Cushing Syndrome: What You Need to Know
Cushing syndrome is caused by prolonged exposure to high levels of cortisol. Cortisol is a hormone produced naturally by the adrenal glands. In addition to being secreted by the adrenals, cortisol is also produced in smaller amounts by many other organs including the brain, liver, kidneys, skin, lungs, stomach, pancreas, heart, spleen, thymus, prostate, testes, ovaries, and bone marrow.
The effects of excess cortisol production vary depending on where the excess cortisol originates. If the excess cortisol comes from the adrenal gland, then the symptoms may include weight gain, muscle weakness, fatigue, depression, anxiety, insomnia, nausea, vomiting, diarrhea, abdominal pain, headaches, joint pain, decreased appetite, increased thirst, menstrual irregularities, low blood pressure, and poor wound healing. If the excess cortisol is derived from the pituitary gland (the master control center for hormones), then the person may experience changes in mood, behavior, personality, sexual function, and vision.
The excess cortisol is derived primarily from the hypothalamus, then the person may develop obesity, diabetes mellitus, hypertension, hyperlipidemia, osteoporosis, impaired glucose tolerance, and cognitive impairment.
If the excess glucocorticoid is derived from the cortex of the adrenal gland, the person may have no symptoms at all. However, if the excess cortisol is derived mainly from the medulla of the adrenal gland (where the body produces mineralocorticoids) then the person may experience salt loss, hypokalemia, and metabolic alkalosis. Cushing syndrome is most common among middle-aged white females. According to the NIH, three times as many females develop Cushing syndrome than males. Women who suffer from Cushing Syndrome may also be at risk for developing infertility. If left untreated, Cushing Syndrome can cause menstrual irregularities.
In some cases, the cause of Cushing’s syndrome cannot be determined.
- Causes: The causes of Cushing’s syndrome are varied. Most commonly, the condition occurs after prolonged exposure to glucocorticoids (cortisone-like drugs). Other possible causes include pituitary tumors, adrenal gland tumors, excessive use of corticosteroid nasal sprays, and certain medications.
- Diagnosis: A doctor will perform a physical examination and ask about your medical history. A urine test will show whether you have excess cortisol in your system. If you do, further tests will determine the level of cortisol in your blood and help identify the underlying cause of the problem.
Cushing disease Symptoms include:
- Muscle weakness
- Weight gain
- High blood pressure
- Abnormal glucose tolerance
- Bone density loss
- Hair thinning/loss
- Skin changes
- Unexplained hair loss
- Increased risk of certain types of cancers
Treatment of Cushing disease
Treatment of Cushing’s syndrome includes removal of the tumor causing the excessive cortisol secretion, treatment of any underlying disease causing the excess cortisol production, and replacement of the missing cortisol. Removal of the tumor is often not possible due to its location. Therefore, medical therapy is the primary treatment option. Medical therapies include medications that block the action of cortisol, reduce the amount of cortisol released, or prevent the release of cortisol altogether. Medications that block the action of cortisone include ketoconazole, mifepristone, metyrapone, and prednisone. Medications that reduce the amount of cortisol produced include mitotane, aminoglutethimide, and etomidate. Finally, medications that prevent the release of cortisol include trilostane and pasireotide.
Prevention of Cushing disease
Prevention of Cushing’s syndrome involves identifying patients who are likely to develop the condition and monitoring them closely. Patients who are at risk for developing Cushing’s syndrome include those who have had their adrenal glands removed, those who have undergone radiation treatments to the head, neck, chest, abdomen, pelvis, or extremities, and those who have received chemotherapy for cancer. Other factors that increase the likelihood of developing Cushing’s syndrome are having a family history of the condition, taking certain medications, and having certain conditions such as Addison’s disease, autoimmune disorders, and diabetes mellitus.
The difference between Cushing disease and Cushing syndrome
What does each mean?
These two terms refer to the same condition, however, they have different meanings. Cushing’s Syndrome refers to high levels of cortisol in the blood. When someone has Cushing’s Disease, their adrenal glands produce abnormal amounts of cortisone, a steroid hormone. These steroids cause problems with the pituitary gland and hypothalamus, resulting in the overproduction of ACTH (the body’s primary regulator of cortisol).
How do I know if I have Cushing’s Disease?
If you have been diagnosed with Cushing’s Disease, then you may already be taking medication to treat it. If not, you may want to talk to your doctor about starting treatment right away. In addition to checking your symptoms, doctors will test your morning urine sample for free cortisol levels.
