CUSHING SYNDROME: SYMPTOMS, CAUSES, TREATMENTS - NUTRITION - 2024

The Cushing 's syndrome is a rare medical condition caused by an excess of the hormone cortisol in the body. Cortisol is a hormone produced by the adrenal glands that is released in stressful situations such as fear, illness, etc.

When the body is subjected to high levels of cortisol for a long period of time, many of the characteristic symptoms of Cushing's syndrome or hypercortisolism may appear: increased blood pressure, weight gain, loss of bone mass, skin changes, among others,

Cushing's syndrome is a rare pathology that can be caused by a wide variety of factors such as tumors in the adrenal glands, excess production of adrenocorticotropic hormone (ACTH), exposure to glucocorticoid drugs, etc.

Generally, different tests and laboratory analyzes are used to confirm the presence of Cushing's syndrome, since the varied symptoms do not allow a precise clinical diagnosis.

Regarding treatment, the most effective interventions refer to those aimed at controlling or eliminating the etiological causes: removal of tumors, removal of adrenal glands, suspension of medication, etc.

Characteristics of Cushing's syndrome

Cushing's syndrome or Hypercortislism is an endocrine or metabolic type pathology (CSRF, 2016) and can be defined as a set of symptoms and signs resulting from the persistent and abnormal elevation of cortisol levels in the blood.

Therefore, Cushing's syndrome develops when cortisol levels are abnormally high. Although it may be due to different factors, one of the most frequent is the excessive consumption of glucocorticoid drugs.

Among the most notable characteristics of Cushing's syndrome is an increase in weight in the upper part of the body, a rounded face, and a propensity to suffer from skin bruises.

What is cortisol?

Cortisol is a type of hormone that belongs to the group of glucorticoids, since it has a prominent role in the metabolism of proteins and carbohydrates.

Glucoroticoids contribute to the production of fats as an energy source, increase blood flow and also stimulate body reactivity, among other functions, Specifically, cortisol is produced by the adrenal cortex and is known as the “stress hormone” (Carlson, 2010), since it is released in stressful situations.

Specifically, cortisol helps to maintain blood pressure levels, reduces the inflammatory response of the immune system, regulates the metabolism of proteins, carbohydrates or fats.

In addition, cortisol allows the body to respond to stressful environmental demands, generating enough energy to maintain the vital functions of the body.

However, when various conditions result in prolonged exposure of the body tissues to elevated levels of cortisol, various medical conditions may appear, including Cushing's syndrome.

Statistics

Cushing's syndrome is a rare medical condition (Healthline, 2016).

Despite the fact that there are few statistical data about the occurrence of this syndrome, it is estimated that it has a prevalence of one case per 50,000 people (NHS, 2015).

Cushing's syndrome can affect anyone, but it is most common in adults between the ages of 20 and 50 (Healthline, 2016). In addition, women are three times more likely to suffer from it than men (NHS, 2015).

Symptoms

The signs and symptoms caused by Cushing's syndrome can vary between those affected.

Some people will develop only some of the symptoms or several in a mild way, such as weight gain. However, in other more severe cases of Cushing syndrome, those affected may have almost all the characteristic symptoms of the disease (Nieman & Swearingen, 2016).

The most characteristic and common signs and symptoms of Cushing syndrome are (Nieman & Swearingen, 2016):

• Weight gain (more noticeable in areas of the body trunk).
• Increased blood pressure or hypertension.
• Changes in mood, concentration and / or memory.

Apart from these, other signs and symptoms that occur frequently in this pathology have also been observed:

• Rounded face.
• Increase in the percentage of fat in areas near the neck and head.
• Weight loss and reduction of muscle mass in arms and legs.
• Slower growth, in the case of the pediatric population.

On the other hand, Cushing's syndrome can also generate various symptoms at the skin and bone level:

• Contusions or small wounds on the skin that tend to progress slowly.
• Purple and pink markings on the abdomen, thighs, buttocks, arms, or breasts.
• Bone weakening
• Increased likelihood of fractures.

Also, Cushing's syndrome in women produces some specific signs and symptoms:

• Excessive growth of hair on the face, neck, chest, abdomen or muscles.
• Missing or irregular menstrual periods.

In the case of men it can also cause:

• Decreased fertility.
• Decreased appetite for sex.
• Erectile dysfunction.

In addition to this varied symptomatology, it is also possible that another series of less frequent medical events occur as a result of suffering from this pathology:

• Recurrent fatigue and tiredness.
• Insomnia.
• Fine skin and stretch marks.
• Acne.
• Alopecia.
• Swelling of the feet and legs
• Muscular weakness.
• Increased blood glucose level, diabetes.
• Increased feeling of thirst and urination.
• Irritability, anxiety, feelings of depression.

Causes

Cushing's syndrome, as we have noted above, occurs when our body is exposed to excessive or abnormally high levels of cortisol for a long period of time.

In many cases of Cushing syndrome, people who suffer from it usually present symptoms as a result of taking drugs that contain glucocorticoid hormones such as some of the treatments for asthma, arthritis, lupus, etc. (Massachusetts General Hospital, 2016).

In other cases, the characteristic symptoms of Cushing syndrome develop as a consequence of an imbalance in the production of cortisol. In addition, some people who suffer from alcoholism, depression, panic disorders, or malnutrition, may also have elevated levels of cortisol (Massachusetts General Hospital, 2016).

