Cushing's Syndrome Specialist
Endocrinologist and Cushing's Syndrome Specialist
located in Peachtree City, GA
Cushing's Syndrome
Cushing’s syndrome is a disorder caused by having too much cortisol in the blood. It can happen when the patient is taking too much cortisol-like medications, such as prednisone or dexamethasone. Endogenous Cushing’s syndrome is caused by disorders of adrenal glands, pituitary gland (Cushing’s disease) or very rarely non-pituitary tumors making hormone ACTH. Patients with Cushing’s syndrome usually notice weight gain, especially in the upper body. A rounder facial appearance, extra fat on the upper back and above the collarbones can be observed. They also struggle with high blood sugars, high blood pressure, loss of bone mass, muscle weakness and skin changes such as skin thinning, bruising and purple stretchmarks. At Peach State Endocrinology in Peachtree City, GA, Evgenia Korytnaya, MD (Dr. K), specializes in Cushing’s Syndrome. Schedule online or call to schedule an appointment with Dr. K today.
Learn more about Cushing’s Syndrome and Cushing’s disease at Endocrine Society.
Cushing's Syndrome
What is it:
Cushing’s syndrome is a medical condition caused by an excessive amount of cortisol in the body. Cortisol is a hormone produced by the adrenal glands, which look like “hats” located above each kidney. This hormone plays a crucial role in various bodily functions, including regulating metabolism, managing blood sugar levels, and controlling inflammation.
Cushing’s syndrome can develop for a variety of reasons:
- Adrenal Tumor: One of the most common causes is the presence of a non-cancerous tumor (adenoma) on one of the adrenal glands. This tumor can lead to an overproduction of cortisol.
- Pituitary Gland Tumor: Sometimes, a benign tumor in the pituitary gland, called a pituitary adenoma, can produce excessive amounts of adrenocorticotropic hormone (ACTH). ACTH, in turn, stimulates the adrenal glands to produce more cortisol.
- Long-term Corticosteroid Use: Prolonged use of corticosteroid medications, such as prednisone, can also cause Cushing’s syndrome. This is known as iatrogenic Cushing’s syndrome
Symptoms:
- Weight Gain: This is often concentrated in the abdominal area, giving rise to a “potbelly” appearance, while the limbs may remain relatively slender.
- Round Face (Moon Face): The face can become round and full, often referred to as “moon face.”
- Buffalo Hump: Some people with Cushing’s syndrome develop a fatty hump between the shoulders, known as a buffalo hump.
- Muscle Weakness: Weakness in the muscles, especially the proximal muscles (those closest to the trunk), can occur.
- Fatigue: Chronic fatigue and weakness are common complaints.
- High Blood Pressure (Hypertension): Elevated blood pressure is a common symptom.
- Skin Changes: These may include thinning of the skin, easy bruising, and the development of pink or purple stretch marks (striae) on the abdomen, thighs, buttocks, and arms.
- Mood Changes: People with Cushing’s syndrome may experience mood swings, irritability, and even depression.
- Cognitive Changes: Memory problems and difficulty concentrating can occur.
- High Blood Sugar (Hyperglycemia): Elevated cortisol levels can lead to insulin resistance, increasing the risk of diabetes.
- Menstrual Irregularities: Women may experience irregular or absent menstrual periods.
- Weakening of Bones (Osteoporosis): Prolonged exposure to high cortisol levels can lead to bone loss and an increased risk of fractures.
- Increased Thirst and Urination: Excessive cortisol can cause increased thirst and urination.
- Hirsutism: In some cases, there may be excessive hair growth, particularly in women.
- Decreased Libido: A reduced interest in sex may be observed.
Diagnosis and Treatment:
Diagnosis and treatment of Cushing’s syndrome involve a combination of clinical evaluation, laboratory tests, and imaging studies. The specific approach to diagnosis and treatment may vary depending on the underlying cause of the syndrome. Here’s an overview of the diagnostic process and treatment options for Cushing’s syndrome:
Clinical Evaluation: A healthcare provider will conduct a thorough medical history and physical examination, paying attention to signs and symptoms associated with Cushing’s syndrome, such as weight gain, moon face, and buffalo hump.
Laboratory Tests:
- Cortisol Levels: Blood, urine and salivary tests are used to measure cortisol levels. These tests may include 24-hour urine cortisol, late-night salivary cortisol, and dexamethasone suppression tests to assess cortisol production and its rhythmic variations.
- ACTH Levels: In cases of suspected Cushing’s disease (caused by a pituitary tumor), or adrenal disease blood tests may be done to measure adrenocorticotropic hormone (ACTH) levels.
- Imaging Studies:
- CT or MRI Scans: These imaging studies can help locate any tumors or abnormalities in the adrenal glands, pituitary gland, or other potential sources of excess cortisol.
- Dynamic Testing: Additional tests, such as high-dose dexamethasone suppression tests may be necessary to confirm the diagnosis and determine the source of excess cortisol production.
The choice of treatment for Cushing’s syndrome depends on the underlying cause and may include the following options:
- Surgery: Surgical intervention may be recommended to remove the tumor or source of excess cortisol production. The specific procedure used will depend on the location of the tumor:
- Adrenalectomy: Removal of an adrenal gland tumor (if present).
- Transsphenoidal Surgery: Removal of a pituitary adenoma in cases of Cushing’s disease.
- Tumor Removal: Surgical removal of tumors causing ectopic ACTH production.
- Medications: In some cases, surgery may not be an option or may not completely resolve the condition. Medications can be used to:
- Block Cortisol Production
- Inhibit ACTH Production
- Radiation Therapy: For Cushing’s disease that persists after surgery or if surgery is not possible, radiation therapy may be considered to target and shrink the pituitary tumor.
- Lifestyle and Dietary Changes: Managing factors like diet, exercise, and stress can help improve overall health and manage some symptoms of Cushing’s syndrome.
- Regular Monitoring: Individuals with Cushing’s syndrome require long-term follow-up and monitoring to ensure that cortisol levels are well-controlled and to manage any potential complications, such as osteoporosis or hypertension.
Treatment outcomes can vary depending on the specific cause and the timing of intervention. Early diagnosis and appropriate treatment are essential to alleviate symptoms, normalize cortisol levels, and prevent long-term complications associated with Cushing’s syndrome. The choice of treatment should be made in consultation with an endocrinologist such as Dr. Evgenia Korytnaya. The treatment approach should be individualized to meet the patient’s specific needs and circumstances.
Patients with Cushing’s Disease are best served at Tertiary Care Centers (Large University Hospitals).
Learn more about Cushing’s Syndrome and Cushing’s disease at Endocrine Society.
