Cushing's Syndrome: Symptoms, Causes, Treatments

He Cushing's syndrome Is a rare medical pathology produced by an excess of the hormone cortisol in the body (Nieman & Swearingen, 2016).

Cortisol is a hormone produced by the adrenal glands that is released from stressful situations such as fear, disease, etc. (Nieman & Swearingen, 2016).

When the body is subjected to high levels of cortisol over a long period of time, many of the symptoms characteristic of Cushing's syndrome or Hypercortisolism : Increased blood pressure, increased weight, loss of bone mass, Cutaneous alterations, among others (Mayo Clinic, 2013).

Cushing's syndrome is a rare disease that can be caused by a wide variety of factors such as tumors in the Glands Adrenals, excess production of the Adrenocorticotropic hormone (ACTH), exposure to glucocorticoid drugs, etc.

Different tests and laboratory tests are usually used to confirm the presence of Cushing's syndrome, since the varied Symptomatology does not allow a precise clinical diagnosis (Nieman & Swearingen, 2016).

Regarding treatment, the most effective interventions refer to those aimed at controlling or eliminating the etiological causes: extirpation Of tumors, extirpation of adrenal glands, suspension of medication, etc. (Nieman & Swearingen, 2016).

Characteristics of Cushing's syndrome

Cushing's syndrome is an endocrine or metabolic pathology (CSRF, 2016) and can be defined as a set of symptoms and Signs resulting from persistent and abnormal elevation of blood cortisol levels (Spanish Society of Pediatric Endocrinology, 2016).

Therefore, Cushing's syndrome develops when cortisol levels are abnormally high. Although it may be due to different Factors, one of the most frequent is excessive consumption of glucocorticoid drugs (Healthline, 2016).

Among the most notable features of Cushing's syndrome are increased weight in the upper body, rounded face and Propensity to have cutaneous hematomas (Healthline, 2016).

What is cortisol?

He Cortisol Is a type of hormone that belongs to the group of Glucocorticoids , Since it has a prominent role in the metabolism of Proteins and carbohydrates (Carlson, 2010).

The glucoroticos, contribute to the production of fats as energy source, incremental the blood flow and also, they stimulate the reactivity Body, among other functions (Carlson, 2010).

Specifically, the Cortisol Is produced by the adrenal cortex and is known as the" Stress hormone "(Carlson, 2010), Since it is released in situations of tension.

Specifically, cortisol contributes to maintain blood pressure levels, reduces the inflammatory response of the immune system Regulates the Metabolism of proteins, carbohydrates or fats (Massachusetts General Hospital, 2016).

In addition, cortisol allows the body to respond to stressful environmental demands, generating enough energy to maintain functions Of the organism (Hernández Trejo, 2009).

However, when various conditions result in prolonged exposure of capillary tissues to elevated levels of cortisol, Various medical pathologies including Cushing's syndrome (Massachusetts General Hospital, 2016).

About us

Cushing's syndrome is a rare medical disorder (Healthline, 2016).

Although there is little statistical data on the occurrence of this syndrome, it is estimated that it presents a prevalence of one case per 50,000 People (NHS, 2015).

Cushing's syndrome can affect anyone, but it is more common in adults between the ages of 20 and 50 (Healthline, 2016). In addition, women are three times more likely to get it than men (NHS, 2015).

symptom

Signs and symptoms caused by Cushing's syndrome may vary among those affected (National Institute of Diabetes and Digestive and Kidney Diseases, 2012).

Some people will develop only some of the symptoms or several mildly, such as weight gain. However, in other more severe cases Of Cushing's syndrome, those affected may have almost all the characteristic symptoms of the disease (Nieman & Swearingen, 2016).

The signs and Most characteristic symptoms And Cushing's syndrome are common (Nieman & Swearingen, 2016):

• Weight increase (Most notable in areas of the body trunk).
• Increased blood pressure or hypertension.
• Changes in mood, concentration and / or memory.

Apart from these, others have also been observed Signs and symptoms that occur frequently In this pathology (National Institute of Diabetes and Digestive and Kidney Diseases, 2012):

• Rounded face.
• Increased fat percentage in areas near the neck and head.
• Loss of weight and reduction of muscle mass in arms and legs.
• Growth slowed down, in the case of the pediatric population.

