Cushing Syndrome Causes: Symptoms of Cushing Syndrome

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Refer the causes, symptoms and treatment of Cushing Syndrome, a disorder that is caused mostly by the hormonal imbalance.

Cushing’s syndrome is a rare endocrine disorder that is caused mainly by the hormonal imbalance in the body. It is also known as hypercorticism or hyperadrenocorticism. Commonly, it affects person between the age of 20 and 50. As per estimation, 10 to15 of every million people are affected each year. Cushing syndrome is named after American doctor Dr. Harvey Cushing. It results when the body’s tissues are exposed to excessive levels of cortisol for long periods of time. People who suffer from type 2 diabetes, obesity and high blood pressure have high risks of developing this disorder.

In this medical condition, the pituitary gland starts to produce large amount of ACTH (Adrenocorticotropic Hormone) in blood, which in turn increases cortisol level in blood (ACTH hormones are essential to stimulate secretion of cortisol by adrenal glands). It is a very complex hormonal condition affecting many parts of the body. Many people suffer from Cushing’s syndrome as they take glucocorticoid hormones. Cushing’s syndrome is common condition in domestic dogs in which causes are the same as the syndrome in humans, and in horses and characterized by a long, tightly curled coat which does not shed and abnormal fat deposition.

Causes of Cushing’s syndrome:

No particular cause is responsible for raised level of cortisol in the blood. Cushing’s syndrome takes place when the body’s tissues are exposed to excessive levels of cortisol for long periods of time. The most common cause of raised cortisol level in the blood is because of exogenous administration of glucocorticoids (steroid hormones). Glucocorticoids are generally given to a patient for treatment of diseases like asthma, rheumatoid arthritis, lupus and other inflammatory diseases, or for immunosuppression after transplantation.

Cortisol level in blood can also be increased due to problems associated to pituitary gland that secrete ACTH hormones. Normally, the secretion of ACTH hormone by pituitary gland is reserved under check/control and only required amount of ACTH hormone is released that help to secrete cortisol in blood by adrenal glands. Cushing’s syndrome can be caused by malfunctioning of this system.

Pituitary Cushing’s disease is associated to problem with pituitary glands and leads to raised secretion of ACTH hormone, which in turn stimulates secretion of cortisol by adrenal glands. Adrenal Cushing’s disease is associated to adrenal glands in which adrenal glands develop tumors that result in excessive secretion of cortisol in blood.

Pituitary Adenomas:

Most cases of Cushing’s syndrome are caused by pituitary adenomas. These benign, or non-cancerous, tumors of the pituitary gland secrete excess amounts of ACTH. Most patients have a single adenoma and this form of the syndrome is known as “Cushing’s disease”. Women are five times more frequently affected by this disease than men.

Adrenal Tumors:

An abnormality of the adrenal glands can also be responsible for the development of Cushing’s syndrome. The average age of arrival is about 40 years and most cases involve non-cancerous tumors of adrenal tissue, called adrenal adenomas, which release excess cortisol into the blood.

Familial Cushing’s syndrome:

Cushing’s disease is inherited in some cases. Due to an inherited tendency to develop tumors of one or more endocrine glands, some individuals have special causes of Cushing’s syndrome. Children or young adults develop small cortisol-producing tumors of the adrenal glands in primary pigmented micronodular adrenal disease. In multiple endocrine neoplasia type I (MEN I), hormone secreting tumors of the parathyroid glands, pancreas and pituitary take place.

Ectopic ACTH Syndrome:

Some benign or malignant (cancerous) tumors that crop up outside the pituitary can generate ACTH. This condition is known as ectopic ACTH syndrome. Over 50 percent of these cases can be caused by lung tumors. It affects 3 times more frequently in men than women. Oat cell, or small cell lung cancer, which accounts for about 25 percent of all lung cancer cases, and carcinoid tumors, are the most common forms of ACTH-producing tumors. Thymomas, pancreatic islet cell tumors, and medullary carcinomas of the thyroid are other less common types of tumors that can produce ACTH.

