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 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.