Cushing’s syndrome – Symptoms, causes, types, and treatment

Cushing’s syndrome, also known as hypercortisolism, is a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol. This condition can result from endogenous sources, such as the body producing too much cortisol, or exogenous sources, such as taking cortisol-like medications. Here, we’ll explore the symptoms, causes, types, and treatment options for Cushing’s syndrome.

Symptoms of Cushing’s Syndrome

Cushing’s syndrome manifests through a variety of symptoms, which can vary from person to person. Common signs and symptoms include:

1. Weight Gain: Central obesity with fat accumulation around the midsection, upper back, and face (moon face), while limbs remain thin.
2. Skin Changes: Thin, fragile skin that bruises easily, slow healing of cuts, and purplish stretch marks (striae) on the abdomen, thighs, breasts, and arms.
3. Muscle Weakness: Especially in the upper arms and legs.
4. Bone Changes: Osteoporosis, which increases the risk of fractures.
5. High Blood Pressure: Often resistant to standard treatments.
6. High Blood Sugar: Can lead to type 2 diabetes.
7. Mood Changes: Depression, anxiety, and irritability.
8. Reproductive Issues: Irregular or absent menstrual periods in women, decreased libido and fertility in men.
9. Cognitive Issues: Memory and attention problems.
10. Fatigue and Weakness: General feeling of tiredness.

Causes of Cushing’s Syndrome

Cushing’s syndrome can be caused by endogenous or exogenous factors:

1. Endogenous Causes:
   • Cushing’s Disease: The most common form of endogenous Cushing’s syndrome, caused by a pituitary adenoma (a benign tumor) that produces excessive adrenocorticotropic hormone (ACTH), stimulating cortisol production.
   • Ectopic ACTH Syndrome: Occurs when ACTH is produced by tumors located outside the pituitary gland, such as in the lungs or pancreas.
   • Adrenal Tumors: Benign or malignant tumors in the adrenal glands that produce excess cortisol.
   • Primary Pigmented Nodular Adrenocortical Disease (PPNAD): A rare cause involving small pigmented nodules on the adrenal glands that produce excess cortisol.
2. Exogenous Causes:
   • Prolonged Use of Corticosteroid Medications: Such as prednisone, which are used to treat inflammatory diseases like asthma, rheumatoid arthritis, and lupus.

Types of Cushing’s Syndrome

Cushing’s syndrome is categorized into different types based on its cause:

1. ACTH-Dependent Cushing’s Syndrome:
   • Cushing’s Disease: Due to a pituitary adenoma.
   • Ectopic ACTH Syndrome: Due to non-pituitary tumors producing ACTH.
2. ACTH-Independent Cushing’s Syndrome:
   • Adrenal Adenomas or Carcinomas: Tumors directly on the adrenal glands.
   • Primary Pigmented Nodular Adrenocortical Disease (PPNAD): A rare form involving nodules on the adrenal glands.
3. Iatrogenic Cushing’s Syndrome: Caused by external administration of glucocorticoids for other medical conditions.

Diagnosis of Cushing’s Syndrome

Diagnosing Cushing’s syndrome involves several steps and tests:

1. Medical History and Physical Examination: Evaluating symptoms and medical history.
2. Laboratory Tests:
   • 24-Hour Urinary Free Cortisol Test: Measures cortisol levels in urine collected over 24 hours.
   • Late-Night Salivary Cortisol Test: Measures cortisol levels in saliva late at night when they should be low.
   • Low-Dose Dexamethasone Suppression Test (LDDST): Measures how cortisol levels change after taking dexamethasone, a synthetic glucocorticoid.
3. Imaging Tests:
   • MRI or CT Scans: To locate tumors in the pituitary or adrenal glands.
   • Petrosal Sinus Sampling: A specialized test to determine if excess ACTH is coming from the pituitary gland.

Treatment of Cushing’s Syndrome

Treatment for Cushing’s syndrome depends on its cause:

1. Surgical Intervention:
   • Transsphenoidal Surgery: Removal of pituitary tumors through the nasal cavity.
   • Adrenalectomy: Removal of one or both adrenal glands in the case of adrenal tumors.
   • Resection of Ectopic Tumors: Surgical removal of non-pituitary ACTH-producing tumors.
2. Medications:
   • Cortisol-Inhibiting Drugs: Such as ketoconazole, mitotane, and metyrapone to reduce cortisol production.
   • Pasireotide: A drug that inhibits ACTH secretion from pituitary tumors.
   • Cabergoline: Dopamine agonist used in some cases to reduce ACTH production.
3. Radiation Therapy:
   • Pituitary Radiation: Used when pituitary surgery is not successful or feasible.
4. Lifestyle and Supportive Therapies:
   • Managing Diabetes and Hypertension: Through appropriate medications and lifestyle changes.
   • Bone Health: Calcium and vitamin D supplementation, along with bisphosphonates for osteoporosis.
   • Psychological Support: Counseling and support groups to help manage emotional and mental health issues.

Prognosis and Follow-Up

The prognosis for individuals with Cushing’s syndrome varies depending on the cause and success of treatment. Early diagnosis and effective management can significantly improve outcomes. Regular follow-up is essential to monitor for recurrence and manage any long-term effects of the disease or its treatment.

Conclusion

Cushing’s syndrome is a complex condition with a wide range of symptoms and causes. Understanding the different types, diagnostic procedures, and treatment options is crucial for effective management. With appropriate treatment, many individuals with Cushing’s syndrome can lead healthy, productive lives. If you suspect you have symptoms of Cushing’s syndrome, consult a healthcare professional for a thorough evaluation and personalized treatment plan.