Cushing's syndrome is a collection of symptoms that arise due to too high levels of the hormone cortisol in the body. These symptoms can appear suddenly or gradually, and can get worse if left untreated.
The hormone cortisol is a hormone produced by the adrenal glands . This hormone has many important functions for the body, including maintaining the function of the heart and blood vessels, reducing inflammation, and controlling blood pressure and blood sugar levels.
However, too high levels of the hormone cortisol (hypercortisolism) in Cushing's syndrome can cause various disorders in the body. In addition, this condition can also increase the risk of developing chronic diseases, including type 2 diabetes.
Causes of Cushing's Syndrome
High levels of the hormone cortisol in Cushing's syndrome can be caused by factors from outside the body (external) or from within the body (internal). The following is an explanation:
External causes of Cushing's syndrome
The most common cause of Cushing's syndrome is the use of corticosteroid drugs in high doses or for a long time. This can happen because corticosteroid drugs have the same effect as the hormone cortisol.
Corticosteroid drugs that often cause Cushing's syndrome are drugs that are taken orally and injected. However, in rare cases, topical and inhaled corticosteroids can also cause Cushing's syndrome, especially when used in high doses.
Internal causes of Cushing's syndrome
Cushing's syndrome can also occur due to high levels of adrenocorticotropic hormone (ACTH), which is a hormone that regulates the formation of the hormone cortisol. Excessive levels of the ACTH hormone can be caused by:
- Tumors in the pituitary gland or pituitary
- Tumors in the pancreas, lung, thyroid gland, or thymus gland
- Tumors in the endocrine glands associated with hereditary factors
- Adrenal gland disease, such as a tumor in the adrenal cortex (adrenal adenoma)
Cushing's syndrome risk factors
Cushing's syndrome is more at risk for adults aged 30–50 years. However, this does not rule out the possibility of this condition occurring in children. In addition, Cushing's syndrome is also three times more at risk of attacking women than men.
Cushing's syndrome is more likely to occur in people who need to receive long-term corticosteroid medications. The example is:
- Chronic asthma sufferers
- Patients with rheumatoid arthritis
- Lupus sufferers
- Organ transplant recipients
Symptoms of Cushing's Syndrome
The symptoms experienced by sufferers of Cushing's Syndrome depend on the high levels of cortisol in the body. Symptoms include:
- Weight gain
- Fat accumulation, especially on the shoulders ( buffalo hump ) and face ( moon face )
- Reddish purple streaks ( striae ) on the skin of the abdomen, thighs, breasts, or arms
- Thinning of the skin, so the skin bruises easily
- Wounds or insect bites on the skin are difficult to heal
- Pimple
- Weak muscles
- Weak
- Depression , anxiety, or irritability
- Trouble remembering
- High blood pressure
- Headache
- Bone loss
- Growth disorders in children
In women, Cushing's syndrome can make menstruation irregular or late and cause symptoms of hirsutism , which is hair that grows thickly on the face or other parts that normally only grow in men.
Whereas in men, other complaints that may arise due to Cushing's syndrome are decreased sexual desire, impaired fertility, and impotence .
When to see a doctor
Check with your doctor if you experience the symptoms above, especially if you are undergoing treatment with high doses of corticosteroid drugs. It is important to remember, the sooner Cushing's syndrome is treated, the greater the chance for recovery.
Diagnosis of Cushing's Syndrome
The doctor will ask the patient about the symptoms experienced and a history of drugs that are routinely consumed. After that, the doctor will carry out a thorough physical examination to see signs of Cushing's syndrome in the patient.
To confirm the diagnosis and rule out other possible diseases, the doctor will carry out supporting examinations, such as:
- Examination of 24-hour urine samples and saliva at night, to measure levels of the hormone cortisol
- Examination of the level of the hormone cortisol in the blood, can be done by preceded by giving a low dose of dexamethasone at night, to see if the patient's cortisol level will decrease in the morning
- Scanning with a CT scan or MRI, to see the possibility of a tumor in the adrenal gland or pituitary gland
- Test a blood sample taken from the petrous sinus, which is the blood vessels around the pituitary gland, to find out whether Cushing's syndrome is caused by a disorder in the pituitary gland or not
Cushing's Syndrome Treatment
Treatment for Cushing's syndrome aims to reduce cortisol levels in the body. The treatment method chosen will be adjusted to the underlying cause.
The following are several treatment methods that doctors can use to treat Cushing's syndrome:
- Gradually reducing the dose of corticosteroids or replacing corticosteroids with other drugs, if Cushing's syndrome is caused by the use of corticosteroids in high doses or in the long term
- Carrying out surgical procedures to remove the tumor, if Cushing's syndrome is caused by a tumor
- Perform radiation therapy procedures ( radiotherapy ), if there is still a tumor left after surgery or if surgery cannot be done
- Giving drugs to control cortisol hormone levels, such as ketoconazole , metyrapon, mitotane, and mifepristone, if surgery and radiotherapy are not effective in treating the patient
Treatment for Cushing's syndrome can affect other hormones produced by the adrenal glands. Therefore, in some cases, patients need to get hormone replacement therapy .
Cushing's syndrome complications
If left untreated, Cushing's syndrome can cause serious complications, such as:
- Deep depression
- Diabetes
- High cholesterol
- Susceptible to infection
- Bone loss ( osteoporosis ) and bone fractures
- Loss of muscle mass
- Blood clots in the legs or lungs
- Heart attack
- Strokes
- Dead
Prevention of Cushing's Syndrome
Cushing's syndrome associated with tumors is difficult to predict and prevent. However, Cushing's syndrome caused by high-dose or long-term use of corticosteroids can reduce the risk by carrying out routine controls to the doctor to check health conditions and hormone levels in the body.