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'''Other Names:'''
Cushing's Syndrome
Cushing syndrome; Hypercortisolism; Nodular primary adrenocortical dysplasia; Adrenal cortex adenoma; Adrenal hyperfunction resulting from pituitary acth excess; Ectopic ACTH syndrome; Ectopic adrenocorticotropic hormone syndrome; Hyperadrenocorticism


== Pathophysiology ==
Cushing's syndrome is a complex endocrine disorder characterized by excessive levels of cortisol in the blood. This condition can result from various causes, including endogenous overproduction of cortisol by the adrenal glands or exogenous sources such as glucocorticoid medications.
'''Cushing's [[syndrome]]''' is an endocrine disorder caused by prolonged exposure of the body's [[tissues]] to high levels of stress harmone [[cortisol]] (a [[harmone]] produced by the [[adrenal gland]]).


It most commonly affects adults between age 20 and 50 years.
==Etiology==
Cushing's syndrome can be classified into two main categories based on its etiology:


=='''Signs and symptoms '''==
===Endogenous Cushing's Syndrome===
[[File:Cushing's syndrome.png|thumb|upright=1.4|Symptoms of Cushing's syndrome]]
* '''[[Pituitary Adenoma]]''': Also known as Cushing's disease, this is the most common cause of endogenous Cushing's syndrome. It involves a benign tumor of the pituitary gland that secretes adrenocorticotropic hormone (ACTH), leading to increased cortisol production by the adrenal glands.
* '''[[Adrenal Tumors]]''': These can be either benign or malignant and directly produce cortisol.
* '''[[Ectopic ACTH Syndrome]]''': This occurs when ACTH is produced by non-pituitary tumors, such as small cell lung cancer.


The signs and symptoms of Cushing's [[syndrome]] may include:
===Exogenous Cushing's Syndrome===
* '''Glucocorticoid Therapy''': Long-term use of glucocorticoid medications for conditions such as asthma or rheumatoid arthritis can lead to Cushing's syndrome.


*Upper body [[obesity]]
==Pathophysiology==
*Severe [[fatigue]]
Cortisol is a steroid hormone produced by the adrenal cortex. It plays a crucial role in regulating metabolism, immune response, and stress. In Cushing's syndrome, the excessive cortisol levels disrupt normal physiological functions, leading to a wide range of symptoms.
*Muscle weakness
*High [[blood pressure]]
*Backache
*Elevated [[blood sugar]]
*Easy [[bruising]]
*Bluish-red stretch marks on the skin
*Neurological issues
[[File:CushingsBody.jpg|thumb|[[Hirsutism|Increased hair]] and [[stria]] in a person with medication-induced Cushing's syndrome<ref name="Cel2012" />]]
Women with Cushing's syndrome may also experience increased growth of facial and body hair, and menstrual periods may become irregular or cease. Men may have decreased fertility, diminished sexual desire, and/or [[erectile dysfunction]].
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=='''cause'''==
Cushing's syndrome  is caused by long-term exposure of the body's [[tissues]] to [[cortisol]],a harmone that is naturally produced by the [[adrenal gland]]. Exposure to too much cortisol can result from long-term use of [[corticosteriod]] medications used to treat [[inflammatory]] illnesses. Pituitary [[adenomas]] ( of the pituitary gland) or tumors of the adrenal gland may also cause cortisol imbalances.


=='''Inheritance'''==
==Clinical Features==
Most cases of Cushing's syndrome are not [[inherited]] . However, Cushing's syndrome rarely occurs in inherited conditions characterized by the development of [[tumors]] of one or more [[endocrine gland]]. These conditions may include:
The clinical presentation of Cushing's syndrome can vary, but common features include:


*Primary pigmented micronodular adrenal disease, in which children or young adults develop small cortisol-producing tumors of the adrenal glands,
* '''[[Weight Gain]]''': Particularly in the face (moon face), abdomen, and upper back (buffalo hump).
* '''[[Hypertension]]''': Elevated blood pressure is a frequent finding.
* '''[[Hyperglycemia]]''': Increased blood sugar levels, which may lead to [[Diabetes Mellitus]].
* '''[[Muscle Weakness]]''': Due to protein catabolism.
* '''[[Osteoporosis]]''': Increased risk of fractures due to bone resorption.
* '''[[Skin Changes]]''': Thinning of the skin, easy bruising, and purple striae.
* '''[[Psychiatric Symptoms]]''': Depression, anxiety, and cognitive dysfunction.


