Cushing Syndrome: Symptoms, Causes, Diagnosis, and Treatment

The endocrine system and hormonal balance are vital for overseeing essential bodily functions such as metabolism, growth, and immune response. Disruptions in this system, involving glands, hormones, and organs, can lead to disorders that significantly affect health and well-being. One such disorder is Cushing Syndrome. It is a rare condition characterised by various symptoms and physical changes resulting from excessive levels of the cortisol hormone.

Cortisol, a critical glucocorticoid, is instrumental in managing glucose metabolism and modulating the body’s response to stress. Cushing Syndrome arises from prolonged exposure to high levels of glucocorticoids, whether produced internally (endogenous) or introduced from external sources (exogenous). Predominantly affecting adults aged 25 to 40, this condition can have profound implications on a person’s physical health, emotional state, and overall quality of life.

Understanding Cushing Syndrome is about understanding its medical complexities and grasping the profound impact it can have on daily living and the importance of timely intervention. As we explore the symptoms, causes, diagnosis, and treatment of Cushing Syndrome, we will provide insights that empower individuals to navigate this challenging condition with knowledge and confidence.

What is Cushing Syndrome?

Cushing Syndrome, also known as hypercortisolism, is characterised by unusually high levels of the hormone cortisol. This condition is most commonly triggered by prolonged use of high-dose corticosteroids. Corticosteroids are medications often prescribed for chronic inflammatory conditions. Notably, Cushing Syndrome affects women about three times more often than men. However, it can lead to specific challenges in both genders.

In women, the syndrome may disrupt the menstrual cycle, sometimes halting it altogether. That can complicate the efforts to conceive. Men may encounter erectile dysfunction, diminished sexual desire, and reduced fertility. These symptoms underscore the hormone’s integral role in stress response, metabolism, and reproductive health.

Cortisol is crucial for managing stress, immune response, and metabolism under normal circumstances. However, when its levels remain elevated for extended periods, the resulting imbalance can impact virtually every part of the body. That leads to the varied symptoms of Cushing Syndrome. It is a progressive disorder, meaning symptoms typically worsen without intervention. Yet, with timely and appropriate treatment, many affected individuals can lead active, fulfilling lives with significantly reduced symptoms.

Summary

Cushing Syndrome arises from prolonged exposure to high levels of cortisol, primarily due to extended use of corticosteroids. Affecting women more frequently, this condition can lead to reproductive health issues in both genders. Although the condition progresses over time, early detection and proper management can enable those affected to maintain an active lifestyle with minimal symptoms.

Cushing Syndrome vs. Cushing Disease

Understanding the difference between cushing Syndrome and cushing Disease can be crucial for accurately diagnosing and treating these conditions. Cushing Syndrome encompasses any situation where the body is exposed to excess cortisol. This excess can come from outside the body, like from taking corticosteroid medications, or from within, such as when a tumour in the pituitary or adrenal glands prompts the body to produce too much cortisol.

On the other hand, cushing Disease is a more specific scenario under the umbrella of cushing Syndrome. It occurs exclusively when a benign tumour in the pituitary gland causes an overproduction of cortisol. This particular cause is significant because it accounts for about 70% of the cases where Cushing Syndrome stems from the body’s internal conditions, making it the most common form of endogenous (internal origin) Cushing Syndrome.

Summary

While Cushing Syndrome can arise from both external sources (like medication) and internal causes (tumours in the pituitary or adrenal glands), cushing Disease refers explicitly to cases caused by a pituitary tumour. This distinction is critical for guiding the correct diagnostic and treatment approaches, as it narrows down the source of excess cortisol to a specific type of internal tumour, affecting roughly 70% of all endogenous cases.

Symptoms of Cushing Syndrome

Cushing Syndrome unfolds gradually, with symptoms varying widely among individuals. Not everyone will experience all the symptoms, and their severity can depend on how much excess cortisol is in the body.

