Cushing's syndrome is a health problem that affects some people as a result of a disorder in the secretion of the hormone cortisol in the body for a long period of time. This happens for several reasons, and results in clear symptoms and signs on the patient, but the proportions may return to normal if treated properly. You can learn more about these symptoms, treatment methods and causes. Let us in this article through Dalili Medical learn about this disease that affects the individual.

**How ​​can I reduce or prevent the chances of developing Cushing's syndrome?**

 

Your body needs cortisol on an ongoing basis, as it plays a vital role in many vital functions such as regulating breathing, converting food into energy, controlling blood sugar levels, and managing stress. Although your body needs cortisol to survive, excessive production can be harmful.

If you are taking steroids or glucocorticoids, it is advisable to contact your doctor to monitor your cortisol levels carefully. Unfortunately, there is no effective way to prevent the excessive growth of cortisol that leads to Cushing's syndrome.

**What to expect if you have Cushing’s syndrome?**

 

Your doctor can offer treatment for Cushing’s syndrome, which can be life-threatening if left untreated. It is important to consult your doctor as soon as possible to assess your symptoms.

**Who is most at risk for Cushing’s syndrome?**

 

This condition is most commonly seen in adults between the ages of 20 and 50, and is three times more common in women than men. People who are obese or have type 2 diabetes are also at higher risk of developing the syndrome. In rare cases, a person may have an inherited genetic mutation such as multiple endocrine neoplasia type 1 (MEN-1). This syndrome increases the risk of developing tumors in various parts of the endocrine system, including pituitary tumors. The cost of pituitary gland treatment in India depends on the type of treatment and the complexity of the condition.

How long does Cushing’s syndrome last?

 

Cushing’s disease can usually be treated, and treatment may take up to 18 months.

Can Cushing’s disease get worse?

 

If Cushing’s syndrome is not treated appropriately, it can get worse. It’s important to stay in touch with your doctor and tell them about any new or worsening symptoms, or if you have any other concerns.

Who should you see about Cushing’s syndrome?

 

You may need to see a doctor who specializes in hormonal disorders, such as an endocrinologist.

What is Cushing’s disease?

 

Cushing’s disease is a medical condition characterized by an abnormally high level of the hormone cortisol, which is caused by a benign tumor on the pituitary gland in the brain. This tumor produces too much adrenocorticotropic hormone (ACTH).

ACTH stimulates the adrenal glands located above the kidneys to produce cortisol, known as the stress hormone. High levels of ACTH lead to excessive production of cortisol, which puts the body in a constant state of stress. This condition was first recognized in 1912 by Dr. Harvey Cushing, a leading figure in the field of neurosurgery and one of the founders of modern neurosurgery.

Cortisol production typically follows a daily pattern, or “circadian rhythm,” with levels highest in the morning to promote alertness and lowest at night. Cortisol is also produced during acute stress, often known as the “fight or flight” response. In both cases, cortisol plays an important role in regulating blood pressure, mobilizing energy stores, and suppressing the immune system. However, when cortisol levels exceed normal limits, it can lead to a range of health problems.

Can Cushing’s syndrome kill?

 

- Heart attack

- Blood clots, especially in the lungs and legs

- High blood pressure

- High cholesterol

- Type 2 diabetes or prediabetes

- Infections

- Weight gain

- Osteoporosis

- Depression

- Poor fasting glucose

- Memory problems or difficulty concentrating

- Death

**Causes of Cushing's syndrome**

There are many common causes of Cushing's syndrome, the most prominent of which are:

- **Adrenal gland tumors**: Tumors in this gland can lead to increased production of cortisol.

- **Prolonged use of high doses of medications**: such as glucocorticoids, which are used to treat autoimmune disorders such as rheumatoid arthritis and lupus, which can lead to increased cortisol levels.

- **Pituitary tumors**: Tumors in the pituitary gland secrete excessive amounts of adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce more cortisol.

Less common causes of Cushing's syndrome include:

- **ACTH production outside the pituitary gland**: In rare cases, tumors that produce ACTH in places such as the lungs, thymus, or pancreas can cause excess cortisol production.

- **Primary pigmented adrenocorticotropic disorder (PPNAD)**: This is a rare genetic condition that stimulates the adrenal glands to produce more cortisol.

- **Familial Cushing's syndrome**: This is a genetic disorder that causes tumors to develop in the pituitary gland or adrenal glands, which increases cortisol production.

