Cushing’s Disease updated 11/2019
Prolonged exposure to high levels of the hormone cortisol results in the signs and symptoms of Cushing’s disease. To better understand how this excess production of cortisol happens, let us look at the endocrine system which consists of hormone producing organs that regulate development, metabolism, mood, and many other bodily functions.
The pituitary gland is often referred to as the “master gland” of the body because it controls the functions of the other endocrine glands. It does so by producing and releasing a variety of specific hormones for that purpose. It is about the size of a pea, shaped like the capital letter H, and located at the base of the brain.
Cushing’s disease occurs when a noncancerous benign adenoma (tumor) forms in the pituitary causing excessive release of ACTH (adrenocorticotropic hormone). This in turn triggers the adrenal glands, located just above the kidneys, to produce excessive amounts of the hormone cortisol (hypercortisolism). This creates a hormonal imbalance resulting in a variety of symptoms that are the result of too much cortisol. This condition improves or disappears as the level of cortisol returns to normal. Cushing’s disease can also occur by increased growth (hyperplasia) of the pituitary gland itself leading to excess ACTH production.
Cushing’s Disease is a form of a larger condition called Cushing’s syndrome which results from excess cortisol production regardless of the cause: examples include, adrenal gland adenomas, pharmaceuticals such as prednisone and periods of stress and depression that lead to excess cortisol production.
Cortisol – helps maintain blood sugar levels, protects the body from stress, reduces the immune system’s inflammatory response, helps maintain blood pressure and cardiovascular function, regulates salt and water balance and regulates the metabolism of proteins, fats and carbohydrates. When under stress, cortisol’s purpose is to provide glucose for cellular energy by utilizing the body’s protein and fat stores. This constant flow of glucose leads to hyperglycemia. At the same time, cortisol reduces the effects of insulin by increasing the body’s resistance to insulin. As a result, blood sugars remain abnormally high.
SYMPTOMS - Cushing’s disease can affect individual’s differently both in terms of the severity of the symptoms and the type of symptoms noted. The first sign is rapid weight gain for no apparent reason with fat deposits around the abdomen, face (moon face), and neck accompanied by thinning arms and legs. A buffalo hump created by a buildup of fatty tissue between the shoulder blades may occur. Stretch marks develop on the thighs and abdomen. Patient’s suffer from osteoporosis, muscle weakness, extreme fatigue, sleeping difficulty, vision problems, headaches, increased blood pressure (hypertension) and diabetes. Other symptoms appear in the skin, which becomes fragile and thin. It bruises easily and heals poorly. It can cause mood disorders such as anxiety, irritability, and depression. Men may experience erectile dysfunction. Women usually have excess hair growth on their faces, necks, chests, abdomens, and thighs. Their menstrual periods may become irregular or stop . Children tend to be obese with slowed growth rates.
DIAGNOSIS is based on a patient’s medical history, physical exam and lab tests for the hormones Cortisol or ACTH. Radiologic imaging tests reveal the size and shape of the pituitary and adrenal glands and help determine if a tumor is present.
TREATMENT - depends on the cause of cortisol excess and may include: surgical removal of the tumor, radiation, chemotherapy or cortisol inhibiting drugs. Untreated, Cushing’s disease can cause severe illness and even death.
COMPLICATIONS – When Cushing’s syndrome is caused by a pituitary tumor (Cushing’s disease), it can lead to other problems including: impaired peripheral vision, impacting other hormones controlled by the pituitary, diabetes, high blood pressure, a reduced immune response leading to infections, kidney stones and mental conditions such as psychosis.
Cushing’s disease generally occurs in adults between the ages of 20 and 50 although children can be affected. Because of its rarity ( affects 10 to 15 people per million worldwide) and the fact that many of the symptoms resemble those of other conditions, physicians tend to overlook the condition as a possible cause of brittleness. No harm in asking your physician to eliminate Cushing’s if you manifest any of the symptoms previously described.