*[[Multiple endocrine neoplasia type 1]] (MEN1), in which [[harmone-secreting tumors]] of the parathyroid glands, pancreas, and pituitary develop. Cushing's syndrome in MEN1 may be due to pituitary or adrenal tumors.
==Diagnosis==
The diagnosis of Cushing's syndrome involves a combination of clinical evaluation and laboratory tests:


=='''Diagnosis'''==
* '''[[24-hour Urinary Free Cortisol Test]]''': Measures cortisol excretion in urine.
The first step is to check the medications a person takes.
* '''[[Dexamethasone Suppression Test]]''': Assesses the feedback inhibition of cortisol production.
The second step is to measure levels of cortisol in the [[urine]], [[saliva]] or in the [[blood]] after taking [[dexamethasone suppression test|dexamethasone]].
* '''[[Salivary Cortisol Test]]''': Measures cortisol levels in saliva, particularly useful for detecting diurnal variation.
If this test is abnormal, the cortisol may be measured late at night.<ref name="NIH2012Diag" /> If the cortisol remains high, a blood test for [[ACTH]] may be done.
* '''[[Imaging Studies]]''': CT or MRI scans to identify pituitary or adrenal tumors.


=='''Treatment'''==
==Treatment==
Most cases can be treated and cured.
The treatment of Cushing's syndrome depends on the underlying cause:
If caused by a tumor, it may be treated by a combination of surgery, [[chemotherapy]], and/or [[radiation therapy|radiation]].
Some, in whom surgery is unable to remove the entire tumor, have an increased risk of death.


The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition.
* '''Surgical Resection''': Removal of pituitary adenomas or adrenal tumors.
'''[[Mifepristone]]''' '''(Brand name: Korlym)'''Korlym is approved for use in patients with endogenous Cushing's syndrome who have type 2 diabetes or glucose intolerance and are not candidates for surgery or have not responded to prior surgery.
* '''Radiation Therapy''': Used for pituitary tumors when surgery is not feasible.
'''[[Pasireotide]]''' '''(Brand name: Signifor)'''approved for the treatment of patients with Cushing’s disease for whom pituitary surgery is not an option or has not been curative. Also, December 2014, approved for the treatment of patients with acromegaly who have had an inadequate response to surgery and/or for whom surgery is not an option.
* '''Medications''': Drugs such as ketoconazole or metyrapone to inhibit cortisol synthesis.
<references />
* '''Lifestyle Modifications''': Diet and exercise to manage weight and blood pressure.


{{Endocrine pathology}}
==Prognosis==
{{Paraneoplastic syndromes}}
The prognosis of Cushing's syndrome varies based on the cause and treatment success. Early diagnosis and appropriate management can lead to significant improvement in symptoms and quality of life.


{{Authority control}}
==See Also==
* [[Adrenal Gland Disorders]]
* [[Endocrinology]]
* [[Hormonal Imbalance]]


{{DEFAULTSORT:Cushing's Syndrome}}
{{Endocrine system disorders}}
[[Category:Endocrine disorders]]
[[Category:Adrenal gland disorders]]
[[Category:Adrenal gland disorders]]
[[Category:Medical conditions related to obesity]]
[[Category:Syndromes]]
[[Category:RTT]]
[[Category:Syndromes affecting the endocrine system]]
[[Category:RTTEM]]
{{stub}}
{{rarediseases}}

Revision as of 12:39, 31 December 2024

Cushing's Syndrome

Cushing's syndrome is a complex endocrine disorder characterized by excessive levels of cortisol in the blood. This condition can result from various causes, including endogenous overproduction of cortisol by the adrenal glands or exogenous sources such as glucocorticoid medications.

Etiology

Cushing's syndrome can be classified into two main categories based on its etiology:

Endogenous Cushing's Syndrome

  • Pituitary Adenoma: Also known as Cushing's disease, this is the most common cause of endogenous Cushing's syndrome. It involves a benign tumor of the pituitary gland that secretes adrenocorticotropic hormone (ACTH), leading to increased cortisol production by the adrenal glands.
  • Adrenal Tumors: These can be either benign or malignant and directly produce cortisol.
  • Ectopic ACTH Syndrome: This occurs when ACTH is produced by non-pituitary tumors, such as small cell lung cancer.

Exogenous Cushing's Syndrome

  • Glucocorticoid Therapy: Long-term use of glucocorticoid medications for conditions such as asthma or rheumatoid arthritis can lead to Cushing's syndrome.

Pathophysiology

Cortisol is a steroid hormone produced by the adrenal cortex. It plays a crucial role in regulating metabolism, immune response, and stress. In Cushing's syndrome, the excessive cortisol levels disrupt normal physiological functions, leading to a wide range of symptoms.

Clinical Features

The clinical presentation of Cushing's syndrome can vary, but common features include:

Diagnosis

The diagnosis of Cushing's syndrome involves a combination of clinical evaluation and laboratory tests:

Treatment

The treatment of Cushing's syndrome depends on the underlying cause:

  • Surgical Resection: Removal of pituitary adenomas or adrenal tumors.
  • Radiation Therapy: Used for pituitary tumors when surgery is not feasible.
  • Medications: Drugs such as ketoconazole or metyrapone to inhibit cortisol synthesis.
  • Lifestyle Modifications: Diet and exercise to manage weight and blood pressure.

Prognosis

The prognosis of Cushing's syndrome varies based on the cause and treatment success. Early diagnosis and appropriate management can lead to significant improvement in symptoms and quality of life.

See Also

Template:Endocrine system disorders

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