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Cushing Syndrome Overview

Cushing syndrome is a condition caused by an overproduction of cortisol, a hormone produced by the adrenal glands. Cortisol, a glucocorticoid hormone, plays a vital role in metabolism, managing stress responses, and controlling inflammation. However, excess cortisol levels can lead to significant health complications.

Cushing syndrome is more common in females than males and, with timely diagnosis and proper treatment, can often be effectively managed or cured. Without treatment, the condition can be life-threatening, making regular medical follow-up and adherence to treatment plans critical.

Causes of Cushing Syndrome

Cushing syndrome can result from:

  1. Overproduction of ACTH by the pituitary gland
    • Often due to benign tumors, a condition known as Cushing disease.
  2. Ectopic ACTH secretion
    • ACTH production by non-pituitary tumors, commonly located in the lungs.
  3. Excess cortisol production by the adrenal glands
    • Caused by adrenal tumors or nodular hyperplasia.
  4. Prolonged use of glucocorticoid medications
    • Such as prednisone, often prescribed for autoimmune conditions or organ transplant patients.

The symptoms of Cushing syndrome vary based on the duration and degree of excess cortisol and the underlying cause. Common symptoms include:

  • Weight gain – Concentrated around the face (“moon face”), neck, abdomen, and upper back.
  • Skin changes – Thin skin, easy bruising, slow wound healing, and purple stretch marks (striae).
  • Hormonal imbalances:
    • Females – Irregular or absent menstrual periods, excess facial or body hair (hirsutism), and acne.
    • Males – Acne (without hirsutism).
  • Muscle weakness – Difficulty climbing stairs or standing up from a chair.
  • Bone loss (osteoporosis) – Increasing the risk of fractures.
  • Metabolic disturbances – Prediabetes or diabetes due to elevated blood sugar levels.
  • Cardiovascular issues – High blood pressure and a heightened risk of heart disease.
  • Psychological effects – Depression, irritability, anxiety, and memory or concentration problems.
  • Weakened immunity – Leading to frequent infections.
  • Blood clots – Increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE), or stroke.

A diagnosis is made through:

  1. Medical history and physical examination
    • To evaluate characteristic symptoms and patterns.
  2. Laboratory testing:
    • Cortisol measurements:
      • 24-hour urine cortisol test.
      • Blood or saliva cortisol test at specific times of the day.
      • Low-dose dexamethasone suppression test.
    • ACTH levels: To determine if the cortisol excess is driven by ACTH or adrenal dysfunction.
  3. Imaging tests:
    • CT or MRI scans – To detect tumors in the pituitary, adrenal glands, or other locations.
    • Scintigraphy – To identify elusive tumors in ectopic ACTH syndrome.
  4. Specialized tests:
    • High-dose dexamethasone suppression test – Differentiates between pituitary tumors and ectopic ACTH production.
    • Petrosal sinus sampling – Direct measurement of ACTH from veins near the pituitary to confirm pituitary-origin ACTH production.

Treatment options depend on the underlying cause and include:

  1. Surgery:
    • Removal of tumors in the pituitary, adrenal glands, or ectopic locations.
    • Often the first-line treatment for Cushing disease.
  2. Medications:
    • Used to suppress cortisol production when surgery is not possible or as a preparatory measure before surgery.
  3. Radiation therapy:
    • For pituitary tumors that cannot be completely removed surgically.
  4. Glucocorticoid tapering:
    • Gradual reduction of glucocorticoid medications if they are the cause of the syndrome.

Effective treatment and regular follow-ups with healthcare providers are critical for managing symptoms, preventing complications, and ensuring the best outcomes. Patients should maintain open communication with their medical team to discuss treatment progress and any concerns.

For more detailed guidance and personalized care, consult your healthcare provider. Regular monitoring and adherence to medical advice can help individuals regain control of their health and improve their quality of life.

Disclaimer: This content is for informational purposes only and should not replace professional medical advice. Always consult your healthcare provider for any concerns or questions about your condition.