Cushing's syndrome (also called hypercortisolism or hyperadrenocorticism) is an endocrine disorder caused by high levels of cortisol in the blood from a variety of causes, including primary pituitary adenoma (known as Cushing's disease), primary adrenal hyperplasia or neoplasia, ectopic ACTH production (e.g., from a small cell lung cancer), and iatrogenic (steroid use). Normally, cortisol is released from the adrenal gland in response to ACTH being released from the pituitary gland. Both Cushing's syndrome and Cushing's disease are characterized by elevated levels of cortisol in the blood, but the cause of elevated cortisol differs between the two. Cushing's syndrome is rare. About 5 in a million people develop it each year. Most cases are in people aged between 20 and 50. Common symptoms of Cushing's syndrome include upper body obesity, severe fatigue and muscle weakness, high blood pressure, backache, elevated blood sugar, easy bruising, and bluish-red stretch marks on the skin. In women, there may be increased growth of facial and body hair, and menstrual periods may become irregular or stop completely. Neurological symptoms include difficulties with memory and neuromuscular disorders.
Causes of Cushing's Syndrome
Cushing's syndrome occurs when the body's tissues are exposed to excessive levels of cortisol for long periods of time. Many people suffer the symptoms of Cushing's syndrome because they take glucocorticoid hormones such as prednisone for asthma, rheumatoid arthritis, lupus or other inflammatory diseases.
Others develop Cushing's syndrome because of overproduction of cortisol by the body. Normally, the production of cortisol follows a precise chain of events. First, the hypothalamus, a part of the brain which is about the size of a small sugar cube, sends corticotropin releasing hormone (CRH) to the pituitary gland. CRH causes the pituitary to secrete ACTH (adrenocorticotropin), a hormone that stimulates the adrenal glands. When the adrenals, which are located just above the kidneys, receive the ACTH, they respond by releasing cortisol into the bloodstream
Symptoms of Cushing's Syndrome
Symptoms vary, but most people have upper body obesity, rounded face, increased fat around the neck, and thinning arms and legs. Children tend to be obese with slowed growth rates.
Other symptoms appear in the skin, which becomes fragile and thin. It bruises easily and heals poorly. Purplish pink stretch marks may appear on the abdomen, thighs, buttocks, arms and breasts. The bones are weakened, and routine activities such as bending, lifting or rising from a chair may lead to backaches, rib and spinal column fractures.
Treatment of Cushing's Syndrome
Treatment for Cushing's syndrome depends on its cause. Surgery may be needed to remove tumors of the adrenal glands.
Gradual withdrawal of cortisone-type drugs (under close medical supervision).
Radiotherapy to the pituitary gland can destroy the pituitary adenoma. This has a good chance of success, but may take months or years to take effect. Medication (see below) may be needed until the radiation treatment takes effect. Also, the radiotherapy may damage the normal pituitary cells, and may cause low levels of other hormones made by the pituitary gland. However, replacement hormone therapy can usually be taken if this occurs..
Adrenal Tumors Surgery is the mainstay of treatment for benign as well as cancerous tumors of the adrenal glands. In Primary Pigmented Micronodular Adrenal Disease and the familial Carney's complex, surgical removal of the adrenal glands is required.
Cushing's syndrome is a rare endocrine disorder caused by high levels of cortisol in the blood. Sometimes called "hypercortisolism. It is relatively rare and most commonly affects person aged 20 to 50. An estimated 10 to15 of every million people are affected each year. Cushing's syndrome occurs when the body's tissues are exposed to excessive levels of cortisol for long periods of time. Many people suffer the symptoms of Cushing's syndrome because they take glucocorticoid hormones such as prednisone for asthma, rheumatoid arthritis, lupus and other inflammatory diseases, or for immunosuppression after transplantation. Cushing's syndrome is also a relatively common condition in domestic dogs in which causes are the same as the syndrome in humans, and in horses, (where it is almost invariably caused by pituitary neoplasia) characterised by a long, tightly curled coat which does not shed and abnormal fat deposition. The syndrome in horses leads to weight loss, polyuria and polydipsia and may cause laminitis.
Cushing's disease is the name given to a type of Cushing's Syndrome caused by too much ACTH production in the pituitary. The most common cause of Cushing's syndrome is the use of oral corticosteroid medication. Common symptoms of Cushing's syndrome include upper body obesity, severe fatigue and muscle weakness, high blood pressure, backache, elevated blood sugar, easy bruising, and bluish-red stretch marks on the skin. Risk factors for Cushing syndrome are adrenal or pituitary tumors, long-term therapy with corticosteroids, and being female. Many people suffer the symptoms of Cushing's syndrome because they take glucocorticoid hormones such as prednisone for asthma, rheumatoid arthritis, lupus or other inflammatory diseases. Cortisol performs vital tasks in the body. It helps maintain blood pressure and cardiovascular function, reduces the immune system's inflammatory response, balances the effects of insulin in breaking down sugar for energy, and regulates the metabolism of proteins, carbohydrates, and fats.
Common findings on routine laboratory tests in people with Cushing's Syndrome include a higher white blood count, a high blood sugar (often into the diabetic range), and a low serum potassium. One of cortisol's most important jobs is to help the body respond to stress. Some rare tumours in other parts of the body sometimes make ACTH. For example, some types of lung cancer. The 'ectopic' ACTH then stimulates the adrenals to make too much cortisol. People suffering from depression, alcoholism, malnutrition and panic disorders also have increased cortisol levels. Treatments for Cushing's syndrome are designed to lower the high level of cortisol in your body. Cushing's syndrome is treated by restoring a normal balance of hormones. Cushing syndrome caused by an adrenal tumor is usually treated by surgical removal of the tumor.Hormone supplements are usually given before surgery and must be taken for weeks and sometimes months after surgery, until the second gland recovers normal function. Medications to control excessive production of cortisol include ketoconazole (Nizoral), mitotane (Lysodren) and metyrapone (Metopirone). Medical therapy is also sometimes used before surgery for people who are very sick.
Treatment for Cushing's disease Tips
1. Cushing's syndrome is treated by restoring a normal balance of hormones.
2. Cushing syndrome is usually treated by surgical removal of the tumor.
3. Hormone supplements are usually given before surgery and must be taken for weeks and sometimes months after surgery, until the second gland recovers normal function.
4. Medications to control excessive production of cortisol include ketoconazole (Nizoral), mitotane (Lysodren) and metyrapone (Metopirone).
5. Radiation therapy-Radiation can be given in small doses over a six-week period, or by a technique called stereotactic radiosurgery or gamma-knife radiation.
6. Chemotherapy - radiation treatments of the pituitary gland (to weaken it and lower its output of ACTH) - or removal of any benign growths of the pituitary gland.
7. Adrenal adenomas are always treated by surgically removing the tumor with either an abdominal or side (flank) incision.
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