Why should I take a test for my cortisol levels?
Taking daily tests can help find out what works best for you. A regular test will tell you how much cortisol is being produced and give you a baseline measurement to compare future results. Your physician might recommend testing before beginning any medical treatments, especially those that could affect your immune system.
Can I stop taking medications once started?
Your physician can prescribe some medications for long-term use, and others for short-term use only. You need to follow his/her instructions carefully. Sometimes people feel they are getting better after stopping treatment, but later realize that they were just tapering off the dosage instead of completely discontinuing them. Be sure to check in regularly with your doctor so he/she knows how you’re doing.
Are there side effects from these drugs?
Many patients report feeling worse while on medication, especially at first. There are many ways to manage side effects, including switching to lower doses or changing the type of medicine taken. People who experience severe side effects, especially depression, fatigue, weight gain, and mood swings, may require alternative therapies.
Is this condition reversible?
Yes. Many patients can reverse the symptoms of Cushing’s Disease. However, some people never fully recover. While the majority of people respond well to surgery, some patients choose to undergo radiation therapy. Radiation destroys cancer cells and helps shrink tumors.
Will having Cushing’s Disease shorten my lifespan?
No. Several studies show that people with Cushing’s Disease live longer than the general population. One study showed that women with Cushing’s Disease lived an average of six years longer than expected. Another study showed that men with Cushing’s Disease had a mortality rate similar to that of normal controls.
Risk factors of Cushing disease
- High blood pressure: High blood pressure is associated with increased Cushing’s Syndrome risk. In addition, high blood pressure increases the risk of heart attack, stroke, kidney disease, and diabetes.
- Obesity: Obesity is linked to higher rates of hypertension and type 2 diabetes. These conditions increase the risk of developing Cushing’s Syndrome.
- Smoking: Smoking cigarettes may lead to weight gain and obesity. Cigarette smoking causes inflammation in the body and may contribute to the development of Cushing’s Syndrome.
- Alcohol consumption: Alcohol use causes liver damage and fatty deposits in the pancreas. Both of these conditions can trigger Cushing’s Syndrome. Heavy alcohol consumption may also lead to depression, anxiety, and insomnia.
- Stress: Stressful situations can affect the adrenal glands and cause them to produce excess cortisol. Cortisol levels rise when we experience stressful events, such as physical illness, injury, surgery, or emotional trauma. When the cortisol level rises, the pituitary gland releases ACTH (adrenocorticotropic hormone), which stimulates the production of cortisol by the adrenal glands.
- Medications: Medication side effects may cause the body to release excessive amounts of cortisol. Certain medications, including cortisone, prednisone, and dexamethasone, the show’s to induce Cushing’s Syndrome. Other drugs, such as beta-blockers, anti-depressants, and anticonvulsants, may lower cortisol levels.
- Thyroid disorders: Thyroid disorders, especially hyperthyroidism, can cause elevated cortisol levels. Hyperthyroidism occurs when the thyroid produces too much thyroid hormone. Symptoms of hyperthyroidism include rapid heartbeat, nervousness, irritability, weight loss, and swelling.
How to treat Cushing’s disease naturally?
Some natural remedies for Cushing’s disease include:
- Vitamin D supplements: Vitamin D is a vitamin that is naturally present in some foods and is a supplement. Studies suggest that taking vitamin D might lower cortisol levels and improve mood in patients with Cushing’s disease.
- Lifestyle changes: Lifestyle changes can help control Cushing’s disease. People with Cushing’s disease should avoid alcohol and caffeine, eat smaller meals throughout the day, exercise regularly, and get plenty of sleep.
- Herbal medicines: Herbs may provide relief for Cushing’s disease. One study suggests that St John’s wort may decrease cortisol levels in people with Cushing’s disease and may improve their quality of life. Other herbs that may help include ashwagandha, licorice root, ginseng, and valerian.
Cushing’s disease occurs when there’s an excess of cortisol in the blood. A tumor on the pituitary gland or an abnormality of the adrenal glands. The sooner you start treating Cushing’s syndrome, the faster you will recover. Your outlook may depend on the particular cause and treatment you receive certain treatments. You may experience improvements within a few weeks but be sure to see a doctor if your symptoms don’t get better after seven months. Ask your doctor for healthy dietary guidelines, and continues to monitor your progress by following up with him/her regularly. Increase your activity gradually.