CUSHING's disease, CUSHING's syndrome

Cushing's syndrome could have several possible causes including tumors of the adrenal gland, adrenal gland stimulating hormone (ACTH) produced from cancer such as lung cancer and ACTH excessively produced from a pituitary tumors within the brain.

Cortisol production

Usually cortisol levels increase and/or changed through a chain reaction of hormones:

First step - the hypothalamus in the brain produces so called “Corticotropin-Releasing Hormone (CRH).

Second step – the hormone CRH “instruct” the pituitary gland to produce next hormone called “AdrenoCorticoTropic Hormone (ACTH).

Third step – the ACTH signal the adrenal glands to produce locally the hormone “cortisol” which can affect almost every part of the body. Cortisol is very important in regulating blood pressure and metabolism. Increased levels of cortisol could cause menstrual dysfunction (mainly oligomenorrhea and amenorrhea).

It is important to know that medicine that acts like cortisol  also can provoke symptoms similar to Cushing's syndrome and/or Cushing’s disease.

Causes

Main cause of the Cushing's disease is a tumor or excess growth (hyperplasia) of the pituitary gland (located at the base of the brain).

Cushing's syndrome could have several causes – any cause which provoke excessive levels of cortisol for long periods of time:

• Stress including depression, alcoholism, malnutrition and panic disorders. During stressful situations body normally produce cortisol which controls the body's use of carbohydrates, fats and proteins as well as helps reduce the immune system's response to risk factors (adaptation, inflammation, swelling). One of cortisol's most important jobs is to help the body respond to stress.
  
  
• Steroid medications. During several diseases and/or conditions (rheumatoid arthritis, inflammations, asthma, lupus, organ transplants) treatment includes steroids. Long “chtonic” use of steroids is the most common cause of Cushing's syndrome.
  
  
• Pituitary tumors can also develop symptoms typical for Cushing's syndrome. Actually tumors on the pituitary gland are known as a main cause for Cushing's disease. In most cases these tumors are not cancerous.
  
  
• Adrenal tumors, tumors in the lung or pancreas. These tumors could be dangerous (even cancerous) and could develop the Cushing's syndrome.
  
  
• Genetic inherited tendency (very rare!). Some people (sometimes family members) have special causes of Cushing's syndrome due to an inherited tendency to develop tumors of one or more endocrine glands.

Cushing’s disease symptoms

Menstrual dysfunctions – mainly rare periods (oligomenorrhea) and absence of periods (amenorrhea);

Obesity – very specific upper body obesity (above the waist) combined with thin arms and legs;

“Moon Face” - round, red, full face;

“Buffalo Hump” - collection of fat between the shoulders;

Specific purplish pink stretch marks (1/2 inch or more wide) called “striae” mainly on the skin of the abdomen, thighs and breasts;

Acne or skin infections;

“Hirsutism” -   excess hair growth on the face, neck, chest, abdomen and thighs;   

Infertility;

Severe fatigue and weak muscles;

Bone pain or tenderness

High blood pressure and high blood sugar;

Increased thirst and urination;

Irritability, anxiety and depression.

Cushing’s disease treatment

Untreated, Cushing's disease can cause severe illness, even death. Removal of the tumor may lead to full recovery, but the tumor can grow back.

Treatment depends on the specific reason for cortisol excess and may include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs.