Do you have these symptoms? Let's talk about Cushing Syndrome!

Have you ever heard of Cushing Syndrome? The name may be a bit new to you. Simply put, it's a condition that occurs when our bodies produce too much of the hormone cortisol . Some people also call it hypercortisolism. A "syndrome" is a collection of symptoms that come together. You may have seen it called Cushing's syndrome by some people.

So what is this cortisol?

Cortisol is a steroid hormone in our bodies. We often call it the "stress hormone" because when we are under stress, our bodies release more cortisol. During these times, cortisol helps us:

• Your heart rate increases.
• Your blood pressure is increasing.
• Controls blood sugar levels.
• Controls breathing.
• Increases muscle tension.

Not only that, but when we are stressed, cortisol also helps to temporarily shut down systems that are not essential to our body at that time, for example, the digestive system and the reproductive system.

Cortisol is an essential hormone for our bodies. Cortisol is essential for these things:

• Maintain blood pressure.
• Regulate blood sugar levels.
• Reduce inflammation.
• Build memories.
• Control your breathing.
• Maintain the salt balance in the body.
• Turn the food we eat into energy.

Cortisol levels are controlled by two small glands on top of our kidneys, the adrenal glands, the pituitary gland in the brain, and the hypothalamus, which is located above the pituitary gland.

Cushing's syndrome is usually caused by a tumor . This can occur in two main ways:

• Endogenous: This means that it is a condition caused by cortisol produced within our bodies.
• Exogenous: This means that a condition is caused by external causes as a side effect of certain medications taken to treat other medical conditions.

Who is most likely to develop Cushing Syndrome?

Cushing's syndrome is most common in children, young adults, and adults. It is most common in people between the ages of 25 and 50. People who take medications that contain cortisol (for example, medications for asthma and rheumatoid arthritis) are at higher risk of developing the condition. About 70% of people with Cushing's syndrome are women and 30% are men.

How common is this situation?

Cushing's syndrome is a very rare condition , affecting between 40 and 70 out of a million people per year.

What is the difference between Cushing Syndrome and Cushing Disease?

Cushing's disease is a type of Cushing's syndrome. It is caused by a benign tumor in the pituitary gland. This tumor secretes too much of the hormone ACTH (adrenocorticotropic hormone) . This causes the adrenal glands to secrete too much cortisol.

Of those with Cushing's syndrome, more than 70% of adults and between 60% and 70% of children and young adults have this type of Cushing's disease.

What kind of doctors treat Cushing Syndrome?

Your general practitioner will refer you to a specialist called an endocrinologist to diagnose and treat this condition.

Can Cushing Syndrome be fatal?

Yes, Cushing's Syndrome can be fatal if not treated properly. If left untreated, this high cortisol level (hypercortisolism) can lead to a variety of health problems. For example:

• Infections
• Blood clots, especially in the lungs and legs
• Depression
• Heart attack
• Weight gain
• Memory problems or difficulty concentrating
• High blood pressure or high cholesterol
• Broken bones
• Type 2 diabetes, prediabetes, or impaired fasting glucose

If left untreated, Cushing's syndrome can even lead to death.

What are the causes of Cushing Syndrome?

Cushing's syndrome is caused by high levels of cortisol in the body. There are a number of factors that can contribute to this:

• Use of Glucocorticoid Medications: Glucocorticoid medications (for example, prednisone) are used to treat chronic asthma, rheumatoid arthritis, lupus, sarcoidosis, and many other autoimmune diseases that cause chronic inflammation. Taking these medications for a long time can cause "iatrogenic" or exogenous Cushing syndrome. The word "iatrogenic" means that something else is caused by a medical treatment.
• Pituitary tumors: Cushing syndrome ( excluding iatrogenic Cushing syndrome) is caused by pituitary tumors that produce too much ACTH, a hormone that tells the adrenal glands to produce cortisol, and affects 8 out of 10 people. This type is called Cushing disease.
• Adrenal cortical tumors: A tumor that develops on top of the adrenal gland can produce too much cortisol. These are usually benign tumors. However, sometimes this tumor can be an adrenal cortical carcinoma, a very rare type of adrenal cancer.
• Lung, pancreas, thyroid and thymus tumors: When ACTH is produced by tumors outside the pituitary gland, it is called ectopic ACTH syndrome. These tumors are usually malignant. The most common of these is small cell lung cancer.

Is Cushing Syndrome hereditary?

Usually, no . Most cases of Cushing's syndrome are not hereditary.

What are the symptoms of Cushing Syndrome?

In addition to the symptoms that are specific to Cushing's syndrome, there are also symptoms that can be common to many other conditions. Not everyone will have the same symptoms. These are the symptoms that may occur:

• Rapid weight gain in the face (some call this a "moon face"), stomach area, back of the neck (some call this a "buffalo hump"), and chest.
• A red, round face.
• Wounds take time to heal.
• High blood pressure (hypertension).
• Excessive hair growth on the face, neck, chest, stomach, breasts, and thighs, or hair loss (baldness).
• Diabetes.