**What is Cushing's syndrome?**

 

Cushing's syndrome, unlike Cushing's disease, is a condition characterized by abnormally high levels of cortisol in the body from any source. The most common cause of this condition is the prolonged use of corticosteroid medications such as prednisone, hydrocortisone, and dexamethasone. This is especially seen in patients who require chronic treatment for conditions such as severe asthma or rheumatoid arthritis. The second most common cause of Cushing's syndrome is a tumor in theThe pituitary gland causes the secretion of adrenocorticotropic hormone (ACTH), which is known as Cushing's disease.

Other causes of high cortisol levels can include tumors in the adrenal glands that secrete cortisol directly, or tumors in other areas of the body that secrete ACTH, which is known as Cushing's syndrome from an abnormal source. Your doctor will perform tests to rule out these other possibilities during a comprehensive Cushing's syndrome evaluation.

Be sure to tell your doctor about any current or past medication use during this evaluation, so that it does not interfere with the medications used to treat Cushing's syndrome. Once you have the correct diagnosis, you can say that your experience with Cushing's syndrome has been a success.

**What are the causes?**

In most cases, there are no genetic factors, medical history, functional conditions, or environmental factors that explain the cause of Cushing's disease. Research is currently underway to better understand the development of Cushing's disease and pituitary tumors.

**How ​​common is it?**

 

Cushing's disease is rare, with about 10-15 cases diagnosed per million people each year. Most people affected are between the ages of 20 and 50, with women three times more likely to be affected than men.

**How ​​is it diagnosed?**

 

Diagnosis is initially based on a review of the patient's medical history, a physical examination, and analysis of laboratory test results. These tests will reveal signs and symptoms that indicate elevated cortisol levels, and additional tests such as measuring cortisol in the urine over a 24-hour period may be required. Many patients find it helpful to compare recent and old photographs, as physical changes are often gradual.

Endocrinologists are responsible for the initial diagnosis of Cushing's disease. It can be complex and difficult to arrive at an accurate diagnosis, especially in simple cases where hormone levels are not clearly visible.

**Symptoms of Cushing's syndrome**

Symptoms of Cushing's syndrome vary depending on the severity and duration of the condition. Common symptoms that may appear include:

- Weight gain, especially in the face, neck and upper body.

- Feeling tired and weak muscles.

- High blood pressure.

- Mood swings, such as irritability, anxiety and depression.

- Thinning skin and the appearance of stretch marks.

- Easy bruising and delayed wound healing.

- Increased thirst and frequent urination.

- Osteoporosis and increased risk of fractures.

- Irregular menstrual cycles in women.

- Decreased libido and impotence in men.

**Laboratory tests (hormone-based)**

The main goal of laboratory tests is to confirm high cortisol levels through the use of appropriate tests.

24-hour urinary cortisol excretion: This test is an effective tool to confirm the presence of high cortisol levels throughout the day. This method is used because cortisol levels change throughout the day, and can be high or low depending on the time of day. Furthermore, the results of this test may appear normal in mild cases, which sometimes requires additional tests to confirm the diagnosis.

Late-night salivary cortisol: Cortisol levels are usually at their lowest during the night. In this test, cortisol levels are measured in saliva taken around midnight. If the levels are high, this may indicate the possibility of Cushing's syndrome. It is important to note that if the result of this test is negative, it largely means that the patient does not have Cushing's syndrome.

Low-dose dexamethasone suppression test: This test aims to assess the feedback regulation function of the pituitary gland by administering a cortisol-like drug, dexamethasone, which should lead to a decrease in the production of both adrenocorticotropic hormone (ACTH) and cortisol. This is the normal mechanism by which the pituitary gland works.

High-dose dexamethasone suppression test: This test is used if the results of the low-dose dexamethasone suppression test are abnormal. The goal of this test is to distinguish between a pituitary adenoma and a tumor growing in an abnormal location (ectopic) as the source of high cortisol levels. The dose of dexamethasone must be high enough to suppress the production of adrenocorticotropic hormone (ACTH) from the adenoma, resulting in lower cortisol levels. If a tumor is the source, ACTH and cortisol levels would be expected to be low. If there is a tumor in the adrenal glands or other tissues that produce these hormones, ACTH and cortisol levels will remain high.

MRI of the pituitary gland: MRI is the most clear way to see the tissues of the brain and pituitary gland. After ruling out obvious causes of high cortisol (such as medications), an MRI of the brain is performed to check for a benign pituitary tumor.

