Cushing’s Syndrome


What is Cushing’s Syndrome?

Cushing’s syndrome is a hormonal disorder in which the body produces too much cortisol. Cortisol, often called the “stress hormone,” plays a vital role in the body. It helps you manage blood sugar levels, regulate your metabolism, reduce inflammation, and it assists with memory formulation. It also helps your body respond to stress.

Early detection and treatment of Cushing’s syndrome are crucial as the condition can lead to a wide range of serious and potentially life-threatening complications. The high levels of cortisol associated with Cushing’s syndrome can affect almost every system in the body, leading to a variety of health issues including high blood pressure, diabetes, and mood disorders. It can also suppress your immune system, making it harder to fight off infections.

Despite the many serious potential complications of the disorder, one of the biggest concerns most patients express is about something called the buffalo hump. A buffalo hump, medically referred to as a dorsocervical fat pad, is a fat deposit that occurs at the base of the neck between the shoulder blades. The development of a buffalo hump is common in those with Cushing’s syndrome and often causes embarrassment and makes people feel self-conscious. Fortunately, plastic surgery may be able to provide a solution.

Understanding Cushing Syndrome Causes

Cushing’s syndrome is caused by an over-production of the hormone cortisol. Cortisol does a lot of things in the body but is most known for being the hormone that the body releases to respond to stress. Because of that, people learning about Cushing’s syndrome are often concerned that being stressed out for a prolonged period of time can cause the syndrome. Fortunately, there is currently no clinical evidence to suggest that this is the case. You can’t stress your way into Cushing’s, but there are other reasons for an increase in cortisol.

The most common cause is an ACTH-secreting tumor on the pituitary gland. ACTH is the hormone that tells your adrenal glands to make cortisol. Exposure to higher levels of cortisol for an extended period of time then leads to Cushing’s disease. Cushing’s disease is a subset of Cushing’s syndrome and refers only to a cortisol increase caused by a pituitary tumor. People often use the terms Cushing’s syndrome and Cushing’s disease interchangeably, but this is not correct.

Less common but still possible is the presence of an ACTH-secreting tumor elsewhere in the body. Tumors of the adrenal glands can also stimulate an excess of cortisol production and lead to Cushing’s syndrome.

Certain medications can also cause the syndrome. When they do it is referred to as iatrogenic Cushing’s syndrome. A common cause is glucocorticoids like prednisone and dexamethasone. These drugs are often used to treat inflammation and autoimmune diseases. Cyclosporine, a drug used to suppress the immune system after organ transplant, can also cause Cushing’s.

Common Symptoms of Cushing’s Disease

Both physical and psychological changes can indicate Cushing’s syndrome. Your doctor will look at many different things if they suspect this disorder.

Physical Signs

The physical signs of Cushing’s syndrome include:

  • Weight gain
  • Fat redistribution (typically a thinning in the legs accompanied by an increase of fat in the upper body and face (moon face) and a buffalo hump on the neck)
  • Easy bruising (ITP)
  • Thinning skin
  • Stretch marks
  • Proximal muscle weakness (muscles near the center of the body)
  • Fatigue
  • Increased thirst and urination
  • High blood pressure
  • Irregular menstrual periods or erectile dysfunction

Psychological Signs

Mental and psychological changes may accompany the physical signs of Cushing’s syndrome. These include:

  • Anxiety and depression
  • Mood swings
  • Difficulty concentrating
  • Memory issues

Diagnosing Cushing’s Syndrome

Diagnosing Cushing’s syndrome involves a series of steps to confirm high cortisol levels and determine their underlying cause. The diagnostic process can be complex because so many other conditions share symptoms of Cushing’s syndrome. Remember too that a syndrome is really a group of symptoms, so there is no basic test that confirms a negative or positive diagnosis of Cushing’s syndrome. Your doctor must rule out other disorders while further investigating your symptoms and their possible causes.

The first step to a diagnosis is a physical examination and detailed medical history. Your doctor will likely ask you a lot of questions. These will include inquiries about changes in weight, muscle weakness, menstrual irregularities, and high blood pressure.

Your doctor will also likely conduct blood and urine tests to check the cortisol levels in both. Sometimes a late-night saliva test is also performed. Cortisol levels typically drop at night. This test measures cortisol in saliva late at night to see if it’s abnormally high, suggesting Cushing’s syndrome.

Imaging studies are also common and look for tumors that may be secreting ACTH. These images tend to focus on your pituitary and adrenal glands unless your doctor suspects that you may have an ACTH-secreting tumor elsewhere. Typically imaging occurs through an MRI or CT scan.

You may also have a suppression test. This test involves taking dexamethasone, a synthetic glucocorticoid, to see if it suppresses cortisol production. In people without Cushing’s syndrome, cortisol levels will drop. In those with Cushing’s syndrome, cortisol levels may remain high.

Treating Cushing’s Syndrome

The goal of Cushing’s syndrome treatment is to correct the errant cortisol levels and fix the symptoms they cause. Doctors can often cure Cushing’s syndrome, but it may leave some symptoms behind. Unfortunately, however, there isn’t always a cure. If the cause is medications that the patient must continue taking, or if a tumor can’t be removed for some reason, treatment may shift to focus around managing cortisol levels.

When a tumor is the source of the problem, as is often the case, doctors may employ radiation therapy to shrink the tumor or surgically remove it. Medication is also used in treatment. Some of these medications aim to inhibit cortisol production in the adrenal and pituitary glands. Others prevent receptors from interacting with cortisol, thereby preventing its effects.

Many people also turn to plastic surgery for help. Liposuction can quickly and effectively remove the fat accumulated within a buffalo hump. For many, restoring their former neckline and removing the hump is the last step towards feeling like themselves again and banishing the symptoms of Cushing’s syndrome.

Once the fat a removed via liposuction those fat cells are gone for good and can’t come back. In the case of iatrogenic Cushing’s syndrome, however, the medications that caused the problem should be discontinued or changed. Resuming those medications could result in the formation of a new buffalo hump.

Living with Cushing’s Syndrome

If your Cushing’s syndrome can’t be cured, you’ll need to learn to live with the condition. It’s important that you follow your treatment plan closely. Doing so will involve a healthy and nutritious diet along with other weight management strategies. You and your doctor will also likely devise a skincare routine to help you manage acne and bruising. Treatment will also focus on managing muscle weakness and fatigue.

Maintaining psychological wellness is also important when managing Cushing’s syndrome. Tips for managing stress will be crucial to managing the condition and support groups can be extremely helpful. Family and friends are also an invaluable source of support, and building a support community will help you to maintain a positive outlook and manage the mood disorders Cushing’s syndrome can cause.

When managing Cushing’s syndrome starts to feel stressful or overwhelming, it’s important to remember how important it is. Over the long term, Cushing’s syndrome can cause major health issues if left unmanaged. These include diabetes, high blood pressure, osteoporosis, cognitive impairment, heart attack, blood clots, and infection. Managing Cushing’s syndrome is possible, and doing so will improve your quality of life today and possibly save it tomorrow.

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