Cushing syndrome is a medical condition caused by high levels of the stress hormone, cortisol, in a person’s blood. Cortisol augments a person’s blood sugars and blood pressure. Also, one of the major complications which may trigger unmanaged Cushing’s syndrome is diabetes.
Cushing Syndrome Symptoms
Some Cushing syndrome symptoms can involve:
- Fatty tissue that accumulates around the upper back, waist, between the face and shoulders
- Inflammation on the cheeks with red patches
- Cushing Striae, purple or red coloured stretch marks. These might resemble big cat stripes, commonly present in the abdomen, around the breasts and thighs, or adjacent to the armpits
- Thin skin which gets bruised easily
- Females might get thicker than the normal body and facial hair (hirsutism) and skipped or abnormal menstrual periods.
- Males might experience trouble in attaining erections, loss of libido, and infertility.
Cushing syndrome accompanies high levels of blood sugar and blood pressure.
Cushing’s syndrome is a health problem marked by excess levels of the glucocorticoid hormone cortisol circulating in the urine and blood. This medical problem is usually termed hypercortisolism.
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Cushing Syndrome Causes
Excess of the hormone cortisol in a person’s body results in Cushing syndrome. Cortisol is formed in the adrenal glands and plays a key role in a person’s body. For instance, cortisol aids in:
- Controlling blood pressure
- Maintains normal functioning of heart and blood vessels
- Lowers inflammation
- Stress response of the body
- Controls the way a person’s body converts carbs, proteins, and fats in a diet into energy.
Exogenous Cushing Syndrome (Corticosteroid Drugs)
- Oral corticosteroids are essential for treating inflammatory conditions like rheumatoid arthritis, asthma, and lupus. Also, they prevent a person’s body from rejecting a transplanted body organ.
- Cushing syndrome may develop from consuming oral corticosteroid drugs including prednisone, in high doses with time.
- Moreover, a person is likely to develop Cushing syndrome from injectable corticosteroids. For instance, recurring injections for back pain, joint pain, and bursitis. Inhaled steroid drugs for asthma as well as skin creams containing steroids are less likely to result in Cushing syndrome as compared to oral corticosteroids. However, in a few people, these drugs might result in Cushing syndrome, particularly when consumed in high doses.
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Endogenous Cushing Syndrome (Body’s own over-formation)
This problem may arise when the body produces either an excess of cortisol or an excess of adrenocorticotropic hormone (ACTH). This hormone is responsible for controlling the production of cortisol.
In such cases, Cushing syndrome might associate with:
- An ACTH-secreting Tumour: This is rare cancer that develops in an organ which usually doesn’t form ACTH. And, thus it starts secreting this hormone in excessive amounts. This tumour may be cancerous (malignant) or noncancerous (benign). Also, it is generally present in the pancreas, lungs, thymus, or thyroid gland.
- Adrenal Cortex Cancerous Tumours: This is also rare, but may result in Cushing syndrome also. Rarely, noncancerous, nodular expansion of both the adrenal glands may give rise to Cushing syndrome.
- Primary disorder of the adrenal gland. Adrenal gland diseases may result in an overproduction of cortisol. A common form is a benign tumour of the adrenal cortex, referred to as adrenal adenoma. However, only a tiny portion of adenomas is from an excess of cortisol.
- Familial Cushing Syndrome: Infrequently, individuals inherit an inclination to develop tumours on one or more of their endocrine glands. This has an effect on cortisol levels and results in Cushing syndrome.
- Pituitary Adenomas or Tumours of the Pituitary Gland: A benign tumour of the pituitary gland is present at the base of the brain. This tumour results in an overproduction of ACTH, thus stimulating the adrenal glands to produce an excess of cortisol. When this type of syndrome develops, it’s named Cushing disease. It happens more frequently in females and is a more common type of endogenous Cushing syndrome.
High cortisol levels might associate with blood glucose metabolism changes. Unusually high cortisol levels in the urine appear to relate to changes in blood glucose metabolism. High levels of cortisol are one of the indications of Cushing syndrome.
Clinical Manifestations of Cushing Syndrome
There is a range of metabolic changes that relate to Cushing’s such as:
- Central or abdominal obesity
- Type 2 diabetes
- High blood pressure
- Alterations in blood glucose metabolism
When combined, these features also constitute a metabolic syndrome. People having metabolic syndrome are at a greater risk of cardiovascular problems and stroke.
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Cushing Syndrome and Diabetes
In obese or overweight people or people with metabolic syndrome, too much activity of the hormonal signalling cascade causes cortisol production. And, this might associate with modifications in the blood glucose metabolism, including insulin resistance. Moreover, insulin resistance means when body cells become insensitive to insulin hormones. And, this might cause prediabetes or type 2 diabetes.
Cushing Syndrome Diagnosis
Consuming glucocorticoid drugs is the most common reason for Cushing’s. A healthcare provider may review all the drugs including creams, pills, injections, and inhalers. This helps in determining if a person is consuming drugs that may result in this condition.
Cushing syndrome due to endogenous production of cortisol might be tough to diagnose as other diseases have comparable symptoms. Diagnosis of Cushing syndrome might be a lengthy and extensive process. A person would likely require to visit a healthcare provider who has expertise in hormonal conditions.
A healthcare provider would carry out a physical assessment and seek indications of Cushing syndrome. If a person has not been utilizing a corticosteroid drug, these diagnostic tests might assist in locating the cause:
Cortisol levels usually elevate and drop during the day. In individuals without Cushing syndrome, the cortisol levels might fall down considerably during the evening. By evaluating the levels of cortisol from a small sample of saliva collected late at night, physicians may observe whether cortisol levels are exceedingly high.
