Cushing's Syndrome - How To Identify It?

The adrenal glands are present above the kidneys (hence the name) and produces an important hormone known as cortisol. Cortisol is responsible for regulating multiple body functions, including controlling the blood pressure, protein and carbohydrate metabolism, and anti-inflammatory response, and stress management.

Under natural circumstances, the body produces excessive cortisol in the following situations:

Physically stressing situations like illness, surgery, injury, pregnancy, etc.

1. Emotionally stressed situations
2. Alcoholism
3. Athletic training
4. Malnutrition
5. Depression
6. Panic disorders

Causes: Cushing’s syndrome is a group of symptoms that manifest when there is too much cortisol in the body. It is more common in women than men, in the age group of 25 to 40. Some of the common causes of Cushing’s syndrome are listed below:

1. Consuming too much of prednisone (and other steroids) or for prolonged periods can cause Cushing’s syndrome. These are strong anti-inflammatory medications and are used in asthma, arthritis, lupus, transplants, etc., to control the body’s inflammation reaction. It is therefore advisable to use topical steroids than oral steroids or injections as their effects are more noticeable and severe.
2. Adrenal gland tumours can cause excessive production of cortisol.
3. Pituitary gland tumours or adenomas also can also cause excessive production of cortisol, leading to Cushing’s syndrome.

The first type is known as exogenous Cushing’s disease and the others are known as endogenous Cushing’s disease.

Signs and symptoms: Cushing’s disease produces characteristic features which are referred to as the Cushingoid appearance. These features include the following:

1. A rounded, plump face with a pinkish hue
2. A moon face, with fat deposits on the face
3. A buffalo hump with fat deposits between the shoulders
4. Stretch marks on the abdomen, thighs, and arms
5. Weak muscles, especially in the hips and shoulder
6. Significant weight gain
7. Skin that gets thin and bruises easily
8. Extreme tiredness
9. High blood pressure
10. High blood sugar
11. Thin arms and legs
12. Delayed healing of cuts and injuries
13. Increased facial hair in women
14. Menstrual disorders
15. Reduced libido, infertility, and erectile dysfunction in men
16. Emotional issues like depression, anxiety, irritability
17. Increased thirst and urination
18. Bone loss, and eventually fractures
19. Affected bone growth in the developing years
20. Increased susceptibility to infections

Complications: Untreated Cushing’s disease can lead to bone fractures, hypertension, full-blown infections, kidney stones, etc.

Treatment: This would depend on the cause. If you are on long-term steroids, the dose would need to be adjusted. This should always be done under medical supervision, as it requires constant adjustment. Underlying tumours (pituitary or adrenal) need to be diagnosed and treated. There are other hormones too which come into the picture and need to be monitored.