Other symptoms may include:

• The appearance of purple stretch marks in the abdominal area.
• Easy bruising of the hands and feet.
• General weakness and fatigue.
• Blurred vision and dizziness.
• Muscle weakness and limb wasting.
• Libido changes and erectile dysfunction in men.
• Impaired growth in children.

How long does Cushing Syndrome last?

How long Cushing's syndrome lasts depends on how you respond to treatment. Most people with high cortisol levels (hypercortisolism) recover after a few weeks of treatment.

Does Cushing Syndrome cause breathing difficulties?

No. Shortness of breath is not a characteristic symptom of Cushing Syndrome.

Does Cushing Syndrome cause osteoporosis?

Yes. Cushing's syndrome can cause weak bones. This can lead to fractures, especially if you have had the condition for a long time. Weak bones can also cause pain.

Does Cushing Syndrome cause hypokalemia?

Hypokalemia is a condition where the level of potassium in your blood is low. This condition can occur if you have Cushing's syndrome.

How is Cushing Syndrome diagnosed?

If your doctor suspects high cortisol levels (hypercortisolism), there are some guidelines they will follow. They will ask questions, take your medical history, do a physical exam, and then order some lab tests. They may also monitor you for a period of time.

Cushing's syndrome can sometimes be a little tricky to diagnose. If you tell your doctor that you're tired and gaining weight, they may not immediately think about Cushing's syndrome. This is because these symptoms are common to many different diseases.

Also, Cushing's syndrome can sometimes be confused with polycystic ovary syndrome or metabolic syndrome . Your doctor will need to rule out other conditions to make a diagnosis.

What tests are done to diagnose Cushing Syndrome?

Your doctor may do some of these tests:

• 24-hour urinary cortisol test: This test measures the amount of cortisol in your urine in micrograms (mcg). Your doctor will ask you to collect your urine over a 24-hour period.
• Midnight salivary cortisol test: Normally, cortisol levels are very low at night. This test checks cortisol levels between 11 and 12 am. If you have Cushing's syndrome, your cortisol levels will be abnormally high at that time.
• Low-dose dexamethasone suppression test: Dexamethasone is a medication similar to cortisol. For this test, you take one milligram (mg) of the medication by mouth at night, and then your cortisol levels are measured between 8 and 9 a.m. This blood test looks at whether your adrenal glands have responded to dexamethasone by reducing the amount of cortisol they secrete. If you have Cushing's syndrome, your cortisol levels will be high.
• Blood test: A blood test measures the level of ACTH in your blood. If the ACTH level is low, you may have an adrenal tumor. If the level is normal or high, you may have a pituitary tumor or an ectopic tumor.
• High-dose dexamethasone suppression test: This is similar to the low-dose dexamethasone suppression test, but the dose is 8 milligrams instead of 1. This test is usually done after the low-dose test shows high cortisol levels in the morning and blood tests show high levels of ACTH in the blood. This test can help find the cause of Cushing's syndrome. It can help differentiate between a pituitary adenoma (also known as Cushing's disease) and a tumor elsewhere in your body (such as in the lungs).

Once your doctor has confirmed that you have Cushing's syndrome, the next step is to find out what's causing it. In most cases, it could be a medication or a tumor. If you're taking glucocorticoids, that's likely the cause, so your doctor may reduce your dose. If you're not taking glucocorticoids, it could indicate a tumor in your adrenal glands, pituitary gland, or elsewhere. Your doctor may recommend imaging studies such as these to help locate the tumor:

• CAT scan (CT scan) or MRI abdomen: Your doctor may do a CT scan or MRI to see if you have a tumor in your adrenal glands. These scans may be done with or without intravenous contrast (IV contrast). These tests are very sensitive for detecting adrenal tumors.
• Magnetic resonance imaging (MRI) of the pituitary gland: An MRI takes pictures of your pituitary gland to look for a tumor. In some cases, an MRI may not be completely accurate. About 50% of people with Cushing syndrome have a "normal" MRI, while 10% may have tumors that are not related to the syndrome.
• Bilateral inferior petrosal sinus sampling (BIPPS): This test finds the source of ACTH secretion. ACTH and other pituitary hormones are released from the pituitary gland into the bloodstream. An experienced interventional radiologist performs this test through two veins called the inferior petrosal sinuses. The accuracy rate of this test is between 95% and 98%.
• CT scan chest: If your doctor suspects an ectopic tumor, they may order a CT scan of the chest to check for possible lung cancer.

How is Cushing Syndrome treated?

The type of treatment depends on the underlying cause of the high cortisol levels. If you are taking glucocorticoids, your doctor will likely reduce your dose or prescribe a non-glucocorticoid medication.

