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Cushing syndrome : Causes, Types, Symptoms, Diagnosis ,Treatment , Risk factors , Complications , Prevention

 What Is Cushing Syndrome?

Cushing's syndrome is a hormonal disorder as a result of high ranges of the hormone cortisol in your body. It’s additionally known as hypercortisolism. Cortisol comes out of your adrenal glands, which sit on top of your kidneys.

Cushing’s syndrome is an unusual syndrome that occurs while your body has too much of a hormone called cortisol. It is likewise called hypercortisolism. Cortisol is a steroid hormone usually known as the “stress hormone.

What Is Cushing Syndrome

Explanation of medical terms and concept Cushing syndrome

Cushing syndrome takes place whilst your frame has too much of the hormone cortisol over time. This can result from taking oral corticosteroid medication. Or your body would possibly produce an excessive amount of cortisol.

Too much cortisol can cause a number of the hallmark symptoms of Cushing syndrome — a fatty hump between your shoulders, a rounded face, and crimson or crimson stretch marks on your pores and skin. Cushing syndrome also can bring about high blood strain, bone loss and, every so often, type 2 diabetes.

Treatments for Cushing syndrome can return your body's cortisol levels to everyday and improve your symptoms. The earlier remedy starts, the better your chances for recovery.

Cushing syndrome also known as hypercortisolism is a condition that results from exposure to high levels of cortisol Cortisol is the main stress hormone in your body produced by the adrenal glands Excessive cortisol can cause symptoms ranging from headaches to abdominal bloating Cushing syndrome is caused by either overproduction or increased secretion of cortisol It can be treated with medications or surgery depending on which gland is producing excess cortisol.

Cushing syndrome is a condition in which your body has too much of the hormone cortisol. Cortisol is produced by your adrenal glands which are located above each kidney. This condition can cause a variety of symptoms and may also be associated with other health problems.

helping out by:

  • Increasing your heart rate.

  • Increasing your blood pressure.

  • Managing your blood glucose.

  • Managing your respiration.

  • Increasing your muscle tension.

Cortisol additionally allows by way of shutting down, temporarily, systems that your body doesn’t need all through times of increased strain, along with digestion and replica.

Cortisol is vital to:

  • Maintaining blood pressure.

  • Regulating blood sugar.

  • Reducing inflammation.

  • Forming memories.

  • Managing respiration.

  • Balancing salt in your body.

  • Transforming your food into energy.

Symptoms Cushing syndrome

Symptoms of Cushing's syndrome can start suddenly or progressively. They have a tendency to get slowly worse if no longer dealt with.The signs and signs of Cushing syndrome can vary depending on the degrees of extra cortisol.

Common signs and symptoms of Cushing syndrome

  • Weight benefit and fatty tissue deposits, specifically around the center and top lower back, within the face (moon face), and between the shoulders (buffalo hump)

  • Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms

  • Thinning, fragile skin that bruises easily

  • Slow healing of cuts, insect bites and infections

  • Acne

Signs and signs girls with Cushing syndrome may additionally revel in

  • Thicker or more visible body and facial hair (hirsutism)

  • Irregular or absent menstrual periods

Signs and symptoms men with Cushing syndrome may experience

  • Decreased sex drive

  • Decreased fertility

  • Erectile dysfunction

Other possible signs and symptoms of Cushing syndrome

  • Severe fatigue

  • Muscle weakness

  • Depression, anxiety and irritability

  • Loss of emotional control

  • Cognitive difficulties

  • New or worsened high blood pressure

  • Headache

  • Infections

  • Skin darkening

  • Bone loss, leading to fractures over time

  • In children, impaired growth

When to see a doctor

Contact your physician if you have signs and symptoms that recommend Cushing syndrome, particularly in case you're taking corticosteroid medicine to treat a situation along with asthma, arthritis or inflammatory bowel ailment.

Causes Cushing syndrome

You can get Cushing's syndrome whilst there’s too much cortisol on your body for too long.

The most common cause is associated with medicinal drugs called glucocorticoids, additionally commonly referred to as corticosteroids, steroids, or prednisone.

These prescription steroids are used for conditions inclusive of bronchial asthma, rheumatoid arthritis, lupus, or after an organ transplant. They’re powerful anti-inflammatory medications. Taking too much, for too long, can cause Cushing's syndrome.

You also can get Cushing’s syndrome from injectable steroids, which include repeated pictures for joint ache, bursitis, and again ache.

Steroid pores and skin lotions, used for eczema and different skin problems, are much less likely to cause Cushing’s syndrome, but it can happen.

