Cushing Syndrome: Treatment, Procedure, Cost and Side Effects

Cushing's syndrome is a hormonal disorder which is caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. Cortisol is a hormone normally made by the adrenal glands which lies above the kidneys and it is necessary for life functions. It allows people to respond to stressful situations (such as illness). Cushing syndrome, also known as hypercortisolism, may also be caused by the use of oral corticosteroid medication.

Symptoms of Cushing’s syndrome can vary depending on the levels of excess cortisol. The hallmark of Cushing’s syndrome is a fatty hump between the shoulders (buffalo hump), a rounded face (moon face), and pink or purple stretch marks on the skin. This happens due to weight gain and fatty tissue deposits. Other signs of this disease are slow healing of cuts, insect bites and infections, acne, thinning of skin etc. Women with Cushing’s syndrome may show thicker or more visible body and facial hair (hirsutism) and irregular or absent menstrual periods. Men may experience decreased libido, fertility and erectile dysfunction. Common in both symptoms are severe fatigue, depression, anxiety and irritability, muscle weakness, loss of emotional control etc.

Treatment for Cushing’s syndrome will depend on the cause and amount of excess cortisol in the body. There are several methods to treat the cortisol level. Medicines are provided to treat the excess level and bring it back to the normal level. Alongside medicines are also taken to aid the body produce its own cortisol. If Cushing’s syndrome is caused due to a tumor, surgery, radiation, chemotherapy and medications are provided. The type of treatment here depends on the location of the tumor.

Diagnosing Cushing’s syndrome is difficult as other conditions share the same signs and symptoms. Several sample tests may be done apart from the symptoms like moon face and buffalo hump to confirm the disease as Cushing’s syndrome. The physical tests include saliva test, urine and blood test etc. Imaging tests like computerized tomography scans or magnetic resonance imaging scans can provide images of the pituitary and adrenal glands to detect abnormalities, such as tumors.

Treatment for Cushing's syndrome depends on the cause of accumulation of high levels of cortisol in the body. There are several treatment options. These options depend on the appropriate method of treatment and includes-reducing corticosteroid use, surgery, radiation therapy and medicines. If Cushing syndrome is caused by long-term use of corticosteroid medications, the doctor may be able to keep the Cushing’s syndrome signs and symptoms under control by reducing the dosage of the drug over a period of time.

It is unsafe to suddenly stop corticosteroids as it causes fatigue, vomiting and diarrhoea. So the doctor uses some other medicines that will adequately supplement for the necessities. Ketoconazole and metyrapone are two widely used cortisol-inhibiting medications. Cortisol inhibiting medicines are usually taken for short durations. Surgical operations are performed when the cause of Cushing syndrome is a tumor.

Pituitary tumors are typically removed by a neurosurgeon while tumor present in the adrenal glands, lungs or pancreas, can be removed through a standard operation or in some cases, with the use of minimally invasive surgical techniques. After surgery, patients are provided with dosage of cortisol replacement medicines. Radiation therapy is used when parts of tumor remain or are unreachable by normal surgery.

If the disease is not cured by medicines, surgeries and radiation therapy, doctors advise to remove the adrenal gland. This is known as bilateral adrenalectomy. This procedure will cure excess production of cortisol, but will require lifelong replacement medications.

People should consult a doctor if symptoms that suggest Cushing syndrome show up. This is especially if one is taking corticosteroid medication to treat a condition, such as asthma, arthritis or inflammatory bowel disease.

People who test negative to excess cortisol level in the body do not need to undergo treatment for Cushing’s syndrome. The symptoms are similar to other problems and hence, confusing. Cushing’s syndrome affected patients will show excess cortisol in the blood and urine tests. Otherwise, people are not eligible for treatment.

There are some side effects in the treatment of Cushing’s syndrome. These side effects are fairly common, and are mostly caused by the medicines. Adverse effects of consuming these medicines over a long time may include diarrhea, nausea, high blood sugar, headache, abdominal pain and fatigue, vomiting, muscle aches, high blood pressure, low potassium and swelling. Some have more serious side effects, such as neurological side effects and liver toxicity. Precaution must also be taken to avoid any adverse effect of the radiation therapy as these can cause skin or cell damage.

After successful removal of the source of excess cortisol, most of the symptoms of Cushing's syndrome disappear within 2 to 12 months. Osteoporosis begins to improve within six months and continues to improve over several years. Children with Cushing's syndrome also regain much of their lost bone density and growth. It is important to prevent Cushing’s syndrome from recurring and thus, following doctor’s advice is very important. Some people, ones who had their adrenal glands removed, have to take continuous medicines for the rest of their lives, failing which, symptoms and other complications may again reappear. Thus, post treatment, it is vital to take care and precautions and prevent Cushing’s syndrome.

People who test negative to excess cortisol level in the body do not need to undergo treatment for Cushing’s syndrome. The symptoms are similar to other problems and hence, confusing. Cushing’s syndrome affected patients will show excess cortisol in the blood and urine tests. Otherwise, people are not eligible for treatment.

Treatment of Cushing’s syndrome can incur a huge cost if surgery or radiation therapy is performed. These can be expensive and cost around Rs 60,000- Rs 80,000/-. If only medicines can lower the level of cortisols, then the cost is less.

The treatment is mostly permanent, provided medicines are taken as advised to avoid recurrence of Cushing’s syndrome. For patients whose adrenalin gland had to be removed, they need to continue a lifelong medicine in order to keep a balance of the cortisol level in the body. Deficit can also cause severe problems.

Apart from medicines and surgeries, Cushing’s syndrome, at an earlier level, can be brought under control by lowering the excess cortisol formation and restricting its accumulation. This can be done by following a healthy diet. Anti-inflammatory foods which include food high in vitamin B, calcium, potassium, and magnesium , protein and omega-3 fatty acids are useful to treat cortisol level. Moderate and healthy exercise can be a great way to lower stress, control cortisol and manage the body weight. Other ways to reduce stress and thus prohibit weight gain are performing meditation, acupuncture, hypnosis, massage therapy etc. Certain herbs and oils are also beneficial for the alternative treatment of Cushing’s syndrome.