If these symptoms are present, you may suspect the presence of cushing syndrome:

Unexpected weight gain

A hallmark sign of Cushing Syndrome is rapid weight gain, particularly around the abdomen and face. It leads to distinct physical changes. These changes are “Buffalo Hump”, which is a noticeable fat accumulation on the back of the neck, and a “Moon Face”, where the face becomes rounder and fuller.

Hirsutism

Women may notice unusual hair growth on the face, chest, and back, a condition known as hirsutism. It occurs because excess cortisol can disrupt the balance of male and female hormones.

Thin skin

The skin may become thinner and more prone to bruising. High cortisol levels weaken the skin’s structure and resilience.

Irregular menstrual cycle

Women might experience irregular menstruation or a complete absence of it. Excess cortisol interferes with the hormones responsible for the menstrual cycle.

Purple Striae

Thin, purplish stretch marks often appear on the skin of the abdomen, hips, thighs, and breasts due to cortisol weakening the skin’s elasticity.

Hypertension

High blood pressure is common and can affect up to 80% of people with Cushing Syndrome. Cortisol causes structural damage to blood vessels and increases sensitivity to vasoconstrictors, which can elevate blood pressure.

Insulin resistance

The body may become less responsive to insulin, a condition known as insulin resistance, due to prolonged high cortisol levels. It disrupts the normal functioning of pancreatic beta cells, which produce insulin and can contribute to the development of diabetes.

Summary

Symptoms of Cushing Syndrome emerge slowly and vary from person to person. Key indicators include unexpected weight gain, particularly around the abdomen and face, excessive hair growth, thin and easily bruised skin, irregular menstrual cycles, purple stretch marks, high blood pressure, and insulin resistance. Recognising these symptoms early can lead to timely diagnosis and management of Cushing Syndrome.

Causes of Cushing Syndrome

Cushing Syndrome is a complex condition with several potential causes, each linked to an increase in the body’s cortisol levels. Here’s a clearer look at why this might happen:

Corticosteroid Medication

The most common trigger is the prolonged use of corticosteroid medications. These drugs, prescribed for conditions like asthma, rheumatoid arthritis, and lupus, mimic the effects of cortisol. When taken in high doses over time, they can elevate cortisol levels to the point of causing Cushing Syndrome. However, it is essential to note that low-dose treatments, such as inhalers for asthma or creams for skin conditions, typically don’t pose this risk, except in prolonged use in children.

Pituitary Tumours

These are benign tumours located in the pituitary gland at the base of the brain. The pituitary gland regulates cortisol production by releasing adrenocorticotropic hormone (ACTH). When a tumour secretes excess ACTH, it drives the adrenal glands to overproduce cortisol, leading to Cushing Syndrome.

Ectopic ACTH-producing Tumours

Tumours outside the pituitary gland, known as ectopic ACTH-producing tumours, can generate excess ACTH, leading to a condition called ectopic ACTH syndrome. These tumours commonly develop in the lungs but may also occur in the pancreas, thyroid, or thymus. Ectopic tumours can be cancerous.

Adrenal Tumours

Occasionally, a tumour on the adrenal gland can overproduce cortisol. While adrenal tumours are usually noncancerous (benign), there are instances where they can be cancerous.

Other Factors

Besides tumours and medications, various other factors can lead to high cortisol levels, such as:

• Dealing with depression, panic disorders, or being under a lot of emotional stress.
• Stress due to sudden illness, surgery, injury, or during the final trimester of pregnancy.
• Doing intense athletic training.
• Not getting enough nutrients (malnutrition).
• Drinking too much alcohol.

Summary

Cushing Syndrome can arise from genetic conditions, but it’s more commonly caused by external factors that increase cortisol levels. These include long-term use of corticosteroid medications, benign or cancerous tumours producing ACTH, and lifestyle or health factors that stress the body. Understanding these causes helps identify and manage the syndrome effectively.