Too a great deal of the hormone cortisol for your frame causes Cushing syndrome. Cortisol, that's produced in the adrenal glands, plays a spread of roles to your body.

For instance, cortisol facilitates adjusting your blood stress, reduces irritation, and continues your coronary heart and blood vessels functioning usually. Cortisol helps your body reply to strain. It also regulates the manner your frame converts proteins, carbohydrates and fat on your food plan into electricity.

The position of corticosteroid medicinal drugs (exogenous Cushing syndrome)

Cushing syndrome can broaden from taking oral corticosteroid medicines, such as prednisone, in excessive doses through the years.

Oral corticosteroids may be essential to treat inflammatory illnesses, together with rheumatoid arthritis, lupus and allergies. They can also be used to prevent your frame from rejecting a transplanted organ.

It's also viable to develop Cushing syndrome from injectable corticosteroids — for instance, repeated injections for joint ache, bursitis and returned pain. Inhaled steroid drugs for bronchial asthma and steroid skin creams used for pores and skin issues which include eczema are normally less likely to cause Cushing syndrome than are oral corticosteroids. But, in some people, these medicines may cause Cushing syndrome, particularly if taken in high doses.

Your body's own overproduction (endogenous Cushing syndrome)

The circumstance can be because of your frame generating both too much cortisol or an excessive amount of adrenocorticotropic hormone (ACTH), which regulates cortisol manufacturing.

In these cases, Cushing syndrome can be associated with:

  • A pituitary gland tumor (pituitary adenoma). A noncancerous (benign) tumor of the pituitary gland, placed at the base of the brain, produces an extra quantity of ACTH, which in turn stimulates the adrenal glands to make more cortisol. When this shape of the syndrome develops, it is called Cushing disorder. It occurs much more often in women and is the most common form of endogenous Cushing syndrome.

  • An ACTH-secreting tumor. Rarely, a tumor that develops in an organ that generally doesn't produce ACTH will begin to secrete this hormone in excess. These tumors, which may be noncancerous (benign) or cancerous (malignant), are typically found in the lungs, pancreas, thyroid or thymus gland.

  • A primary adrenal gland disease. Disorders of the adrenal glands can reason them to supply an excessive amount of cortisol. The most commonplace is a noncancerous tumor of the adrenal cortex, known as an adrenal adenoma, however handiest a small fraction of adenomas produce too much cortisol.
    Cancerous tumors of the adrenal cortex are rare, but they could cause Cushing syndrome as nicely. Occasionally, benign, nodular growth of each adrenal glands can bring about Cushing syndrome.

  • Familial Cushing syndrome. Rarely, humans inherit a bent to broaden tumors on one or greater in their endocrine glands, affecting cortisol stages and inflicting Cushing syndrome.

Complications

Cushing’s syndrome can cause extreme health issues or even dying if not dealt with. Without treatment, headaches of Cushing syndrome may additionally encompass:

  • Bone loss (osteoporosis), which can result in unusual bone fractures, such as rib fractures and fractures of the bones in the feet

  • High blood pressure (hypertension)

  • Type 2 diabetes

  • Frequent or unusual infections

  • Loss of muscle mass and strength

Risk factors Cushing syndrome

The fundamental threat factor for developing Cushing syndrome is taking high-dose corticosteroids over a protracted time frame. If your doctor has prescribed corticosteroids to treat a fitness circumstance, ask them approximately the dosage and how long you’ll be taking them.

Other risk factors can include:

  • being labeled female at birth

  • your age

  • living with pituitary or adrenal tumors

Diagnosis Cushing syndrome

Cushing syndrome may be mainly difficult to diagnose. This is due to the fact most of the signs, like weight benefit or fatigue, may have other causes. Additionally, Cushing syndrome itself can have many unique reasons.

A healthcare professional will evaluate your scientific history. They’ll ask questions about signs and symptoms, any fitness conditions you may have, and any medications you’re taking.

They’ll also perform a bodily examination where they’ll search for signs and symptoms like a bump between your shoulders, stretch marks, and bruises.

Taking glucocorticoid medicinal drugs is the most common purpose of Cushing syndrome. Your medical doctor can evaluate all your medicinal drugs — drugs, injections, creams and inhalers — to decide if you're taking medications which can motivate the ailment. If you are, you probably won't need other tests.

Cushing syndrome from endogenous cortisol production can be difficult to diagnose due to the fact different conditions have comparable signs and signs and symptoms. Diagnosing Cushing syndrome may be a long and significant procedure. You'll possibly need to look for a doctor who specializes in hormonal disorders (endocrinologist).