Signs and symptoms of Common Cushing’s syndrome:

Cushing Syndrome Causes: Symptoms of Cushing Syndrome

Severe fatigue
Muscle weakness
Rounding of your face (moon face)
Facial flushing
Acne
Decreased libido
Headache
Erectile dysfunction in males
Weight gain, particularly around your midsection and upper back
Thin and fragile skin that bruises easily
New or worsened high blood pressure
Glucose intolerance that may lead to diabetes
Slow healing of cuts, insect bites and infections
Depression, anxiety and irritability
Increase in urination and thirst
Loss of emotional control
Thicker or more visible body and facial hair (hirsutism)
Irregular or absent menstrual periods in females
Bone loss, leading to fractures over time
Fatty pad or hump between your shoulders (buffalo hump)
Pink or purple stretch marks (striae) on the skin of your abdomen, thighs, breasts and arms

Diagnosis of Cushing’s syndrome:

Several tests are performed to diagnose Cushing’s syndrome in patient. These tests include:

LDDS Test (Low Dose Dexamethasone Suppression Test): In this test, the patient is given low dose of synthetic glucocorticoid at some interval. Dexamethasone stops cortisol production, except when the patient has Cushing’s syndrome and urine samples are taken before, during and after taking tablets to come to any conclusion.

Urine Test for Cortisol Level: In this test, urine samples are collected over a 24-hour period and tested for levels of cortisol. Patients with Cushing’s syndrome have constantly high levels of cortisol in their urine. For test, the patient may be asked to urinate every hour or 2 hours to collect urine.

Dexamethasone-CRH Test (Dexamethasone-Corticotropin-Releasing Hormone Test): This test is used to differentiate between cases of pseudo-Cushing and mild Cushing. It is a combination of LDDS Test and CRH-stimulation.

Midnight Plasma Cortisol and Late-night Salivary Cortisol Measurements: The cortisol production in patient’s body does not get suppressed as in normal person during night, if he/she is suffering from Cushing’s syndrome. Patient’s saliva sample is taken to assess the cortisol level in blood and come to any conclusion.

Several other tests are also used to find out causes of Cushing’s syndrome which includes:

Petrosal Sinus Sampling
CRH Stimulation Test
Radiologic Imaging (visualization of endoctrine glands)
HDDS (High Dose Dexamethasone Suppression) Test

Treatment for Cushing’s syndrome:

Treatment is aimed to restore a normal balance of hormones and bringing down cortisol levels. Treatment options for Cushing’s syndrome are based on the patient’s condition and necessity.

Corticosteroid use:

Patients who take long-term high dosage corticosteroids may have their dosages slowly decreased. It is essential that the dosage lowers enough to reduce cortisol levels, while at the same time still effectively treating the asthma, arthritis or other condition. Sometimes, the patient may be prescribed a non-corticosteroid medication.

Surgery:

Sometimes, the surgery is recommended to remove a tumor. A pituitary tumor may be eliminated through the patient’s nose. Adrenal glands, pancreas or lung tumor may be eliminated with conventional surgery, or keyhole surgery (laparoscopic surgery, or minimally invasive surgery). After surgery, patients will require to take cortisol replacement drugs. The doctor will taper down the cortisol replacement drugs as the adrenal hormone production returns to normal level.

Radiotherapy (radiation therapy):

If the surgeon cannot eliminate the tumor completely, then this may be used. Patients who are not suitable for surgery may recommend receiving radiation therapy in small doses over a number of weeks. Sometimes, the radiation therapy is administered as a single treatment.

Drugs:

The doctor may prescribe medications to control excessive production of cortisol, if surgery or radiation is not effective enough. Examples of these medications include ketoconazole (Nizoral), mitotane (Lysodren) and metyrapone (Metopirone). The doctor may prescribe HRT (hormone replacement therapy), if a tumor causes low hormone production,.

Chemotherapy:

If the syndrome is caused by a cancerous tumor, such as a lung tumor, then the doctor may suggest chemotherapy. Drugs are injected to devastate cancer cells.