Diagnosis of Cushing Syndrome

Diagnosing cushing syndrome can be challenging because symptoms occur gradually, leading to patients being undiagnosed or misdiagnosed for years. Your symptoms might be associated with another condition. Therefore, it is crucial first to confirm whether these symptoms are connected to elevated ACTH and cortisol levels.

• ACTH dependent: This may be due to a pituitary tumour or, rarely, a tumour elsewhere in the body.
• ACTH-independent: Could result from overactive adrenal glands or an adrenal tumour.

1. Explore Potential Causes:

• Discuss the use of steroid medications, creams, or inhalers containing hydrocortisone, prednisone, or dexamethasone with your doctor.
• Inquire about the use of birth control pills; adjustments may be necessary during testing.

2. Screening Tests for Cushing Syndrome:

Blood Tests: Measure ACTH and cortisol levels in the morning since hormone levels vary throughout the day.

Urine Tests:

• Assess cortisol levels in urine, possibly requiring multiple samples.
• Check with your doctor regarding any medicines or conditions that might influence the results.

Late-Night Saliva Test:

• Examine cortisol levels in saliva.
• Collect several samples just before midnight, when cortisol typically reaches its lowest level.
• High levels may indicate cushing disease/syndrome.

3. Imaging Tests for Cushing Disease/Syndrome:

MRI:

• Provides detailed images of the pituitary gland to identify tumours, including size and location.
• You may need a new MRI if a previous scan was inconclusive, as pituitary tumours can sometimes be challenging to visualise.

Abdominal CT Scan:

• Recommended if an adrenal tumour is suspected.
• Reveals the presence of a tumour, its characteristics, and its location on a specific side.

4. Diagnosis Confirmation

Petrosal Sinus Sampling: Performing Petrosal Sinus Sampling involves drawing blood from a vein near the pituitary and another from a distant vein. After administering a CRH shot, an increase in ACTH in the blood near the pituitary may suggest a pituitary tumour. At the same time, comparable levels from both samples may indicate an ectopic tumour.

Blood adrenocorticotropin hormone (ACTH) test: This test measures ACTH levels in the blood, with low ACTH and high cortisol levels potentially signalling the existence of a tumour on the adrenal glands.

Corticotropin-releasing hormone (CRH) stimulation test: Administering a shot of CRH in this test results in an increase in ACTH and cortisol levels in individuals with pituitary tumours.

High-dose dexamethasone suppression test: It is similar to the low-dose version but involves a higher dexamethasone dose. A decrease in cortisol levels may signify a pituitary tumour, while elevated cortisol levels could indicate an adrenal or ectopic tumour. This test helps differentiate the potential sources of excessive cortisol production.

Summary

Diagnosing cushing syndrome poses challenges due to its gradual onset, leading to years of undiagnosed or misdiagnosed cases. Screening tests include morning blood tests and urine tests. Imaging tests like MRI and abdominal CT scans help with tumour identification. Confirmation involves Petrosal Sinus Sampling, blood ACTH test, CRH stimulation test, and the high-dose dexamethasone suppression test, each playing a role in pinpointing the source of excessive cortisol production.

Natural Ways for Managing Cushing Syndrome

Managing Cushing Syndrome requires a holistic approach that combines medical treatment with lifestyle adjustments. Incorporating natural strategies can significantly improve symptoms and enhance quality of life. Here’s how:

Weight Management

Excessive weight gain, especially around the abdomen, is a hallmark of Cushing Syndrome. So, work with a nutritionist and increase physical activity to achieve optimal weight. Engaging with experts at HealthifyMe allows for a personalised approach to weight management. With HealthifyMe, you receive the guidance of an expert nutritionist and meal planner suiting your unique metabolic profile and BMI. This method ensures you are following a nutrition and exercise plan tailored to your specific needs. It will help control cortisol-induced weight gain.

