Cushing syndrome is a hormonal disorder that develops due to the body's prolonged overproduction of the cortisol hormone. Cortisol plays roles in various vital functions such as metabolism management, stress response, immune system regulation, and blood pressure control. However, persistently high levels of this hormone can lead to symptoms and health issues negatively affecting many body systems. Cushing disease refers to a specific subtype of this syndrome, which can develop in the presence of a tumor producing ACTH in the pituitary gland that increases cortisol release.
What is Cushing Syndrome?
Cushing syndrome is a hormonal disorder that emerges when the body produces excess cortisol hormone or due to external cortisone intake. Cortisol is involved in many vital functions like regulating blood pressure, metabolism control, and stress response. Chronically high levels of this hormone can cause significant changes in different systems of the body, affecting physical appearance, metabolic processes, and psychological status.
Cushing syndrome does not develop due to a single cause; it can arise from different mechanisms such as excessive ACTH release from the pituitary gland, cortisol-producing tumors in the adrenal glands, or prolonged use of cortisone. Thus, the cause, symptoms, and treatment approach can vary from person to person.
What Causes Cushing Syndrome?
There are two main mechanisms leading to the development of Cushing syndrome: endogenous and exogenous causes.
Endogenous Causes
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Pituitary adenoma: This is the most common cause of Cushing's disease. A small benign tumor in the pituitary gland may overproduce ACTH, causing the adrenal glands to overrelease cortisol.
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Adrenal tumors: Benign or malignant tumors developing in the cortisol-producing part of the adrenal glands can lead to uncontrolled cortisol production.
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Ectopic ACTH production: Some rare lung and pancreatic tumors can produce hormones similar to ACTH, raising cortisol levels.
Exogenous Causes
Cortisone treatments given for asthma, rheumatic diseases, allergic conditions, or autoimmune diseases can artificially increase the cortisol level in the body.
Chronic high cortisol levels have multifaceted effects on the immune system, metabolism, musculoskeletal system, and vascular structure, leading to the development of the syndrome's symptoms.
What Are the Symptoms of Cushing Syndrome?
Cushing syndrome affects many systems in the body, so symptoms may develop over time. The symptoms span a range that affects both physical appearance and metabolic processes.
Physical Symptoms
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Noticeable weight gain and fat accumulation in the trunk area
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Formation of a round face
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Buffalo hump appearance observed when fat accumulates on the back and shoulder level
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Prominent purple streaks on the abdomen, hips, and thighs
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Thinning skin and slowly healing wounds
Systemic Symptoms
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Hypertension
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Blood sugar imbalance and insulin resistance
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Muscle weakness, difficulty climbing stairs
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Osteoporosis and increased risk of fractures
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Menstrual irregularity, increased hair growth
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Mood changes, depression, and anxiety
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Recurrent infections due to weakened immune system
How is Cushing Syndrome Diagnosed?
The diagnosis of Cushing syndrome includes special laboratory tests and imaging methods aiming to determine the cortisol level. An endocrinologist's evaluation is crucial in the diagnostic process.
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Blood and urine tests: Free cortisol measurement in a 24-hour urine, serum cortisol levels are checked.
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Low-dose dexamethasone suppression test: Assesses the controllability of cortisol.
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Nighttime salivary cortisol test: Indicates whether the cortisol rhythm is disrupted.
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Imaging methods:
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Pituitary MRI
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Adrenal CT or MRI
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Chest and abdominal imaging when ectopic ACTH is suspected
Both laboratory and radiological data may need to be interpreted together in diagnosis.
How is Cushing Syndrome Treated?
Treatment can be planned by identifying the factor causing the excess cortisol. The treatment method to be followed differs for each patient.
Surgical Treatment
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Removal of adenomas producing ACTH in the pituitary gland
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Surgical removal of tumors in the adrenal gland
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Surgery is the most effective treatment method for most patients and can help cortisol levels return to normal.
Medical Treatment
In patients where surgery is not applicable or post-operative high cortisol levels persist, medications that suppress cortisol production may be used.
Cortison-Related Cushing Syndrome
In cases developing due to long-term cortisone therapy, dose reduction and transition to alternative treatments can be planned under medical supervision.
The treatment process requires long-term follow-up. Regular endocrine check-ups are important for monitoring hormonal balance.
What are the Lifestyle Recommendations for Patients with Cushing Syndrome?
While the treatment of Cushing syndrome requires a medical process, adjusting daily life habits can support the patient's recovery process and help control symptoms.
- Balanced and controlled diet
High cortisol can lead to abdominal fat accumulation and blood sugar disorders. Therefore, a diet rich in fiber, avoiding refined sugars, rich in vegetables and fruits, and maintaining protein balance should be preferred.
- Regular and appropriate exercise
Muscle weakness is a common complaint in Cushing syndrome. Light to moderate exercises can support muscle structure and help regulate metabolism.
- Adequate intake of calcium and vitamin D
Excess cortisol can reduce bone density. Therefore, a diet rich in calcium and regular exposure to sunlight are important for bone health.
- Regular sleep and stress management
A disrupted sleep pattern can affect hormone balance. Quality and uninterrupted sleep can help keep the cortisol rhythm more balanced. Techniques aimed at stress management support this process.
- Regular medical check-up
Cushing syndrome is a disease that requires long-term monitoring. Post-treatment, hormone levels should be followed, and physician check-ups should not be neglected for early detection of potential recurrences and to evaluate the general health status.
Frequently Asked Questions
What is Cushing syndrome, and how is it recognized?
Cushing syndrome is a hormonal imbalance that occurs due to prolonged high levels of the cortisol hormone. Weight gain, purple streaks on the skin, fullness in the facial area, and high blood pressure are among the early signs of the disease.
Does Cushing syndrome make losing weight difficult?
Yes. Excess cortisol can lead to increased fat accumulation, especially in the abdominal area, and slow down metabolism, making it difficult to lose weight. Weight control may become easier as hormone levels return to normal after treatment.
What is the difference between Cushing's disease and Cushing syndrome?
Cushing syndrome is a general condition characterized by excess cortisol, while Cushing's disease is a specific subtype of this syndrome caused by a tumor in the pituitary gland producing ACTH. Therefore, the diagnosis and treatment approach may also differ.
Can Cushing syndrome be completely cured?
In many patients, especially those with conditions originating from the pituitary and adrenal glands, the disease can be completely controlled with the right surgical treatment. However, some cases might require medication or long-term follow-up.
