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Cushing Syndrome Symptoms Causes Treatment

December 2, 2021
Cushing Syndrome Symptoms Causes Treatment Preventions

Cushing's syndrome is a hormonal imbalance condition caused by the release of an increased level of a hormone in your body called cortisol. It can cause serious or even life-threatening medical conditions if it's not treated properly.

Two small glands called adrenal glands or simply adrenals are present on the upper surface of the kidneys (one adrenal gland on each kidney).

The adrenal gland has two parts. The outer part is called the adrenal cortex and the inner part is called the adrenal medulla. The adrenal cortex releases the hormone cortisol.

When there is too much cortisol in the body, it causes problems in the body’s organ systems; this condition is called Cushing Syndrome.

What are the symptoms of Cushing syndrome?

Signs and symptoms of Cushing's syndrome vary very much. They depend upon the levels of cortisol, gender of the individual, and age of the person.

If a person has high levels of cortisol for a prolonged period of time, the person can have the following symptoms:

  1. Moon face: Cortisol causes breakdown of fat for energy. High levels of cortisol cause so much breakdown of fat that the body cannot use all of it and has to restore it. This extra fat is deposited in the soft tissue of the face causing a round or moon shaped face.
  • Buffalo hump: The extra fat in the circulation caused by high level of cortisol is also deposited in the soft tissue of the neck between the shoulders. This fat deposition causes the formation of a hump on the back of the neck between the shoulders. It looks just like the hump on the back of a buffalo.
  • Repeated infection: Cortisol and other steroids are strong immunity depressors. Secretion of cortisol is tightly regulated to prevent too much immunity depression. But in case of Cushing’s syndrome, high levels of cortisol depress the immunity too much. Immune system is required by the body to fight off the infections.Thus, immune depression due to Cushing’s syndrome makes the body more susceptible to infections.
  • Weight gain: Cortisol is also called the stress hormone. It causes the breakdown of fats and proteins for the production of energy. It also stimulates the release of insulin from pancreas. All these actions triggers cravings for sweets and fatty foods and make over eating a daily habit. Overeating then causes the weight gain.
  • Truncal Obesity: Truncal obesity means increased fat deposition around abdomen. Cortisol causes breakdown of fat but high levels of cortisol causes breakdown of fat more than what the body can utilize. This fat is then restored in the adipose tissue in the abdomen and thus causes truncal or central obesity.
  • Thin arms and legs: Proteins are not stored in the body. They are rather converted into sugars or triglycerides and then these are stored. However, when cortisol levels are very high like in Cushing syndrome, these stores are depleted and the body starts breaking down the protein present in muscles for the production of energy. This breakdown of muscle protein causes muscle wasting and thus thin arms and legs.
  • Easy bruising: Skin is made up of different types of proteins that give it strength. Collagen is the most common protein in the skin and in the body. Collagenase is an enzyme that breaks down the collagen. High levels of cortisol increases the activity of collagenase. Increase break down of collagen makes the skin thin, fragile and bruise easily.
  • Fatigue: Fatigue is a common symptom of Cushing’s syndrome. Increased breakdown of glucose, fats and proteins due to high cortisol levels causes depletion of the energy stores in the body and you feel fatigued because of the low energy levels.
  • Weakness: Low energy levels due to breakdown of nutrients and depletion of energy stores, muscle wasting due to breakdown of muscle proteins causes weakness.

Following are the symptoms that can be seen in men in the case of Cushing’s syndrome:

  1. Decreased libido
  2. Erectile dysfunction
  3. Decreased fertility

Following are the symptoms that can be seen in women in the case of Cushing’s syndrome:

  1. Irregular menstruations
  2. Decreased fertility

Following are some other possible symptoms of Cushing’s syndrome:

  1. Hypertension
  2. Hair loss
  3. Acne
  4. Renal stones
  5. Increased thirst
  6. Sleep disturbances
  7. Vision problems

What are the causes of Cushing syndrome?

The amount of cortisol in your body increases because of two reasons. First, your body is receiving steroids from outside (exogenous); second, your body is producing too much cortisol (endogenous).

  1. Exogenous causes of Cushing’s Syndrome

Adding steroids in your body is the most common cause of Cushing’s syndrome. It occurs when you use medications that contain steroids for a long time. This exogenous steroid works in the same way as cortisol in the body and causes Cushing’s syndrome.

  • Endogenous Causes of Cushing’s Syndrome

If you are not using medicines with steroids inside them and develop Cushing’s syndrome, it means your body is producing excess cortisol. Following are the causes due to which your body produces excessive cortisol:

  1. Pituitary tumor: Pituitary adenoma is the tumor of the pituitary gland (gland present near the brain). Pituitary gland produces a hormone called Adrenocorticotropic hormone or ACTH. ACTH stimulates the adrenals to secrete cortisol and other hormones. Tumor of the pituitary gland produces high amounts of ACTH which causes increased secretion of cortisol from the adrenals.
  • ACTH-secreting tumor: A tumor can be present in other parts of the body and secrete ACTH. It is usually a tumor of thyroid, lungs or pancreas. ACTH secreted from these tumors causes increased secretion of cortisol by the adrenals.
  • Adrenal problems: It is also possible that there is some problem in the adrenals causing excessive secretion of cortisol. It can be a tumor or inflammation or some other disease.
  • Stress: Cortisol is called the stress hormone. It is secreted at the time of stress to prepare your body to deal with it. It you have anxiety disorders or take a lot of stress, your body will secrete more cortisol which will cause Cushing’s syndrome.
  • Athletic training: Athletic training is also a cause of Cushing’s syndrome. Athletes have to do a lot of exercise which requires energy. This energy is arranged by secreting cortisol that will cause break down of protein and fats for energy. So athletic training can cause you to develop Cushing’s syndrome.
  • Malnutrition: Malnutrition means you are not eating very less and your body is not getting many nutrients for energy production. When this is the case, your body increases the secretion of cortisol to produce energy.
  • Familial Cushing’s syndrome: Cushing’s syndrome has genetic inheritance. If someone in your family has Cushing’s syndrome, you may also have those genes that cause familial Cushing’s syndrome.

