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Health and Disease

Cushing’s Syndrome: Causes, Symptoms, and Treatment

An article discussing the symptoms, causes, risk factors and treatment of Cushing’s Syndrome.

What is Cushing’s Syndrome?

Cushing’s syndrome is a rare disease caused by the body having excess of the hormone, cortisol. Cortisol is the hormone that causes a stress response, increasing glucose concentration in the blood and allowing the brain to increase respiration to repair tissue and, similarly the adrenaline, temporarily stops non-essential bodily functions such as digestion. Cushing’s syndrome is the umbrella term for the effects caused by abnormally high cortisol levels, which can become more serious if left untreated over a long period of time. 

What causes Cushing’s Syndrome?

Due to the rare nature of the syndrome, the main cause of Cushing’s Syndrome is through taking steroids, in medication such as hydrocortisone skin cream, over too long a period of time, increasing cortisol in the bloodstream. In a select few cases, Cushing’s Syndrome can be caused by a tumour causing the excess secretion of cortisol. There are two different areas that a tumour could be that may cause increased cortisol secretion: the pituitary gland in the brain or a tumour in the adrenal glands, above the kidneys. The pituitary gland is vital as it controls the release of hormones from other glands, such as the thyroid gland and adrenal glands. Pituitary related tumours can cause effects ranging from low energy, feeling depressed, delay or advanced reproductive development and delayed or enhanced growth. The adrenal glands are where the hormones cortisol and aldosterone are produced and stress hormones such adrenaline. 

What are the risk factors of Cushing’s Syndrome?

Cushing’s Syndrome is more common in adolescent to young women than men and it can be induced through taking steroid medications over a long period of time or at too high a dosage. Those who already have pre-existing pituitary or adrenal tumours, or have a family history of benign or malignant tumours in these regions, are also more at risk of developing the syndrome.

What are the main symptoms of Cushing’s Syndrome?

According to the NHS website, symptoms of Cushing’s Syndrome can manifest suddenly or gradually over a longer period of time and intensify the longer that they are left untreated. A key initial symptom tends to be weight gain and a higher percentage of body fat. This weight accumulation may be more prominent on the chest and stomach, while the limbs do not noticeably change size. A defining feature of Cushing’s Syndrome is a “buffalo hump” on the back of the neck, which is a protruding deposit of fat and a “moon” face, which is a puffy or rounded appearance, is also a characterising feature. 

Other less noticeable symptoms may also be presented, such as skin sensitive to bruising, prominent stretch marks, weakness in the arms and thighs, low libido, difficulty conceiving and  frequent change in mood. Cushing’s Syndrome can also lead to other comorbidities such as high blood pressure, which needs treatment to prevent it from becoming more serious. 

At what point should you consider seeking medical advice for Cushing’s Syndrome?

In the UK, if you believe you are suffering from multiple symptoms of Cushing’s Syndrome, especially if you are most at risk due to taking steroids, seek the advice of a GP. Cushing’s Syndrome presents itself in a similar way to other diseases, with closely linked symptoms, therefore they may undertake investigations but find that Cushing’s Syndrome is not the cause. 

How is Cushing’s syndrome Diagnosed?

The amount of cortisol in your body can be determined through a 24 hour urine test, which may show any abnormalities. Saliva tests and blood tests are also, although less commonly, used and you may receive a referral to a specialist hormone doctor, an endocrinologist, if raised levels are detected. If Cushing’s Syndrome is diagnosed and you are not taking steroids, you may be referred for further examinations such as X-Ray or MRI scans to check the pituitary gland for tumours or ultrasounds to check the adrenal glands, which are situated above the kidneys. 

What is the treatment for Cushing’s Syndrome?

If steroid medication is found to be the cause of Cushing’s Syndrome, your consultant may gradually decrease your dosage or eventually remove you from the medication completely. If a tumour is detected, surgery may be used to remove the tumour or less invasive options such as radiotherapy can be used. If the tumour cannot be removed or destroyed, medications can be used to reduce the impact of cortisol in your body. 

Sophie Farr, Youth Medical Journal 2022

Bibliography

By Sophie Farr

I am a student from the UK and my ambition is to become a doctor.

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