Cushing’s syndrome – what is it?

Cushing's syndrome - what is it?

Cushing’s syndrome (also called hypercortisolism) is a complex of symptoms caused by excessive levels of the hormone cortisol in the human body. Cushing’s syndrome usually develops after taking medication that contains cortisol. More rarely, the body produces too much cortisol due to a tumour. In both cases, the typical symptoms of Cushing’s syndrome can then occur: a full moon face develops, those affected put more fat around the middle of the body, the skin becomes thinner, and blood pressure rises. The following section will inform you about Cushing’s syndrome’s causes, diagnostics, and treatment.

Causes of Cushing’s Syndrome: What is Cortisol?

Cushing’s syndrome (pronounced: Kushing) in humans is caused by too much cortisol in the body. Cortisol is an endogenous hormone and is produced in the adrenal glands. It is the most important representative of the hormone group glucocorticoids, also called the body’s “stress hormones”.

Synthetically produced glucocorticoids, such as cortisone (the inactive form of the hormone cortisol), are often used in medicine. They have an immunosuppressive effect, reducing the body’s immune response.

This mechanism is used in autoimmune diseases (such as multiple sclerosis ) or allergic reactions. In autoimmune diseases, the immune system of those affected reacts too strongly to the body’s substances. By reducing the immune response, such as cortisone, the body attacks itself less and symptoms of the disease are alleviated.

 

What is the difference between exogenous and endogenous Cushing’s syndrome?

In simple terms, Cushing’s disease can be triggered by two causes.

In the most common cases, Cushing’s syndrome is caused by an excessive intake of cortisone as a drug. The recommended dose threshold up to which the drug should be given is exceeded over a long period. In this case, one speaks of an exogenous Cushing’s syndrome.

Rarely, a tumour can also lead to Cushing’s syndrome. Tumors in the pituitary gland (the pituitary gland) can lead to increased production of ACTH (adrenocorticotropic hormone). This hormone, in turn, stimulates the production of cortisol in the adrenal glands. Therefore, the tumour leads to a sharp increase in cortisol in the body, also known as endogenous Cushing’s syndrome or Cushing’s disease. A cortisol-producing tumour in the adrenal cortex can also be the cause of endogenous Cushing’s syndrome.

What are the symptoms of Cushing’s Syndrome?

Since the hormone cortisol affects many parts of the body, Cushing’s syndrome also leads to diverse symptoms.

Very typical signs are:

  • the so-called “full moon face” (a plump, swollen face)
  • the “buffalo hump” or “bull hump” (a collection of fatty tissue in the neck)
  • trunk obesity: More fat accumulates on the upper body while the arms and legs remain slim.

In 90 per cent of cases, there is also high blood pressure. The body’s glucose tolerance is also reduced. This means the body is less able to metabolize sugar from the diet. Over an extended period, a metabolic situation similar to that of type 2 diabetes can develop.

There is also muscle and bone loss. The skin of those affected also often becomes thinner (so-called parchment skin). Red stretch marks (striae rubrae) on the skin, especially the stomach, are also common.

The reduction in the body’s immune response has already been described as leading to an increased susceptibility to infections in Cushing’s syndrome. Affected people tend to get more and more severe colds and other illnesses.

Cushing’s syndrome can also occur in children. In addition to the symptoms already described, there is also a reduction in growth, meaning the children remain smaller.

 

How is Cushing’s syndrome diagnosed?

The diagnosis of Cushing’s syndrome consists of several stages.

If you observe the symptoms described, you should seek medical advice. Your family doctor will then explain your exact medical history (anamnesis), and you will be physically examined. The question of which medications have been taken recently is fundamental since the majority of Cushing’s syndrome is triggered by taking medication.

In addition, if Cushing’s syndrome is suspected, a blood sample is taken.

A one-time measurement of the blood’s nocturnal cortisol level can indicate permanently elevated concentrations. Since the cortisol level fluctuates over the day, the cortisol concentration in the 24-hour urine collection is also determined. Those affected have to collect their urine excretions over 24 hours. If the cortisol concentration also increases here, there is a high probability of Cushing’s syndrome.

The dexamethasone inhibition test is often carried out as a further test. Patients receive a certain amount of the drug dexamethasone for this test. This substance leads to a lower production of the hormone ACTH. This leads to a drop in cortisol production in healthy people, as ACTH stimulates this.

However, if Cushing’s syndrome is present, the cortisol concentration in the blood does not drop; it only decreases slightly.

If Cushing’s syndrome is diagnosed after these diagnostic procedures, it is still essential to determine whether it is an exogenous or endogenous Cushing’s syndrome. If a tumour is suspected to cause Cushing’s, imaging tests such as an MRI are initiated.

How is Cushing’s Syndrome treated?

The therapy for Cushing’s syndrome also depends on the cause.

The treatment is relatively simple if it is an exogenous Cushing’s syndrome. Ideally, all cortisol-containing medications are gradually discontinued or reduced below a certain threshold under medical supervision. The medication must be slowly “tapered off” so the body can adjust its hormone production again.

In the case of endogenous Cushing’s syndrome, treatment is more complicated. The tumour is usually surgically removed after a precise clarification of the cause. A hormone-producing tumour of the pituitary gland is generally deducted through the nose. A hormone-producing tumour located in the adrenal gland is also possible. These tumours are usually removed during an operation.

Is Cushing’s Syndrome curable?

Exogenous Cushing’s syndrome usually has a good prognosis. Discontinuing the offending medication under medical supervision will resolve most of the symptoms. Losing weight despite Cushing’s syndrome is then also possible.

Endogenous Cushing’s syndrome has a more variable prognosis. In many cases, the tumour can be successfully treated. In advanced stages, however, endogenous Cushing’s can reduce life expectancy or be fatal. However, this is very rare.

 

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