Cushing's syndrome in humans, also called human Cushing's disease, is caused by long-term exposure to glucocorticoids, or cortisol, in the body. Most often, this is from overuse of therapeutic cortisol steroid creams and steroid medications like prednisol. Other times, it can be from a adrenocorticotropic hormone (ACTH) secreting tumor on the pituitary gland or adrenal gland that tells the body to make more cortisol. The prognosis for Cushing's disease patients is good, with treatment that usually involves the removal of the tumor or cortisol-secreting gland or hormone therapy.
Symptoms
Most people with Cushing's tend to have upper-body obesity, a rounded face, a lot of fat around the neck area and thin arms and legs. Children with Cushing's disease tend to be obese with a slowed growth rate. The skin of a Cushing's disease patient is often thin and fragile, bruising easily and healing poorly. Bright red or purple stretchmarks, called striations, may appear on the lower part of the belly and the armpits, thighs, breasts and buttocks. Bones are weakened, and even small activities like bending or standing can cause backaches or even bone fractures. Severe fatigue, weak muscles,high blood sugar and high blood pressure as well as irritability, depression and anxiety are also common. Cushing's disease occurs most frequently in women of childbearing age. In addition to the other symptoms, women may also experience excessive hair growth from their face down to their thighs. Menstrual periods may become irregular or even stop altogether. Men who suffer from Cushing's disease may experience a decreased libido. Additionally, their sperm count may go down, resulting in infertility.
Treatments
The treatment for Cushing's disease will be different for many patients, depending on the root cause of their disease--mainly, why the patient's body has been subjected to excessive amounts of the hormone cortisol. If there's a tumor at work, then removing it may be all that's necessary. If the tumor is cancerous, which does occur, especially with lung cancer, then radiation or chemotherapy might be necessary. If it's due to overuse of steroids or hormone medications, then prescription medication may be in order to counteract the effects. If the patient is using steroids to treat another disease, then doctors may experiment with the dosage to find the healthiest balance.
Diagnostic Tests
Before Cushing's disease can be treated, doctors must find out the cause. By injecting the patient with CRH, doctors can monitor their body's chemical response with timed blood tests to check the levels of reactive cortisol in the blood. Certain parameters have been established for tumors lying outside of the glands and on the glands. Imaging tests are also used to pinpoint the specific location of tumors before surgery. A 24-hour collection of several urine specimens can help doctors figure out where the cortisol is coming from, too. Finally, a sampling of the sinus tissue, taken through the nose, is also telling. Once the doctor finds out why the body is excreting extra cortisol, she can make a treatment plan.
Surgery
Generally, surgery to remove the tumor is the most important part of curing Cushing's disease. Sometimes, patients will be premedicated with suppressive hormones, and other times, doctors will simply operate to remove the tumor. Because the pituitary and adrenal glands are easily accessible via the nasal cavity, surgeons prefer to use a camera-guided technique that's incision-free and can allow patients to recover faster.
Chemotherapy and Radiation
Where the root cause of Cushing's is cancerous, doctors may use spot irradiation, radiation or chemotherapy to destroy the cancerous cells and keep them from relocating to another part of the body. Chemotherapy is a combination of radiation and medication and has a long list of side effects; doctors generally use it as a last resort.
Suppressive Medications
Sometimes, suppressive prescription medications can be used to prevent the body's release of excess cortisol. This solution works for patients who aren't candidates for surgery, like the immune-suppressed and the elderly.
