Cushing’s Syndrome - Symptoms and Treatments

What is Cushing’s Syndrome

Cushing’s Syndrome (also known as hypercorticism or hyperadrenocorticism), named after American doctor Dr. Harvey Cushing, is an endocrine/hormonal disorder caused by high level of cortisol in blood. Cushing’s syndrome mainly refers to a medical condition (abnormality) in which the pituitary gland starts producing large amount of ACTH (Adrenocorticotropic Hormone) in blood, which in turn increases cortisol level in blood (ACTH hormones are necessary to stimulate secretion of cortisol by adrenal glands).

Cushing’s syndrome is not only limited to human beings, domestic animals such as dogs and horses also suffer from high level of cortisol in blood (Cushing’s syndrome).

Causes of Cushing’s Syndrome

There is no one particular cause that leads to increased level of cortisol in the blood, there are in fact several causes of Cushing’s syndrome as given below:The most common cause of increase in cortisol level in the blood is due to exogenous administration of glucocorticoids (steroid hormones). Generally, glucocorticoids are given to a patient for treatment of other diseases.

Other steroids used for treatment of various diseases such as rheumatoid arthritis, asthma etc. and after operations such as organ transplant. In such scenarios, the patient also may be given synthetic ACTH hormones, which may lead to increased level of cortisol in the blood.

Other than external causes, cortisol level in blood can increase due to problems (malfunctioning of) related to pituitary gland that secrete ACTH hormones. Normally, the secretion of ACTH hormone by pituitary gland is kept under check/control and only necessary amount of ACTH hormone is released to help secrete cortisol in blood by adrenal glands. Malfunctioning of this system can lead to Cushing’s syndrome. Pituitary Cushing’s disease is related to problem with pituitary glands and leads to increased secretion of ACTH hormone, which in turn stimulates secretion of cortisol by adrenal glands. Adrenal Cushing’s disease is related to adrenal glands in which adrenal glands develop tumors that lead to excessive secretion of cortisol in blood. Tumors outside the pituitary-adrenal system can also cause excess secretion of ACTH hormones leading to ectopic or paraneoplastic Cushing’s (which occurs commonly in conjunction with other diseases such as small cell lung cancer).

According to some doctors, Cushing’s disease is inherited in some cases. If your parents or any of your ancestors had this disorder, there is a possibility that you may develop it too.

Signs and Symptoms of Cushing’s Syndrome

The intensity of signs and symptoms of Cushing’s syndrome may vary from patient to patient. The signs and symptoms of this disorder include:

• Patient may get obese in the upper part of his/her body such as area around neck, face etc., but still be left with slender arms and legs.
• Patients may become fragile and thin, and can get bruised easily. Development of pink or purple stretch marks on skin.
• Weakened bones and muscles.
• Severe fatigue
• High blood pressure and increased blood sugar level.
• Increase in urination and thirst.
• Increase in depression, irritability etc.
• In some cases, especially women patients experience excessive hair growth on entire body, irregularity in menstrual cycles etc.
• Men may experience problem with sexual desire, erectile dysfunction etc.

Diagnosis and Treatment Available

Your doctor may suggest you to go for some tests before confirming the disorder. These tests include:

Urine Test for Cortisol Level: In this test, urine samples are collected from the patient within 24 hours. The patient may be asked to urinate every hour or 2 hours to collect urine for test.

LDDS Test (Low Dose Dexamethasone Suppression Test): In this test, the patient is given low dose of synthetic glucocorticoid at some interval and cortisol level is administered to come to any conclusion.

Midnight Plasma Cortisol and Late-night Salivary Cortisol Measurements: If a person is suffering from Cushing’s syndrome, the cortisol production in his/her body does not get suppressed as in normal person during night. Patient’s saliva sample is taken to measure the cortisol level in blood and come to a conclusion.

Dexamethasone-CRH Test (Dexamethasone-Corticotropin-Releasing Hormone Test): This test is used to distinguish between cases of pseudo-Cushing’s and mild Cushing’s. This test is a combination of LDDS Test and CRH-stimulation.

Along with the above mentioned tests, there are several other tests which are used to find out causes of Cushing’s syndrome:

• Petrosal Sinus Sampling
• Radiologic Imaging (visualization of endoctrine glands)
• HDDS (High Dose Dexamethasone Suppression) Test
• CRH Stimulation Test

There are several options used to treat Cushing’s syndrome based on the patient’s condition and necessity.

Surgical Removal of Tumors: This is one of the most commonly used treatments for Cushing’s syndrome because of its high success rates and the fact that surgery can be repeated in case the previous surgery fails. In this, the tumors are removed surgically (also known as Transsphenoidal Adenomectomy) with the help of special microscope.

Medication: In case surgery is not recommended, the doctor may choose to go for treatment of Cushing’s syndrome with the help of medication. If medication fails to cure the condition, surgery is used to remove the tumors and sometimes removal of adrenal glands (also known as bilateral adrenalectomy) can be suggested.

Radiation, Chemotherapy or Use of Cortisol Inhibiting Drugs: This option is used when the syndrome is developed in conjunction with other diseases such as cancer.