Your doctor will perform a physical examination and look for warning signs of Cushing syndrome, including rounding of the face, a pad of fatty tissue between the shoulders and neck, and skinny skin with bruises and stretch marks.

If you haven't been using a corticosteroid remedy, these diagnostic checks may additionally assist pinpoint the cause:

  • Urine and blood tests. These tests degree hormone stages and display whether your frame is producing immoderate cortisol. For the urine take a look at, you will be requested to acquire your urine over a 24-hour period. Urine and blood samples can be dispatched to a laboratory to be analyzed.
    Your doctor may advise different specialized checks that contain measuring cortisol degrees before and after using hormone medicines to stimulate or suppress cortisol.

  • Saliva test. Cortisol tiers normally upward push and fall all through the day. In human beings without Cushing syndrome, levels of cortisol drop notably within the night. By analyzing cortisol degrees from a small pattern of saliva accrued past due at night, doctors can see if cortisol ranges are too excessive.

  • Imaging tests. CT or MRI scans can offer photographs of your pituitary and adrenal glands to hit upon abnormalities, including tumors.

  • Petrosal sinus sampling. This check can assist determine whether the motive of Cushing syndrome is rooted within the pituitary or some place else. For the check, blood samples are taken from the veins that drain the pituitary gland (petrosal sinuses).
    A skinny tube is inserted into your top thigh or groin region at the same time as you're sedated and is threaded to the petrosal sinuses. Levels of ACTH are measured from the petrosal sinuses and from a blood sample taken from the forearm.
    If the ACTH level is better in the sinus pattern, the hassle stems from the pituitary. If the ACTH tiers are comparable between the sinuses and forearm, the root of the problem lies out of doors of the pituitary gland.

These assessments help your medical doctor diagnose Cushing syndrome, and they will help rule out other scientific conditions, such as polycystic ovary syndrome — a hormone disease in girls with enlarged ovaries. Depression, consuming problems and alcoholism can also partially mimic Cushing syndrome.

Treatment Cushing syndrome

The form of treatment relies upon the underlying purpose of the high cortisol tiers. If you operate glucocorticoids, your healthcare provider will probably decrease the dosage or prescribe a non-glucocorticoid remedy. If a tumor is inflicting Cushing’s syndrome, it'd want to be killed with radiation or eliminated surgically. Another choice is for your healthcare provider to prescribe a medicine including ketoconazole with a purpose to sluggish down the production of cortisol. You may match with numerous healthcare providers to deal with the tumor and Cushing’s syndrome signs.

Treatments for Cushing syndrome are designed to lower the excessive stage of cortisol in your frame. The quality remedy for you depends on the cause of the syndrome. Options consist of:

Reducing corticosteroid use

If the cause of Cushing syndrome is lengthy-time period use of corticosteroid medicinal drugs, your doctor can be able to hold your Cushing syndrome symptoms and signs and symptoms below control by means of decreasing the dosage of the drug over a period of time, at the same time as nevertheless handling the situation for which you take it. Don't lessen the dose of corticosteroid capsules or stop taking them in your personal life. Do so only under your health practitioner's supervision.

Abruptly discontinuing these medicinal drugs should cause poor cortisol tiers. Slowly tapering off corticosteroid tablets lets in your body to renew ordinary cortisol manufacturing.

Surgery

If the purpose of Cushing syndrome is a tumor, your health practitioner may also propose complete surgical elimination. Pituitary tumors are commonly eliminated through a neurosurgeon, who might also perform the procedure through your nostril. For a tumor in the adrenal glands, lungs or pancreas, the health practitioner can eliminate it via a fashionable operation or by the use of minimally invasive surgical techniques, with smaller incisions.

After the operation, you may need to take cortisol alternative medicines to offer your frame with the proper amount of cortisol. In most cases, you'll sooner or later go back to normal adrenal hormone production, and your medical doctor can taper off the alternative tablets. Your endocrinologist will use blood checks to help determine if you want a cortisol alternative and while it is able to be stopped.

However, this manner can soak up to a year or longer. In some instances, people with Cushing syndrome never return to regular adrenal features. They then need lifelong substitute therapy.

Radiation therapy

If the healthcare professional cannot definitely take away a pituitary tumor, he or she can usually prescribe radiation remedy as well as surgical treatment. Additionally, radiation can be used for those who aren't appropriate applicants for surgery.

