Read more about this disease, some with Classification – Types – Signs and symptoms – Genetics – Pathophysiology – Diagnosis – Screening – Prevention – Treatment and management – Cures and much more, some including pictures and video when available.
Cushing’s syndrome (also called hyperadrenocorticism or hypercorticism) is an endocrine disorder caused by high levels of cortisol in the blood. This hypercortisolism can be caused by intake of glucocorticoids, or by tumors that produce cortisol or adrenocorticotropic hormone (ACTH).[1] Cushing’s disease refers to one specific cause, namely an adenoma in the pituitary gland that produces large amounts of ACTH which in turn elevates cortisol.
Cushing’s syndrome is not confined to humans and is also a relatively common condition in domestic dogs and horses. It was described by American Dr. Harvey Cushing in 1932.[2]
There are several possible causes of Cushing’s syndrome. The most common is exogenous administration of glucocorticoids prescribed by physicians to treat other diseases (called iatrogenic Cushing’s). This can be an effect of steroid treatment of a variety of disorders such as asthma and rheumatoid arthritis, or in immunosuppression after an organ transplant. Administration of synthetic ACTH is also possible, but ACTH is less often prescribed due to cost and lesser utility.
Endogenous Cushing syndrome (also known as Cushing’s Disease) results from some derangement of the body’s own system of secreting cortisol. Normally, ACTH is released from the pituitary gland when necessary to stimulate the release of cortisol from the adrenal glands. In pituitary Cushing’s, a benign pituitary adenoma secretes ACTH. This is also known as Cushing’s disease and is responsible for 65% of endogenous Cushing’s. In adrenal Cushing’s, excess cortisol is produced by adrenal gland tumors, hyperplastic adrenal glands, or adrenal glands with nodular adrenal hyperplasia. Finally, tumors outside the normal pituitary-adrenal system can produce ACTH that affects the adrenal glands. This final etiology is called ectopic or paraneoplastic Cushing’s and is seen in diseases like small cell lung cancer.
Cushing’s syndrome can also be sub-classified according to whether or not the excess cortisol is dependent on increased ACTH. ACTH-dependent Cushing’s is driven by increased ACTH and includes exogenous ACTH administration as well as pituitary and ectopic Cushing’s. ACTH-independent Cushing’s shows increased cortisol, but the ACTH is not elevated but rather decreased due to negative feedback. It can be caused by exogenous administration of glucocorticoids or by adrenal adenoma, carcinoma, or nodular hyperplasia.
Symptoms include rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity). A common sign is the growth of fat pads along the collar bone and on the back of the neck (buffalo hump) (known as a lipodystrophy) and a round face often referred to as a “moon face”. Other symptoms include excess sweating, telangiectasia (dilation of capillaries), thinning of the skin (which causes easy bruising and dryness, particularly the hands) and other mucous membranes, purple or red striae (the weight gain in Cushing’s stretches the skin, which is thin and weakened, causing it to hemorrhage) on the trunk, buttocks, arms, legs or breasts, proximal muscle weakness (hips, shoulders), and hirsutism (facial male-pattern hair growth). The excess cortisol may also affect other endocrine systems and cause, for example, insomnia, reduced libido, impotence, amenorrhoea and infertility. Patients frequently suffer various psychological disturbances, ranging from euphoria to psychosis. Depression and anxiety are also common.[3]
Cushing’s syndrome may present with striking and distressing skin changes including hyperhidrosis, dryness, fragility of the skin, facial acne, susceptibility to superficial dermatophyte and pityrosporon infections, a plethora over the cheeks, anterior neck, and V of the chest, and the characteristic purplish, atrophic striae on the abdomen.[4]:500
NOTE: Cortisol increases may be contributed to abdominoplasty, or gastric by-pass surgery.
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