Understanding Cushing’s Syndrome
Cushing’s syndrome is a condition when the body is exposed to a very high level of cortisol hormone, also known as “stress hormone”. Cortisol, secreted by the adrenal gland, is the most vital hormone for survival. However, the excess levels can cause a lot of medical conditions and complications.
Causes of Cushing's Syndrome
Cushing’s syndrome can occur for several reasons, categorised mainly by endogenous (internal) causes and exogenous (external) causes.
Endogenous Causes
- Pituitary Adenomas: These benign tumours in the pituitary gland produce high levels of ACTH (adrenocorticotropic hormone), which stimulates cortisol production in the adrenal glands. This is known as Cushing’s disease and is the most common cause of endogenous Cushing’s syndrome.
- Adrenal Tumours: These include adenomas, carcinomas, and nodular adrenal hyperplasia that directly produce excess cortisol.
- Ectopic ACTH Syndrome: Some tumours outside the pituitary, such as those in the lungs, can produce ACTH and cause Cushing’s syndrome.
Exogenous Causes
- Corticosteroid Medication: Long-term use of corticosteroid drugs used for treating chronic autoimmune conditions such as asthma, rheumatoid arthritis, and lupus can lead to Cushing’s syndrome. These medications are structurally similar to cortisol and can cause similar effects when taken in high doses over extended periods.
Symptoms of Cushing's Syndrome
The symptoms of Cushing’s syndrome vary but generally include a combination of:
Physical Changes
Weight gain in the face (moon face), back of the neck (buffalo hump), and midsection is common. The skin may become fragile and thin, bruising easily and showing stretch marks (purple or pink) on the abdomen, thighs, buttocks, arms, and breasts. Hair loss may be a possible symptom, too.
Skin Abnormalities
Acne and superficial infections, particularly fungal infections, are more common in people with Cushing’s syndrome.
Muscle and Bone Effects
There is often a noticeable loss of muscle strength along with bone weakening (osteoporosis), which can lead to fractures.
Mood and Cognitive Alterations
Many experience significant mood swings, irritability, depression, or cognitive difficulties.
Hormonal Changes
Women may show signs of excess hair growth on their faces and bodies and have irregular or absent menstrual cycles. Men may experience decreased libido and reduced fertility.
Metabolic Issues
Increased blood pressure, high blood sugar (potentially leading to type 2 diabetes), and high cholesterol are common metabolic disturbances associated with the syndrome.
Seeking early help from an endocrinologist for Cushing’s syndrome is crucial because untreated Cushing’s can lead to severe complications like type 2 diabetes, high blood pressure, osteoporosis, serious or multiple infections and increased cardiovascular risks.
Early diagnosis and treatment help control cortisol levels, preventing these complications and improving long-term health outcomes. If the condition is diagnosed at early stages, the complications of cortisol excess causing diabetes and hypertension can be completely reversed. An endocrinologist specialises in diagnosing hormone disorders and can provide targeted treatments to manage symptoms and prevent progression.
Diagnosis of Cushing's Syndrome
At Harmony Thyroid, Endocrinology and Diabetes Centre, our experienced endocrinologist in Singapore will conduct a thorough assessment that may include:
- Initial Testing: Screening tests to measure cortisol levels in the urine, saliva, or blood, often done with a dexamethasone suppression test to see how cortisol levels respond to an anti-inflammatory steroid.
- Confirmatory Testing: Once elevated cortisol levels are confirmed, further tests to determine the cause include ACTH measurements, high-dose dexamethasone suppression tests, and imaging studies like MRI or CT scans to look for tumours on the pituitary or adrenal glands.
- Differential Diagnosis: It is important to differentiate between various forms of Cushing’s syndrome (e.g. pituitary-dependent vs. adrenal tumours vs. ectopic ACTH production) for appropriate management.
Treatment Options for Cushing's Syndrome
Dr Vikram will tailor your treatment according to your individual condition. This may involve one or more of the following:
- Radiation Therapy: This may be used when surgery is incomplete or not possible.
- Medication: There are drugs available that can control cortisol production if surgery and radiation are not feasible or effective.
- Managing Corticosteroid Use: If the syndrome is caused by external steroids, gradually reducing the medication under medical supervision can resolve the symptoms.
If you or your loved ones are suffering from Cushing’s syndrome or symptoms of the condition, please schedule an appointment with our Senior Consultant Endocrinologist, Dr Vikram, from Harmony Thyroid, Endocrinology, and Diabetes Centre.
