Cushing’s syndrome

February 1, 2017

Cushing syndrome is a rare endocrine disorder caused by the body’s exposure to an excess of the hormone cortisol. Cortisol affects all tissues and organs in the body. These effects together are known as Cushing’s syndrome.

The disorder, which leads to a variety of symptoms and physical abnormalities, is most commonly caused by taking medications containing the hormone over a long period of time. A more rare form of the disorder occurs when the body itself produces an excessive amount of cortisol.

In 1932, a physician named Harvey Cushing described 8 patients with central body obesity, glucose intolerance, hypertension, excess hair growth, osteoporosis, kidney stones, menstrual irregularity, and emotional liability. Hence, the name Cushing’s syndrome.

What leads to Cushing’s Syndrome?

Cortisol is a powerful steroid hormone, and excess cortisol has detrimental effects on many cells throughout the body. Keep in mind that Cushing’s syndrome is rare, occurring in only about 10 patients per one million. On the other hand, simple obesity can be associated with some of these symptoms in the absence of an adrenal tumor; this is related to the slightly different mechanism by which normally-produced steroids are metabolized by individuals who are obese. Since cortisol production by the adrenal glands is normally under the control of the pituitary, overproduction can be caused by a tumor in the pituitary or within the adrenal glands themselves.

When the adrenal glands develop a tumor, like any other endocrine gland, they usually produce excess amounts of the hormone normally produced by these cells. If the adrenal tumor is composed of cortisol-producing cells, excess cortisol will be produced. Under these conditions, the normal pituitary will sense the excess cortisol and will stop making ACTH in an attempt to slow the adrenal down. In this manner, physicians can readily distinguish whether excess cortisol is the result of a pituitary tumor or an adrenal tumor.

An estimated 10-15 per million people are affected every year. Pituitary adenomas (Cushing’s disease) account for more than 70 percent of cases in adults and about 60-70 percent of cases in children and adolescents. Cushing’s syndrome most commonly affects adults ages 20-50 and is more prevalent in females, accounting for about 70 percent of all cases.

Causes

Cushing’s syndrome can be caused by overuse of cortisol medication, as seen in the treatment of chronic asthma or rheumatoid arthritis (iatrogenic Cushing’s syndrome), excess production of cortisol from a tumor in the adrenal gland or elsewhere in the body (ectopic Cushing’s syndrome) or a tumor of the pituitary gland secreting adrenocorticotropic hormone (ACTH) which stimulates the over-production of cortisol from the adrenal gland (Cushing’s disease).

Other causes may include –

Pituitary Adenomas – When the cause of excess cortisol is a pituitary adenoma, this is called “Cushing’s disease”. The excess ACTH produced by the pituitary tumor stimulates the adrenal to secrete excess cortisol. Adenomas are benign, or non-cancerous, tumors of the pituitary gland which can secrete increased amounts of ACTH. Women are affected 5 times as often as men.

Adrenal Tumors – Sometimes, an abnormality of the adrenal glands, most often an adrenal tumor, causes Cushing’s syndrome. The average age of onset is about 40 years. Most of these cases involve non-cancerous tumors of adrenal tissue, called adrenal adenomas, which release excess cortisol into the blood.

Ectopic ACTH Syndrome – Some benign or malignant (cancerous) tumors that arise outside the pituitary can produce ACTH, which leads to excess cortisol production by the adrenal glands. This condition is known as ectopic ACTH syndrome. The most common forms of ACTH-producing tumors are carcinoid tumors, which can be benign or malignant and small cell lung cancer, which accounts for about 25 percent of all lung cancer cases.

Adrenocortical carcinomas, or adrenal cancers, are the least common cause of Cushing’s syndrome. Cancer cells can secrete excess levels of several adrenal cortical hormones, including cortisol and adrenal androgens.

Familial Cushing’s Syndrome – Most cases of Cushing’s syndrome are not inherited. Rarely, however, some individuals have special causes of Cushing’s syndrome due to an inherited tendency to develop tumors of one or more endocrine glands. In Primary Pigmented Micronodular Adrenal Disease, children or young adults develop small cortisol-producing tumors of the adrenal glands.

