What is Cushing’s syndrome?
Cushing’s syndrome is a rare disorder that has a prevalence of 10 patients per 100 million population per year. It can be classified into pituitary dependent or ACTH dependent Cushing’s syndrome which is also known as Cushing’s disease. Most patients with Cushing’s syndrome will have this problem. However 10 or 15% of patients will have a tumor in the adrenal gland and another 10 or 15% will have a tumor outside of the adrenal gland that is making adrenocorticotrophic hormone or ACTH. These latter patients have what is known as ectopic ACTH syndrome. Cushing’s syndrome is due to excess cortisol secretion. It causes characteristic symptoms including obesity of the trunk and thinning of the extremities, a thickening at the base of neck called a buffalo hump, a rounding of the face, weakness of the proximal muscles, thinning of the skin, hirsutism or an increase in hair, easy bruisability, depression, osteoporosis, high blood pressure and glucose intolerance or diabetes. Cortisol has widespread effects on metabolism and organ function and prolonged exposure can be detrimental to the body. The symptoms of hypercortisolism may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is Cushing’s syndrome diagnosed and treated?
The various causes of Cushing’s syndrome can be sorted out by doing blood tests and radiologic images of the adrenal gland. This is important because tumors in the adrenal gland causing Cushing’s syndrome are best treated by removal. Ectopic ACTH tumors are also best treated by removal. Cushing’s disease or pituitary dependent Cushing’s syndrome is usually treated by removing a small microscopic tumor from the pituitary gland. Removing both adrenal glands will completely reverse this problem of Cushing’s disease and is done when a rapid reversal of the patient’s symptoms is needed. The best way to remove the adrenal glands and their tumors are laparoscopic adrenalectomy. This can be done safely if there is no risk of cancer.
In addition to a complete medical history and physical examination, diagnostic procedures for a cortisol producing tumor may include:
- Blood and urine tests to measure hormone levels
- Computed tomography (CT or CAT scan) or magnetic resonance imaging (MRI) -are non-invasive procedures that take cross-sectional images of the adrenal or other internal organs; to detect any abnormalities that may not show up on an ordinary x-ray.