Radiation can be given in small doses over a six-week length, or with a technique called stereotactic radiosurgery. In the latter system, a huge, one-time dose of radiation is added to the tumor, and the radiation publicity to surrounding tissues is minimized.

Medications

Medications may be used to control cortisol manufacturing while surgery and radiation don't work. Medications may additionally be used before surgical procedure in human beings who have emerged as very sick with Cushing syndrome to enhance signs and symptoms and reduce surgical threat. Medical therapy might not absolutely improve all the symptoms of excess cortisol.

Medications to govern excessive production of cortisol on the adrenal gland consist of ketoconazole, mitotane (Lysodren) and metyrapone (Metopirone).

Mifepristone (Korlym, Mifeprex) is authorized for humans with Cushing syndrome who have kind 2 diabetes or glucose intolerance. Mifepristone does not lower cortisol production, but it blocks the effect of cortisol for your tissues.

Side effects from these medications may include fatigue, nausea, vomiting, headaches, muscle aches, high blood stress, low potassium and swelling. Some have extra-extreme side outcomes, which includes neurological aspect outcomes and liver toxicity.

Newer medicines for Cushing syndrome include pasireotide (Signifor), given as a two times-every day injection, and osilodrostat (Isturisa), a pill. Other medications are being developed.

In a few cases, the tumor or its remedy will cause the pituitary or adrenal gland to no longer supply enough of different hormones, and your doctor will suggest hormone replacement medicines.

If none of these treatment alternatives is appropriate or powerful, your medical doctor may additionally suggest surgical removal of your adrenal glands (bilateral adrenalectomy). This manner will treat excess manufacturing of cortisol but would require lifelong alternative medications.

Lifestyle and home remedies

The period of your healing from Cushing syndrome will rely on the severity and reason of your circumstance. You failed to develop Cushing syndrome in a single day, and your symptoms might not disappear overnight, either. In the meantime, those guidelines can also assist you in your adventure returned to fitness.

  • Increase activities slowly. Work as much as an affordable stage of exercise or hobby that feels comfortable without overdoing it. You'll improve little by little, and your staying power could be rewarded.

  • Eat sensibly. Nutritious foods provide a great source of gasoline on your recovering frame and allow you to lose pounds you won from Cushing syndrome. Make sure you are getting sufficient calcium and diet D. Taken collectively, they help your body absorb calcium, that could assist give a boost to your bones, counteracting the bone density loss that frequently takes place with Cushing syndrome.

  • Monitor your mental health. Depression can be a facet impact of Cushing syndrome, but it could additionally persist or increase after treatment starts off. Don't forget about your depression or wait it out. Seek help directly out of your health practitioner or a therapist in case you're depressed, beaten or having difficulty coping in the course of your recovery.

  • Gently soothe aches and pains. Hot baths, massages and coffee-affect sporting activities, consisting of water aerobics and tai chi, can help alleviate some of the muscle and joint pain that accompanies Cushing syndrome recovery.

Coping and support

Support companies can be precious in handling Cushing syndrome and healing. They convey you collectively with other folks that are handling the identical varieties of challenges, together with their households and pals, and provide a setting in which you can percentage commonplace issues.

Ask your health practitioner to approximately guide organizations for your network. Your local health department, public library and cellphone e-book in addition to the internet also may be good resources to discover an aid group in your area.

Preparing for your appointment

You're possibly first to see your primary care medical doctor. However, in some instances whilst you set up an appointment, you may be referred without delay to a physician who focuses on hormonal disorders (endocrinologist).

It's a terrific concept to prepare for your appointment so you can make the most of your time with your doctor. Here's some records that will help you get geared up, and what to anticipate from your physician.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you're making the appointment, make certain to ask if there may be something you want to do earlier to prepare for diagnostic assessments.

  • Write down any symptoms you're experiencing, Which include any that could seem unrelated to the purpose for which you scheduled the appointment. For instance, in case you've had complications extra regularly or in case you've been feeling down or extra tired than normal, these are critical facts to consider along with your doctor. Also tell your medical doctor about adjustments on your bodily look, inclusive of weight advantage, new zits or increased frame hair.

  • Write down key personal information, Which includes any modifications on your personal relationships and to your intercourse lifestyles. Let your physician recognise if the people closest to you have noticed that you appear irritable or that you appear to have extra temper swings than in the past. It may additionally help to take along a photograph of yourself that indicates any modifications for your bodily look considering you've begun experiencing signs.

