Cushing’s Syndrome
Dominique Soriano; Mr. Harris’ Anatomy and Physiology:
Integumentary and Endocrine
The College of Healthcare Professions; July 2019
Cushing’s Disease is a disease in which there is an excess production of cortisol being produced by the adrenal gland. The very first categorization of the symptoms associated with this specific disease were in 1932, by a physician named Harvey Cushing whom had 8 patients with these grouped symptoms. The excess amounts of cortisol that is released into the body is a steroid hormone that regulates a wide range of processes through the body, which include the metabolism and the immune system. Cortisol is also one of the main components in helping the body handle stress. Having excessively high levels of this very important hormone in the body can cause detrimental effects on many cells throughout the body. Cushing’s Disease, also known as hypercortisolism, is very rare only occurring in about ten out of every one million patients.
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The signs and symptoms for this rare disease can vary and not everyone with this disease will experience the same symptoms. The most common symptoms found in patients with Cushing’s are having a round, red face often referred to as “moon face”, having an increased amount of fat around the neck area, thin arms and legs, rapid weight gain, especially around the stomach area of the body. Something more common in children is signs of slowed and delayed growth as well as obesity. Although the most common symptom list may seem short, other symptoms that can be linked to Cushing’s is extensive with alternate signs such as anxiety and/or depression, headaches, bone pain and/or tenderness, low sex drive, extreme fatigue, a fat build up in between the shoulders also referred to as a “buffalo hump”, back pain that occurs with everyday tasks, elevated blood pressure, high glucose level, increased thirst and urine output, weakened muscles especially in the hips and shoulders, poor healing of wounds, the skin can become more sensitive and the person may be more prone to bruising, and purple and/or pink stretch marks can occur on the arms, breasts, abdomen, thighs, and buttocks. Some signs are more specific to men such as decreased fertility and erectile dysfunction, and others are gauged more towards women like excessive hair growth in the face, neck, chest, abdomen, and thighs, and also irregular or completely absent menstrual periods. In feeling sick it is important to remember that the signs and symptoms for this disease often mimic those of others, so make sure to document any manifestations that may occur to discuss with a physician.
In diagnosing Cushing’s the process to get to this diagnosis may be long due to the fact that this diseases symptoms mimic those of other things such as metabolic syndrome or polycystic ovarian syndrome. Several tests may be needed in order for the physician to confirm Cushing’s, and with those tests the physician can also rule out that your symptoms aren’t indicative of another disease or syndrome. It all starts off with a doctors visit, when they may ask for a past family medical history as well as want to document any medications that are being taken, especially if on any corticosteroids because prolonged use of them may be what’s led to Cushing’s. Even if during the physical exam portion of the office visit the doctor notices any of the common signs of the disease special testing is needed to confirm any of the doctors suspicions. Tests such as blood and urine tests may be run to establish the amounts of hormones in the body, a saliva test, or imaging tests. In a saliva test the small sample is taken mainly at night when in a normal person cortisol is commonly very low or even undetectable, but if troubled with Cushing’s the amounts in the body stay consistent throughout the day so they would still be very high at night. Imaging tests ordered may consist of an abdominal CT to check for an adrenal gland tumor or tumor in any other part of the abdomen, a pituitary mri to search for a pituitary tumor, or a dual x-ray absorptiometry to measure mineral bone density as often times people with this disease have low bone density.
Going into treatment for Cushing’s all depends on the type of symptoms the patient is experiencing and moreover the origin of the Cushing’s. If on any corticosteroid medication it must be gradually decreased if it was diagnosed that the medication was contributing to the disease. If a tumor was the cause of the over production of the cortisol in the body, the tumor must be removed with surgery. If a tumor was the cause but surgery is not the correct route for the patient because the tumor would not be able to be removed as a whole or all at once, radiation may be the best way to go about shrinking the tumor. Although if surgery nor radiation is a viable option to take medications can be given to the patient to control the cortisol production in the body, and if the case is extremely severe medication can be used as a means to control the cortisol before the radiation and/or surgery.
If a person is looking for help and/or support in their journey of Cushing’s disease there are a wide variety of help and support groups to be a helping hand through the scary and not so scary stepping stones leading to getting the treatments needed for a better life. Resources such as Cushing’s Help and Support websites or Cushing’s Support and Research Foundation are always readily available with any help they are equipped to provide.
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Cushing’s disease is a disease that may negatively impact only a small amount of the world’s population because of its rarity but that doesn’t mean that it’s something that’s any less important. Cushing’s disease is something that can happen to anyone just simply because they have too much cortisol being produced by their body or have something in their body that is causing the over production. The wide range of symptoms may make it difficult to easily see and pinpoint, but constant overview of health and close attention and communication with physicians may make the process of diagnosis and treatment a lot more easily produced.
References
https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cushings-Disease
https://www.endocrineweb.com/conditions/cushings-syndrome/cushings-syndrome-treatments
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Once a patient has been diagnosed, a plan of care should be actioned to include further diagnostic testing, medications, referrals, and follow-up care. Patient education should also be provided regarding diagnosis, exercise, diet, medicines, and warning signs of medication and diagnoses.
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