Corticosteroid drugs

Prolonged intake of high-dose corticosteroid drugs can increase corticol levels and unbalance its production.

Oral corticosteroids are used in the treatment of some inflammatory diseases such as rheumatoid arthritis, lupus and aspa, or with an immunosuppressive function (Mayo Clinic, 2013).

One of these drugs is prednisone, which has the same effect on the body as cortisol produced by the body. Because it is necessary to use it in high doses, side effects may appear, such as Cushing's syndrome due to excess cortisol (Mayo Clinic, 2013).

In addition to oral corticosteroids, Cushing's syndrome can also occur associated with the use of injectable corticosteroids such as those aimed at reducing joint pain, back pain, etc. (Mayo Clinic, 2013).

Inlate steroid drugs (asthma treatment) and steroid lotions (eczema treatment) are less likely to cause Cushing's syndrome (Mayo Clinic, 2013).

Cortisol production imbalance

Cushing's syndrome can also develop as a result of high cortisol production by the body.

In this case, Cushing's syndrome can be caused by an increase in the production of cortisol by the adrenal glands or an overproduction of the adrenocorticotropic hormone, responsible for controlling the production of cotisol.

Some of the conditions that are related to an overproduction of cortisol are (Massachusetts General Hospital, 2016):

• Tumor in the pituitary gland (pituitary adenoma): a tumor located in the pituitary gland, stimulates the production of adrenocorticotropic hormone (ACTH) which, in turn, stimulates the adrenal glands, increasing the production of cortisol. Generally, adenomas are benign or non-cancerous and occur more frequently in women than in men, in a ratio of 5: 1. When Cushing syndrome results from this disorder, it is called Cushing's disease.
• Ectopic ACTH syndrome: the presence of some tumors (benign or malignant) outside the pituitary gland can increase the production of adrenocorticotropic hormone (ACTH) and therefore cortisol levels.
• Primary pathology in the adrenal glands: some abnormalities in the adrenal glands such as cancerous tumors or carcinomas, can increase the release of various hormones such as cortisol.
• Familial Cushing syndrome: Although most cases of Cushing syndrome do not have a heritability component, some people have a genetic predisposition to develop tumors in the cortisol-secreting glands.

Diagnosis

Not all those affected by Cushing's syndrome present the same symptoms and course, in addition to hypertension and weight gain, are common conditions in the general population, so the precise and clinical diagnosis of Cushing's syndrome can be complicated (Nieman & Swearingen, 2016).

Medical specialists often use different diagnostic and laboratory tests to determine both the presence of the syndrome and the etiological cause (Nieman & Swearingen, 2016).

The most widely used diagnostic tests are those that measure the levels of free cortisol in 24-hour urine, blood and saliva (Spanish Society of Pediatric Endocrinology, 2016).

In addition, it is also possible to determine the excessive production of cortisol by the body through the dexamethesone suppression test. An oral drug is used to determine the concentration of cortisol through its regulation (Nieman & Swearingen, 2016).

Although these tests are the most common, they do not always reliably diagnose Cushing's syndrome, mainly because it can be caused by various medical pathologies (Nieman & Swearingen, 2016).

Therefore, it is usual to use other diagnostic procedures such as (Spanish Society of Pediatric Endocrinology, 2016):

• Determination of plasma ACTH concentrations by immunoradiometry.
• CRH stimulus test.
• Adrenal computed tomography.
• Pituitary nuclear magnetic resonance.

Treatment

Treatment for Cushing's syndrome essentially depends on the cause of the excess cortisol.

If the cause is related to the persistent intake of corticosteroid medications used to treat other conditions, medical specialists may reduce the doses until the symptoms of Cushing's syndrome are controlled.

In the case of the presence of tumors as an etiological factor of Cushing's syndrome, interventions such as surgery, radiotherapy, chemotherapy, immunotherapy, etc. may be used.

Therefore the treatment of Cushing's syndrome may include:

a) Reduction of corticosteroid medication.

b) Surgical treatment: pituitary surgery, adrenalectomy, removal of ACTH-producing tumor.

c) Radiotherapy, chemotherapy, immunotherapy.

d) Pharmacological treatment to reduce the level of cortisol.

Bibliography

1. Cleveland Clinic. (2016). Cushing's Syndrome. Obtained from Cleveland Clinic.
2. Healthline. (2016). Cushing's syndrome. Obtained from Healthline Media.
3. Massachusetts General Hospital. (2016). Cushing's Information. Obtained from Neuroendocrine Clinical Center.
4. Mayo Clinic. (2016). Cushing syndrome. Obtained from Mayo Clinic.
5. NHI. (2013). Cushing's Syndrome. Obtained from National Institute of Neurological Disorders and Stroke.
6. NHS. (2015). Cushing's Syndrome. Obtained from NHS.
7. Niema, L., & Swearingen, B. (2016). Cushing's syndrome and Cushing's disease. The pituirary Society.
8. NIH. (2012). Cushing's Syndrome. Obtained from the National Institute of Diabetes and Digestive and Kidney Diseases.
9. Pituitary Network Association. (2016). Cushing's Syndrome. Obtained from Pituitary Network Association.
10. Spanish Society of Pediatric Endocrinology. (2016). Cushing's syndrome.