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 is a third type of Cushing's called iatrogenic Cushing's which results from the overuse of corticosteriod medications. Cushing's also may have other labels: mild, subclnical, hereditary, episodic, familial, and more. As the month goes on, I'll discuss these. Regardless of the label, the list of possible symptoms is the same.
Cushing's 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, causing production of too much cortisol by the adrenal glands. 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 sugars 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.
My friend, Kate, who died way too early, made this video with my endocrinologist for a National Geographic documentary explaining Cushing's Disease:
Without prompt treatment for Cushing's syndrome, other complications may occur, such as:
- 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).
If Cushing's is not diagnosed and treated, there can be extreme, life-threatening complications.
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.
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