Cushing’s Syndrome

Cushing’s Syndrome is a condition that happens with hormonal changes that occur because the body has too much of the hormone Cortisol over a long period of time.

Because of the abundance of Cortisol, the body changes and it is possible to see a hump on the back, between the shoulders. The patient may develop a rounded face and pink and purple stretch marks on the skin. Additionally, other medical conditions such as Hypertension, Type II Diabetes, and Bone Loss can be seen.

Sometimes the excess Cortisol comes from taking medicines called glucocorticoids for long periods of time.

The goal of treatment is to lower the body’s cortisol levels and improve symptoms. Earlier that treatment can be given, the greater chances of improvement.

Symptoms

–  Weight gain in the trunk – often the legs and arms are thin.
–  Moon face – weight gain in face area
–  Buffalo Hump – weight gain, lump, between shoulders
–  Stretch marks – on stomach, hips, thighs, breasts, and underarms (axilla).
–  Skin that is frail and easily bruises.
–  Slow healing wounds
–  Worsening acne
–  Hirsutism – brown/dark facial and body hair.
–  Periods that are irregular or have stopped completely
–  Lower or absent sex drive
–  Fertility problems
–  Erectile Dysfunction
–  Muscle Weakness
–  Difficulty sleeping
–  Skin darkening
–  Headaches
–  Fatigue
–  Emotional changes
–  Insomnia
–  Others

Causes

–  Cortisol is a hormone that can help control blood pressure, reduce inflammation, helping control blood sugar, and is part of the process of metabolism.
–  When the source of extra Cortisol is from outside the body, from an external source it is called Exogenous.
–  Glucocorticoids can be taken by mouth, given a shot, or rubbed into the skin.
–  When the body makes too much steroids – it is called Endogenous.
–  ACTH (adrenocorticotropic hormone) is a hormone made in the pituitary gland that controls how much Cortisol is made.
–  Some tumors make ACTH, which creates more cortisol and can cause Cushing syndrome.
–  Problems with the adrenal glands also can affect cortisol and cause Cushing syndrome.

Complications

Without treatment, Cushing syndrome can cause complications, including:

1.) Bone loss – Osteoporosis – which can lead to broken bones.

2.) High blood pressure, also called hypertension.

3.) Type 2 diabetes.

4.) Serious or multiple infections.

5.) Loss of muscle mass and strength.

Diagnosis

Taking glucocorticoid medicines is the most common way to get Cushing syndrome. Your health care provider can look at all your medicines — pills, injections, creams and inhalers — to see if you’re taking medicines that can cause the syndrome. If you are, you won’t need other tests.

Other Testing:

1.) Blood Work and Urine Testing

2.) Saliva Testing

3.) CT or MRI

4.) Inferior petrosal sinus sampling

–  This test can help decide if an ACTH-producing pituitary adenoma, or ACTH-producing tumor in another organ.

Treatment

Designed to lower the amount of cortisol in the body.

1.) Reduce Glucocorticoid Use

2.) Surgery

–  If tumor is present, surgery may be required – which can be a Pituitary tumor and can be removed through the nose.

–  If the surgery is required for a tumor in a different part of the body, a less invasive surgery may be performed

3.) Radiation Therapy

–  If the tumor cannot be completely removed, radiation treatment may be required.

–  This can be done in 1 large dose or six smaller doses.

4.)  Medications

There are medications to control cortisol production at the adrenal gland.

.     Ketoconazole

.     Osilodrostat (Isturisa)

.     Mitotane (Lysodren)

.     Levoketoconazole (Recorlev)

.     Metyrapone (Metopirone)

.     Mifepristone (Korlym, Mifeprex) is approved for people with Cushing syndrome who have type 2 diabetes or high blood sugar. Mifepristone does not lower the amount of cortisol the body makes, but it blocks the effect of cortisol on tissues.

.     Pasireotide (Signifor) is a shot that is given two times a day. It works by lowering the amount of ACTH from the tumor, which lowers cortisol levels. Other medicines are being developed.