Do you feel that your skin becomes dark, brittle and bruised and your face looks round like the full moon? So there could be a permanent surplus of the hormone cortisol behind it. Learn to recognize the symptoms and what you can do to prevent Cushing’s syndrome .

What is Cushing’s syndrome?

Cushing’s syndrome is a metabolic disorder that occurs as a result of too high levels of cortisol  in the body. The grouping of symptoms that causes the disease is summarized in the term, which owes its name to the American neurosurgeon Harvey Williams Cushing.

Cortisol is a hormone that belongs to the glucocorticoids and is formed in the adrenal cortex. It is influenced, among other metabolisms, the immune system, cardiovascular system and nervous function.

In case of stress, the body releases more hormone so that it can better handle stress. Hence, it is often referred to as the stress hormone. However, if new cortisol is constantly formed over a long period of time, it will lead to  hypercortisolism , which has an effect on health.

What are the causes of Cushing’s syndrome?

The cause of Cushing ‘s syndrome is mainly prolonged hypercortisolism , so there is an excess of cortisol in the blood. Again, there are different triggers, which are divided into two groups. Because the body receives too many glucocorticoids or produces more cortisol than normal:

1. External causes:

Cushing’s syndrome is most commonly caused by the use of cortisone or other glucocorticoid medications. Then doctors talk about exogenous Cushing’s syndrome. Taking ACTH (adrenocorticotropic hormone), a hormone that increases glucocorticoid production, can also trigger the disease.

Another possible cause that can be influenced from the outside is the excessive consumption of alcohol , since it increases the production of ACTH. In rare cases, taking birth control leads to a change in cortisol levels.

2. Internal causes:

In rare cases, tumors in the adrenal cortex, bronchi, thyroid, or brain are the cause of Cushing’s syndrome. If there is a tumor in the pituitary gland, the disease is known as Cushing’s disease. The so-called  endogenous Cushing syndrome  occurs only with a frequency of 1 in 100,000, but women are more affected than men.

Endogenous Cushing syndrome differs further in:

ACTH-dependent:  A tumor in the pituitary gland is the cause of excess cortisol in about 85 percent of cases. Because in so-called Cushing’s disease, more ACTH is released, which in turn causes the level of cortisol to rise.

ACTH independent:  In very rare cases, cortisol is produced directly in the adrenal cortex, independent of ACTH. The cause is usually also a tumor.

What are the symptoms?

Persistent excess cortisol affects metabolism, the cardiovascular system, and the nervous system. Cushing’s syndrome therefore has the following symptoms:

  • Weight gain, especially in the abdomen, upper body, and hips.
  • Rounded face (moon face).
  • Hypertension.

In the course of the disease, there may be other signs and symptoms that occur individually or simultaneously:

  • Bull neck (neck not distinguishable)
  • Water retention (edema).
  • Excess body hair, especially in women.
  • Impotence problems, loss of sexual desire.
  • Changes in the skin in the form of red stripes (stretch marks), acne, itching.
  • Wound healing problems.
  • High cholesterol level
  • Tiredness, apathy.
  • Changes in the psyche, mood swings, depression.
  • Increased susceptibility to infections.
  • Mellitus diabetes.
  • Loss of muscle mass.
  • Osteoporosis as a result of a calcium deficiency.
  • Poor growth in children.

If Cushing’s syndrome is not detected for a long time, the sequelae can be dangerous. Therefore, at the first sign, a doctor should be consulted to check cortisol levels . If the excess of the hormone cortisol is treated, the chances of recovery are quite good.

How does the doctor recognize Cushing’s syndrome?

Already during the conversation, the doctor can recognize external symptoms, such as the typical round face or being overweight. On the basis of blood and urine, the cortisol level is determined in the laboratory for further diagnostics:

  • Dexamethasone short test : Blood is tested for its cortisol content after taking dexamethasone.
  • 24-hour urine : In addition, the urine is tested for cortisol.

If the suspicion also confirms the blood values, there are other tests to confirm the diagnosis. These investigations are primarily to clarify the cause of Cushing’s syndrome and exclude tumors:

  • CT (computed tomography).
  • MRI (magnetic resonance imaging).
  • X-ray.
  • Scintigraphy.
  • Angiography.

Which doctor is the right one

Since Cushing’s syndrome is based on a hormonal imbalance , an  endocrinologist  is a specialist. However, at first glance, you can visit the GP, who can make the referral in case of suspected disease for the specialist to examine again.

How is Cushing syndrome treated?

Treatment depends on whether it is an exogenous or endogenous Cushing syndrome:

  • Exogenous Cushing syndrome : Since an intake of cortisone is usually the trigger for symptoms, the doctor adjusts the dose of the drug.
  • Endogenous Cushing syndrome : If the cause is a tumor, the doctor will consider whether an operation is necessary and what treatment is done, such as radiation, chemotherapy, or medication.

How long does the treatment last?

In most cases, weight loss and the first improvement in symptoms begin after discontinuation or conversion of the drug. The duration of therapy for endogenous Cushing syndrome depends on the type of tumor. However, it may take several months for  the cortisol level in the blood to return to normal .

How can it be prevented?

Endogenous Cushing syndrome is difficult to prevent. To prevent the formation of tumors, it is advisable to have a generally healthy lifestyle with a diet rich in nutrients, exercise, sufficient sleep, and abstinence from nicotine and alcohol.

To prevent exogenous Cushing syndrome, no cortisone or ACTH medication should be taken. However, since many diseases can only be treated with this, the doctor can prescribe and, if necessary, adapt an appropriate therapy. Regular monitoring of cortisol levels generally helps prevent the symptoms of Cushing’s syndrome.

What are the chances of recovery?

Since it is primarily cortisone or other medications that cause it, Cushing’s syndrome can be well treated or even cured completely . In about 50 to 80 percent of those affected, the symptoms return completely. Even in the treatment of tumors, the chances of recovery are quite good. Only with cancer in the bronchi a therapy is not very promising.

However, if Cushing’s syndrome remains unrecognized for a long time, the sequelae, such as hypertension or cardiovascular disorders, can lead to death. In addition, severe depression can occur, which if not treated can have serious consequences for the individual.

Consultation with a specialist is always necessary in order to detect any disease in time.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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