Symptoms

Weight gain – particularly around the gut or mid-section
“Moon face” – a rounded shape of the face that develops from a specific pattern of fat distribution.
Easy bruising – the arms and legs are frequently covered with multiple bruises.
“Buffalo hump” – a mound of fat at the base of the back of the neck.
Abnormal hair growth – women with Cushing’s syndrome may develop more hair growth on the face or near the belly button.
Edema (leg swelling) – due to excess fluid buildup in the lower legs and feet.
Stretch marks (purple striae) – most common around the sides and lower abdomen, these may have a pink, red, or purple color.
Hypertension (high blood pressure)
Diabetes (high blood sugar levels)
Mood changes – many patients feel “hyper”, others may experience sudden emotional ups and downs or be quick to anger.
Thinning of the skin – the skin may develop a shiny, paper-thin quality and may rip or tear easily.
Ruddy complexion (plethora) – a reddening of the face or cheeks.
Muscle weakness – the arms and legs may become skinny like twigs from muscle wasting.
Menstrual disturbances – a woman’s period may be irregular or stop altogether.

Patients who have too much cortisol but do not have any clear signs or symptoms of hypercortisolism are said to have “subclinical Cushing’s.”

Complications

Bone loss (osteoporosis), which can result in unusual bone fractures, such as rib fractures and fractures of the bones in the feet
High blood pressure (hypertension)
Diabetes
Frequent or unusual infections
Loss of muscle mass and strength

Treatment

Tumour of the pituitary gland – The tumour is surgically removed. Other options include radiation therapy and drug therapy to shrink the tumour and stop it from producing hormones. Various hormone replacements may be required after pituitary surgery.

Tumour of the adrenal gland – The tumour is surgically removed. Replacement hormone therapy may be necessary for a short while.

ACTH–producing tumours – Treatment includes surgery to remove the tumour, followed possibly by chemotherapy, immunotherapy and radiation therapy. Medication can reduce the ability of the adrenal glands to make cortisol.

MEN1 – Radiation therapy and surgery are used to remove the tumours and associated glands. Ongoing hormone replacement therapy is needed after surgery.

Glucocorticoid hormone therapy – Induced Iatrogenic Cushing’s syndrome – symptoms will gradually resolve if treatment can be reduced or stopped, which depends on the activity of the disorder. Treatment should never be stopped suddenly because of the possibility of adrenal suppression.

Alternative Treatment

Stop exposing the brain and head to strong magnetic or sound vibrations.

DHEA – DHEA may help to protect against the overproduction of cortisol from the adrenal glands and enhance the immune system. This is an important factor since too much cortisol accelerates aging and causes immune system disorders. Studies show that DHEA deficiency may actually debilitate immune status

Vitamin C – Studies show that vitamin C and aspirin can attenuate and influence cortisol, inducing an anti-inflammatory response to prolonged exercise and stress. Vitamin C has been shown to reduce the elevation of cortisol in response to heavy exercise.

Melatonin – Melatonin is secreted by the pineal gland and functions to regulate circadian rhythm and induce sleep. Melatonin circadian secretion in patients with pituitary- or adrenal-dependent Cushing’s syndrome was shown to be significantly lower compared to healthy control groups.

Phosphatidylserine (PS) – Phosphatidylserine is a phospholipid that is a structural component of the biological membranes in animals and plants. In studies, supplemental PS has been shown to improve mood and blunt the release of cortisol in response to physical stress.

Antioxidants – Antioxidants may improve immune functioning. Choosing a wide variety of low-potassium fruits and vegetables may help.

Fiber – A high-fiber diet can help maintain normal blood glucose levels.

Refined starches – Eliminating refined starches, following a consistent carbohydrate diet, and eating five or six small meals a day may help decrease carbohydrate cravings that typically occur with Cushing’s syndrome.

Dandelion – Helps normalize adrenal function. It is also an excellent tonic for the liver and kidneys. Dandelion reduces inflammation in the body and also contains vitamins and minerals necessary for hair growth.

Reference –

http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/basics/complications/con-20032115

http://www.emedicinehealth.com/cushing_syndrome/page5_em.htm#medical_treatment

http://familydoctor.org/familydoctor/en/diseases-conditions/cushings-syndrome/treatment.html

http://pituitary.mgh.harvard.edu/CushingsSyndrome.htm#Causes

http://www.medicinenet.com/cushings_syndrome/article.htm

http://csrf.net/

http://www.endocrineweb.com/conditions/cushings-syndrome/diseases-adrenal-cortex-cushings-syndrome

http://patient.info/health/cushings-syndrome-leaflet

http://www.nadf.us/adrenal-diseases/cushings-syndrome/

http://www.nhs.uk/conditions/Cushings-syndrome/Pages/Introduction.aspx

https://www.nlm.nih.gov/medlineplus/ency/article/000410.htm