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Cushing Syndrome

What is Cushing syndrome?

Cushing syndrome is a disease that results from the production of too many glucocorticoids (cortisol) by the adrenal glands in the body. Secretion of cortisol is controlled by the hypothalamus, the pituitary gland, and the adrenal gland- often referred to as the HPA (hypothalamic-pituitary-adrenal) axis. This condition can cause various symptoms that can cause physical and mental changes in the body.

  1. Pituitary tumor – a benign (non-cancerous) tumor called adenoma producing an excess of a hormone called ACTH, is the most common cause of Cushing disease.
  2. Adrenal tumor – benign (non-cancerous) or rarely malignant (cancerous) tumors of the adrenal gland.
  3. Ectopic tumors that occur in other parts of the body—like the lungs—can also rarely produce an excess of cortisol hormones.
  4. Medications – Steroid medications like prednisone – taken for conditions like Bronchial asthma and rheumatoid arthritis or after an organ transplant can cause Cushing syndrome.

People with Cushing syndrome can experience some or all the following symptoms:

  • Weight gain, especially in the upper body
  • Rounded face and extra fat on the upper back and above the collarbones
  • High blood sugar (diabetes)
  • High blood pressure (hypertension)
  • Thin bones (osteoporosis)
  • Muscle loss and weakness
  • Thin, fragile skin that bruises easily.
  • Purple-red stretch marks (usually over the abdomen and under the arms)
  • Mood changes – depression and cognitive deficits- memory problems.
  • Too much facial hair in women
  • Fatigue
  • Muscle weakness
  • Menstrual cycle disorders

Sometimes, Cushing syndrome can lead to

  • Heart attack
  • Stroke
  • Fracture

Diagnosing Cushing disease can be challenging because the symptoms can have many different causes, and the elevated cortisol levels can happen in cycles. Having a high degree of clinical suspicion is important to diagnose and successfully treat this condition.

Dr Thomas will perform a comprehensive medical evaluation, including eliciting all the different symptoms and signs of the condition. She will order the relevant blood, salivary, and urine tests to help with the diagnosis of this condition. A prompt, successful diagnosis is important for early diagnosis, treatment, and prevention of complications due to the disease.

Three tests are commonly used to diagnose Cushing syndrome. These tests include:

  • Saliva Test: One of the most sensitive tests measures cortisol levels in the saliva between 11:00 p.m. and midnight. A saliva sample is collected in a small plastic container and sent to the laboratory for analysis.
  • Urine Test: Cortisol levels can also be measured in urine collected over a 24-hour.
  • Overnight Steroid Test: In another screening test, people with suspected Cushing syndrome have their cortisol levels measured the morning after taking a late-night dose of dexamethasone, a laboratory-made steroid.

Following the above tests, she will arrange for you to have the appropriate radiology imaging studies, like a CT scan/MRI of the adrenal glands or pituitary gland, to localize the adrenal gland tumor.

Dr Thomas will review all the results of the blood, salivary, and urine tests along with the relevant imaging. She will educate you on the condition, explain all the results of the tests, and formulate an individualized treatment plan for you.

For an adrenal adenoma, she will refer you to an experienced surgeon for surgery to remove the adrenal gland that is producing excess cortisol.

You will need long-term follow-up to monitor any recurrence of this condition. During your follow-up, Dr Thomas will do a comprehensive medical evaluation and arrange for you to have relevant blood, salivary, and urine tests to monitor for any recurrence of the tumor.

At a Glance

Dr. Reena Thomas, MD

  • Dual American board-certified endocrinologist
  • Author of numerous academic and clinic research
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