Cushing's Syndrome

###  What is Cushing's Syndrome?

**Cushing's syndrome** is a collection of signs and symptoms due to prolonged exposure to cortisol.

https://en.wikipedia.org/wiki/Cushing%27s\_syndrome#Treatment

Cushing syndrome is what happens when they body has been exposed to high levels of cortisol for and extended level of time or when the body makes an excess of cortisol. These high levels of cortisol are often from overuse of corticosteroid medications.

### How does Cushing's Syndrome Affect the Endocrine System?

There are four ways that the syndrome can be caused through organs in the endocrine system. A pituitary adenoma secrets a large amount ACTH which stimulates the adrenal glands to make more cortisol.  A primary adrenal gland disease which causes the gland to secrete more cortisol than normal. An ectopic ACTH-secreting tumor can also cause more than normal cortisol levels in people which causes this disease. Very rarely Cushing syndrome can be genetic or from parents. All of these are based on the release of hormones which the Endocrine system is responsible for controlling. These causes flood the system with hormones which confuses the system.

### Signs and Symptoms

Signs and symptoms may include: high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a round red face, a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals poorly. Women may have more hair andirregular menstruation. Occasionally there may be changes in mood, headaches, and a chronic feeling of tiredness.

The most common symptoms of Cushing syndrome are weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face and between the shoulders. Pink or purple stretch marks on the skin of the abdomen, thighs, breasts and arms. Thinning, fragile skin that bruises easily. Slow healing of cuts, insect bites and infections and acne. Less common symptoms are, Fatigue, muscle weakness, depression, anxiety and irritability, loss of emotional control, cognitive difficulties, new or worsened high blood pressure, glucose intolerance that may lead to diabetes, headache, and bone loss, leading to fractures over time Women specific symptoms are irregular menstrual cycle and abnormal facial hair growth. Male specific symptoms are decreased libido and fertility and erectile dysfunction.

### Diagnosis

Urine, blood and saliva tests are all common tests for Cushing syndrome. This is because hormone levels can be tested through these. The sample is sent to a lab and the hormone levels are analysed to determine the amount.

## Treatment

*Most Cushing's syndrome cases are caused by corticosteroid medications (iatrogenic), such as those used for asthma, arthritis, and other inflammatory conditions. Consequently, most patients are effectively treated by carefully tapering off (and eventually stopping) the medication that causes the symptoms.*

~~If an adrenal adenoma is identified, it may be removed by surgery. An ACTH-secreting corticotrophic pituitary adenoma should be removed after diagnosis. Regardless of the adenoma's location, most patients require steroid replacement postoperatively at least in the interim, as long-term suppression of pituitary ACTH and normal adrenal tissue does not recover immediately. Clearly, if both adrenals are removed, replacement with hydrocortisone or prednisolone is imperative.~~

~~In those patients not suited for or unwilling to undergo surgery, several drugs have been found to inhibit cortisol synthesis (e.g. ketoconazole, metyrapone) but they are of limited efficacy. Mifepristone is a powerful glucocorticoid type II receptor antagonist and, since it does not interfere with normal cortisol homeostatis type I receptor transmission, may be especially useful for treating the cognitive effects of Cushing's syndrome. However, the medication faces considerable controversy due to its use as anabortifacient. In February 2012, the FDA approved mifepristone to control high blood sugar levels (hyperglycemia) in adult patients who are not candidates for surgery, or who did not respond to prior surgery, with the warning that mifepristone should never be used by pregnant women.~~

~~Removal of the adrenals in the absence of a known tumor is occasionally performed to eliminate the production of excess cortisol. In some occasions, this removes negative feedback from a previously occult pituitary adenoma, which starts growing rapidly and produces extreme levels of ACTH, leading to hyperpigmentation. This clinical situation is known as Nelson's syndrome.~~

If the cause for Cushing syndrome is a tumor often time the tumor is surgically removed. Medicine wise there are drugs that reduce the amount of cortisol produced or they decrease cortisol’s effect to the body. These drugs are ketoconazole (Nizoral), mitotane (Lysodren) and metyrapone (Metopirone) and mifepristone (Korlym) for people with diabeties.