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Blood Sugar Control

Cushing Syndrome can disrupt your body’s glucose regulation, leading to elevated blood sugar levels. To counteract this, prioritise a diet rich in low-glycemic foods such as non-starchy vegetables, nuts, berries, and fish. These foods help maintain steady blood glucose levels. HealthifyMe’s nutritionists can guide you in selecting the right foods to minimise blood sugar spikes, incorporating them into your daily meals in a way that supports your health goals.

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Limit Alcohol Intake

Alcohol can worsen the symptoms of Cushing Syndrome by contributing to weight gain and disrupting blood sugar and fat metabolism. Reducing alcohol consumption can help mitigate these effects.

Manage Blood Pressure

High blood pressure is a common issue for those with Cushing Syndrome. Adopting lifestyle changes such as reducing sodium intake, maintaining a balanced diet, and engaging in regular physical activity are essential. HealthifyMe’s continuous monitoring and personalised guidance ensure you can make the necessary adjustments to your diet and exercise routine. This ongoing support helps manage hypertension effectively.

Summary

Effective management of Cushing Syndrome involves addressing its symptoms through strategic lifestyle changes. By partnering with HealthifyMe, you gain access to personalised nutrition plans, expert guidance on exercise, and lifestyle modification support tailored to your condition. This comprehensive approach not only helps manage symptoms like hypertension and elevated blood sugar levels but also supports overall well-being and health improvement. With HealthifyMe, navigating the challenges of Cushing Syndrome becomes a more manageable and supported journey.

Treatment and Management of Cushing Syndrome

The primary goal of treating Cushing syndrome is to decrease cortisol levels within the body, with a specific approach depending on the underlying cause. One avenue for achieving this is through medication. Certain drugs are capable of reducing cortisol production in the adrenal glands or inhibiting the production of ACTH in the pituitary gland. Additionally, some medications can block the effects of cortisol on tissues.

Surgery is often the preferred method for addressing tumours associated with Cushing syndrome. While surgical removal of the tumour is the primary choice, if this is not possible or ineffective, alternative treatments such as chemotherapy, radiation therapy, or other cancer treatments may be considered to shrink the tumour. In severe cases where tumours are resistant to treatment or cause significant complications, the removal of both adrenal glands may be necessary. In such instances, lifelong medication becomes imperative to replace the hormones, including cortisol, normally produced by the adrenal glands.

Summary

The key goal while managing Cushing syndrome is lowering cortisol levels, and the method depends on the cause. Along with medications surgery is often preferred for tumours, followed by alternatives like chemotherapy. In severe cases requiring adrenal gland removal, lifelong hormone replacement therapy ensures balanced hormone levels.

HealthifyMe Suggestion

Cushing syndrome symptoms can be difficult to manage, but maintaining a healthy lifestyle and diet can make a significant difference. Prioritising sleep can help to lower cortisol levels. Chronic sleep disorders, such as obstructive sleep apnea, insomnia, or shift work, are related to elevated cortisol levels. Do not forget to drink plenty of water. Staying hydrated helps your body work properly and minimises fluid buildup. Cortisol indirectly affects bone by blocking calcium absorption, which reduces bone cell formation, so consume calcium-rich diets and exercise regularly.

The Final Word

Managing cushing syndrome involves combining medical interventions with lifestyle adjustments. Understanding the causes, symptoms, and diagnosis processes is crucial for effective treatment. Medications, surgery, and, in severe cases, adrenal gland removal are the best options. Additionally, natural ways, such as weight management, blood sugar control, limited alcohol intake, and blood pressure management, play a significant role. With the support of a HealthifyMe nutritionist, you can navigate this journey, ensuring continuous monitoring and tailored guidance for sustained well-being.

Disclaimer: The purpose of this article is just to disperse knowledge and raise awareness. It does not intend to replace medical advice from professionals. For further information, please contact our certified nutritionists Here.

Research Sources

cushing disease: a multidisciplinary overview of the clinical features, diagnosis, and treatment

Effect of increase in cortisol level due to stress in healthy young individuals on dynamic and static balance scores

Frequently Asked Questions (FAQs)