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Cushing’s disease: Treatment, symptoms, advice & help

About Cushing’s disease

Cushing’s disease is a hormonal disorder characterised by excess production of a hormone named cortisol by adrenal glands. Cortisol also called stress hormone is responsible for various functions like metabolism and utilization of nutritional products and also takes part in immune function of the body. Exposure to excess level of cortisol for prolonged periods may result in a spectrum of typical clinical manifestations which is termed as Cushing’s disease.

Cushing’s disease: Incidence, age and sex

Cushing’s syndrome is a fairly common phenomenon seen in general population and can afflict any age group. However individuals in age group between 30 to 50 years are most likely to be affected.

Signs and symptoms of Cushing’s disease: Diagnosis

Cushing’s disease is a hormonal problem which may affect or involve the soft tissue, skin, muscles, bones and affect the physical attributes in an affected individual. There is a marked change in the distribution of fat which leads to increased fat between the shoulders and trunk. The affected person has a characteristic large abdominal girth with thin limbs and prominent hump in the upper back. The face may be puffy and the skin may show acne on the face or purple marks on the abdomen and the thighs. The skin may become very thin and exhibit easy bruising. Furthermore, the bones may become weak and less dense, resulting in pain and easy fractures. Muscles may become weak and manifest reduced tone.

Women with Cushing’s disease may complain of irregular menstrual cycles and excess hair growth on the face and the chest which is called hirsutism. Erectile dysfunction is a common complaint in affected men. Other vague features include anxiety, irritability and fatigue.

This disease can be diagnosed by some blood and urine tests which will assess the level of cortisol in the body. Imaging modalities like MRI and CT scans of the brain and the abdomen may be done to detect the cause of this hormonal problem.

Causes and prevention of Cushing’s disease

Cushing’s disease may result from taking a high oral dose of steroids mainly prednisolone. It may also result from a benign tumour of the adrenal gland termed as adenoma or enlargement (hyperplasia) of both the adrenal glands. Adrenal glands are placed on top of the kidneys and are responsible for synthesizing cortisol. Therefore, hyperplasia or adenoma of adrenal glands may result in excess production of cortisol. Benign tumour of the pituitary gland may also cause Cushing’s disease by releasing high levels of adrenocorticotrophic hormone (ACTH) which stimulates the production of cortisol from adrenal glands.

Cushing’s disease: Complications

Cushing’s disease if left untreated, may result in various health hazards like high blood pressure, diabetes mellitus and compression fractures. Many individuals with Cushing’s disease may exhibit poor healing of wounds and also have increased chances of infections.

Cushing’s disease: Treatment

The goal of the treatment is to diminish the excess production of cortisol hormone. Thus, the first step is to evaluate the reason behind the excess cortisol production. If it is a result of overdose of oral steroid medication, then it is advisable to discontinue it. The steroids are never stopped abruptly since that may result in serious adverse affects. Gradual tapering of the dose is done over a period of time before the medication is eventually discontinued. Surgical resection of adrenal adenoma or pituitary adenoma (depending on the cause) is the most effective treatment. Radiation may be needed after surgery to effectively eliminate the abnormal growth and reduce the chances of recurrence. Cortisol replacement may be needed for a few months after surgery. The prognosis of this disorder is fairly good especially when diagnosed and managed in the early stage.