Cushing Syndrome is a condition affecting worldwide, due to an increased use in a type of drug called steroids. However, there are a reduced amount of cases that can happen from inner-body hormonal impairments that lead to the same dead-end. This condition is highly associated with complications in the long run. Therefore, it is important to acknowledge the risk factors and symptoms for an early assessment and diagnosis. Please, just keep reading through for an in-depth knowledge directly from a physician of Cushing Syndrome.
What is Cushing Syndrome?
Since the first description by Harvey Cushing in the early 20th century. Cushing Syndrome is the term used for an excessive level of steroid hormones (glucocorticoids) within the body. The source of glucocorticoid hormones could be from endogenous (body production) or exogenous (treatments with steroids). By far, the most common cause of this condition is by exogenous steroid hormones, due to mismanagement by either a physician, the patient, or just a long-term needed treatment. Even though exogenous Cushing syndrome accounts for more than 99% of the cases, endogenous Cushing syndrome must be always ruled out before starting treatment.
What are the steroid hormones?
Steroids hormones are molecules principally composed of cholesterol which converts them in specialist transcending cell membranes. There are many types such as sex steroids and corticosteroids. But strictly speaking in this case, glucocorticoids which are a subset of corticosteroids are the core molecules implicated in this condition.
Glucocorticoid hormones display a wide range of functions within the body by binding to their specific receptor command functions like regulation of metabolism, cognition, mental health, cell wellness and even control inflammatory responses. In fact, due to the extensively known anti-inflammatory properties, glucocorticoids are employed in several inflammatory and autoimmune diseases worldwide such as allergic disorders, rheumatoid arthritis, lupus erythematosus, inflammatory bowel disease, transplant rejection, and asthma.
Glucocorticoids synthesis and release takes place in the adrenal gland that lies just over the kidney. This process is rigorously regulated in the body by upper structures located in the skull that is called the hypothalamus, and hypophysis. Hypothalamus secretes a molecule called ACRH that stimulates the hypophysis to secrete ACTH which activates the adrenal gland to produce glucocorticoids.
What causes Cushing Syndrome?
When the cause is endogenous, there are two possible mechanisms for a decontrolled overproduction of glucocorticoids. Depending on ACTH and independent of ACTH. ACTH dependent is the most common cause in 9 of every 10 patients by an ACTH-secreting pituitary adenoma which means that non-cancer related tissue grows and starts overproducing ACTH that stimulates the adrenal gland to produce a vast number of glucocorticoids hormones. The other mechanism which is independent of ACTH could be by adrenal corticosteroid secreting tissue located in anomalous places and ACRH overproduction. These two latter mechanisms account for less of 5% of the cases in children above the 5 years. Nevertheless, in children below 5 years independent of ACTH mechanisms could explain nearly half of the cases.
The exogenous mechanism is by a long period of taking steroids treatment. Despite their beneficial influence over the patient’s disease, there are multiple side effects associated with steroid treatment such as osteoporosis, hyperglycemia, insulin resistance, disturbed fat localization, hypertension, and muscle atrophy.
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What are the symptoms of Cushing Disease?
Typically, these symptoms have been occurring for about 4 or 5 years. The patients manifest thin skin, easy bruising, and muscle weakness. Other characteristics are purple striae, oily skin, the face appearance changes towards a moon-shaped one, face’s color turned into a pale red (the oldest indicator of an active and acute disease), and obesity. What should really raise the suspicious in regards to Cushing Disease, is the appearance of chronic conditions of the elderly happening in relatively young people such as the aforementioned hypertension, type 2 diabetes mellitus, and osteoporosis.
How is Cushing Disease diagnosed?
The foremost important instrument to diagnose this condition is a well-elaborated interrogation. Given that, more than 99% of the cases are from exogenous causes the first clue must be to find out if the patient is taking any kind of steroid treatment. Then, to evaluate the levels of the steroids in the patient’s body to reassure that indeed are elevated. There are many types of tests available for determining cortisol (glucocorticoid) levels such as Twenty-four-hour urinary free cortisol assay, Low-dose dexamethasone suppression test, and Diurnal serum cortisol measurement. Also, ACTH and ACRH levels are measured. Furthermore, if an ACTH dependent Cushing Syndrome is suspected a magnetic resonance image (MRI) of the pituitary gland within the head is warranted to identify any anomalous growth.
Does Cushing Syndrome have a treatment?
Yes, nearly all the causes of Cushing Syndrome have treatment, although the underlying cause must be found first. In the exogenous Cushing Syndrome, a change in the amount and form steroid treatment is received must take place. Even if it requires to stop the medication. But, when steroids treatment has been given for long term stopping them could trigger severe life-threatening conditions (acute or chronic adrenal insufficiency).
Therapy could carry a life-time medication if the capacity of the gland capacity worn-out, surgery for removing adrenal gland in patients with endogenous over-production of Cushing Syndrome, and treatment for reducing the impact of cortisol in the body when the source cannot be found.
I am presenting symptoms of Cushing Disease, what can I do?
I designed a Cushing Disease symptoms checker for helping you to determine how likely is that your symptoms are indeed caused by this condition. It is free, and would only take a few minutes.