Inferior petrosal sinus sampling (IPSS): This is a more invasive procedure (angiography), in which samples of ACTH are drawn directly from the veins that drain blood from the pituitary gland. These levels are compared with those in another vein away from the gland, helping the doctor determine whether the source of the ACTH is the pituitary gland or is coming from somewhere else in the body. This procedure requires inserting a catheter through a vein in the patient's groin to access the veins surrounding the pituitary gland. After the procedure is completed, the patient can go home the same day.

**Complications of Cushing's syndrome**

If left untreated, Cushing's syndrome can develop serious health problems, including death. These problems include:

- Stroke or heart attack

- Blood clots in the lungs or legs

- InjuryInfection

- Fractures and loss of bone density

- High blood pressure

- Increased cholesterol levels

- Depression or mood changes

- Memory loss or difficulty concentrating

**Treatment of Cushing's syndrome**

The treatments available for Cushing's syndrome aim to reduce the high levels of cortisol in the body, which cause the symptoms associated with this syndrome. The most appropriate treatment depends on the underlying cause of the syndrome, and the available options include:

**Avoid medications containing cortisone**If long-term use of cortisone medications is the cause of Cushing's syndrome, your doctor may be able to control the symptoms by reducing the dose of the medication over a specific period of time, while continuing to treat the underlying condition that requires taking these medications. It is important not to reduce the dose of cortisone or stop taking it on your own, but rather to do so under the supervision of a specialist doctor, as suddenly stopping taking these medications can lead to serious problems in the heart and nervous system due to low levels of cortisol in the blood. Gradually reducing cortisone medications allows the body to regain its ability to produce cortisol naturally.

**Surgical Treatment** If a tumor in the pituitary or adrenal gland is the cause of Cushing’s syndrome, your doctor may recommend a complete surgical removal. Pituitary tumors are usually removed by a neurosurgeon. After surgery, you will need to take cortisol replacement medications to ensure your body is getting the right amount of this hormone. In most cases, normal production of adrenal hormone returns, allowing your doctor to gradually reduce the dose of replacement medications. Your endocrinologist will use blood tests to determine whether you need to continue taking cortisol and when you can stop it. However, this can take a year or more. In some cases, people with Cushing’s syndrome may not be able to regain normal adrenal function, requiring lifelong replacement therapy. **Radiation Therapy** When the surgeon is unable to remove the entire pituitary tumor, radiation therapy is often recommended as part of the treatment plan in conjunction with surgery. It may also be used for patients who are not well enough to undergo surgery. Radiation can be given in small doses over six weeks, or through a technique known as stereotactic radiosurgery, where a large dose of radiation is delivered to the tumor at once, minimizing radiation exposure to surrounding tissue.

**Medications** Medications are used to control cortisol production in cases where surgery and radiation therapy have failed. They may also be used before surgery for patients with severe symptoms of Cushing's syndrome, with the aim of improving signs and symptoms and reducing the risks of surgery. However, medications may not completely improve all symptoms of hypercortisolism. In some cases, the tumor or its treatment may cause a dysfunction in the pituitary or adrenal glands, in which case your doctor may recommend alternative medications to replace these hormones. If none of the above treatment options are appropriate or effective, your doctor may suggest removing the adrenal glands (bilateral adrenalectomy).

**Diet for Cushing's syndrome** Strategies for managing Cushing's syndrome naturally include eating foods that help reduce symptoms and potential risks, as well as improving the patient's quality of life.

. **Calcium-Rich Foods** Calcium-rich foods help prevent bone fractures and reduce the risk of osteoporosis. Green leafy vegetables, milk, nuts, and fortified foods are excellent sources of calcium. Vitamin D also plays an important role in bone and skin health, and is found in abundance in foods such as fatty fish, mushrooms, and some grains.

. **Fiber-Rich Foods** Fiber-rich foods help control blood sugar levels, which reduces the risk of diabetes in patients. To keep blood sugar levels within healthy limits, it is best to avoid sweets and overly processed foods, and focus on eating foods rich in fiber such as whole wheat bread, oatmeal, nuts, berries, and sweet potatoes.

*Protein-Rich Foods** Muscle loss is a common side effect of high cortisol levels, and people with this syndrome may experience a decrease in muscle mass.

-** Low-sodium foods** High cortisol levels caused by Cushing's syndrome can increase blood pressure, causing hypertension. Therefore, it is important to avoid processed foods that contain large amounts of sodium. To achieve this, experts recommend focusing on eating fruits and vegetables, in addition to soups, sauces and spreads that contain low amounts of sodium.