The adrenal glands produce cortisol, a hormone that helps the body deal with stress, inflammation, and metabolism. Cushing syndrome occurs when cortisol levels are too high for an extended period of time. Cortisol levels can, however, cause a variety of health problems and affect the quality of life when they are abnormally high for a long period of time.
Causes of Cushing Syndrome
The two main types of Cushing syndrome are exogenous and endogenous.
In the case of exogenous Cushing syndrome, medications such as corticosteroids, which contain or mimic cortisol, are used to treat asthma, arthritis, or inflammatory bowel disease. However, if they are taken in high doses or for a long period of time, they can cause Cushing syndrome by increasing cortisol levels.
A person with endogenous Cushing syndrome produces too much cortisol on their own. This can be caused by several factors, such as:
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At the base of the brain, the pituitary gland is home to a number of benign tumors known as pituitary gland tumors. A number of hormones are produced by the pituitary gland, including adrenocorticotropic hormone (ACTH), which stimulates cortisol production in the adrenal glands. It is known as Cushing syndrome and is most common when the pituitary gland produces too much ACTH, causing the adrenal glands to produce too much cortisol.
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Tumors of the adrenal glands, which are located above the kidneys, can be benign or malignant. Cortisol and other hormones are produced by the adrenal glands. Tumors of the adrenal glands can produce too much cortisol, causing Cushing syndrome if they produce too much.
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In ectopic ACTH syndrome, a tumor outside the pituitary or adrenal glands produces ACTH. An excess ACTH can stimulate the adrenal glands to produce too much cortisol, which can cause Cushing syndrome if it is located in any organ, such as the lungs, pancreas, or thyroid.
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An inherited condition called familial Cushing syndrome produces multiple endocrine neoplasia type 1 (MEN1) or Carney complex. These are genetic disorders that increase the risk of developing tumors in various endocrine glands, including the pituitary and adrenal glands. The tumors can cause Cushing syndrome when they produce too much cortisol.
Symptoms of Cushing Syndrome
Symptoms of Cushing syndrome vary depending on the level and duration of excess cortisol in the body.
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Obesity and weight gain, especially around the abdomen, face, and upper back (buffalo hump).
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The appearance of purple or pink stretch marks on the abdomen, breasts, arms, and thighs
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Skin that bruises easily and heals slowly due to thinning and fragility
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In women, acne and excessive facial and body hair (hirsutism) are common
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Fatigue and weakness of muscles
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Blood sugar and blood pressure are high
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Cognitive impairment and headaches
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Anxiety, irritability, and depression are symptoms of mood changes
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Poor wound healing and increased infection risk
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An increased risk of fractures and bone loss (osteoporosis)
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Women's menstrual irregularities and infertility
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Men with erectile dysfunction and reduced libido
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Children with growth retardation
Diagnosis of Cushing Syndrome
The diagnosis of Cushing syndrome is based on the medical history, physical examination, and laboratory tests. The doctor will ask about the symptoms, medications, family history, and possible infections or stressors. As well as looking for signs of excess cortisol, the doctor will also examine the body for signs of obesity, moon face, buffalo hump, stretch marks, thin skin, muscle weakness, and high blood pressure.
Among the laboratory tests are:
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In this test, the level of cortisol in the blood, urine, or saliva is measured. It can detect either an excess or a deficiency of cortisol.
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Dexamethasone suppression test: This test evaluates how well the adrenal glands respond to a synthetic steroid called dexamethasone. By acting on the pituitary gland, dexamethasone normally suppresses ACTH and cortisol production. In Cushing syndrome, however, suppression may not occur or may be incomplete, which indicates an abnormal source of cortisol.
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Cushing syndrome can be caused by a pituitary tumor (high ACTH), an adrenal tumor (low ACTH), or an ectopic tumor (high ACTH).
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These tests use X-rays, ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, or positron emission tomography (PET) scans to produce images of the internal organs. The tumors that cause Cushing syndrome can be located and identified using them.
Treatment of Cushing Syndrome
A major goal of Cushing syndrome treatment is to lower cortisol levels in the body and relieve symptoms. Treatment options include:
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Drugs that reduce cortisol production or action include:
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Ketoconazole, mitotane, and metyrapone are examples of drugs that inhibit the synthesis of cortisol in the adrenal glands.
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Glucocorticoid receptor antagonists, such as mifepristone, block the receptors that bind to cortisol and mediate its effects.
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An example is aminoglutethimide, which inhibits the conversion of inactive steroids into active cortisol in the adrenal glands.
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It involves removing the tumors that cause Cushing syndrome through surgery. It can be performed on either the pituitary glands or adrenal glands, or any other organs where the tumors are located. Endoscopic, laparoscopic, or open surgery can be used to perform the surgery.
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High-energy rays are used in radiation therapy to destroy tumor cells that produce excess cortisol. It can be used as a primary or adjuvant treatment after surgery. A variety of methods are available for delivering it, including external beam radiation, stereotactic radiosurgery, and radiofrequency ablation.
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Modifications to your lifestyle can help improve the symptoms and complications of Cushing syndrome. These include:
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Providing adequate calories, protein, calcium, and vitamin D through a healthy and balanced diet.
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Preventing fluid retention, weight gain, high blood pressure, and high blood sugar by limiting sodium, fat, and sugar intake.
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Preventing dehydration and electrolyte imbalance by drinking plenty of fluids.
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Regular exercise improves muscle strength, bone health, mood, and overall well-being.
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It is important to quit smoking and avoid alcohol and other substances that can worsen the condition.
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The emotional challenges of living with Cushing syndrome can be managed by managing stress and seeking psychological support.
Prevention of Cushing Syndrome
However, some preventive measures can reduce the risk or severity of Cushing syndrome, including:
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If you are taking corticosteroid medications, follow your doctor's instructions, which include taking the lowest effective dose for the shortest time, tapering off gradually when stopping the medication, and monitoring for side effects or signs of excess cortisol.
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Regular check-ups and tests to monitor cortisol levels in the body and detect any changes or problems early.
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Infections, injuries, and stressors can trigger or worsen Cushing syndrome.
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Protecting the pituitary and adrenal glands by eating a nutritious diet, exercising moderately, sleeping well, and avoiding toxins.
