Cushing disease refers to a type of Cushing syndrome. A benign tumor located in the pituitary gland that secretes too much adrenocorticotropic hormone (ACTH) causes Cushing disease. This leads to an increase in cortisol secretion from the adrenal glands. Out of all the people who have Cushing syndrome, Cushing disease accounts for more than 70% of cases in adults and about 60% to 70% of cases in children and adolescents.
Cushing syndrome refers to an uncommon condition that occurs when the body has too much of a hormone known as cortisol. Another word for Cushing syndrome includes hypercortisolism. A syndrome refers to a medical term that involves a group of signs and symptoms that happen together. One may see some people call this condition Cushing’s syndrome.
Cortisol refers to a steroid hormone commonly called the “stress hormone”. The body releases extra cortisol during times of stress. This hormone helps by:
- Increasing blood pressure
- Increasing heart rate
- Managing blood glucose
- Managing respiration
- Increasing muscle tension
Cortisol also helps by temporarily shutting down systems that the body does not need during times of increased stress, such as digestion and reproduction. Cortisol also proves essential in:
- Regulation of blood sugar
- Maintaining blood pressure
- Memory formation
- Reducing inflammation
- Managing respiration
- Balancing salt in the body
- Transforming ingested food into energy
The adrenal glands (two small glands on top of the kidneys), pituitary gland (in the brain) and the hypothalamus (the part of the brain above the pituitary gland) control cortisol levels. A tumor typically causes the cortisol levels found in Cushing syndrome.
- Endogenous (from within the body): Cushing syndrome happens due to increased cortisol produced by the body.
- Exogenous (from external sources): Cushing syndrome occurs due to the side effects of certain medications taken to treat other conditions.
How fatal is Cushing syndrome?
Cushing syndrome may prove fatal if one does not get treatment. Without treatment, hypercortisolism may cause health problems, such as:
- Blood clots, especially in the lungs and legs.
- Weight gain.
- Memory problems or difficulty concentrating.
- Broken bones.
- High blood pressure or high cholesterol.
- Type 2 diabetes, prediabetes or impaired fasting glucose.
If left untreated, Cushing syndrome may also result in death.
Causes of Cushing syndrome
Too much cortisol causes Cushing syndrome. Many underlying causes may contribute to this increase in cortisol levels, including:
- Use of glucocorticoid medications: Doctors prescribe glucocorticoid medications (for example, prednisone) to treat many autoimmune diseases, such as lupus, rheumatoid arthritis, chronic asthma, sarcoidosis and many other diseases that result in chronic inflammation. Chronic treatment with these medications causes “iatrogenic” or exogenous Cushing syndrome. The word “iatrogenic” means that medical treatment has caused something else to happen.
- Adrenal cortical tumors: A tumor (usually benign) on the adrenal gland itself can make too much cortisol. However, the tumor can sometimes present as an adrenal cortical carcinoma, a very rare adrenal cancer.
- Pituitary tumors
- Lung, pancreas, thyroid and thymus tumors
Symptoms of Cushing syndrome
Cushing syndrome has some unique symptoms as well as some that could point towards a variety of other syndromes. Not everyone presents with the same symptoms. Probable symptoms include:
- Rapid weight gain in the face (sometimes called “moon face”), abdomen, back of the neck (sometimes called “buffalo hump”) and chest.
- Libido changes (sex drive) and erectile dysfunction.
- Stunted growth in children.
- Poorly healing wounds.
- Blurry vision and dizziness
- Weak muscles (hypotonia and thinner limbs.
- Purple stretch marks over the abdomen
Management and Treatment
The type of treatment depends on the underlying cause of the high cortisol levels. If one uses glucocorticoids, the healthcare provider may likely lower the dosage or prescribe a non-glucocorticoid medication.
An alternative option includes prescription of a medication such as ketoconazole by the healthcare provider. Ketoconazole slows down cortisol production. One may work with several healthcare providers to treat the tumor and Cushing syndrome symptoms.
- Medications: Adding drugs that reduce cortisol or taking away drugs that can cause Cushing syndrome.
- Chemotherapy: Chemotherapy may prove necessary if a cancerous tumor has spread to other parts of the body. Ensure to discuss all side effects with the healthcare provider.
With proper treatment of Cushing syndrome, the disease may go away after two to 18 months. Ensure to stay in contact with the healthcare provider during and after this period.