Cushing's syndrome

Cushing’s syndrome – also known as hypercortisolism – is a metabolic disorder, occuring when the body is exposed to elevated levels of cortisol, the so-called ‘stress hormone’, for an extended period of time. 

Cushing's syndrome

Cortisol, a hormone produced by the adrenal glands, is vital to the body’s stress response, but it can negatively impact on other bodily systems. Usually this prolonged elevation in cortisol levels occurs as a result of high doses of glucocorticoids, a class of corticosteroid medication (used to treat, amongst others, conditions such as lupus, asthma and rheumatoid arthritis).

Other possible Cushing’s syndrome causes include overproduction of ACTH (adrenocorticotropic hormone, which signals for the body to release cortisol), often caused by tumour of the pituitary or adrenal glands, and familial Cushing’s syndrome.

What are its symptoms?

Cushing’s syndrome symptoms include:

  • Weight gain, usually quite rapid, particularly in the trunk, between the shoulders (a “buffalo hump”) and around the face, resulting in the condition’s characteristic round ‘moon face’
  • Easily bruised and thinning skin
  • Acne
  • Fatigue
  • Infections that take a long time to heal
  • Purple/pink stretch marks (striae) on the thighs, breasts and abdomen (caused by accelerated weight gain and weakened skin)
  • Muscle weakness
  • High blood pressure (hypertension)
  • High glucose levels
  • Excess facial and body hair in women
  • Decreased libido
  • Irregular periods
  • Depression and anxiety
  • Bone loss
  • Poor growth in children
  • Headache
  • Increased thirst and urination

How is it diagnosed? 

There is no definitive screening test used to reach a Cushing’s syndrome diagnosis. Your doctor will usually conduct a physical examination and take a medical history. If you’re a long-term user of corticosteroid drugs then this may point towards Cushing’s syndrome. 

However, in those cases where medication is not the cause, additional tests must be carried out. These may include a urine test, in which samples of your urine collected over 24 hours tested for consistent signs of excess cortisol, or saliva and blood tests, also used to determine cortisol levels. 

Imaging test may also be used to look for abnormalities of the pituitary and adrenal glands.

What are your treatment options? 

Cushing’s syndrome treatment options vary, depending on what is behind the raised cortisol levels. If the use of corticosteroid medication is the culprit, your doctor may suggest reducing your dosage over time or, if available, may prescribe a non-corticosteroid alternative. 

If a tumour is causing the Cushing’s syndrome, surgery may be necessary to remove it and radiation therapy may be employed to use any part that cannot be surgically removed. In some cases, cortisol replacement therapy may then become necessary. 

If neither surgery nor radiation therapy are viable treatment options, medication to inhibit the body’s production of cortisol may be prescribed.

Can it be prevented? 

While Cushing’s syndrome can be endogenous (meaning it originates within the body as a result of the body’s own overproduction of cortisol), it is most often exogenous – the result of too much cortisol being introduced into the body as a result of corticosteroid therapy being used to treat another condition. 

As a result, it is essential that you always use these medicines exactly as prescribed and don’t take them unnecessarily. Additionally, make sure you work with your doctor to monitor your health and take heed of any new symptoms early, so your treatment can be modified if needs be.

IMAGE CREDIT: 123rf.com

The accuracy of this information was checked and approved by physician Dr Thomas Blake in June 2016