ask:

  • When was the first you have symptoms?
  • Do you have symptoms all the time, or come and go? They have gotten worse over time?
  • Have you noticed changes in your sexual performance or your interest in sex?
  • Has your menstrual cycle changed or ceased to have your period?
  • Have you gained weight? In what part of your body?
  • Has had trouble controlling their emotions?
  • Have you ever noticed that you bruise more easily, or that the cuts and infections take longer to heal?
  • Do your muscles feel weak? It is difficult to get out of the bathtub or walk up or down stairs?
  • Have you noticed new acne or more body or facial hair?
  • Has been taking a medication with glucocorticoids? For how long?
  • What, in any case, it makes your symptoms better or worse?
Symptoms and treatment of Cushing's syndrome