ENLmedical.com: Conditions And Concerns: Medical Encyclopedia: Cushing's syndrome

Cushing's syndrome

Causes and Risks:
Cushing's syndrome results from excess cortisol (glucocorticoid) hormone over a long period of time. The most common cause of Cushing's syndrome is excessive production of adrenocorticotropic hormone ( ACTH ) by the pituitary gland. ACTH stimulates the growth of the adrenal glands and the secretion of other corticosteroids.

Cushing's disease can be caused by a tumor of the pituitary gland , a tumor of the adrenal gland, a tumor somewhere other than the pituitary or adrenal glands (ectopic Cushing's syndrome), or by long-term use of corticosteroids (drugs commonly used to treat conditions such as rheumatoid arthritis and asthma ).

Risk factors are adrenal tumor or pituitary tumor , chronic therapy with corticosteroids, and being female. The incidence of all types of Cushing's syndrome is 2 out of 10,000 people.

See also:

Prevention:
Cushing's syndrome may be prevented by an awareness of the associated symptoms so that early detection can be made.

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

Additional symptoms that may be associated with this disease:

Signs and Tests:
Tests to confirm high cortisol level :

cortisol, urine
creatinine urine
dexamethasone suppression test
serial serum cortisol levels do not show diurnal variations

Tests to determine the cause:

ACTH
cranial MRI or cranial CT scan may show pituitary tumor
abdominal CT may show adrenal mass
general findings:
glucose test is elevated
potassium test may be low

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

Treatment:
Treatment depends upon the cause of the disorder. In Cushing's syndrome caused by drug therapy with corticosteroids, the drug must be slowly decreased under medical supervision.

In Cushing's disease caused by a pituitary tumor , surgery to remove the tumor is recommended. Hydrocortisone replacement therapy is needed until the pituitary returns to normal function.

Cushing's syndrome caused by an adrenal tumor is usually treated by surgical removal of the tumor. In inoperable cases, certain medications can suppress the secretion of cortisol.

In Cushing's syndrome caused by an ectopic ACTH-secreting tumor, the tumor is resected.

Cortisol replacement therapy is indicated after surgery until cortisol production resumes. In some cases, life-long therapy with cortisone drugs becomes necessary.

Prognosis:
Tumor removal may lead to full recovery, but there is a chance of recurrence. Survival for people with ectopic tumors depends upon the probable outcome associated with the particular tumor type. Untreated, Cushing's syndrome can lead to death.

Complications:

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

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).