What are the complications of Cushing syndrome?

Undiagnosed and untreated Cushing’s syndrome can cause following complications:

  1. Diabetes: Cortisol is a glucocorticoid. It tends to cause hyperglycemia (increased blood glucose level) by increasing the production of glucose and reduce the use of glucose. Hyperglycemia is the characteristic feature of diabetes.  Thus Cushing’s syndrome can give you diabetes if it is not treated.
  • Osteoporosis: Cortisol has effects on nearly every cell in the body. It also interferes with calcium metabolism and causes dissipation of calcium from bones into the blood. Without the calcium deposits in its structures, the bones become brittle and easy to fracture.
  • Heart attack: One of the reasons why Cushing’s syndrome can be fatal is that it causes heart attack.
  • Loss of strength: In Cushing’s syndrome, there is muscle wasting due to the breakdown of muscle proteins. If Cushing’s syndrome is not treated early, you will have thin arms and legs and thus loss of muscle strength.
  • Hypertension: One of the functions of cortisol in the body is to control the blood pressure. When your blood pressure goes below the normal value, adrenals release cortisol to elevate it. Too much cortisol will increase your blood pressure above the required limit and cause hypertension.
  • Repeated infections: High cortisol levels depress the immune system. Body loses its defense system and becomes more susceptible to infections.  People with Cushing’s syndrome can have repeated infection in very short time period due to the weal immunity. The infection can range from mild and harmless to severe and fatal ones.

Diagnoses of Cushing syndrome ?

It consists of two things. First is checking whether you have Cushing’s syndrome or not. Second, if you have Cushing’s syndrome, what is the cause?

Diagnosis of Cushing’s syndrome is made by:

  1. Medical history: Exogenous intake of steroids is the most common cause of this disease. Your will ask if you are taking steroid medications before proceeding further.
  • 24 hour urine analysis: To check if your cortisol level is elevated, patient’s urine is collected for 24 hours and then sent to laboratory for analysis.
  • Midnight salivary cortisol test: In this test, saliva samples are taken between 11pm and 12am and sent to laboratory.
  • Low-dose methadone suppression test: Dexamethasone is given to the patient at night and cortisol levels are checked in the morning.

The cause of Cushing’s syndrome is found by:

  1. CT or MRI abdomen: It is to check for any problem in the adrenals.
  2. CT chest: It is used to find any lung cancer.
  3. MRI head: MRI is used to see if there is any pituitary tumor.

What is the treatment of Cushing syndrome?

The treatment depends on the cause.

  1. Medical treatment:
    1. If you are taking steroid medications, the doctor will advise you to discontinue or lower the dosage.
    1. If a tumor is causing the disease, you will be started on chemotherapy.
    1. Radio therapy: Radiotherapy is another way to remove the tumor. It is used when a tumor is causing the disease.
  2. Surgical treatment: In case of a tumor, it can be removed surgically.

When to see a doctor?

You should consult your doctor if you experience:

  1. Decrease libido
  2. Menstrual problems
  3. Hump in the neck
  4. Purple stretch marks on the abdomen
  5. Muscle weakness
  6. Repeated infection
  7. Easy bruising

What are the home remedies for Cushing syndrome?

Although they won’t cure you, there are the following ways to prevent complications:

  1. Quit alcohol
  2. Low-salt diet
  3. Monitor calorie intake
  4. Calcium and Vitamin D rich foods

What are the risk factors of Cushing syndrome?

Following things increases your chances of getting Cushing’ syndrome:

  1. Use of Steroids: If you have asthma, rheumatoid arthritis, lupus or skin allergy and use steroid medications for their cure, you are at risk of getting Cushing’s syndrome.
  2. Family History: Cushing’s syndrome can be inherited. If someone in your family has Cushing’s syndrome, you can also develop this disease in the future.
  3. Athletes: Athletes do frequent and severe exercise requiring a lot of energy. Lots of energy means lots of cortisol. So athletes are also at risk.

What is the prevention of Cushing syndrome?

Prevention from Cushing’s syndrome can be done by preventing yourself from its causes. If you are taking steroids, consult with your doctor about its discontinuation or lowering the dosage.

Unfortunately, there is no prevention to any kind of tumor that causes Cushing’s syndrome.

Conclusion:

How our body is composed of several cells and tissues that make many organ systems, with each other organ system consisting of multiple organs.  Each organ in the body has its specific role.

The heart pumps blood, lungs are for getting oxygen from the air, etc. All these organs work in coordination with each other to maintain the normal functioning of the body.

If any of these organs start to work independently and without coordination, the functioning of all the organs will be affected. Just like when one tire of a car gets punctured, the car cannot without it despite having the other three tires working properly.

So coordination among various body organs is important for the body to function properly. But you might be thinking exactly how these organs coordinate with each other? They communicate with each other by two means: Nervous coordination and hormonal coordination.

In nervous coordination, the brain and spinal cord coordinate with other organs through electrical impulses. While in hormonal coordination, different endocrine glands present in the body secretes chemical substances called hormones which modulate the functioning of other organs.

Different problems can arise from defects in coordination and one of them is Cushing Syndrome.

Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist

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