ENLmedical.com: Conditions And Concerns: Medical Encyclopedia: Cushing's syndrome caused by adrenal tumor

Cushing's syndrome caused by adrenal tumor

Causes and Risks:
Cushing's syndrome is caused by excess glucocorticoid hormone secretion over a long period of time. Primary tumors of the adrenal glands that secrete cortisol account for 15% of the cases of Cushing's syndrome, and are frequently malignant (cancerous). Other causes are secretion of adrenocorticotrophic hormone (ACTH) by a pituitary tumor or from another organ ( ectopic Cushing's syndrome ), or by chronic administration of corticosteroids--drugs commonly used to treat conditions such as rheumatoid arthritis and asthma . Adrenal tumors may occur at any age, but 70% occur in adults. The frequency is higher among women. The incidence is 6 out of 1,000,000 people.

Prevention:
Appropriate treatment of tumors may reduce the risk of some cases. Use caution when taking corticosteroid medications.

Symptoms:

moon face (round, red and full)
buffalo hump (a collection of fat between the shoulders)
central obesity with protruding abdomen and thin extremities
weight gain
weakness
backache
headache
acne or superficial skin infections
thirst
increased urination
purple striations on the skin of the abdomen, thighs, and breasts
mental changes
impotence or cessation of menses
breast development in males

Signs and Tests:
Tests to confirm hypercortisolism :

24 hour urine for
- cortisol, urine
- creatinine-urine
dexamethasone suppression test
serial serum (blood tests) to measure cortisol level do not show diurnal variations

Tests to determine cause:

ACTH is low normal or undetectable
high-dose dexamethasone suppression test
abdominal CT may show adrenal mass

Other findings:

fasting glucose is elevated
serum potassium may be low

This disease may also alter the results of the following tests:

estriol-urine
estriol-serum
adrenal biopsy
17-ketosteroids

Treatment:
Cushing's syndrome due to an adrenal tumor is treated by surgical removal of the tumor. In inoperable cases, certain medications can suppress the secretion of cortisol. Medications used may be mitotane, ketoconazole, aminoglutethimide, or metyrapone. Irradiation of the tumor may follow surgery if symptoms do not improve. Glucocorticoid replacement therapy is usually required until the other adrenal gland recovers from the surgery 9 to 12 months of therapy may be required.

Prognosis:
Most people with adrenal carcinoma survive less than 5 years after diagnosis.

Complications:

metastasis (spread) of the causative tumor to the liver or lungs

Call Your Healthcare Provider:
Call your health care provider if symptoms of Cushing's syndrome develop.

The endocrine system is the chemical control center of the body. The pituitary gland is often considered the master control; sending out hormones that regulate the function of the thyroid, adrenal glands, ovaries, and testis. Over- or under-production of hormones from any of these glands is associated with many different types of disease.

This CT scan of the upper abdomen shows an adrenal metastasis (spreading of a tumor to the adrenal gland, above the kidney) in a person with lung cancer.

CT scan of the upper abdomen in a person with a right adrenal mass. The adrenal glands are located above the kidneys.

This X-ray shows a tumor of the adrenal gland, which is located above the kidney. A dye that is visible on X-rays has been injected into the blood stream (the procedure is called an intravenous pyelogram; IVP).

The Buffalo hump is an accumulation of fat on the back of the neck and upper back. This condition can occur with oversecretion of cortisone by the adrenal gland, a condition called Cushing syndrome.

Excess cortisone, whether produced by the adrenal gland or introduced from an external source (medications or steroids, like Prednisone), can produce Cushing's disease with a "moon face" (round puffy appearance), acne, and central obesity (sparing the arms and legs).