Cushing's syndrome: everything there is to know

What is Cushing's syndrome? 

Cushing's syndrome is caused by chronic exposure to an endogenous excess of glucocorticoids. There are two main types of Cushing disease: 

In the majority of cases (85% of cases), Cushing's syndrome is dependent on ACTH or corticotropic hormone, which is a hormone secreted by the pituitary gland in the brain whose role is to stimulate the adrenal gland that produces both testosterone and cortisol, two hormones that are essential for the body to function properly. 

In ACTH-dependent Cushing's syndrome, the adrenal glands are stimulated by excessive and inappropriate secretion of ACTH.

In Cushing's disease, the most common type of Cushing's syndrome, the excess of ACTH secretion is caused by a benign tumor which forms from the pituitary corticotropic cells.

In rarer cases, there is also ectopic secretion of ACTH from a non-pituitary endocrine tumor, known as paraneoplastic Cushing's syndrome.  

What are the symptoms of Cushing syndrome?  

Patients with Cushing's syndrome develop such symptoms as high blood pressure, obesity and mood swings, which are not particularly specific. However, Cushing's syndrome can also provoke rarer symptoms such as stretch marks or bruising, and thin, fragile skin.

Other rare signs include a rapid weight gain, particularly in the face and around the stomach. Muscular strength declines, especially in the thigh muscles, making movement difficult. In addition, fractures caused by small impacts may occur. Spontaneous fractures, i.e. without trauma, may also occur in the vertebrae (vertebral compression), ribs or feet. 

When faced with these symptoms, it is essential to see a doctor, as untreated Cushing's syndrome significantly reduces life expectancy, particularly due to possible cardiovascular complications. 

How is Cushing's syndrome diagnosed?  

To confirm Cushing's syndrome, patients must undergo some tests: one of these tests involves taking several measurements of cortisol in the urine or saliva. It is also possible to have an MRI or a CT scan of the pituitary gland to identify tumours. These tests can be prescribed by your primary care physician. If the results are abnormal, you will be referred to an endocrinologist, who will identify the cause (ACTH-dependent or not) and prescribe the necessary treatment. 

How can Cushing's syndrome be treated?  

As the main aim of treatment for Cushing's syndrome is to normalize cortisol levels, the first thing to do is to surgically remove the tumor responsible for the overproduction of cortisol - in the case of Cushing's disease, this involves removing the micro-adenoma from the pituitary gland. In some cases, adrenal gland surgery can be recommended.  

However, surgery is not always possible, in which case doctors usually go with radiotherapy of the pituitary gland. Drug treatments for Cushing's syndrome also exist. Here are some of the medications that endocrinologists can prescribe:

• Ketoconazole,
  
• Metyrapone,
  
• Mitotane,
  
• Osilodrostat, 
  
• Etomidate, 
  
• Cabergoline,
  
• Pasireotide,
  
• Mifepristone.

The treatment of Cushing's syndrome is complex and should be tailored to each patient, their needs and expectations. If you have any doubts about potential side effects, it is essential to talk to your doctor and together decide on the appropriate treatment options.  

What are the most well-known patient support groups for Cushing's syndrome?  

If you know someone who suffers from Cushing's syndrome, or if you are yourself a patient and you feel the need to talk to someone about it, or simply to share your experience with other patients who find themselves in the same situation, you can do so on our Carenity forum. 

There are also a number of patient support groups and foundations, such as:

• Cushing's support and research foundation  
• The Brain Charity 

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