On the other hand, the Cushing's syndrome can also generate diverse symptoms at the cutaneous and bone level:

• Contusions or small wounds on the skin that have to curse slowly.
• Purple and pink markings on the abdomen, thighs, buttocks, arms or breasts.
• Bone weakness.
• Increased likelihood of fractures.

In addition, Cushing's syndrome in women Produces some specific signs and symptoms:

• Excessive growth of hair on the face, neck, chest, abdomen or muscle.
• Absent or irregular menstrual periods.

In the case of mens , Cushing's syndrome can also produce:

• Decreased fertility.
• Decreased sexual appetite.
• Erectile dysfunction .

In addition to this varied symptomatology, it is also possible to have another series of less frequent medical events as a result of the disease Pathology (National Institute of Diabetes and Digestive and Kidney Diseases, 2012; Nieman & Swearingen, 2016):

• Fatigue and recurrent tiredness.
• Insomnia .
• Fine skin and stretch marks.
• Acne .
• Alopecia .
• Swelling of feet and legs
• Muscular weakness.
• Increased blood glucose level, diabetes.
• Increased thirst and urination.
• Irritability, anxiety, feelings of depression.

Causes

Cushing's syndrome, as we noted earlier, occurs when our body is exposed to excessive or abnormally high levels of Cortisol over an extended period of time (Massachusetts General Hospital, 2016).

In many cases of Cushing's syndrome, people who have it often have symptoms as a result of Intake of drugs containing glucocorticoid hormones As some of the treatments for asthma, arthritis, lupus, etc. (Massachusetts General Hospital, 2016).

In other cases, the characteristic symptoms of Cushing's syndrome develop as a consequence of An imbalance in the production of cortisol . In addition, some people who suffer from alcoholism , depression , Panic disorders T the Malnutrition, may also have elevated levels of cortisol (Massachusetts General Hospital, 2016).

Drugs Corticosteroids

Prolonged intake of corticosteroid drugs at high doses may increase corticol levels and imbalance their production.

The Oral corticosteroids Are used in the treatment of some inflammatory diseases such as rheumatoid arthritis , he lupus and the Aspa, or with an immunosuppressive function (Mayo Clinic, 2013).

One of these drugs is the Prednisone , Which at the body level has the same effect as the cortisol produced by the organism. Because it is necessary The use of this in high doses, may appear secondary effects, such as Cushing's syndrome due to excess cortisol (Mayo Clinic, 2013).

In addition to oral corticosteroids, Cushing's syndrome may also be associated with the use of Injectable corticosteroids Such as those aimed at reducing joint pain, back pain, etc. (Mayo Clinic, 2013).

Inhaled stearate drugs (asthma treatment) and steroid lotions (eczema treatment) are less likely to cause cushing syndrome (Mayo Clinic, 2013).

Imbalance of cortisol production

Cushing's syndrome can also develop as a result of increased production of cortisol by the body.

In this case, Cushing's syndrome may be caused by an increase in the production of cortisol from the adrenal glands or an overproduction Of the hormone adrenocorticotropa, responsible for controlling the production of cotisol (Mayo Clinic, 2013).

Some of the conditions that are related to an overproduction of cortisol are (Massachusetts General Hospital, 2016):

• Tumor in the pituitary gland ( Pituitary adenoma ): A tumor located in the pituitary gland , Stimulates the Production of the hormone adrenocorticotrope (ACTH) which in turn stimulates the adrenal glands by raising cortisol production. Usually Adenomas are benign or noncancerous and occur more frequently in women than in men, in a ratio of 5: 1. When the syndrome of Cushing results from this alteration, it is called Cushing's disease.
• Ectopic ACTH syndrome. The presence of some tumors (benign or malignant) outside the hypophysis Can increase production Of the adrenocorticotropic hormone (ACTH) and hence cortisol levels.
• Primary pathology in the adrenal glands : Some abnormalities in the adrenal glands such as cancerous tumors or Carcinomas, can increase the release of several hormones like cortisol.
• Family Cushing's Syndrome : Although most cases of cushing's syndrome do not have a heritable component, Some people have a genetic predisposition to develop tumors in the cortisol-secreting glands.

