A Family Doctor's Tale - CUSHING SYNDROME

DOC I HAVE CUSHING SYNDROME

Cushing Syndrome is a  disease which is caused by the exposure of the body to excessive quantities of glucocorticoids steroids.

People of all ages are affected but more are seen in females between 30 to 50 years of age.

The causes are believed to be:
1. Cushing Disease -excessive production of adrenocorticotrophin hormone(ACTH) by the pituary gland causes bilateral adrenal(gland above kidney)hyperplasia(overgrowth of gland tissue).The enlarged adrenal gland will produce excessive corticosteroids.
A pituitary basophil or chromphobe adenoma may be present.

2.Adrenal tumors which may be benign or malinant can produce excessive corticosteroids

3.Ectopic ACTH syndrome
Production of ACTH by a tumor such as cancer of the lungd leads to adrenal hyperplasia

4.Iatrogenic -patients receiving excessive doses of corticosteroids may present as Cushing syndrome

Symptoms of Cushing Syndrome:
1.Obesity predominally truncal often with pad of fat between shoulders(buffalo hump)

2.Round flat plethoric(red) face (moon face)

3.Skin is thin and bruises easily

4.Purole striae on abdomen, thighs, and shoulders.

5.Proximal myopathy leads to difficulty in getting out of chairs and walking upstairs

6.Excessive adrenal androgen secretions leads to hirsutism, amenorrhea and acne

7.Osteoporis can lead to back pain

8.Hypertension and glycosuria(glucose in urine) are common

9.Depression and other psychiatric disturbance common

10.In children there may stunting of growth

Diagnosis of Cushing Syndrome:
1.The typical moon face and buffalo hump can suggest the diagnosis of Cushing Syndrome

2.24 hour urine cortisol tests

3.Overnight dexamethasone suppression test

4.Plasma ACTH level

5.Chest X-ray to exclude lung cancer

6.X-ray of pituitary fossa to exclde pituitary tumors

7.Ultrasound of adrenal glands for enlargement

Complications of Cushing Syndrome:
1.Hypertension

2.fractures from osteoporosis

3.stunted growth in children

Treatment of Cushing Syndrome:
1.Anti-sdrenal drug such as aminogluthemide

2.bilateral adrenalectomy

3.Surgery to remove pituitary tumor

4.surgery to remove primary neoplasm in lungs or pancreas

Prognosis of Cushing Syndrome:
The prognosis of Cushing Syndrome varies with cause.

The response is often excellent in cases of pituitary tumor removal. However recurrence of tumor or increase in size of the tumor will affect the prognosis.

Benign adrenal tumors have excellent response to treatment.

Iatrogenic Cushing syndrome often responds well to decreasing doses of corticosteroids.

In cases of lung cancer, treatment may have poor response.