Urine and Blood Tests
They help to evaluate hormone levels and indicate whether a person’s body is forming too much cortisol. For a urine test, a person must collect urine over a 24-hour duration. Blood and urine samples are then sent to a laboratory for analysis. A doctor may also suggest other specific tests involving the measurement of cortisol levels prior to and after utilizing hormone drugs for suppressing or stimulating cortisol.
CT or MRI scans might offer images of pituitary and adrenal glands to identify irregularities like tumours.
These tests aid a healthcare provider in diagnosing Cushing syndrome. Also, they might aid in ruling out other health problems like polycystic ovary syndrome. PCOS is a hormone condition in females having enlarged ovaries. Alcoholism, depression, and eating disorders all may partially mimic Cushing syndrome.
The diagnosis of Cushing’s syndrome is done by evaluating the levels of cortisol in blood, urine, and saliva. A person might be asked to use dexamethasone prior to carrying out the test. If a person does not have Cushing’s syndrome, dexamethasone must reduce cortisol levels.
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Cushing Syndrome Treatment
Its treatment involves surgery for the removal of the tumour. In certain cases, mainly where there is at least one adrenal gland tumour, the gland might get removed.
If there is a tumour in the lungs and that’s the reason for Cushing’s syndrome, and the tumour is deep inside the lungs, a surgical procedure might not be suitable. Also, people might require consuming certain cortisol-inhibiting drugs like ketoconazole or metyrapone. If surgery goes unsuccessful, radiotherapy might be useful for reducing the size of the tumour. Moreover, if Cushing syndrome puts a person’s health at risk, it’s better to remove one or both of the adrenal glands.
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Steroid-Induced Cushing Syndrome Treatment
When Cushing syndrome disease arises due to corticosteroids, the dosage would require to be decreased or stopped. If a person has been consuming high doses of steroids for a considerable duration of time, the dose would generally be decreased prior to their stoppage. A doctor would recommend to a person how to lower the doses of steroids.
Complications of Cushing Syndrome
Without treatment, Cushing syndrome complications might be:
- High blood pressure
- Bone loss (osteoporosis), which may bring about rare bone fractures like rib fractures or fractures of the bones in the feet
- Recurrent or rare infections
- Loss of muscle strength and muscle mass
- Type 2 diabetes
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Cushing Syndrome Diet
Regulating Blood Glucose Levels
Cortisol promotes the liver to augment the levels of blood glucose. Hence, individuals having Cushing’s syndrome experiencing continually high cortisol levels might also experience blood glucose spikes. Hyperglycemia is associated with many chronic complications such as nerve damage, renal damage, heart problems, bone, and joint disorders. Healthcare providers may recommend the way to space out meals throughout the day to regulate the blood glucose levels.
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Lowering the Consumption of Sodium
Too much sodium might deteriorate the Cushing syndrome symptoms by augmenting blood pressure and resulting in weight gain. As a result, people must reduce their sodium by avoiding refined foods and restricting salt that’s added to food.
A common sign of Cushing syndrome is high levels of cholesterol. Thus, people must avoid fatty foods and include more fibre-containing foods like apples, kidney beans, prunes, pears, and barley might aid in offsetting higher cholesterol effects that are related to Cushing syndrome and diabetes.
Decreasing or Removing Alcohol and Tobacco
Many experts suggest lowering the consumption of alcohol and tobacco as well. Chronic, heavy drinking may harm the hypothalamic-pituitary-adrenal (HPA) axis network, causing signs resembling those of Cushing syndrome. Tobacco use enhances the risk of complications during a surgical procedure. If surgery is a treatment alternative for Cushing’s, it is better to quit smoking. As it might lower the risk of surgical complications.
Enhancing the Intake of Calcium and Vitamin D
Cushing syndrome may lead to a lowered bone density or osteoporosis. As calcium and vitamin D help in strengthening bones, physicians suggest a healthy diet containing calcium and vitamin D for individuals with Cushing’s. This involves cheese, kale, broccoli, milk and drinks invigorated with vitamin D. In addition, multivitamins are a rich source of calcium and vitamin D. Adults must have a goal of eating nearly 800 mg of calcium and 5-15 micrograms of vitamin D daily. Also, the intake of vitamin D must increase with age.
Cushing’s syndrome is a medical problem which may happen in the presence of high levels of cortisol in the bloodstream. Cortisol is also known as a stress hormone. And, it augments a person’s blood pressure and blood sugars. Hence, one complication which might arise due to an unmanaged Cushing’s syndrome is diabetes.
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Can metformin result in Cushing’s disease?
Metformin is an oral type 2 diabetes medication. It supports cell death in tumors responsible for Cushing’s syndrome and lowers too much production of the ACTH.
Does Cushing’s disappear on its own?
Many instances of Cushing’s syndrome are treatable. Even if, it might take some time for the signs to get relieved. The health problem is more common in females as compared to males.
How does sugar have an impact on cortisol levels?
Regular high extra sugar consumption might cause higher cortisol levels. Fascinatingly, a high glucose diet might also result in the suppression of cortisol released during stressful events. This makes it more problematic for a person’s body to deal with such stressful circumstances.
Does Cushing’s syndrome result in insulin resistance?
It was found in studies that people with Cushing’s syndrome showed insulin resistance out of proportion to obesity. Also, it was of higher severity as compared to obese people.
Last Updated on by Dr. Damanjit Duggal
The information included at this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.