Cushing’s Syndrome
Overview
Cushing's syndrome is a serious endocrine disorder caused by prolonged exposure to high levels of cortisol, leading to characteristic physical changes such as a "moon face," "buffalo hump," and purple stretch marks. The condition requires precise diagnosis to determine the underlying cause—medication use or the presence of a tumor—and is treated by gradually discontinuing steroids, surgically removing growths, or medicinal therapy to regulate hormonal balance.Symptoms
- muscle weakness
- moon-shaped face
- buffalo hump
- hypertension
- red striae
- depression
- high cortisol
Cushing’s syndrome is an endocrine disorder characterized by excessively high levels of the hormone cortisol in the body for an extended period.
The most common cause is the intake of high doses of corticosteroid medications (iatrogenic Cushing). When it is not medication-related, it can be caused by tumors that overproduce cortisol or stimulate the adrenal glands to do so (e.g., pituitary adenoma leading to Cushing’s disease). Cortisol is a vital hormone, but its excessive amount disrupts metabolism, immune function, and the cardiovascular system.
Symptoms
Symptoms include characteristic physical changes and a general decline in health:
- Fat accumulation: On the face (“moon face”), in the neck and shoulder area (“buffalo hump”), and around the abdomen.
- Limb weakness: Muscle weakness and thinning of the skin.
- Stretch marks: Wide, purplish-red stretch marks, most commonly appearing on the abdomen, thighs, and chest.
- High blood pressure (Hypertension).
- High blood sugar (Hyperglycemia) and increased risk of type 2 diabetes.
- Mental changes: Depression, irritability, anxiety.
- Others: Easy bruising, osteoporosis; in women – menstrual irregularities and excessive hair growth (hirsutism).
Diagnosis
The diagnosis is made by confirming chronically elevated cortisol levels. The methods used include:
- 24-hour urine collection to measure free cortisol.
- Overnight dexamethasone suppression test.
- Late-night salivary cortisol test.
- After confirming the syndrome, imaging studies (MRI, CT) and other tests are conducted to localize the cause (whether it is in the pituitary gland, adrenal glands, or elsewhere).
Treatment
The goal of treatment is to reduce and normalize cortisol levels.Medication-induced cause: Gradual and controlled reduction of corticosteroid dosage.Tumors:
- Surgery: Surgical removal of the tumor (in the pituitary gland, adrenal gland, or ectopic source) is the most common and successful method.
- Radiation therapy: May be used after pituitary surgery or when surgery is not feasible.
- Medication treatment: Medications are used to block the production of cortisol in the adrenal glands (e.g., Ketoconazole, Mitotane) or to block its action.
Synonyms: Hypercortisolism, Cushing’s disease
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Endocrinology
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