Cushing's syndrome

Cushing's syndrome: a disorder of overproduction of cortisol hormone from the adrenocortical glands, usually involving malfunction of the pituitary gland, and likely to lead to symptoms of psychpathology as well as severe somatic pathology.

Dictionary of Sexology Project: Main Index

A disease caused by excessive secretion of the hormone cortisol by the adrenal glands. Among the signs and symptoms of Cushing's syndrome are: protein depletion, causing muscle wasting and weakness; fragility of the blood vessels, causing increased susceptibility to bruising; decalcification of the bones, causing spinal curvature; occasional biochemical disorders such as diabetes; and---most obvious of all---the "moon face" and "buffalo hump" caused by facial obesity and redistribution of body fat. Women also suffer masculinization: Excessive hair grows on the body, the voice deepens, and menstruation ceases.

Cushing's syndrome is relatively rare, is more common in women than in men, and develops most frequently in women over 30, particularly after a pregnancy. The complicated disorders of the body seen in Cushing's syndrome---all due to an excess of cortisol hormones---are nowadays more commonly seen as a result of long-term treatment with large doses of cortisone or similar steroid drugs. People who depend on steroids to control such conditions as asthma, rheumatoid arthritis, or colitis can develop the characteristic "moon face" of Cushing's syndrome as an early sign of chronic over dosage.

Apart from excessive steroid treatment, the cause of Cushing's syndrome is either a small tumor of one of the adrenal glands (which lie just above the kidneys) or a tumor of the pituitary gland leading to excessive production of the adrenal-stimulating hormone ACTH. In either case, the tumor must be treated. Pituitary tumors must be surgically removed or, if this proves impossible, treated with supervoltage irradiation. Adrenal tumors can usually be treated by surgery.

The diagnosis is made by careful biochemical assessment of hormone output and, in particular, by measurement of the urinary excretion of cortisone breakdown products over a given period. Skull X-ray studies (to reveal a possible tumor of the pituitary gland) and complicated blood tests also are necessary. Once the diagnosis is made, drugs are necessary to compensate for the chemical, mineral, and other hormonal deficiencies.

When the diseased adrenal gland is removed surgically along the tumor, the remaining gland is often found to be shrunken. Thus, supplements of the correct amount of cortisone-like hormone are necessary until the other gland recovers function; they may be necessary throughout life.

Cushing's syndrome (hypercortisolism), happens when tissues are exposed to an overabundance of the hormone called cortisol.  When an inappropriate amount of cortisol is released by the adrenal glands, it can alter the normal functions of blood pressure, energy production, the ability to fight disease and how the body maintains and handles stress.  This results in the symptoms of Cushing's syndrome.

Symptoms

Many teenagers and young children with Cushing's syndrome often show many of the following symptoms:

• excess hair growth
• high blood pressure
• growth retardation
• early or late puberty
• acne
• missed menstrual cycle in teenage girls
• extreme weight gain
• red and blue streaks in the skin
• weakness and tiredness

Adults who suffer from Cushing's syndrome may also have some of the same symptoms.  In addition, they may also have such symptoms as:

• menstrual disorders in women
• decreased fertility in men
• moodiness
• irritability
• depression
• high blood sugar
• bone and muscle weakness
• sleep disorders

Causes

Cushing's syndrome occurs when:

• a non-cancerous tumor in the pituitary gland produces increased amounts of the adrenocorticotropin hormone (ACTH).  This, in turn, prompts the adrenal glands to over-produce cortisol.  This form of Cushing's syndrome is better known as Cushing's disease.
• growth on the adrenal glands whether cancerous or not, can cause the adrenal glands to release extra cortisol. 
• certain types of cancerous tumors found in other parts of the body can produce adrenocorticotropin  This causes the adrenal glands to produce an abundance of cortisol. 
• a person taking certain hormones for an extended amount of time as treatment for another disease or disorder, for example, a person taking a steroidal anti-inflammatory medication for arthritis.

Diagnosis

The patient's physician will review their medical records and perform a physical exam.  If enough evidence suggests the patient may have Cushing's syndrome, the physician will have more tests performed on the patient.  The process of getting a definite diagnosis will involve:

• seeing if there is an abundance of cortisol in the body and discovering the cause of the extra cortisol.
• a urine test to measure how much cortisol is being produced.

If the cortisol level indicates Cushing's syndrome, the physician may order other tests to discover the cause. These tests may include:

• Computerized Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• scans of the patient's pituitary and adrenal glands, chest and abdomen
• ultrasound imaging of the adrenal glands
• chest x-rays
• radioisotope procedure which is called iodocholesterol scan

The physician will also order a series of biochemistry tests.  The dexamethasone suppression test involves taking man-made cortisol orally for several days.  While the patient is taking this test, the cortisol levels in the blood and urine are measured on a daily basis.  Another test called the corticotropin-releasing hormone (CRH) simulation test involves the patient getting an injection of CRH followed by a blood test to see if there is a rise in the cortisol and ACTH levels.

Samples of the blood are gathered through a catheterization procedure and are tested to see if the pituitary gland is what is causing the high level of ACTH. 

Treatments

If it is discovered that Cushing's syndrome is the result of taking hormones as treatment for another disease, the physician will adjust the hormone dosage.  If Cushing's syndrome is being caused by the body producing an abundance of cortisol, the physician will use such treatments as:

• radiation
• medications
• surgery to remove a tumor that could be the cause of the problem
• a combination of treatments that depend on what is causing the abundance of cortisol

In many cases, Cushing's syndrome can be cured.  But, as with any disease, there is no guarantee.  The effectiveness of the treatment depends on what is causing it and the severity of the disease.  Even if a cure is not possible, most patients will eventually achieve some level of recovery.

My aunt was diagnosed with Cushing's syndrome four years ago.  Her doctor discovered it early enough, and through treatment and medication the doctor expects a full recovery as long as she continues to keep taking the medication.  She is living a normal life and there have not been any relapses and no symptoms of the disease.  She is thankful that the doctor prescribed the treatments that he did and is expected to live a long happy life.

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Sources: 
National Institute of Child Health and Human Development
National Institutes of Health