CUSHING’S SYNDROME
Cushing’s syndrome is caused by elevated cortisol levels with multisystemic consequences
What is Cushing’s Syndrome?
Cushing’s syndrome is the disease that results from exposing the body to high levels of cortisol for too long. The rise of cortisol in the blood, at high levels for a long time, results either because it is administered exogenously, or because it is abnormally produced in large amounts in the body.
TopHow common is it?
Cushing’s syndrome resulting iatrogenically, from exogenously administered cortisone to treat various diseases is quite common. However, Cushing’s syndrome resulting from abnormal cortisol production by a tumour is quite rare with an incidence of 2-3 cases per million population per year.
TopWhat are the causes of Cushing’s Syndrome?
The causes of Cushing’s Syndrome are:
- Administration of cortisone exogenously, such as for the treatment of autoimmune diseases
- A Pituitary neuroendocrine tumour that creates excess ACTH (pituitary adenoma).
- A Neuroendocrine tumour of lung, thymus, pancreas, thyroid gland that hypersecretes ACTH. These tumours can be benign or malignant.
- An Adrenal tumour (adenoma) that hypersecretes cortisol
What are the symptoms and signs of Cushing’s syndrome?
- Weight gain
- Round (Moon) face
- Buffalo Hump (increased fat at the base of the neck)
- Purple stretch marks
- Easy bruising
- Acne
- Hypertrichosis
- Difficulty in healing wounds
- Muscle weakness
- Depression
- Infertility
- Menstrual Irregularities
- Erectile dysfunction
What are the complications of Cushing’s syndrome?
The complications of Cushing’s syndrome depend on the severity of the disease and its duration:
- Osteopenia, Osteoporosis, Fractures
- Hypertension
- Arrhythmias
- Cardiomyopathy
- High Cardiovascular Risk
- Diabetes
- Hyperlipidemia
- Immunosuppression, frequent and rare infections
- Psychosis
- Thromboembolic events
- Death
How is Cushing’s syndrome diagnosed?
The diagnosis of Cushing’s syndrome requires complex endocrine tests, extensive experience in interpreting the results and a specialized center. It includes history, physical examination and blood tests. Sometimes it can take a long time to make a diagnosis. Finding the cause is also difficult and involves, among other things, neuroimaging, and even then, the cause may not be found. A specialized multidisciplinary team is required to diagnose the syndrome, identify its cause and plan the best treatment.
TopHow is Cushing’s syndrome treated?
Treatment of the syndrome depends on its cause. If it is caused by external cortisone administration, a gradual reduction in dose is required. If the syndrome is due to a tumor, the treatment is surgical removal. However, many times a combination of treatments is needed which may include:
- surgical removal
- radiation and
- drugs that lower cortisol levels.
Is Cushing’s Syndrome dangerous?
When Cushing’s syndrome is due to a tumor, it is usually a rare, slow-growing, benign but potentially fatal tumor. The 5-year survival of untreated severe hypercortisolism (elevated blood cortisol levels) is 50%. On the other hand, if it is due to a malignant tumor the prognosis is even worse.
Top