Cushing's syndrome is a rare condition that occurs when your body is exposed to high levels of the hormone cortisol for a long time. It can be caused by various factors and can lead to a range of symptoms.

Symptoms

  • Weight Gain: Particularly around the midsection and upper back.

  • Round Face: Often described as a "moon face."

  • Skin Changes: Such as thinning, bruising, and purple stretch marks.

  • Muscle Weakness: Especially in the upper arms and thighs.

  • Fatigue and Depression: Common mental health symptoms.

  • High Blood Pressure and High Blood Sugar Levels: Leading to a risk of diabetes.

  • Bone Loss: Leading to an increased risk of fractures.

  • Irregular or Absent Menstrual Periods: In women.

  • Decreased Libido and Fertility Issues: In men.

Causes

  1. Corticosteroid Medications: Long-term use of corticosteroid medications like prednisone is the most common cause.

  2. Pituitary Gland Tumors: Producing excess adrenocorticotropic hormone (ACTH), which stimulates cortisol production.

  3. Adrenal Gland Tumors: Leading to excess cortisol production.

  4. Ectopic ACTH Syndrome: Non-pituitary tumors, such as lung cancer, may produce ACTH.

  5. Familial Cushing's Syndrome: Rare genetic disorders can increase the risk of tumor development in endocrine glands.

Treatment

Treatment for Cushing's syndrome depends on its cause:

  1. Reducing Corticosteroid Use: If caused by medication, gradually reducing the dose under medical supervision.

  2. Surgery: To remove pituitary or adrenal tumors.

  3. Radiation Therapy: Used if surgery isn’t an option or doesn’t fully remove the tumor.

  4. Medications:
    • Ketoconazole, Metyrapone, or Mitotane: To reduce cortisol production.

    • Pasireotide: To reduce ACTH production in cases caused by pituitary tumors.

    • Mifepristone: Can be used to block the effect of cortisol on tissues.

  5. Lifestyle Changes: Including diet and exercise to address weight gain, diabetes, and other side effects of excess cortisol.

Medication

  • Ketoconazole, Metyrapone, Mitotane: Reduce cortisol production in the adrenal glands.

  • Pasireotide: Inhibits ACTH production in pituitary gland tumors.

  • Mifepristone: Blocks cortisol's effects on tissues.

The treatment strategy typically involves endocrinologists, neurosurgeons, and sometimes oncologists, depending on the underlying cause. Post-treatment, patients often require long-term follow-up care to monitor for recurrence and manage any lingering effects of excess cortisol.