Day 3 of the Cushing's Awareness Challenge: What is Cushing's Disease/Syndrome?

I have been asked that umpteen times by folks who care about me. Other folks just look at me like I'm from an alien planet, and even others just nod and go on like they already know. I'm sure they go right home and google it. Ok, maybe some of them do.

When you get right down to it, I've become a walking library of sorts with facts and figures most medical students and doctors don't know. It's a matter of self-preservation, but you already know that if you are fighting any illness.

So, what is Cushing's? There are two terms used with Cushing's: Disease and Syndrome. They signify the source of the illness, although the presentation is pretty much the same with both. Cushing's Disease is hypercortisolism due to a pituitary source of stimulation. Cushing's Syndrome is hypercortisolism due to an ectopic or adrenal source. There really is a third type of Cushing's called iatrogenic Cushing's which results from the overuse of corticosteriod medications. And actually another type called pseudo-Cushing's.

I want to discuss Cushing's Disease/Syndrome (CD/CS). CD/CS is an endocrine disorder caused by chronic exposure of the body's tissues to excess levels of cortisol - a hormone naturally produced by the adrenal gland. Pituitary adenomas, usually benign, secrete increased amounts of ACTH (adrenocorticotropic hormone), a substance that controls the release of cortisol in that feedback loop I mentioned the other day. It typically causes an overproduction of cortisol. Tumors of the adrenal gland and ectopic ACTH producing tumors can cause similar problems with cortisol overproduction.

What are the symptoms? The most common symptoms are:

• Striae
• Buffalo hump
• red-faced all the time
• sweaty or hard to control body temp
• High blood pressure (often hard to control even with medication)
• High blood sugar and/or insulin resistance
• Insomnia
• Fatigue
• Altered diurnal rhythm (See previous post)
• Secondary hypothyroidism
• Low hormones such as FH, LSH, testosterone, growth hormone
• Low Vitamin D
• Low ferritin
• Unexplained muscle, bone, and joint pain
• Easy bruising
• Difficulty when drawing blood
• Upper body obesity
• Muscle weakness
• Increased facial hair/body hair (hirsutism)
• Loss of hair on head
• Loss of menstrual cycle and/or ovulation
• Loss of libido
• galactorrhea

Not everyone has all the symptoms. And the weight gain can vary by individual. Some folks don't gain a lot. Others do.






Without prompt treatment for Cushing's syndrome, other complications may occur, such as:

• Cardiovascular disease
• Bone loss (osteoporosis), due to the damaging effects of excess cortisol
• High blood pressure (hypertension)
• Kidney stones
• Diabetes
• Unusual infections
• Hypothyroidism

When the cause of Cushing's syndrome is a pituitary tumor (Cushing's disease), it can sometimes lead to other problems, such as interfering with the production of other hormones that the pituitary controls. It can also affect the optic nerves and carotid arteries if large. The majority of pituitary tumors that cause Cushing's disease are small (less than one cm in size).

Long-Term Remission Rates After Pituitary Surgery for Cushing's Disease: the Need for Long-Term Surveillance says:
Morbidity and mortality are higher in patients with Cushing's disease, with vascular disease a frequent cause of death.[2,32,33] Cardiovascular complications, including coronary heart disease, congestive heart disease and cerebrovascular events, contribute to the morbidity and mortality of patients with undiagnosed or untreated Cushing's disease.[34,35] Early diagnosis and successful treatment of Cushing's disease is therefore most important.


Now, diagnosis....that's a whole 'nuther ballgame. To mix metaphors, it is no walk in the (ball)park.

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