If Cushing's syndrome is caused by a tumor, your doctor may suggest surgery or radiation therapy.

Another option is for your doctor to prescribe a medication that reduces cortisol production, such as ketoconazole. You may need to work with several different doctors to treat the tumor and symptoms of Cushing's syndrome.

• Chemotherapy: If a tumor is cancerous and has spread to other parts of the body, chemotherapy may be necessary. Be sure to talk to your doctor about any side effects.
• Medications: Adding medications that lower cortisol or removing medications that can cause Cushing's Syndrome.
• Radiation: A pituitary tumor may not be surgically removed. In such cases, you may have to undergo six weeks of radiation therapy. It can take years for cortisol levels to return to normal. Talk to your doctor about any side effects.
• Surgery: Surgery to remove pituitary tumors, adrenal tumors, and ectopic tumors is successful, but you will need to adjust to the new, lower cortisol levels. During this time, you may need to take cortisol medication in the form of hydrocortisone pills. You will be able to stop taking this medication after 6 to 18 months. In most cases, after laparoscopic surgery, you will be able to leave the hospital in a day or two.

If Cushing's syndrome is treated properly, it can take anywhere from 2 to 18 months to recover. Stay in close contact with your doctor during this time and beyond.

What can I expect if I have Cushing Syndrome?

Your doctor can and should treat Cushing's syndrome. If left untreated, it can be fatal. See a doctor as soon as possible to discuss your symptoms with your doctor.

Can Cushing Syndrome get worse?

Cushing's syndrome can get worse if not treated properly. Stay in touch with your doctor and let them know about any new symptoms, worsening symptoms, or any other problems.

How can I reduce or prevent the risk of Cushing Syndrome?

Your body needs cortisol all the time. You need it to stay active. It controls your breathing, turns the food you eat into energy, regulates your blood sugar levels, helps you deal with stress, and does a lot more. Cortisol is not your body's enemy, but too much of it is not good. However, you can't live without cortisol.

If you are taking glucocorticoids or steroids, have your doctor monitor your cortisol levels closely. Unfortunately, there is no way to prevent a tumor from causing Cushing's Syndrome (hypercortisolism).

What is it like to live with Cushing Syndrome?

Living with Cushing's syndrome can be difficult, but it doesn't have to be a life-threatening condition. There are doctors trained to help you, and there are treatments. These treatments can usually cure Cushing's syndrome and improve the symptoms of high cortisol levels (hypercortisolism).

Cushing's syndrome can cause you to experience some emotional and social problems. Some people may feel embarrassed by hair loss, excessive hair growth, and/or weight gain on the face and back of the neck. A "moon face" and "buffalo hump" may make you think twice about participating in social situations. Over time, treatment can help improve these symptoms. Cushing's syndrome can also cause depression and other mental illnesses. If necessary, see a therapist for counseling and a psychiatrist for medication to help you deal with the emotional effects of high cortisol levels (hypercortisolism).

When should I see a doctor?

See a doctor if you have any of these symptoms of Cushing's syndrome:

Symptoms that specifically affect women:

• New or excessive facial hair growth.
• Change in sex drive.
• Change in menstrual cycle.

Symptoms that affect everyone:

• Rapid weight gain in the face (some call this a "moon face"), stomach area, back of the neck (some call this a "buffalo hump"), and chest.
• A red, round face.
• High blood pressure (hypertension).
• Excessive hair growth on the face, neck, chest, stomach, and thighs.
• Diabetes.
• New or excessive acne.
• The appearance of purple stretch marks in the abdominal area.
• Easy bruising of the hands and feet.
• General weakness and fatigue.
• Blurred vision and dizziness.
• Wounds take time to heal.
• Muscle weakness.

What questions should I ask my doctor?

• What medications can I take to help with my Cushing's syndrome?
• Are there exercises I can do to help my weak muscles?
• Are there any medications that can be applied to help with stretch marks?
• Should I see a specialist for Cushing Syndrome?
• Do I need to stop taking any of the medications I am currently taking?
• What is the best treatment for me?
• Are there any additional preventive measures I should take?

Cushing's syndrome can be a difficult condition to deal with. It can cause weakness, high blood pressure, and fatigue. Treatments such as surgery, medication, radiation therapy, and chemotherapy can be difficult. But they are worth it, because with the right treatment, Cushing's syndrome can be cured.

Summary (Take-Home Message)

Cushing Syndrome is a condition caused by an increase in the hormone cortisol in our body. It is a bit rare, but if diagnosed and treated properly, it can be cured . If you have symptoms like facial swelling, weight gain, excessive hair growth, or high blood pressure, it is very important to seek medical advice. Treatment methods vary depending on the cause. So talk to your doctor about everything and follow their advice. Remember, you are not alone, and help is available.

` Cushing's Syndrome, cortisol, hormones, adrenal glands, pituitary gland, ACTH, symptoms, treatment, endocrinologist