Cushings syndrome is a disorder where there is an excessive production of cortisol inside the body.
Cortisol is a hormone that is released by the adrenal gland which is anatomically located at the upper most portions of the kidneys. This hormone is primarily responsible in supporting the individual in coping with stressful circumstances. It also regulates blood pressure.
In addition, cortisol maintains the function of the circulatory system. A reduction in the inflammatory phase during the immune response is also one of the vital functions of cortisol. It also maintains and controls the effect of insulin which is mainly responsible in breaking down glucose inside the body. It also has an influence on fat, carbohydrates, and protein metabolism.
When there is an adequate amount of cortisol circulating within the body, there are certain mediators that lessen the release of this hormone in the blood. However, because of inherent problems present inside the body, the production of cortisol cannot be regulated.
Causes of Cushings Syndrome
Cushings syndrome is the term that is used to describe a disorder that is characterized by an increase production of cortisol. The problem may be due to a tumor that is localized at the adrenal glands. The disease has a predilection for women than men and occurs more frequently at ages 20 to 40 years old.
Moreover, the term “Cushings disease” may be considered as a subtype of Cushing’s syndrome. It is the term used when the excessive production of cortisol is caused by a problem in the pituitary gland.
The hormones released by the pituitary gland that mainly supervise the release of cortisol in the adrenal glands are called adenocorticotropic hormone (ACTH). The increase in production of ACTH entails an excessive creation of the cortisol hormone in the body. The problem may be due to the presence of pituitary adenoma. In cases of Cushing’s syndrome, this type of case is a frequent finding.
Other tumors present in other areas of the body may have the capacity to release ACTH, and these are commonly termed as ectopic tumors.
Rarely, within the family, there is the tendency to inherit problems related to the disease. For example, the predisposition of the body to develop tumors on the endocrine glands. However, in most cases, it is not genetically inherited.
Clinical Features of Cushings Syndrome
Generally, the most common clinical features of an individual with Cushings syndrome are a sudden gain in weight, high blood pressure, mood swings, and memory difficulties. Weight gain is commonly associated with an increase in the size of the trunk. The extremities, such as the arms and the legs, are usually not involved in this process.
Muscle fatigue, presence of additional adipose tissue around the collar, moon face, and menstrual cycle irregularity are also common features of Cushings syndrome.
In mild cases of this disorder, the clinical features are not all present. Some individuals may present only a slight gain in weight and irregular menstrual cycle. In severe cases, most of the clinical features are observed.
Cushings Syndrome and Pseudo-Cushings States
There are certain illnesses that mimic Cushings syndrome and are cumulatively called pseudo-Cushing’s states. These include psychiatric problems such as depression and uncontrolled diabetes. Individuals undergoing strenuous activities and pregnant women may also present the same clinical features.
Diagnosis of Cushings Syndrome
There are three types of laboratory examinations that specifically distinguish the amount of circulating cortisol inside the body. These tests either measure the amount of cortisol in the saliva or in the urine.
These laboratory exams are the most commonly used. These are called the 24-hour urinary free cortisol level, low-dose dexamethasone suppression test.
These laboratory exams don’t specifically detect the presence of Cushings syndrome because of the existence of pseudo-Cushing’s states. So the best thing to do is treat pseudo-Cushing’s states before a definitive diagnosis can be made.
Diagnosis of the disorder can be made through careful evaluation of the medical history, laboratory examinations, and physical examination. Tumors can be located specifically using radiographic examinations.
Treatment of Cushings Syndrome
In any kind of disease, eliminating the etiologic factor is always the priority of treatment. That is the reason why when treating this syndrome it is best to know what causes it.
The treatment options for Cushing’s syndrome include the surgical removal of the ectopic tumor, removal of the adrenal glands, or removal of the pituitary adenoma. Removal of the adrenal glands entail that the patient has to take a cortisol-like hormone for the rest of his/her lifetime.
Taking medicines are also effective in decreasing the amount of cortisol inside the body.
Radiation therapy offers another option when surgical removal of the tumor is not successful. However, this therapy takes approximately ten years for it to have a complete effect. One side effect of this therapy is that it has an influence on the cells of the pituitary. That is why replacement hormones are also taken during those ten years.
After undergoing treatment for Cushings syndrome, the patient will eventually feel better. The change is gradual because the cortisol levels are responsible in physically changing the brain and the body. This process is slow so the individual’s patience is essential.