Diagnosis

Not all those affected by Cushing's syndrome present the same symptomatology and course; arterial hypertension And weight gain, are Normal conditions in the general population, so that the precise and clinical diagnosis of cushing's syndrome can be complicated (Nieman & Swearingen, 2016).

Medical specialists often use different diagnostic and laboratory tests to determine both the presence of the syndrome and the cause Etiological (Nieman & Swearingen, 2016).

The Most commonly used diagnostic tests Are those that measure the levels of Free 24-hour urine, blood and saliva cortisol (Spanish Society of Pediatric Endocrinology, 2016).

In addition, it is also possible to determine the excessive production of cortisol by the organism through Dexamethasone suppression test. An oral drug is used to determine cortisol concentration through regulation of cortisol (Nieman & Swearingen, 2016).

Although these tests are the most common, they do not always reliably diagnose Cushing's syndrome, mainly because it can Being caused by various medical pathologies (Nieman & Swearingen, 2016).

Therefore, it is usual to use other diagnostic procedures such as (Spanish Society of Pediatric Endocrinology, 2016):

• Determination of plasma ACTH concentrations by immunoradiometry.
• CRH stimulus test.
• Adrenal computed tomography.
• Pituitary nuclear magnetic resonance.

Treatment

Treatment for Cushing's syndrome depends essentially on the cause of excess cortisol (National Institute of Neurological Disorders and Stroke, 2013).

If the cause is related to the persistent intake of corticosteroid medications used for the treatment of other pathologies, the Medical specialists can reduce the dose to control the symptoms of Cushing's syndrome (National Institute of Neurological Disorders and Stroke, 2013).

In the case of the presence of tumors as an etiological factor of Cushing's syndrome, interventions such as surgery, radiotherapy , chemotherapy , Immunity , etc. (National Institute of Neurological Disorders and Stroke, 2013).

Therefore, treatment of Cushing's syndrome may include:

A) Reduction of corticosteroid medication.

B) Surgical treatment: pituitary surgery, adrenalectomy, ACTH-producing tumor excision.

C) Radiotherapy, chemotherapy, immunotherapy.

D) Pharmacological treatment for the reduction of cortisol level.

conclusion

In summary, the most important aspects of Cushing's syndrome are: (National Institute of Diabetes and Digestive and Kidney Diseases, 2012):

• Disorder caused by prolonged exposure to elevated levels of cortisol.
• The most frequent symptoms are: obesity, round face and / or arterial hypertension.
• The etiologic causes of Cushing's syndrome can be found in the prolonged use of glucocorticoid drugs or other medical pathologies.
• In the diagnosis, several laboratory tests are usually used, including the study of cortisol levels in blood, saliva or
  urine.
• The treatment of Cushing's syndrome depends fundamentally on the specific cause that causes the elevation of cortisol level. The interventions Most common are pharmacological and surgical.

Bibliography

1. Cleveland Clinic. (2016). Cushing's Syndrome . Obtained from Cleveland Clinic.
2. Healthline. (2016). Cushing's syndrome . Retrieved from Healthline Media.
3. Massachusetts General Hospital. (2016). Cushing's Information . Obtained from Neuroendocrine Clinical Center.
4. Mayo Clinic. (2016). Cushing syndrome . Obtained from Mayo Clinic.
5. NHI. (2013). Cushing's Syndrome . Retrieved from the National Institute of Neurological Disorders and Stroke.
6. NHS. (2015). Cushing's Syndrome . Obtained from NHS.
7. Niema, L., & Swearingen, B. (2016). Cushing's Syndrome and Cushing's Disease. The pituitary Society.
8. NIH. (2012). Cushing's Syndrome . Retrieved from the National Institute of Diabetes and Digestive and Kidney Diseases.
9. Pituitary Network Association. (2016). Cushing's Syndrome . Obtained from Pituitary Network Association.
10. Spanish Society of Pediatric Endocrinology. (2016). Cushing's syndrome.