Cushing's Syndrome - Everything You Need To Know
Cushing's Syndrome is the result of too much cortisol in the body. It's rare but can be brought on by corticosteroids which are widely used to treat inflammation.
People with autoimmune diseases, such as rheumatoid arthritis and lupus are more prone due to the long term build of corticosteroids treatments. Cushing's leads to weight gain particularly on the face and upper body, brittle bones and easily bruised skin.
Who Gets It?
Cushing's is also called hypercortisolism and it usually affects the 20-50 age range with women more likely to develop symptoms. Those with obesity or with uncontrolled high blood pressure and type 2 diabetes are more at risk of developing the illness.
The Cushing's Support and Research Foundation estimates 10 to 15 people out of a million are affected each year.
How Does It Develop?
There are two ways a person can develop Cushing's Syndrome.
Iatrogenic Cushing's Syndrome
Cushing's is often due to a build up of corticosteroid medications. This is called Iatrogenic Cushing's Syndrome.
Corticosteroids reduce inflammation in illnesses like eczema and asthma as well as autoimmune diseases. They are taken as inhalers, sprays and tablets, lotions and injections by many people.
Although they are prescribed in a low doses long term use of corticosteroids is sometimes needed to suppress painful inflammatory symptoms.
Endogenous Cushing's syndrome
This can happen when the pituitary or adrenal glands are disrupted and produce too much cortisol. This can be due to a tumour for example.
Much rarer is the growth of a tumour in the lungs that produces hormones. It's not known why exactly these tumours grow but more often than not they are benign rather than cancerous.
The risk of developing a tumour in the endocrine areas can be genetic. When this happens it's called 'Familial Cushing's'.
What Does Cortisol Do?
Cortisol is a hormone that maintains blood pressure and healthy cardiovascular levels. It balances insulin, proteins, carbohydrates and fats. It also manages the immune system's inflammatory response.
Cortisol manages stress levels too. Those with long term stress can have higher levels of cortisol in their body. Unfortunately corticosteroids contain man-made cortisol.
What Are the Symptoms Of Cushing's?
Cushing's can develop slowly or very rapidly. Here are the main symptoms:
Excess cortisol causes weight gain on the face, chest and stomach areas. Those with Cushing's will have thin arms and legs in comparison to their trunk and face.
The neck and shoulders develop fat deposits nicknamed 'buffalo hump' and their faces are often red, puffy and rounded. Children will have slow growth rates and often be obese.
Cushing's affects the skin causing excessive sweating, spots, acne, dark neck skin, thin skin that bruises and cuts easily, stretch marks and swollen ankles due to fluid retention. Injuries take a long time to heal.
The skin is affected because cortisol breaks down proteins in the skin and weakens blood vessels.
Bones and muscle
Too much cortisol also leads to weak muscles and brittle bones. This manifests as backache, bone pain, height loss, a curved spine and easily fractured bones.
- Moods swings - people with Cushing's may experience rapid moods swings and out of place emotional reactions like crying for no obvious reason
- Kidney stones - a build up of stones inside the kidneys which can be painful
- High blood pressure
- Frequent infections
- An increase of blood sugar levels which may lead to diabetes
- Increased thirst and urination
- Excess face or body hair in women
- Erectile dysfunction and loss of libido
- Infertility and absent menstrual periods
How It's Diagnosed
There are tests to uncover Cushing's Syndrome.
- Urine tests - these measure the body's amount of cortisol. Urine is collected over a 24 hour period for testing.
- Blood tests - these also measure the amount of cortisol in the body.
- Saliva tests - people without Cushing's experience a drop in cortisol during the evening. Saliva collected at this time may contain elevated cortisol levels.
- Scans - scans provide images of tumours or abnormalities present in the glands.
- Petrosal sinus sampling - a tube is inserted in the pituitary gland from the groin area to measure hormone levels. This is done under sedation.
Cushing's Syndrome Treatment
Cushing's is treatable, but it's not simple given that people taking corticosteroids need them to control pain and inflammation.
The main treatment is to reduce the use of corticosteroids in a gradual, controlled manner. Those with tumours face surgery.
Weight gain, osteoporosis and heart disease symptoms can be treated independently with a healthy balanced diet, appropriate medicines and close medical supervision. It is possible to recover from Cushing's completely, but some complications such as type 2 diabetes cannot be cured and must be treated as stand-alone illnesses.
Seeing a doctor is important but there are ways you can help yourself feel better. These include:
Increasing activity levels slowly
Exercise is important, but take it slowly because bones, muscle and skin can easily be injured.
Cut out junk food and alcohol which will only increase your weight. Eat fresh, whole foods to ensure you get enough vitamins and minerals. Calcium and vitamin D supports bone loss which is associated with Cushing's, so get plenty of sunlight, dairy, leafy green vegetables and fortified cereals.
Heat packs, massage and exercises such as yoga or walking can help manage pain levels.
There are plenty of online support groups that help members through Cushing's, but those feeling overwhelmed must seek out their doctor's support too.
Cushing's can be cured in a few weeks or it can take years depending on the severity and cause, but if not controlled Cushing's can increase the risk of heart disease, diabetes and osteoporosis.
If you think you may be developing Cushing's it's important to keep taking your medication and see your GP as soon as possible.