  • Make a list of all medications, As well as any vitamins, lotions or supplements, which you're presently taking or have used within the past. Include in your list the particular name, dose and dates of any steroid medicines you've taken in the past, which include cortisone injections.

  • Take a family member or friend along, If feasible. Sometimes it can be hard to recall all the facts provided to you during an appointment. Someone who accompanies you could remember something that you ignored or forgot.

  • Write down questions to ask your doctor.

Your time along with your health practitioner may be constrained, so getting ready a list of questions ahead of time may additionally help you're making the most of a while collectively. For Cushing syndrome, some basic inquiries to ask your doctor encompass:

  • What's the most likely cause of my symptoms?

  • What kinds of diagnostic tests do I need? How are these tests performed?

  • What are my treatment options? Which do you recommend for me?

  • Will my physical signs and symptoms improve with treatment? Will I see a difference in my appearance as well as in the way I feel?

  • Will treatment help make me feel more emotionally stable?

  • What long-term impact could each treatment option have? Will there be an impact on my ability to have children?

  • How will you follow my response to treatment over time?

  • I have other health conditions. How can I best manage these conditions together?

  • Are there any brochures or different revealed clothes that I can take home with me? What websites do you propose?

In addition to the questions that you've organized to ask your physician, do not hesitate to ask any extra questions at some stage in your appointment.

What to expect from your doctor

Your doctor is likely to ask you some questions. Being prepared to reply to them may also reserve time to go over any points you want to spend greater time on. Your medical doctor may ask:

  • When did you first begin having symptoms?

  • Do you have symptoms constantly, or do they come and go? Have they gotten worse over time?

  • Have you noticed any changes in your sexual performance or your interest in sex?

  • Has your menstrual cycle changed or have you stopped having your period?

  • Have you gained weight? On what part of your body?

  • Have you had difficulty controlling your emotions?

  • Have you noticed that you bruise more easily, or that wounds and infections take longer to heal than in the past?

  • Do you have weak points for your muscular tissues, together with trouble getting out of the tub or strolling stairs?

  • Have you developed new acne or more body or facial hair?

  • Have you been taking corticosteroid medication? For how long?

  • What, if anything, seems to either improve or worsen your symptoms?

General summary

Cushing syndrome is a condition in which the body produces too much of the hormone cortisol It’s caused by the pituitary gland producing excess amounts of corticotropin-releasing factor or CRF People with Cushing syndrome may experience: weight gain — especially around the face neck and trunk fatigue dry skin and hair thinning scalp hair slow-healing sores muscle weakness easy bruising or fragile skin that tears easily stretch marks on the abdomen or thighs depression memory loss mood swings or irritability (especially in children) high blood pressure enlargement of the abdomen (potbelly) high blood sugar.

What is the most common cause of Cushing's syndrome?

Cushing's syndrome is a disorder in which the body produces too much cortisol from the adrenal glands The most common cause of Cushing's syndrome is an adenoma which is a benign tumor on one of the two adrenal glands that produce cortisol The majority of these tumors are found on the top (or "suprarenal") portion of the right adrenal gland The rest are situated on the bottom (or "infrarenal") portion of the left adrenal gland.

Is Cushing's syndrome serious?

Cushing\'s syndrome a condition caused by abnormal production and release of cortisol by the adrenal glands is serious if not diagnosed and addressed early Left untreated the effects of Cushing\'s syndrome can be devastating to your health affecting your heart bones and brain But fortunately with timely diagnosis and treatment you can effectively manage Cushing\'s syndrome and live a healthy life.

How can I reduce my cortisol levels quickly?

Cortisol is a hormone that helps us respond to stress The body releases cortisol when it's under physical or mental distress This can happen when you're under pressure at work on a tight deadline or during an argument with your spouse Cortisol levels can be measured in saliva blood and urine samples It's also possible to measure the level of cortisol in a person's hair A high level of cortisol in the bloodstream causes the level of glucose (sugar) to rise as well Too much cortisol can lead to diabetes weight gain high cholesterol and heart disease.

What is the diet for Cushing syndrome?

The diet for Cushing syndrome consists of foods low in calories, proteins and carbohydrates These foods include fruits vegetables, lean meats, fish and soups Foods high in fiber such as legumes, whole grains and nuts are also included in this dietary plan.

What should I avoid with Cushings?

It's important to follow the guidelines for treatment and medication so that you get the most benefit from your care Below is an overview of some important things to avoid with Cushings.

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Cushing syndrome : Causes, Types, Symptoms, Diagnosis ,Treatment , Risk factors  , Complications , Prevention

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