What is Cortisol
At Atlantic Endocrinology & Diabetes Center we feel that before discussing Cushing’s, we must first discuss cortisol.
Cortisol is a glucocorticoid (steroid) hormone which plays an important role in glucose and fat metabolism and reducing inflammation.
The hormone is also referred to as the “stress” or “flight-or-fight” hormone, as it, along with epinephrine (adrenaline) is released during “flight-or-fight” situations.
What is Cushing’s Syndrome?
Cushing’s Syndrome is a disorder in which the level of the hormone cortisol increases in the body.
High cortisol causes weight gain around the abdomen, chest, face, and neck.
Cushing’s Syndrome is a rare condition affecting around 10-15 out of one million people every year.
It strikes adults between 20 and 50 years of age, but it can also occur in children. Cushing’s Syndrome is more prevalent in women than men, contributing to about 70 percent of all cases.
Causes of Cushing’s Syndrome
Cushing’s Syndrome is caused due to the following reasons:
Long-term use of corticosteroid medicines
People who take high doses of corticosteroid medicines for a long time may develop Cushing’s Syndrome.
Corticosteroids are usually prescribed to treat rheumatoid arthritis, asthma and to prevent rejection after organ transplantation.
Excessive production of the hormone cortisol
Several medical conditions can trigger the adrenal gland to produce too much cortisol, including:
- Tumor in the adrenal gland.
- Tumor of the pituitary gland increases the secretion of adrenocorticotropic hormone (ACTH), causing the adrenal glands to release more cortisol.
- Tumors in the pancreas, lungs, or thyroid can increase the secretion of adrenocorticotropic hormone (ACTH).
Signs and Symptoms
- Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), and between the shoulders (buffalo hump)
- Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms
- Thinning, fragile skin that bruises easily
- Slow healing of cuts, insect bites and infections
- Acne
- Severe fatigue
- Muscle weakness
- Depression, anxiety and irritability
- Loss of emotional control
- Cognitive difficulties
- New or worsened high blood pressure
- Headache
- Infections
- Skin darkening
- Bone loss, leading to fractures over time
- In children, impaired growth
Signs and symptoms women with Cushing syndrome may experience
- Thicker or more visible body and facial hair (hirsutism)
- Irregular or absent menstrual periods
Signs and symptoms men with Cushing syndrome may experience
- Decreased sex drive
- Decreased fertility
- Erectile dysfunction
Cushing’s Syndrome treatment
Various treatment options are available for Cushing’s Syndrome, depending on the causes of high cortisol.
Tapering the doses of corticosteroids
If Cushing’s Syndrome is caused due to over-use of corticosteroids, your doctor at Atlantic Endocrinology & Diabetes Center will gradually reduce the dose of the medicine. The doctor will recommend the lowest possible dose of corticosteroids required to manage your disease.
Surgically removing a tumor
If Cushing’s Syndrome is caused due to a tumor in the adrenal glands, pituitary gland, lungs, or pancreas, your doctor will suggest surgery to remove a tumor. It will reduce the production of cortisol hormones in the body. But after the surgery, patients will require hormone replacement therapy to maintain the levels of cortisol.
Radiation therapy
The doctor recommends radiation therapy if a tumor can not be removed via surgery or if a patient is unfit for surgery. In radiation therapy, small doses of radiation are given for six weeks, or a high dose of radiation is given all at once to destroy the tumor cells.
Medications
The doctor may prescribe medications such as Mitotane, Metyrapone, and Ketoconazole to reduce the production of cortisol. These medicines are used when other treatment options such as surgery and radiation therapy do not work.
After complete treatment, most patients observe improvements in the symptoms of Cushing’s Syndrome and recover fully.