June 12, 2012, I was diagnosed with Cushing’s disease, a rare and mostly undiagnosed endocrine disorder that ravages the … Read More
- Blood Tests
- 24 Hour Urine Tests
- Salivary Cortisol Tests
- Low-Dose Dexamethasone Suppression Testing
- MRI Scans of the Pituitary Region
- CT Scans of the Adrenals
- Corticotropin-Releasing Hormone Stimulation Test
- Minimally invasive surgical removal of the pituitary adenomas (transsphenoidal surgery) is the most widely used therapeutic approach.
- In the event that the tumor cannot be removed, radiation therapy is another option. However, treatment can take up to several weeks and is more effective in children than in adults
- Stereotactic radiosurgery is another viable option, delivering a precise high-dose burst of radiation to the tumor. However, the effects can be delayed for months or years.
- Minimally invasive surgery to remove an offending adrenal tumor.
- In the event of medication-caused Cushing’s Syndrome, lowering dosages of external glucocorticoids can stop Cushing’s.
- Bilateral Adrenalectomy to remove both adrenal glands, thus stopping production of Cortisol.
- Medication, such as ketoconazole and pasireotide can be used to lower cortisol levels. However, they frequently can cause unwanted side-effects, such as increasing blood sugar.
Hello, and welcome back to this short series on Cushing’s Disease. Today, we are going to talk about the Signs and Symptoms of Cushing’s, as well as the difference between Cushing’s Disease and Cushing’s Syndrome.
Signs and Symptoms
Cushing’s Syndrome and Disease are both caused by excess cortisol in the bloodstream. One of the reasons Cushing’s is so hard to diagnose is because the symptoms are relatively non-specific. Listed below are some of the more common symptoms.
This is one of the most common symptoms of Cushing’s. Most people with this disease will rapidly gain excess weight, especially around the stomach, chest, and face . Interestingly, there is little to no weight gain around the arms and the legs. Excess weight is linked to cardiovascular diseases.
As written above, many people gain weight around the face, leading to a rounded or “moon-like” face. It is also common for Cushing’s patients to have very red cheeks.
High Blood Sugar and Glucose Intolerance
Both of these symptoms, if left untreated, can lead to Type II Diabetes.
High Blood Pressure
Increases risk of Heart Disease and Stroke
Muscle and Bone Weakness
Untreated Cushing’s can result in atrophied muscles and bone fractures.
Additional symptoms include mental fogginess, anxiety, and depression.
Cushing’s Disease? Cushing’s Syndrome?
There are three main causes of Cushing’s. If excess cortisol is caused by either external steroid use (for allergies, asthma, etc.) or a cortisol-producing adrenal Tumor, then the disorder is known as Cushing’s Syndrome. If excess cortisol is produced by an ACTH-producing pituitary tumor, then the disorder is known as Cushing’s Disease. There are multiple ways to diagnose and treat Cushing’s Syndrome and Cushing’s Disease, but we will cover that next time.
Hello and welcome to this short series of posts on Cushing’s Syndrome/Disease! The series is divided into five posts, each with its own topic. So without further ado, let’s jump right in.
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.
The hypothalamus, at the base of the brain, secretes CRH (corticotropin-releasing-hormone), which signals the pituitary gland to secrete ACTH, which in turn signals the adrenal glands to start producing cortisol. This pathway has a negative feedback loop, meaning that, under normal circumstances, if there is too much cortisol in the body, CRH production will stop, causing ACTH production to stop, which in turn causes cortisol production to stop until levels normalize. In Cushing’s disease, this negative loop does not work, causing a buildup of excess cortisol (but more on that next time!).
Glucocorticoids, such as cortisol, are used for a variety of medical purposes. Hydrocortisone (another name for cortisol) is used in creams to alleviate the symptoms of hemorrhoids and other diseases. Prednisone is used to relieve swelling in asthma patients. Nasonex is another glucocorticoid, with the the generic name mometasone. Taking any of these medications in excess or for a prolonged time could lead to excess cortisol in the bloodstream (see the next post for details).
Next post, we will discuss the effects of high cortisol in the bloodstream and the difference between Cushing’s Disease and Cushing’s Syndrome.
Sources/ Further Reading