Cushing syndrome

Overview

Cushing syndrome, also referred to as hypercortisolism, is a condition characterized by the excessive production of cortisol in the body. This can be triggered by either the overproduction of cortisol by the body itself or by the administration of glucocorticoid medications. 

Cortisol, often known as the “stress hormone,” is a steroid hormone produced by the body. It plays a crucial role in various physiological processes, particularly during stressful situations. 

During periods of stress, your body releases excess cortisol, which aids in:

• Elevating your heart rate.
• Raising your blood pressure.
• Regulating your blood glucose levels.
• Controlling your respiration.
• Heightening your muscle tension.

Cortisol is temporarily suppressing some non–essential bodily functions during times of stress.

Cushing syndrome can result in excessive blood pressure, bone loss, and sometimes lead to type 2 diabetes. A fatty hump between the shoulders, a rounded face, and pink or purple stretch marks on the skin are among the common symptoms of Cushing syndrome. Possible treatment options encompass pharmaceuticals, radiation therapy, and surgical intervention.

Symptoms

Cushing syndrome has several symptoms that are unique to it, as well as some that could indicate a range of other conditions. Not everyone experiences the same symptoms as it varies depending on the level of excess cortisol. 

Cushing syndrome symptoms include:

• Rapid weight increase in the abdomen, face (moon face), back of the neck (buffalo hump), and chest, with thin arms and legs 
• Stretch marks that are pink or purple on the stomach, hips, thighs, breasts, and underarms 
• Acne 
• Wounds that do not heal normally 
• Skin that is thin and weak, prone to bruising 

In some cases, symptoms may also include:

• Fatigue 
• Muscle weakness
• Difficult–to–control emotions
• Difficulties concentrating or remembering
• Anxiety, depression, and irritability
• Sleeplessness
• Slow growth in children
• Dizziness and hazy vision
• Bone loss, which can lead to fractures
• Hypertension
• Headache
• Infections
• Darkening of the skin 

There are symptoms of Cushing syndrome that are more common in men than in women, and vice versa. Men may experience lower sex drive, lower fertility, and difficulty getting an erection. Women may experience hirsutism or excessive hair growth and irregular menstrual cycle. 

If any signs and symptoms persist, it is important to seek medical attention from a healthcare provider for an accurate diagnosis and appropriate treatment. Individuals who are prescribed glucocorticoid medication for conditions like asthma, arthritis, or inflammatory bowel disease should remain vigilant for any symptoms indicative of Cushing syndrome. While Cushing syndrome can cause discomfort, it is a treatable condition with the use of appropriate medications.

Causes

Cortisol, a hormone synthesized by the adrenal glands, plays a central role in developing Cushing syndrome when present in excessive amounts. Elevated levels of cortisol can be attributed to various underlying factors, including the use of glucocorticoid medications, the presence of tumors, and, in rare cases, genetic predisposition.

• Exogenous Cushing syndrome: Exogenous Cushing syndrome occurs when a person takes glucocorticoid medicines to treat a disease. Taking significant dosages of this medication over an extended period can lead to Cushing syndrome. It can be taken orally, as a shot, rubbed into the skin, or inhaled into the lungs via an inhaler. 

Glucocorticoids can be used to relieve back or joint pain, as well as various skin rashes. Glucocorticoid drugs, such as prednisone are commonly used to treat a variety of autoimmune disorders, including persistent asthma, rheumatoid arthritis, lupus, sarcoidosis, and many others that cause chronic inflammation. Glucocorticoids may also be used to prevent the body from rejecting a new organ following a transplant. 

• Endogenous Cushing syndrome: Adrenocorticotropic hormone (ACTH) is the hormone that tells the adrenal glands to produce cortisol. Some tumors produce ACTH, which increases cortisol levels and can lead to Cushing syndrome.
  • ACTH–producing pituitary adenoma: It is the most common kind of endogenous Cushing syndrome and occurs more frequently in women. Pituitary adenomas are typically discovered at the base of the brain and are not cancerous. These tumors that form in the pituitary gland can produce an excessive amount of ACTH which is responsible for 8 out of 10 cases of Cushing syndrome. Cushing syndrome is known as Cushing disease when it manifests in this manner. 
  • Ectopic ACTH–producing tumor: In this case, tumors form outside of the pituitary gland and produce ACTH. These tumors, commonly discovered in the lungs, pancreas, thyroid, and thymus gland may or may not be malignant. Small cell lung cancer is the most prevalent form. Ectopic ACTH production causes the body to produce an excessive amount of cortisol.
  • Adrenal gland tumors or disease: Adrenal gland problems can result in excessive cortisol production. Adrenal adenoma is the most prevalent type of tumor in the outer region of the adrenal gland. These tumors are not cancer, and only a few produces excessive cortisol. Adrenal nodular hyperplasia occurs when several cortisol–producing tumors form in the adrenal glands and causes Cushing syndrome. Adrenocortical carcinoma, which refers to cancerous tumors located in the outer region of the adrenal glands, is an infrequent occurrence. Adrenocortical carcinoma can produce cortisol and cause Cushing syndrome.
  • Familial Cushing syndrome: Cushing syndrome can occur if certain tumors produce ACTH or cortisol. Infrequently, individuals may genetically acquire a predisposition to develop tumors in one or multiple of their endocrine glands, responsible for hormone production.