Q: Would you please explain Cushing’s disease. How is it diagnosed? What are the symptoms?
A: Cushing syndrome results from excess levels of the hormone cortisol. It is produced in various glands, usually the adrenal that is situated above the kidneys on both sides, and the pituitary gland, which is in the centre of the brain.
Cortisol also regulates the way fats, carbohydrates and proteins are turned into usable forms of energy. These glands produce other hormones that affect things such as blood pressure and the body’s response to stress.
Cortisol may be added from outside the body by taking medications such as prednisone, often used for the control of chronic inflammatory or autoimmune diseases like lupus or rheumatoid arthritis.
Prednisone is also used for the treatment of acute illnesses such as severe allergies. Poison ivy is often treated this way.
Women in the last three months of pregnancy also have increased blood levels of cortisol and may temporarily display some of symptoms of Cushing’s syndrome.
Any problem with the pituitary gland, the nearby hypothalamus in the brain or adrenals can lead to Cushing’s syndrome. The most common is a benign tumour of the pituitary gland known as a pituitary adenoma.
This type of tumour may produce an excessive amount of a stimulating hormone known as ACTH, which in turn activates the hormones in the adrenal glands. On rare occasions, some types of lung or thyroid cancer can also behave in a similar way.
The most obvious sign of Cushing’s disease is marked weight gain, mostly in the abdomen, face and neck, while the arms and legs remain relatively thin.
As the skin in these areas becomes thinner, there may be purple coloured stripes or stretch marks. Women may also lose their periods and grow facial or body hair.
Blood pressure is usually high and sufferers feel weak and tired.
Cushing’s disease is diagnosed by measuring the amount of cortisol in a person’s urine during a 24 hour period.
If there is a tumour it will require surgical removal. If Cushing’s syndrome is a result of prescribed medication, the dosage can be reduced gradually or another type of medication can be tried. Prednisone must never be suddenly discontinued or the person’s blood pressure could drop dramatically, which could be serious and potentially fatal.