Cushing’s Syndrome Causes, Symptoms, Diagnosis, and Treatment

• Cushing’s disease is a hormone disorder caused by high levels of cortisol in the blood disease in which there is ex­cess ACTH secretion, by pituitary adenomas.
• Cushing’s syndrome is the signs and symptoms that result from prolonged exposure to excessive glucocorticoid hormones.

Cushing’s disease:

• Cushing’s syndrome hormone disorder  caused by excessive production of adrenocorticotropic hormone in the body.
• It is more common in women.
• There is hypercortisolemia.
• On giving glucocorticoids, the cortisol levels are sup­pressed indicating a pituitary origin.
• Cushing’s disease is hypercortisolemia due to pitu­itary adenomas.
• Cushing’s syndrome is excess cortisol due to any cause like exogenous ACTH tumor, adrenal tumor, pituitary ACTH secreting tumor, excess glucocorticoid therapy.

Cushing’s Syndrome Causes, Symptoms, Diagnosis, and Treatment

Cushing’s Syndrome Symptoms

Clinical features:

• most common feature of patients with Cushing’s syndrome hormone disorder is progressive central (centripetal) obesity
• thin, brittle skin, purple striae, gonadal dysfunction, osteoporosis, central obesity, hypertension, moon facies, diabetes mellitus / glu­cose intolerance,depression, mania, osteoporosis.
• proximal muscle weakness, acne, hir­sutism,
• Menstrual irregularities are common in women with Cushing’s syndrome
• There is leukocytosis, lymphopenia, delayed hyper­sensitivity.
• In patients on steroids there is hyperpigmentation, myopathy,
• hypertension, hypokalemic alkalosis, edema, glucose intolerance.

Cushing’s Syndrome Lab Diagnosis

• Estimation of 24-hour free cortisol in urine (UFC).
• Failure to suppress plasma cortisol after 1 mg dexamethasone given at night.
• Increased midnight levels of cortisol are found in Cushing’s syndrome (in normal persons the level of cortisol is low at midnight).

Cushing’s Syndrome Treatment

• Transsphenoidal resection Pituitary irradiation
• Ketoconazole, an antimycotic agent, lowers cor­tisol in Cushing’s disease, in doses of 600- 1200 mg/day.
• Other drugs are metyrapone, mitotane
• Adrenalectomy – Removal of both adrenal glands corrects hypercortisolism but results in Nelson’s syndrome i.e. pituitary tumor with high ACTH levels.