CUSHING’S SYNDROME

Cushing's syndrome is a hormonal disorder caused by high levels of the hormone cortisol in
your body. It’s also known as hypercortisolism. Cortisol comes from your adrenal glands,
which sit on top of your kidneys. It helps your body:

 Maintain blood pressure

 Regulate blood sugar

 Lower inflammation

 Turn the food you eat into energy

But when you have too much cortisol, it can throw off your body's other systems.

Most cases of Cushing's syndrome can be cured, though it may take some time for your
symptoms to ease up.

The condition is more common in women than in men. It's most often seen in people ages 25-
40.

SYMPTOMS:
The signs and symptoms of Cushing syndrome can vary depending on the levels of excess
cortisol.

Common signs and symptoms of Cushing syndrome

 Weight gain and fatty tissue deposits, particularly around the midsection and upper
back, in the face (moon face), and between the shoulders (buffalo hump)

 Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and
arms

 Thinning, fragile skin that bruises easily

 Slow healing of cuts, insect bites and infections

 Acne
Signs and symptoms women with Cushing syndrome may experience

 Thicker or more visible body and facial hair (hirsutism)

 Irregular or absent menstrual periods

Signs and symptoms men with Cushing syndrome may experience

 Decreased sex drive

 Decreased fertility

 Erectile dysfunction

Other possible signs and symptoms of Cushing syndrome

 Severe fatigue

 Muscle weakness

 Depression, anxiety and irritability

 Loss of emotional control

 Cognitive difficulties

 New or worsened high blood pressure

 Headache

 Infections
  Skin darkening

 Bone loss, leading to fractures over time

 In children, impaired growth

CAUSES:
Cushing’s syndrome is caused by an excess of the hormone cortisol. Your adrenal
glands produce cortisol.

It helps with a number of your body’s functions, including:

 regulating blood pressure and the cardiovascular system

 reducing the immune system’s inflammatory response

 converting carbohydrates, fats, and proteins into energy

 balancing the effects of insulin

 responding to stress

Your body may produce high levels of cortisol for a variety of reasons, including:

 high stress levels, including stress related to an acute illness, surgery, injury, or
pregnancy, especially in the final trimester

 athletic training

 malnutrition

 alcoholism

 depression, panic disorders, or high levels of emotional stress

Corticosteroids

The most common cause of Cushing’s syndrome is the use of corticosteroid medications, such
as prednisone, in high doses for a long period. Healthcare providers can prescribe these to treat
inflammatory diseases, such as lupus, or to prevent rejection of a transplanted organ.

High doses of injectable steroids for treatment of back pain can also cause Cushing’s
syndrome. However, lower dose steroids in the form of inhalants, such as those used
for asthma, or creams, such as those prescribed for eczema, usually aren’t enough to cause the
condition.
Tumors

Several kinds of tumors can also lead to a higher production of cortisol.

Some of these include:

 Pituitary gland tumors. The pituitary gland releases too much adrenocorticotropic
hormone (ACTH), which stimulates cortisol production in the adrenal glands. This is
called Cushing’s disease.

 Ectopic tumors. These are tumors outside of the pituitary that produce ACTH. They
usually occur in the lung, pancreas, thyroid, or thymus gland.

 Adrenal gland abnormality or tumor. An adrenal abnormality or tumor can lead to

irregular patterns of cortisol production, which can cause Cushing’s syndrome.

 Familial Cushing’s syndrome. Although Cushing’s syndrome isn’t typically inherited,

it’s possible to have an inherited tendency to develop tumors of the endocrine glands.

Cushing’s disease

If Cushing’s syndrome is caused by the pituitary gland overproducing ACTH which in turn
becomes cortisol, it’s called Cushing’s disease.

As with Cushing’s syndrome, Cushing’s disease affects more women than men.

DIAGNOSIS:

Cushing’s syndrome can be particularly difficult to diagnose. This is because many of the
symptoms, like weight gain or fatigue, can have other causes. Additionally, Cushing’s
syndrome itself can have many different causes.

