Cushing’s Syndrome is a relatively rare endocrine disorder. In simple terms, it means your cortisol level is high in the body. When you have elevated cortisol level, you can develop a variety of signs and symptoms. In this article, you will learn about the symptoms, diagnosis and treatment of Cushing’s Syndrome.
Signs and Symptoms of Cushing’s Syndrome
- 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 a sitting position, climbing upstairs or raising the arms.
- Depression.
- Excess hair growth on the face and menstrual irregularities in women.
What Causes Cushing’s Syndrome?
The most common cause of Cushing’s Syndrome is steroid use. Physicians often prescribe steroids for a number of medical conditions such as asthma, ulcerative colitis, rheumatoid arthritis. Excessive use of steroids is the most common cause of Cushing’s Syndrome. Therefore, it is important to keep steroid use to a minimum and only when absolutely necessary.
Rarely, your body may start to produce excessive amounts of cortisol. This type is known as Endogenous Cushing’s Syndrome as compared to the exogenous type due to excessive steroid use.
Endogenous Cushing Syndrome can be caused by excessive cortisol produced by:
- Pituitary tumor
- Adrenal tumor
- Ectopic ACTH-producing tumor such as Carcinoid tumor
In a study from Sweden, researchers looked at cases of endogenous Cushing’s Syndrome over a 15-years period. They found a total of Eighty-two patients. The breakdown of various causes was as follows: Thirty-nine patients (48%) had pituitary tumor, 21 (26%) had ectopic ACTH-producing tumor, 17 (21%) had a benign adrenal tumor, and 5 (6%) had adrenal carcinoma.
Cushing’s Syndrome vs. Cushing’s Disease
Cushing’s Syndrome simply means you have a high level of cortisol. That’s why we also call it hypercortisolism. Cushing’s Disease is high level of cortisol due to Pituitary tumor.
Diagnostic Evaluation
A constellation of the above-mentioned clinical signs and symptoms in a patient who is 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 Suppression test.
- Midnight salivary cortisol.
Once a diagnosis of high cortisol level is made, the next step is to find out the source of the excess cortisol: pituitary vs adrenal.
This involves quite complex testing and should be carried out by an experienced endocrinologist.
Treatment
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.
