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Treatment of Type 2 Diabetes: One Extreme to Another.

 

By Sarfraz Zaidi

Arch Intern Med. 2009;169(13):1246-1247.

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Cushing's Syndrome

Cushing's Syndrome is a rare endocrine disorder.

In simple words, Cushing's Syndrome means an excess of cortisol in the body, which gives rise to a variety of signs and symptoms.

Signs and Symptoms of Cushing's Syndrome

Signs and symptoms of Cushing's Syndrome include:

-Truncal Obesity.

-Facial Plethora, moon shaped face.

-Purplish striae.

-Supraclavicular fullness.

-Buffalo's hump.

-High blood pressure.

-High blood sugar, diabetes or pre-diabetes.

-Osteoporosis.

-Weakness of limb muscles, causing difficulty getting up from sitting position, climbing upstairs or raising the arms.

-Depression.

-Excess hair growth on face and menstrual irregularities in women.

Causes of Cushing's Syndrome

The most common cause of Cushing's Syndrome is steroids use.

Other causes are:

-Pituitary tumor

-Adrenal tumor

-Carcinoid tumor

Diagnostic Evaluation of Cushing's Syndrome

A constellation of the above-mentioned clinical signs and symptoms in a patient on steroids is enough to make a diagnosis of Cushing' Syndrome.

If there is no history of steroid use, then further diagnostic work-up is needed, which includes: 

24-hour urine for free cortisol. Overnight 1 mg Dexamethasone Suppressionjn test.  Midnight salivary cortisol.

Once a diagnosis of high cortisol level is made, next step is to find out the source of excess cortisol: pituitary vs adrenal.

This involves quite complex testing and should be carried out by an experienced endocrinologist.

Treatment of Cushing's Syndrome

Treatment obviously depends upon the cause:If it is a pituitary, adrenal or any other tumor, then surgical removal of the tumor, if possible is the logical choice of treatment.

If steroid use is the cause of Cushing's Syndrome, then steroids should be slowly tapered under the supervision of an endocrinologist. Because chronic steroid use causes a suppression of your own adrenal gland.If you were to suddenly stop your steroids, you will likely develop acute adrenal insufficiency which can be life-threatening.

 

 

 

This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, Endocrinology and Metabolism.

Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.

 

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