Your healthcare provider will review your medical history. They’ll ask questions about
symptoms, any health conditions you may have, and any medications you may be prescribed.

They’ll also perform a physical exam where they’ll look for signs like buffalo hump, and
stretch marks and bruises.

Next, they may order laboratory tests, including:

  24-hour urinary free cortisol test: For this test, you’ll be asked to collect your urine
over a 24-hour period. The levels of cortisol will then be tested.
 Salivary cortisol measurement: In people without Cushing’s syndrome, cortisol levels
drop in the evening. This test measures the level of cortisol in a saliva sample that’s
been collected late at night to see if cortisol levels are too high.
 Low-dose dexamethasone suppression test: For this test, you’ll be given a dose of
dexamethasone late in the evening. Your blood will be tested for cortisol levels in the
morning. Normally, dexamethasone causes cortisol levels to drop. If you have
Cushing’s syndrome, this won’t occur.

TREATMENT:
The overall goal of Cushing’s syndrome treatment is to lower the levels of cortisol in your
body. This can be accomplished in several ways. The treatment that you receive will depend on
what’s causing your condition.

Your healthcare provider may prescribe a medication to help manage cortisol levels. Some
medications decrease cortisol production in the adrenal glands or decrease ACTH production in
the pituitary gland. Other medications block the effect of cortisol on your tissues.

Examples include:

 ketoconazole (Nizoral)

 mitotane (Lysodren)

 metyrapone (Metopirone)

 pasireotide (Signifor)

 mifepristone (Korlym, Mifeprex) in individuals with type 2 diabetes or glucose

intolerance

If you use corticosteroids, a change in medication or dosage may be necessary. Don’t attempt
to change the dosage yourself. You should do this under close medical supervision.

Tumors can be malignant, which means cancerous, or benign, which means noncancerous.

LIFESTYLE MODIFICATIONS:
The length of your recovery from Cushing syndrome will depend on the severity and cause of
your condition. You didn't develop Cushing syndrome overnight, and your symptoms won't
disappear overnight, either. In the meantime, these tips may help you on your journey back to
health.

 Increase activities slowly. Work up to a reasonable level of exercise or activity that

feels comfortable without overdoing it. You'll improve little by little, and your
persistence will be rewarded.

 Eat sensibly. Nutritious foods provide a good source of fuel for your recovering body
and can help you lose pounds you gained from Cushing syndrome. Make sure you're
getting enough calcium and vitamin D. Taken together, they help your body absorb
calcium, which can help strengthen your bones, counteracting the bone density loss that
often occurs with Cushing syndrome.

 Monitor your mental health. Depression can be a side effect of Cushing syndrome,
but it can also persist or develop after treatment begins. Don't ignore your depression or
wait it out. Seek help promptly from your doctor or a therapist if you're depressed,
overwhelmed or having difficulty coping during your recovery.

 Gently soothe aches and pains. Hot baths, massages and low-impact exercises, such as
water aerobics and tai chi, can help alleviate some of the muscle and joint pain that
accompanies Cushing syndrome recovery.

CUSHING’S DIET:
Some dietary tips for those with Cushing’s syndrome include:

 Monitor your calorie intake. Keeping track of your calorie intake is important since
weight gain is one of the main symptoms of Cushing’s syndrome.

 Try to avoid drinking alcohol. Alcohol consumption has been linked with a rise in
cortisol levels, particularly in heavy drinkersTrusted Source, according to a 2007 study.

 Watch your blood sugar. Cushing’s syndrome can lead to high blood glucose, so try not
to eat foods that can cause a rise in blood sugar. Examples of foods to focus on eating
include vegetables, fruits, whole grains, and fish.

 Cut back on sodium. Cushing’s syndrome is also associated with high blood pressure
(hypertension). Because of this, try to limit your sodium intake. Some easy ways to do
this include not adding salt to food and carefully reading food labels to check sodium
content.
 Make sure to get enough calcium and vitamin D. Cushing’s syndrome can weaken your
bones, making you prone to fractures. Both calcium and vitamin D can help to
strengthen your bones.

M. PADMAVATHI PRIYA

16Z51T0016