Cushing's syndrome is a hormonal disorder caused by long-term exposure to abnormally high levels of cortisol. Sometimes, corticosteroids used to treat inflammatory disease can lead to Cushing's syndrome. At other times, the disorder is caused by a tumor on one of the endocrine glands or on the lungs. Cushing's syndrome should not be confused with Cushing's disease, which is a form of Cushing's syndrome in which the pituitary gland secretes too much adrenocorticotropic hormone (ACTH) which in turn promotes the release of too much cortisol. Cushing's syndrome most frequently occurs in adults between the ages of 20 and 50. Patients who are obese, diabetic, or suffer from hypertension are at greater risk of developing the disorder.
Symptoms of Cushing's Syndrome
Because cortisol affects so many systems of the body, Cushing's syndrome has a wide variety of symptoms. A patient with this disorder may have only some of the symptoms and they may develop gradually, making diagnosis difficult. Symptoms of Cushing's syndrome include:
- Weight gain, particularly as a hump on the back
- Bone or muscle weakness, bone fractures
- Puffy round face (moon face)
- Stretch marks, acne, or bruising
- Slow healing of wounds
- Depression, anxiety or irritability
- Cognitive difficulties
- Irregularity or absence of menses
- Sexual or reproductive difficulty
- Hirsutism in women
- Glucose intolerance
- Glaucoma or cataracts
If Cushing's syndrome is the result of a tumor on the lungs, weight loss, loss of appetite or hyperpigmentation may also occur.
Diagnosis of Cushing's Syndrome
The diagnosis of Cushing's syndrome is based on a review of medical history, a physical examination, and laboratory tests. Blood, urine and saliva may be examined to check cortisol and ACTH levels. In addition, blood glucose, testosterone, potassium, and cholesterol levels may be taken, and clotting time may be measured. Imaging tests, such as X-rays, CT scans and MRI may also be administered to locate any possible tumors.
Risks of Cushing's Syndrome
Cushing's syndrome carries a risk of serious, sometimes life-threatening complications. Without successful treatment it may lead to:
- Bone loss and compression fractures
- Kidney stones
Left untreated, Cushing's syndrome may also lead to frequent infections.
Treatment of Cushing's Syndrome
Treatment for Cushing's syndrome is dependent on the cause of the disorder. If the condition is found to be the result of corticosteroid use, the patient may be weaned from such medications and other drugs may gradually be substituted. If the disorder is found to be caused by a tumor, treatment will probably include some combination of surgery, chemotherapy, radiation, or the administration of cortisol-inhibiting medication. While surgery is usually the first line of defense, it may not be possible for all patients. Treatment of Cushing's syndrome is usually successful, but the condition may reoccur. Recurrence of the syndrome is much more frequent in children. In the case of tumor regrowth, surgery may have to be repeated